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PubMed1985

[Oxygen pressure fields in ulcers of the lower leg].

Using a multi-wire surface electrode, oxygen pressure fields were determined in leg ulcers of 11 patients with chronic venous insufficiency (cvi). In three of them, cvi was combined with arterial occlusive disease. The histograms of all patients with very low PO2 values revealed microcirculatory disturbances of the ulcer tissue. The influence of leg position is reflected in the histograms. Patients with cvi showed higher PO2 values when the leg was raised in comparison with when it was in the hanging position. The patients with mixed ulcerations showed a significant increase in tissue PO2 when the leg was in the hanging position, which shows the importance of arterial perfusion pressure. After a compression bandage had been applied to the legs with cvi, the tissue oxygen pressure of the ulcers increased markedly, probably as a result of diminished blood stasis. These results can be explained either by a rarefaction of capillaries in the ulcer tissue or by fibrin diffusion barriers around the capillaries. The changes in the histograms after bandaging are thought to be caused by an improvement in venous circulation.

Adult↗
PubMed1979

[Advances in the field of surgical therapy of strabismus (author's transl)].

During the past 10 years the surgical treatment of strabismus has received different new impulses. Two fundamental novelties in this field have been reported and three not unimportant contributions towards the facilitation of, or improvement in therapy: Cüppers described a method to improve and/or eliminate the dynamic squinting angle in cases of ocular nystagmus by the so-called "Fadenoperation" and Aichmair demonstrated the possibility of re-establishing the function of a traumatically paralyzed abducens muscle by means of muscular neurotisation. Aichmair and Abel discovered in a comparative study that there is no necessity to bandage patients after a squint operation; this is of especial importance in small children as there need no longer be any fear of the postoperative binocular bandage. Aichmair and Fries demonstrated a simple method for the precise measurement of the volume of implantates to eliminate enophthalmus after blow-out fractures; this helps the surgeon to avoid over- or undercorrection. They stressed, furthermore, the importance of the right shape of the implantate. de Decker published a new method of tucking of the superior oblique and of recession of the inferior oblique that facilitates the operation and at the same time enables more accurate dosation.

Abducens Nerve Injury↗
PubMed1983

[Simplified method of covering skin defects on the extremities].

The following simplified and time-saving method of covering skin defects has been tested on 125 patients. Opsite foil is loosely attached to the donor skin area which has been previously dried and disinfected carefully before removing the split thickness skin graft using the dermatome. Thus the graft can be brought onto the defect without shrinkage. Fixation is simply performed by adhesive tape being covered by a compression bandage. The extremity is then immobilized by a Bycast bandage. This technique has proved to show good results that are fully compatible with other more time-consuming methods.

Adult↗
PubMed1983

[Morphological and cytological characteristics of the burn healing process by various treatment methods].

Morphological and cytological methods were used to study the healing of a burn wound in local isolation wards (an open treatment method) and under ointment bandages (a closed treatment method). Biopsy specimens and imprints from the burn wound surface were taken from 40 patients. During treatment in an abacterial medium, burn wound was rapidly decontaminated, which was a consequence of the appearance in wound exudate of segmented neutrophils with marked neutrophilic granularity. Granulation tissue was formed in the wound cavity at the 5th-7th day after the treatment commencement. During treatment under bandages wound decontamination was extremely slow. For a long time wound exudate shows the predominance of dystrophically changed neutrophils, while granulation tissue in the wound cavity if formed only at the 21st-24th day after the treatment commencement.

Asepsis↗
PubMed1982

[Use of histoacryl tissue adhesive in iliac crest biopsy].

