1
|
Sondermann S, Boppel T, Fieseler K, Schramm P, Bäumer T, Trillenberg P. Needle electromyography does not meaningfully impact findings in MR-neurography/-myography. Muscle Nerve 2024; 69:409-415. [PMID: 38323736 DOI: 10.1002/mus.28049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/08/2024]
Abstract
INTRODUCTION Magnetic resonance neurography (MRN) and myography (MRM) are emerging imaging methods for detecting diseases of the peripheral nerve system (PNS). Most patients with PNS diseases also undergo needle electromyography (EMG). This study examined whether EMG led to lesions that were detectable using MRN/MRM and whether these lesions could impair image interpretation. METHODS Ten patients who underwent clinically indicated EMG were recruited. MRN/MRM was performed before and 2-6 h after EMG, and if achievable, 2-3 days later. T2 signal intensity (SI) of the tibialis anterior muscle (TA) was quantified, and sizes and SI of the new lesions were measured. Visual rating was performed independently by three neuroradiologists. RESULTS T2 lesions at the site of needle insertion, defined as focal edema, were detectable in 9/10 patients. The mean edema size was 31.72 mm2 (SD = 14.42 mm2 ) at the first follow-up. Susceptibility-weighted imaging lesions, defined as (micro) hematomas were detected in 5/10 patients (mean size, 23.85 mm2 [SD = 12.59 mm2 ]). General muscle SI of the TA did not differ between pre- and post-EMG examinations. Lesions size was relatively small, and the readers described image interpretation as not impaired by these lesions. DISCUSSION This study showed that focal edema and hematomas frequently occurred after needle EMG and could be observed using MRN/MRM. As general muscle SI was not affected and image interpretation was not impaired, we concluded that needle EMG did not interfere with MRN/MRM.
Collapse
Affiliation(s)
- Stefan Sondermann
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Tobias Boppel
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Katharina Fieseler
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Peter Schramm
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Tobias Bäumer
- Institute of System Motor Science, University of Lübeck, Lübeck, Germany
| | - Peter Trillenberg
- Department of Neurology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| |
Collapse
|
2
|
Abstract
To analyze the use of compression stockings to avoid the formation of occupational edema of the lower limbs in jobs with prolonged orthostatism. We carried out a review of the articles published in PubMed, from the 1st of January 2008 to 31st of December 2018 using the term "Occupational Leg Swelling". Only articles that met the following criteria were selected: prospective, observational and experimental retrospectives articles written in Portuguese or English. The research resulted in 23 articles. After reading the titles and abstracts and applying the inclusion and exclusion criteria, 5 were selected. Prolonged orthostatism is considered a risk factor for the development of chronic venous disease. The use of compression stockings reduces the occupational edema of the lower limbs. Professionals exposed to prolonged orthostatism during their work activity have a higher risk of developing lower limb edema; Despite few studies demonstrated the effectiveness of wearing compression stockings to prevent occupational edema of the lower limbs, they have showed benefit in reducing edema as well as associated symptoms. The use of compression stockings should therefore be recommended to all professionals at increased risk for occupational edema of the lower limbs.
Collapse
|
3
|
Rastel D, Crébassa V, Rouvière D, Manéglia B. Physician interpretation of ultrasound in the evaluation of ankle edema. Phlebology 2020; 35:623-630. [DOI: 10.1177/0268355520923195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives The aim of this study was to assess inter‑ and intra‑observer agreement of detection and grading of oedema measured by vascular physicians using ultrasonography. Method In this observational study, three investigators read 113 videos of ultrasonography of the medial lower leg of 77 patients using a 15–18 MHz linear probe and reported whether oedema was present or not and, if present, to what extent. The videos were selected by the coordinator and sent every two months for a period of six months to the three investigators. Intra‑ and interobserver agreements were calculated using the Fleiss Kappa coefficient, reported with their 95% confidence interval and interpreted using the Landis and Koch values. Results Inter-observer agreement as to whether oedema was present or not was 0.88 (0.77–0.98), 0.96 (0.89–1.0) and 0.91 (0.80–1.0) for the first, second and third readings, respectively. The concordance was considered to be “excellent.” Inter-observer agreement as to the severity of oedema was 0.52 (0.38–0.65), 0.53 (0.39–0.66) and 0.61 (0.47–0.75) for the first, second and third readings, respectively. The concordance was “moderate”. Intra-observer reliability for the diagnosis of oedema was only 0.89 (0.70–1.0), 0.93 (0.75–1.0) and 0.92 (0.74–1.0) for the first, second and third reader, respectively, which was “excellent”. Conclusions The inter-observer agreement interpreting ultrasound videos using standard probes was excellent. Only moderate agreement in grading the severity of the edema using our arbitrary criteria was shown.
