Publicações sobre Mecanismos de Contenção em Inglês Listamos para vocês todas as publicações formatadas em INGLÊS e na categoria MECANISMOS DE CONTENÇÃO que estão cadastradas em nosso banco de dados.
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Intermittent Massage as a Therapeutic Option for Compartment Syndrome after Embolectomy of the Lower Limbs
The case of a 54-year-old cardiac patient is reported, who was admitted to hospital with a complaint of sudden pain in the legs associated with edema, paresthesia, and coldness. Arterial embolism of the lower limbs was diagnosed and the patient was submitted to bilateral embolectomy. The patient evolved with a burning sensation, hypersensitivity in the right leg, swelling, and difficulty bending and stretching the sole of the foot and the knee. A physical examination detected edema and increased tension in the anterior, lateral, and posterior compartments. Treatment using intermittent massage of the leg during the evaluation of the patient was chosen in an attempt to stimulate lymphatic and venous drainage. After a few minutes of stimulation, there was significant improvement in the pain and edema. In 40 minutes, there was total reduction of the pain in the posterior and lateral compartments and improvement of over 50% in the anterior compartment. After this, the patient started to bend the knee without pain and bend the sole of the foot with slight pain. On the following day, the patient was walking around the hospital ward without difficulty. It seems that intermittent massage is a therapeutic option in selected cases of compartment syndrome.
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Comparison of 15-20 mmHg versus 20-30 mmHg Compression Stockings in Reducing Occupational Oedema in Standing and Seated Healthy Individuals.
BACKGROUND: Elastic compression stockings (ECS) are effective in preventing and reducing occupational edema (OE), but the optimal pressure according to the prevalent working position during the day is still controversial. OBJECTIVE: To compare the effectiveness of ECS with different pressures (15-20 mmHg or 20-30 mmHg) for reducing OE in individuals working in different prolonged postures. METHODS: This cross-sectional study comprised 116 lower limbs of 58 individuals divided into three groups according to their prevalent postures over the day (sitting, standing, or combination). Volumetric measurements were taken at the beginning and at the end of three consecutive days. On the first day, individuals did not use compression stockings; on the second and third days, they used, respectively, 15-20 mmHg and 20-30 mmHg knee-length stockings. Differences between morning and evening volumes (measured edema) were calculated, compared, and correlated. RESULTS: Volumetric variations were significantly lower on the second compared to the first day when individuals in all three groups used 15-20 mmHg compression stockings (p-value < 0.001). Measurements were even lower when they used 20-30 mmHg stockings: this decrease was more significant for the sitting (p-value < 0.001) than the standing (p-value < 0.05) and combined groups (p-value < 0.05). Reduction of measured edema was more significant in individuals working in a prolonged seated position. No significant difference was found only on comparing sitting and standing groups after the use of the 15-20 mmHg compression stockings. CONCLUSIONS: The use of ECS over a working day reduces OE in prolonged sitting, standing, and combined positions, with the reductions being greater with the higher pressure.
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ASSESSMENT OF INELASTIC SLEEVES IN PATIENTS WITH UPPER LIMB LYMPHOEDEMA
Lymphoedema patients need mechanical help to complete removal of lymph from the tissues. The objectives of this study were to adapt and evaluate a fabric which would fill the basic requirements of compression, tolerability, easy to find and of a low cost. A new inelastic sleeve made from a type of polyester fabric called “gorgurão” was evaluated in six female patients with lymphoedema of the upper limbs. The sleeves always need to be well adjusted so that they act as a compartment limitation during exercises. A method to measure the pressure using a modified pressure apparatus was developed. This new fabric was compared with conventional dressings. The pressure variations during the flexion and extension of arm fluctuated from 20 to 60 mmHg with the sleeve dressings. The sleeves were very tolerable and reduced the measurement of the circumferences of the affected limbs 2 to 4 cms in three weeks of use. In conclusion, the sleeves made from this fabric with low elasticity are effective to reduce the circumferences of upper limbs with lymphoedema. Key words: lymphoedema, development, inelastic sleeves.