In the up to now most customary methods of the biopsy of the iliac crest it was usual to shut the incision of the skin necessary for the intervention after having finished the biopsy with a clamp or a suture, which, as a rule could be removed together with a fracture bandage covering all only after a week, which on principle made necessary a repeated consultation of the physician. The restrictions in the development of physical activities or in the settlement of hygienic necessities (prohibition of shower and bath) showed that these methods are unsuitable for the diagnostic interests in sports medicine. Therefore on 41 test persons or patients 44 biopsies were performed with a modified technique after Jamshidi and Swaim, using histoacryl tissue adhesive as closure of a wound. The course without complications and the shortening of the time up to the removal of the protective bandage to 2-3 days show, that this technique is suited also for the application in sports medicine and in so-called "risk biopsies".

Adult↗
PubMed1978

[Treatment of low fractures of the leg bones].

UNLABELLED: The reposition-fixation method was used successfully in 35 cases of low diaphyseal fractures of the bones of the crus. Reposition of the tibial fragments was carried out by means of four wires tightened in pairs in two stirrups. This was followed with the application of a circular plaster bandage. After X-ray checking of the fracture site the stirrups were removed, the ends of the wires were bent and plastered into the bandage. All the patients recovered and started working again. COMPLICATIONS: 2 patients, who had sustained open fractures, developed osteomyelitis, refracture occurred in 2 other patients, osteomyelitis in the site of the insertion of the wires--in 1 patient.

Adult↗
PubMedDate not supplied

Sclerous atrophic cellulitis.

The author deals only with the sclerous subcutaneous inflammation caused by venous stasis. There is no clear distinction between inflammation, and tissular sclerosis, the final stage of its development. There may be a certain lesional reversibility. The term "scleroinflammatory cellulitis" is therefore quite apt. Physiopathology. Pathology venous reflex results in a flood of proteins in the interstitial tissue, and this shows in signs of tissular pain, especially at the level of the hypoderm and dermis (anatomical reasons). Clinical. This is most often in the case of women with varicose affections or with post-phlebitic syndromes causing a painful, inflamed plaque, on the surface of the inside leg, at the junction of the middle and lower thirds. As well as the inflammation of this area, adhesion to the subjacent layers and induration are also confirmed. Venous dilations may be detected at the centre of this scleroinflammatory plaque. To begin with, the skin is red and taut, but later becomes dry and atrophic. It is prone to eczema and sometimes to ulceration. The development of subcutaneous inflammation is marked by sudden manifestation of inflammation which may be extensive and results in circular suffing, in extreme cases. Varicose sclerosis can provoke sudden manifestations of inflammation and especially if the technique is faulty (excessive dosage, lack of compression, insufficient compression). Treatment. 1. Local. Bandaging and walking are imperative. The bandage must be compressive, immovable, durable, and should be reinforced as necessary at the site of the induration, by latex rubber pads. Once the object of these slightly or non-elastic pads has been achieved they can be replaced by elastic contention. 2. General. Corticoids and phenylbutazone in short courses of treatment. Other products constitute auxiliary remedies. Thermal cures are always indicated in difficult cases. Medical treatment is often enough. In certain perverse cases a surgical treatment may be required, such as hypodermal resection and ligation of the perforants. Grafts (Vigoni). Certain severe cases remain unresponsive to all treatment and in such cases it is regrettable that suitable treatment was not administered at an earlier stage.

Atrophy↗
PubMedDate not supplied

Clinical comparison of elastic supports for venous diseases of the lower limb and thrombosis prevention.

There is little objective evidence available when prescribing aids and appliances such as elastic supports for the leg. Doctors are generally ill-informed about effectiveness, fitting and costs of these garments. The claims of competing suppliers cannot be applied to clinical situations because the garments are tested in vitro on rigid forms. Elastic support for the lower limb is required in the treatment of varicose veins and gravitational disease and has been found effective in prevention of deep venous thrombosis. This study examined the in vivo effectiveness of four commercially purchased garments for these two purposes. The legs of 40 patients with varicose veins, 12 with gravitational disease and 20 patients admitted for elective operations were studied. Pressure exerted by the garment was detected by partly fluid filled bags between garment and limb. The results in patients with varicose veins and gravitational disease were similar. Only two garments exerted effective pressure and of these two the combination of a roller bandage and tapered tubigrip is recommended on grounds of least expense and ease of application. Of the four anti-embolism supports only the roller bandage plus tapered tubigrip produced effective compression: two garments produced reversed flow gradients in the majority of tests. Elastic supports should be double tested, firstly by the manufacturer for basic stretch and regain characteristics and secondly in vivo by clinicians to provide objective evidence of cost effectiveness.