Collapse
|
4
|
Wall R, Garcia G, Läubli T, Seibt R, Rieger MA, Martin B, Steinhilber B. Physiological changes during prolonged standing and walking considering age, gender and standing work experience. ERGONOMICS 2020; 63:579-592. [PMID: 32009579 DOI: 10.1080/00140139.2020.1725145] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 01/14/2020] [Indexed: 06/10/2023]
Abstract
Occupational standing is associated with musculoskeletal and venous disorders. The aim was to investigate whether lower leg oedema and muscle fatigue development differ between standing and walking and whether age, gender and standing work habituation are factors to consider. Sixty participants (15 young females, 15 young males, 15 older males, and 15 young males habituated to standing work) were included and required to stand/walk for 4.5 hours in three periods with two seated breaks. Waterplethysmography/bioelectrical impedance, muscle twitch force and surface electromyography were used to assess lower leg swelling (LLS) and muscle fatigue as well as gastrocnemius muscle activity, respectively. While standing led to LLS and muscle fatigue, walking did not. Low-level medial gastrocnemius activity was not continuous during standing. No significant influence of age, gender and standing habituation was observed. Walking can be an effective prevention measure to counteract the detrimental effects of quasi-static standing.Practitioner summary: Prolonged standing leads to lower leg oedema and muscle fatigue while walking does not. The primary cause of fatigue may be in other muscles than the medial gastrocnemius. Walking may be an effective prevention measure for health risks of occupational standing when included intermittently.Abbreviation: BI: bioelectrical impedance; LLS: lower leg swelling; SEMG: surface electromyography; MTF: muscle twitch force; WP: waterplethysmography; Bsl: Baseline; L: Lunch; E: Evening; MTM: method times measurement; EA: electrical activity; IQR: interquartile range; p: percentile; M: mean; SE: standard error; Adj: adjusted.
Collapse
Affiliation(s)
- Rudolf Wall
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital, Tuebingen, Germany
| | - Gabriela Garcia
- Department of Health Sciences and Technology, Sensory-Motor Systems Lab, ETH Zürich, Zurich, Switzerland
- Industrial Engineering Department, Universidad San Francisco de Quito, Quito, Ecuador
| | - Thomas Läubli
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital, Tuebingen, Germany
- Department of Health Sciences and Technology, Sensory-Motor Systems Lab, ETH Zürich, Zurich, Switzerland
| | - Robert Seibt
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital, Tuebingen, Germany
| | - Monika A Rieger
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital, Tuebingen, Germany
| | - Bernard Martin
- Industrial and Operations Engineering Center for Ergonomics, University of Michigan, Ann Arbor, MI, USA
| | - Benjamin Steinhilber
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital, Tuebingen, Germany
| |
Collapse
|
5
|
Agle CG, de Sá CKC, Amorim DS, Figueiredo MADM. Evaluation of the effectiveness of wearing compression stockings for prevention of occupational edema in hairdressers. J Vasc Bras 2020; 19:e20190028. [PMID: 34178050 PMCID: PMC8205113 DOI: 10.1590/1677-5449.190028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Occupational lower limb edema is an important factor in deterioration of quality
of life. Prevention involves prescription of prophylactic measures, such as
wearing compression stockings. Objectives To evaluate the effectiveness of compression stocking for prevention of
occupational edema and its repercussions for the quality of life of
hairdressers. Methods A clinical trial involving measurements of the ankles (point B) and calves (Point
C) of 38 hairdressers without venous disease at the beginning and end of workdays
spent wearing or not wearing compression stockings. Participants also answered a
questionnaire about symptoms and quality of life in venous disease. Results Point B measurements were: 21.1 ± 2.2 cm in the morning without stockings; 22.1 ±
2.3 cm at the end of the day without stockings (p = 0.0001 compared to baseline
without stockings); and 21.2 ± 2.1 cm at the end of the day wearing compression
stockings (p = 0.0001 compared to the end of day not wearing compression
stockings). The comparison between point B values for the start of the day without
compression stockings and the end of the day with stockings (p = 0.324) was not
significant, showing that there was no lower limb edema at the end of the working
day when compression stockings were worn. Improvements were observed in ratings
for limitations of work activities (p = 0.0001), domestic activities (p = 0.008)
and leisure or social activities performed standing up(p = 0.0001). Conclusions Compression stockings are effective for preventing occupational lower limb edema
and the attenuation of symptoms such as pain and fatigue directly contributes to
better quality of life for hairdressers.