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COMPRESSION STOCKINGS AND SPORTS: TRUTHS, MYTHS AND OPINIONS
It is amazing how artifacts that optimize the performance of athletes arouse interest and have immediate adhesion. In addition to the known use of elastic stockings for venous and lymphatic insufficiency, their indication in other non‐pathological conditions such as in combatting occupational edema has recently been demonstrated and scientifically proven (1‐3). However, the benefits of the use of compressive mechanisms in sport, as has been extensively publicized by the media thanks to the great interest of athletes and manufacturers, have not always been verified by methodologically correct studies that are able to substantiate their appropriate and effective medical prescription.
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GODOY & GODOY COMPRESSION SLEEVE IN THE TREATMENT OF ARM LYMPHEDEMA: NEW CONCEPTS FOR MATERIALS
The aim of this work was to study on a new low-elastic textile that fulfilled the criteria of fabrics for the manufacture of compression garments to treat lymphedema. The evolution of Godoy & Godoy compression sleeves was performed by following the patients treated for arm lymphedema. Sixty-six patients with ages ranging from 35 to 83 years and a mean of 58.8 years were included in this study. Diagnosis, by the clinical evaluation confirmed by the volumetry, was defined as a volume difference of more than 200 mL between the arms. All the participants were submitted to treatment sessions once, or two times weekly in an outpatient setting. The material used for the compression sleeve in this study was commercialized in Brazil under the name of Gorgurão®. When high alterations in the pattern of sleeves were made, the patients were monitored by weekly volumetric assessments. The criterion to maintain the modifications in the design was that the hand did not present with edema. By the end of the study, the design of the sleeve was changed so as not to use compression therapy of the hands in 81.8% of the cases; 12.2% continued with compression of the hand, 3.0% stopped using compression completely and 3.0% used only a glove. Thus, Godoy & Godoy compression sleeves could be an efficient option for compression in the treatment of arm lymphedema as they provided better independence in day-to-day activities.
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HOME-MADE COMPRESSION STOCKINGS AND SHOES OF A COTTON–POLYESTER MATERIAL IN THE TREATMENT OF PRIMARY CONGENITAL LYMPHEDEMA
The recommended treatment of lymphedema is the association of therapies such as manual and mechanical lymph drainage, compression therapy (hosiery and bandaging), exercising, myolymphokinetic activities and hygienic precautions [1–3]. In primary congenital lymphedema, the forms of treatment are the same but the treatment must be adapted for children with respect to their social reality. The objective of the current study is to report on the treatment of congenital lymphedema utilizing stockings and shoes made of a cotton–polyester material.
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INTERFERENCE OF BENDING AND STRETCHING THE TOES AND FOOT ON THE WORKING PRESSURE OF ELASTIC STOCKING
INTERFERENCE OF BENDING AND STRETCHING THE TOES AND FOOT ON THE WORKING PRESSURE OF ELASTIC STOCKING
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INTERFERENCE OF DAY‐TO‐DAY ACTIVITIES ON THE WORKING PRESSURES IN PATIENTS USING ELASTIC STOCKINGS
The objective of current study was to evaluate if day‐to‐day activities can exert an influence on the treatment of patients that use elastic stockings. Working pressures during day‐to‐day activities were evaluated. Five male and five female individuals, with ages varying from 36 to 47 years old, participated in the study. They were requested to continue with routine day‐to‐day activities during the evaluation period. Sigvaris® 30/40 mmHg elastic stockings were utilized. An apparatus that assesses the pressure at half‐second intervals, either dynamically or under static conditions was employed. The individuals were monitored for variable lengths of time of from one to three hours and at the end of data collection, the measurements were expressed as pressures at half‐second intervals in the form of a graph. Pressure variations were identified in accordance to the muscle activity, mainly when the calf muscle was involved. Day‐to‐day activities have a great influence on the variations of working pressure in individuals using elastic stockings and so, the stockings are useful as an adjuvant form of therapy in patients with venolymphatic diseases.