Clothing↗
PubMed1982

[Superficial and deep thromboses. Prophylaxis, diagnosis and conservative therapy (author's transl)].

After reviewing the predisposing factors for venous leg thrombosis prophylactic attempts for patients carrying a continuous risk of thromboembolism and for patients with transient hazards (e.g. after operations) are discussed. Mobilisation with non-elastic bandages and low-dose-heparin in combination with dihydroergotamine is recommended for short term prophylaxis. The unreliability of clinical diagnostic criterias ("thrombosis signs") is pointed out. So additional apparative diagnostic trials are necessary; their values are critically discussed. With certain limitations X-ray phlebography has been proved to be the method of reference. 131 iodine fibrinogen uptake test is recommended best for the detection of calf vein thrombosis. The Doppler sonography is indicated for the detection of pelvic vein thrombosis. Isotope phlebography of the pelvic veins is evaluated, supporting additional information about pulmonary perfusion defects. Due to various contraindications (age, localisation of thrombi, age of thrombi etc.) only a minority of patients with venous thromboses of the lower limbs can be treated by thrombectomy or fibrinolysis, which are regarded as methods of the first choice. So for the vast majority only conservative treatment is feasibly including mobilisation with compression aids and ankle joint exercises for bedridden patients. Direct or indirect anticoagulations seems not to be necessary for patients with calf vein thrombosis, but is indicated for thrombotic affections of the femoral and pelvic veins. Anticoagulation treatment is always combined with compression therapy and mobilisation, except for some patients who had been immobilized before the clinical attendance. The treatment of superficial thrombophlebitis consists of incision and extrusion of thrombotic masses, antiphlogistic drugs and mobilisation with compression bandages.

Clothing↗
PubMedDate not supplied

Varicosities of uncommon sites: therapeutic aspects.

Five cases of varicosities of uncommon sites-suprapubic (2), abdominal and lower thoracic wall (1), gluteal region (1), and vulva (1)-are reported. The treatment given consisted of sclerotherapy and compressive bandaging. In order to obtain adequate compression in the inguinal and pubic regions it was necessary to resort to various improvisations (using wide elastic bandages and sheets of firm foamy material).

Abdomen↗
PubMed1994

Can pulse oximetry detect raised intracompartmental pressure?

Pulse oximetry has been advocated as a simple noninvasive investigation of vascular compromise. Its usefulness in aiding diagnosis of microvascular compromise in a developing compartment syndrome is questioned. This study investigates the reproducibility of pulse oximetry and the effect on arterial haemoglobin saturation of raising limb intracompartmental pressure by compression bandaging. In 32 out of 50 normal subjects there was a difference in percentage saturation between right and left arms, with a 2% difference in 6 people (12%). Percentage saturation fell significantly at average bandage pressures of 80 mmHg (P < 0.0001) and 60 mmHg (P < 0.001). At clinically relevant pressures, the test had a sensitivity of 40.4%. With a greater than 50% risk of a false-negative result, pulse oximetry is not an appropriate additional investigation in the detection of raised intracompartmental pressure.

Adult↗
PubMed1995

[Ergotherapy of severely burned patients].

Occupational therapy for severely burned patients includes individual exercise programmes, activities of daily living (ADL), assessment of the need for technical aids, splinting and pressure bandages, as well as psychological and social support. There are different focal points in the three stages of treatment. In the burn-care unit (first stage), if necessary, the patient is provided with splints. At this time the first contact is made. In the burn-care ward (second stage), the occupational therapy is focused on individual exercise programmes, dynamic splinting, ADL, and preparation for discharge from hospital. In the outpatient department (third stage), the aims of occupational therapy are: providing the patients with pressure bandages, checking of splints, assessment of the need for technical aids and special support if the patients have difficulties at home and work.