Collapse
Affiliation(s)
- Claudia Guimarães Agle
- Faculdade de Tecnologia e Ciências - FTC, Departamento de Medicina, Salvador, BA, Brasil
| | | | - Dejean Sampaio Amorim
- Clínica CEAVE, Departamento de Cirurgia Vascular e Endovascular, Salvador, BA, Brasil
| | | |
Collapse
|
6
|
Comparison of 15-20 mmHg versus 20-30 mmHg Compression Stockings in Reducing Occupational Oedema in Standing and Seated Healthy Individuals. Int J Vasc Med 2018; 2018:2053985. [PMID: 30364041 PMCID: PMC6188858 DOI: 10.1155/2018/2053985] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 08/14/2018] [Indexed: 11/18/2022] Open
Abstract
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.
Collapse
|
7
|
Lurie F, Schwartz M. Patient-centered outcomes of a dual action pneumatic compression device in comparison to compression stockings for patients with chronic venous disease. J Vasc Surg Venous Lymphat Disord 2017; 5:699-706.e1. [DOI: 10.1016/j.jvsv.2017.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 06/11/2017] [Indexed: 11/24/2022]
|
8
|
Maintenance of the Results of Stage II Lower Limb Lymphedema Treatment after Normalization of Leg Size. Int J Vasc Med 2017; 2017:8515767. [PMID: 28835857 PMCID: PMC5557258 DOI: 10.1155/2017/8515767] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 06/20/2017] [Indexed: 11/18/2022] Open
Abstract
Objective The aim of this study was to identify strategies to transfer responsibility of the maintenance of the results of lymphedema treatment to the patient. Methods Maintenance of the reduction of edema was evaluated in a prospective clinical trial in patients with Stage II leg lymphedema. Twenty-one lymphedematous lower limbs were evaluated in Clínica Godoy in 2014 and 2016. The evaluation was done by volumetry at baseline and weekly thereafter for volume control. Patients wore Venosan® cotton 20/30 and 30/40 mmHg elastic compression stockings followed by a custom-made inelastic stocking made of grosgrain fabric. The Friedman test for multiple comparisons and Conover post hoc test were used for statistical analysis with an alpha error of 5%. Results On comparing leg volume changes using the different types of stockings, the 20/30 mmHg elastic compression stockings failed in the first week to maintain the volume reductions but the 30/40 mmHg compression stockings did not allow significant increases in volume (p value > 0.05). During one week, the grosgrain stocking reduced leg volumes to baseline values (p value = 0.24). Conclusion Higher compression of elastic stockings is better than lower compression but the inelastic grosgrain stocking is even better than both to maintain the results.