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NEW COMPRESSION MECHANISM IN PENILE‑SCROTAL LYMPHEDEMA AND SEXUAL REHABILITATION
The objective of this study is to describe a new compression mechanism in the treatment of lymphedema of the penis and scrotum and the ensuing sexual rehabilitation. The patient, a 58‑year‑old man, had edema of the penile and scrotal region as a result of surgery of the pancreas and spleen and chemotherapy. The patient complained of pain, discomfort, and difficulties to walk and urinate. A clinical diagnosis of lymphedema of the penis and scrotum was reached. Treatment involved the continuous use of a cotton‑polyester compression garment for the region together with thorough hygiene skin care. The swelling reduced significantly within a week to almost a normal aspect which was accompanied by clinical improvements of the symptoms. The reduction in penile edema allowed sexual rehabilitation even though erectile dysfunction required the use of a specific medication (sildenafil). In conclusion, simple and low‑cost options can improve lymphedema of the penis and scrotum and allow sexual rehabilitation.
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POSTURAL HYPOTENSION ASSOCIATED WITH NONELASTIC PANTYHOSE DURING LYMPHEDEMA TREATMENT
Rapid cardiovascular adjustment is essential to avoid orthostatic hypotension in the passage from the decubitus to the standing position; a response is required within seconds [1, 2]. Orthostatic hypotension is defined as a drop of at least 20mmHg of systolic pressure or 10 mmHg of diastolic pressure within three minutes when changing from the supine or sitting position to the standing position [3]. Dizziness, blurred vision, weakness, nausea, palpitations, headache, syncope, and chest pains are the most commonly reported symptoms. Ineffective adrenergic vasoconstriction provides an inadequate response to adjust the systemic arterial pressure [4]. Studies suggest that orthostatic stress evokes regional differences in cerebral blood flow with possible differences in the carotid dynamics between the two vascular brain regions leading to acute changes in blood pressure [5, 6]. Graduated compression stockings might affect the sympathoadrenergic variability and heart rate variability in response to rest and after strenuous exercise by individuals in wheelchairs with spinal cord injury [7].
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RATE OF OCCUPATIONAL LEG SWELLING IS GREATER IN THE MORNING THAN IN THE AFTERNOON
The aim of this study was to investigate the rate of occupational leg swelling depending on the time period of the working day. Volumetric variations of the legs of 70 hospital employees, enrolled in three groups, were evaluated. Group I: 35 morning shift workers; Group II: 35 afternoon shift workers; and Group III: 15 individuals randomly selected from Groups I and II, who were evaluated on the day they worked 12 hours consecutively. Volumetry was performed before and after each shift for both legs of the participants in Groups I and II. For Group III volumetry was performed early in the morning, at noon and in the evening. For statistical analysis, the Student’s t-test and Mann-Whitney test were used with an alpha error of 5% being considered acceptable (P value , 0.05). Significant increases in volume were recorded for the limbs in all three groups (P value, 0.001). On comparing Groups I and II, the accumulation of fluids was significantly higher in the morning than in the afternoon (P value , 0.003). Asymptomatic workers may present with oedema of the legs during their work with the rate of oedema being different for morning and afternoon shifts. The possibility of wearing compression stockings should be considered for this type of work.
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REDUCTION OF PAIN AND EDEMA OF THE LEGS BY WALKING WEARING ELASTIC STOCKINGS
he world causing signs and symptoms that lead to disablement from work and loss of quality of life [1, 2]. However the symptoms reported by patients are not always exclusively due to venous diseases. Therefore, a differential diagnosis must be made, in particular in respect to orthopedic alterations especially those involving the feet [2]. Another condition thatmay cause or aggravate the symptoms is the external environment due to gravitational pressure and temperature. It has been reported that individuals working in specific positionsmay feel leg pain, have a bloated feeling, have a feeling of heaviness, and have several other disturbing sensations [3]. These symptoms can be relieved with the use of elastic stockings and compression with bandages [3–6].
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SURGICAL TREATMENT OF ELEPHANTIASIS OF THE FEET IN CONGENITAL LYMPHEDEMA TO FACILITATE THE USE OF A COMPRESSION MECHANISM
The aim of the current study is to report on the minimal surgical treatment of elephantiasis of the feet to facilitate the use of compression mechanisms. The cases of two patients with congenital lymphedema that evolved to elephantiasis involving the feet are reported. Intensive treatment of the lymphedema was performed with a significant reduction in size thus allowing a better identification of the limits of tissue masses for the surgical approach. This reduction enabled primary suturing of the lesions to be carried out and fast healing of the wounds. The surgery greatly improved large deformities of the toes and feet and facilitated further treatment of the lymphedema using bandaging. Thus, the skin was preserved, there was a reduction in the size of the feet, and the patients were able to start wearing shoes.