Activities of Daily Living↗
PubMed1994

Efficacy of Fat Mobilisation System (FMS) in the treatment of obesity and its utility in the resolution of gynecological problems related to overweight.

In industrialised countries the problem of overweight affects more than 50% of the adult population. Knowledge acquired over the past years has replaced the principally esthetic concept of obesity with the notion of a multifactorial pathology, the outcome of an imbalance in the individual's energy balance caused by an excessive food intake as well as an inadequate energy consumption. The Fat Mobilisation System (FMS), which is able to activate a fat clearance process following cold local application, has proved a valuable and well tolerated tool capable of influencing the entire system responsible for obesity. A group of 109 patients of both sexes, aged between 15 and 71 years old, with problems of overweight and/or figure faults linked to the localised accumulation of fat, underwent out-patient treatment in the form of bandaging with elasticated bandages soaked in active solution able to lower body temperature by 2-3 degrees C. The results were satisfactory in all cases. In particular, a group of 24 women (10 of a childbearing age, 7 in premenopause and 7 in menopause), in whom overweight was associated with gynecological problems, were evaluated by Department A of the Department of Gynecology and Obstetrics at the University of Turin. An improvement in gynecological symptoms was achieved in parallel to weight loss in all patients.

Adipose Tissue↗
PubMed1994

Long-term neuropathy after regional isolated perfusion with melphalan for melanoma of the limbs.

The incidence of long-term (> or = 3 months) neuropathy in 350 melanoma patients treated with single normothermic or 'mild' hyperthermic perfusion with melphalan in the period 1978 to 1990 was studied. Long-term neuropathy was encountered in 14 patients; in 10/51 patients (20%) after perfusion at the axillary level and in 4/247 patients (2%) after perfusion at the iliac level. After brachial and femoro-popliteal perfusions no long-term neuropathy was observed. Neuropathy, mainly consisting of paresis/paralysis of the hand and/or fingers, anaesthesia, and/or paraesthesiae, improved over a mean period of 16 (3-43) months in eight patients, but three patients still had serious neuropathy one year after perfusion. In another six patients little improvement was seen and four died with permanent neuropathy. Acute regional toxicity after perfusion and the application of 'mild' hyperthermia did not seem to influence the incidence of long-term neuropathy. This complication is probably a result of the isolating Esmarch rubber bandage being applied too tightly during perfusion at a proximal level. At the axillary level, where the brachial plexus lacks the protection from enveloping tissues, nerve damage is especially prone to occur. We recommend applying this bandage no tighter than is necessary to maintain the isolation of the circuit. This implies meticulous surgical isolation of the vascular system and accurate monitoring of leakage.

Adolescent↗
PubMed1994

[Hallux valgus. A prospective study of staple fixation in Mitchell's osteotomy].

Twenty-two feet (17 patients) with hallux valgus were operated with a distal osteotomy of the first metatarsal bone ad modum Hawkins, Mitchell and Hedrick (1945). Fixation of the osteotomy was achieved using two staples driven into the bone by a pneumatic stapler (3M). Postoperatively the patients were treated without plaster bandage in a heel-shoe for two weeks and then allowed full weight bearing. There were two superficial infections, but no deep ones. Within six weeks all the osteotomies had healed without any secondary dislocation. Two staples had to be removed in local anaesthesia after healing. Staple fixation gives adequate support during healing of the osteotomy and allows early mobilisation without the need of a plaster bandage.

Adolescent↗
PubMedDate not supplied

Nonpharmacologic circulatory support in the brain-dead animal.