Collapse
|
9
|
Vena D, Rubianto J, Popovic MR, Fernie GR, Yadollahi A. The Effect of Electrical Stimulation of the Calf Muscle on Leg Fluid Accumulation over a Long Period of Sitting. Sci Rep 2017; 7:6055. [PMID: 28729617 PMCID: PMC5519746 DOI: 10.1038/s41598-017-06349-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 06/12/2017] [Indexed: 11/09/2022] Open
Abstract
Leg fluid accumulation during sedentary behaviours such as sitting can lead to leg edema and associated adverse health consequences. This study investigates the use calf muscle electrical stimulation (ES) to reduce seated leg fluid accumulation. Thirteen non-obese, normotensive men (mean age 51 yr.) with sleep apnea were enrolled in the study. Participants first lay supine for 30 minutes to equalize fluid distribution and then sat for 150 minutes. While seated, participants received either active or sham ES of the calf muscles, according to random assignment. Participants returned one-week later to cross over to the other study condition. Leg fluid was measured continuously while sitting using the bioelectrical impedance method. Fluid accumulation in the leg was reduced by more than 40% using active ES, compared to sham ES (∆ = 51.9 ± 8.8 ml vs. ∆ = 91.5 ± 8.9 ml, P < 0.001). In summary, calf muscle ES is an effective method for reducing accumulation of fluid during long sedentary periods and has potential use as a device for preventing leg edema to treat associated health consequences in at-risk groups and settings.
Collapse
Affiliation(s)
- Daniel Vena
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Jonathan Rubianto
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Milos R Popovic
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Geoff R Fernie
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Azadeh Yadollahi
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada.
| |
Collapse
|
10
|
Wall R, Lips O, Seibt R, Rieger MA, Steinhilber B. Intra- and inter-rater reliability of lower leg waterplethysmography, bioelectrical impedance and muscle twitch force for the use in standing work evaluation. Physiol Meas 2017; 38:701-714. [DOI: 10.1088/1361-6579/aa6711] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
11
|
Belczak CEQ, Godoy JMP, Seidel AC, Ramos RN, Belczak SQ, Caffaro RA. Influence of prevalent occupational position during working day on occupational lower limb edema. J Vasc Bras 2015. [DOI: 10.1590/1677-5449.0079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND: The lower limb edema observed in normal people at the end of their working days can vary in intensity and frequency depending on the predominant working positions required to perform different jobs.OBJECTIVES: To compare lower limb volumes of volunteers allocated to three study groups, depending on the predominant positions in which they work.METHODS: Volumetric assessments were conducted of both lower limbs of 51 people free from vascular disease, allocated to three groups of 17 individuals each by predominant working position: sitting, static standing or alternating between the two. Volumes were measured at the start and at the end of the working day and the differences in volumes were calculated for each group. Means and frequencies were compared using appropriate inferential statistics and correlation coefficients were calculated.RESULTS: The groups were homogenous in terms of sex distribution, age, skin color and BMI. The volumetric data from measurements taken before starting work revealed significant differences between all three groups. Volunteers who predominantly worked sitting down had largest volumes, followed by those who remained standing for long periods and then those who varied between these positions. The frequency of lower limb volume increase > 100 mL was significantly higher in the group of people who worked sitting down and maintained this position for long periods.CONCLUSIONS: Postural edema is more common among people who work sitting down for long periods, among whom it appears that there is a cumulative effect from the position, since they exhibit larger lower limb volumes at the start of the day.
Collapse
|
12
|
Synergistic effect of adjustments of elastic stockings to maintain reduction in leg volume after mechanical lymph drainage. Int J Vasc Med 2014; 2014:640189. [PMID: 25328707 PMCID: PMC4190019 DOI: 10.1155/2014/640189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 08/30/2014] [Indexed: 11/17/2022] Open
Abstract
The objective of the present study was to evaluate the effect of elastic compression stockings on volumetric variations of lymphedematous limbs between mechanical lymph drainage sessions. Eleven patients with Grade II leg lymphedema, regardless of etiology, were evaluated in a randomized clinical trial. The ages ranged from 47 to 83 years old with a mean of 62.4 years. Participants were submitted to mechanical lymph drainage (RAGodoy) associated with adjusted and unadjusted knee-high elastic compression stockings (20/30 Venosan). The effect of these stockings on the maintenance of volumetric reductions between sessions of lymph drainage was assessed. In all, 33 evaluations were carried out, 18 of patients using well-adjusted stockings and 15 with badly-adjusted stockings. The differences in volumes were significant (unpaired t-test; P-value < 0.0001). Adjusting the compression provided by elastic stockings according to the size of the leg has a synergistic effect in reducing volume during mechanical lymph drainage.