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SYNERGISTIC EFFECT OF ADJUSTMENTS OF ELASTIC STOCKINGS TO MAINTAIN REDUCTION IN LEG VOLUME AFTER MECHANICAL LYMPH...
Use of elastic stockings is one of themain clinical approaches to the treatment of venous edema and lymphedema [1, 2]. The pressures introduced by compression hosiery, muscle activity, the environmental temperature, and the integrity of joint mobility are factors that can interfere in reductions in edema and in maintaining the size of limbs [2–5]. Elastic stockings exert working and resting pressures at the interface between the stocking and the skin which decreases fromthe top of the thigh to the foot thus facilitating drainage of fluids even at rest. Muscular activity causes pulse wave-type variations in pressure, similar to what occurs in the venous systembymuscle contraction [6]. The integrity of the muscle “pumps” is crucial to effectively generate pressure gradients during activity [5, 6]. The best option is to continuously use elastic stockings throughout the day, but when this is not possible, their utilization during part of the day can be considered beneficial [7]. Care should be taken not only to use the correct size of stocking for each patient but also to avoid creases and folds as this may cause a tourniquet effect inhibiting venous return thereby aggravating the edema [8].
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SYNERGISTIC EFFECT OF ELASTIC STOCKINGS TO MAINTAIN VOLUME LOSSES AFTER MECHANICAL LYMPHATIC THERAPY
Lymphedema is an accumulation of water, salts, electrolytes, high molecular weight proteins, and other elements in the interstitial space resulting from dynamic or mechanical changes of the lymphatic system which lead to a progressive increase in size of an extremity or body region with decreased functional and immune capacity and morphological changes [1]. Clinical staging takes into account the manifestation of the edema and the deformities observed. In grade I lymphedema, the swelling appears during the day and in grade II, the patient awakens with edema in the morning which normally worsens during the day. Grade III lymphedema is similar to grade II but more advanced and with worse deformities [2]. Severitymay be mild with a volume increase of up to 20% (compared to the normal contralateral leg), medium with increases of between 20% and 40%, or severe with increases of more than 40% [1, 2]. An association of therapies is recommended to treat lymphedema with lymph drainage, compression mechanisms, and exercising constituting the cornerstone of treatment [3–6].Management of lymphedema using drugs is also possible. The RAGodoy device, a Mechanical Lymphatic Therapy option that uses plantar flexion and extension movements, is a newaddition to the armory of lymphedema treatment [7, 8]. Several studies have shown its effectiveness in reducing the volume of legs [7]. The association of therapies is a clinical option, but it is essential to assess whether combinations provide a synergistic effect.
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THE EFFECT OF HABITUALLY INCORRECT USAGE OF ELASTIC STOCKINGS ON RESTING AND WORKING PRESSURES
Compression is a treatment method which, applied to the body surface, exerts a pressure by means of elastic or inelastic material on the enveloped tissues. The resting pressure is conferred by the compression of tissues and the working pressure is a result of muscle activities on contention 1. Elastic stockings maintain a constant pressure on the limb and so muscle activity causes changes in the pressure, the working pressure 2. Elastic stockings are designed with the exerted pressure decreasing from the distal to proximal limits thereby favoring lymphovenous return. Recent Publications have reported that elastic stockings improve the hemodynamics of venous return during walking and that the habitual use of Class 1 elastic compression (10 to 15 mmHg) for a period of only 15 days is sufficient to provide a significant improvement of the symptoms and in the overall discomfort caused by pain, thereby improving the quality of life of patients 3,4. Over the long term, elastic compression stockings may even prevent post-thrombotic syndrome in patients with deep venous thrombosis (DVT) 5-7. On the other hand, there are warnings that signs and symptoms may not improve with the use of elastic stockings during exercising in patients suffering from deep venous thrombosis. Nowadays elastic stockings are indicated for a wide range of diseases in the clinical practice however their utilization demands care by the doctor when prescribing and by the patient whilst wearing.
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