A nonpharmacologic technique for providing an artificial peripheral resistance enabled the canine heart to pump blood for 12 hours in a brain-dead (spinal) animal model. The artificial peripheral resistance was provided by binding the body with elastic bandage. The only other support provided was artificial respiration. Following the 12-hour preservation period, the hearts were challenged to pump by the intravenous infusion of saline. Aortic pressure, cardiac output (CO), oxygen uptake, body temperature, arterial Na+, K+, pH, and HCO3-, and transchest ECG were monitored in all five animals studied during the control and 12-hour preservation periods. Mean blood pressure fell to 50-60 mmHg following cervical cord transection, rising to above 100 mmHg when the body was bound with elastic bandage that restored the peripheral resistance. During the 12-hour preservation period the average mean blood pressure fell from 118 to 60 mmHg, at which point the average normalized CO was 34 mL/min/kg. Following the saline challenge, the average CO increased to 1.89 times the value at the end of the preservation period, representing an average normalized value of 64.3 mL/min/kg (a typical value for the normal resting dog is 70 mL/min/kg). Body temperature decreased slightly in four animals and increased slightly in one. Na+ was virtually unchanged throughout the control and preservation periods, but K+ increased slightly in all animals, exceeding 5 mEq/L in one animal after 8.5 hours and in another after 10 hours. HCO3- was almost constant in all animals, as was pH. However, the pH was elevated during the preservation period due to slight overventilation to assure a high oxygen saturation.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

[Current concepts in treatment of the unstable shoulder. Results of a countrywide survey].

The object of the study was to evaluate the management of patients with acute or recurrent shoulder instabilities. Therefore all trauma, general surgery, and orthopaedic departments in Germany were asked to complete a standardized evaluation form; completed questionnaires were returned from 880 institutions treating shoulder instabilities. Questions were asked about the diagnostic imaging techniques used and about conservative and operative treatment. In addition, the treatment regimens that would be followed for two typical patients were asked for. In patients with shoulder instabilities the following diagnostic imaging techniques were used: X-ray (97.1%), ultrasound (61.3%), CT (29.1%), arthro-CT (26.2%), MRI (13.3%), arthrography (24.1%), and arthroscopy (30.6%). After the first traumatic dislocation the average period of immobilization was 2.2 weeks. Immobilization was achieved with a sling in 2.0%, with a Desault bandage in 38.8%, with a Gilchrist bandage in 72.7%, and with a cast in 4.2% of cases. Open surgical stabilization was performed according to Bankart (30%), Eden-Hybinette (28.6%), Weber (Osteotomy) (27.1%), Lange (15.5%), Putti-Platt (13.6%), and other procedures (Magnusson-Stack, Bristow) only occasionally. The average period of immobilization after open surgery was 3.0 weeks. Arthroscopic stabilization techniques were applied by 7.5%. In a 19-year-old handball player stabilization would be performed immediately after the first traumatic dislocation in 9.2% of the institutions; in 34.4% the patient would not be operated on, and in 56.3% the shoulder would be stabilized after the third redislocation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Therapy of diaphyseal fractures of the leg in a district hospital].

During the period between 1987 and 1991 at the surgical department of the Trebíc hospital 136 casualties with closed diaphyseal fractures were treated. All patients were older than 18 years and monotraumas were involved. The patients were treated by immobilization by a classical high plaster bandage, functional plaster as recommended by Sarmient, extension treatment, miniosteosynthesis, osteosynthesis using a splint, intramedullary fixation as described by Küntscher and Simon-Enders-Weidner, or possibly by a combination of the mentioned methods. The author divides fractures of the leg into stable and unstable fractures and fracture with so-called urgently indicated osteosynthesis. The mean period of treatment with high plaster bandage was 31.7 weeks, functional plaster according to Sarmient 20.2 weeks, miniosteosynthesis with plaster fixation 25.5 weeks. When splints were used, the mean period of treatment was 30.5 weeks, in osteosynthesis according to Enders 20.6 weeks. The best results in stable fractures were achieved by functional plaster according to Sarmient, in unstable fractures and those with indicated osteosynthesis by using intramedullary fixation as described by Enders.

Adolescent↗