Collapse
|
13
|
Smolensky MH, Portaluppi F, Manfredini R, Hermida RC, Tiseo R, Sackett-Lundeen LL, Haus EL. Diurnal and twenty-four hour patterning of human diseases: cardiac, vascular, and respiratory diseases, conditions, and syndromes. Sleep Med Rev 2014; 21:3-11. [PMID: 25129838 DOI: 10.1016/j.smrv.2014.07.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 07/04/2014] [Indexed: 11/25/2022]
Abstract
Various medical conditions, disorders, and syndromes exhibit predictable-in-time diurnal and 24 h patterning in the signs, symptoms, and grave nonfatal and fatal events, e.g., respiratory ones of viral and allergic rhinorrhea, reversible (asthma) and non-reversible (bronchitis and emphysema) chronic obstructive pulmonary disease, cystic fibrosis, high altitude pulmonary edema, and decompression sickness; cardiac ones of atrial premature beats and tachycardia, paroxysmal atrial fibrillation, 3rd degree atrial-ventricular block, paroxysmal supraventricular tachycardia, ventricular premature beats, ventricular tachyarrhythmia, symptomatic and non-symptomatic angina pectoris, Prinzmetal vasospastic variant angina, acute (non-fatal and fatal) incidents of myocardial infarction, sudden cardiac arrest, in-bed sudden death syndrome of type-1 diabetes, acute cardiogenic pulmonary edema, and heart failure; vascular and circulatory system ones of hypertension, acute orthostatic postprandial, micturition, and defecation hypotension/syncope, intermittent claudication, venous insufficiency, standing occupation leg edema, arterial and venous branch occlusion of the eye, menopausal hot flash, sickle cell syndrome, abdominal, aortic, and thoracic dissections, pulmonary thromboembolism, and deep venous thrombosis, and cerebrovascular transient ischemic attack and hemorrhagic and ischemic stroke. Knowledge of these temporal patterns not only helps guide patient care but research of their underlying endogenous mechanisms, i.e., circadian and others, and external triggers plus informs the development and application of effective chronopreventive and chronotherapeutic strategies.
Collapse
Affiliation(s)
- Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, 1 University Station C0800, Austin, TX 78712-0238, USA.
| | - Francesco Portaluppi
- Hospital S. Anna and Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Roberto Manfredini
- Hospital S. Anna and Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Ramon C Hermida
- Bioengineering & Chronobiology Laboratories, University of Vigo, Campus Universitario, Vigo, Spain
| | - Ruana Tiseo
- Hospital S. Anna and Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Linda L Sackett-Lundeen
- Department of Laboratory Medicine & Pathology, University of Minnesota, HealthPartners Institute for Education and Research and the Department of Pathology, Regions Hospital, St. Paul, MN, USA
| | - Erhard L Haus
- Department of Laboratory Medicine & Pathology, University of Minnesota, HealthPartners Institute for Education and Research and the Department of Pathology, Regions Hospital, St. Paul, MN, USA
| |
Collapse
|
14
|
Mestre S, Veye F, Perez-Martin A, Behar T, Triboulet J, Berron N, Demattei C, Quéré I. Validation of lower limb segmental volumetry with hand-held, self-positioning three-dimensional laser scanner against water displacement. J Vasc Surg Venous Lymphat Disord 2013; 2:39-45. [PMID: 26992967 DOI: 10.1016/j.jvsv.2013.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 07/26/2013] [Accepted: 08/07/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Measurement of limb volume is helpful for the evaluation and follow-up of edema, especially in patients with chronic venous insufficiency (CVI) or lymphedema. Water displacement (WD) is the reference method for limb volumetry but is not really suitable for clinical routine. Indirect volumetry based on circumference measurements as well as the more expansive but automatic optoelectronic techniques do not allow detailed measurement at the extremity of the limb. METHODS We used a self-positioning laser scanner with dynamic referencing for acquisition and real-time three-dimensional (3D) reconstruction of the lower limb volume in 30 patients with CVI, 30 patients with lymphedema, and 30 healthy controls. Two independent observers performed either one or two laser scans, whose results were tested for intra- and interobserver reproducibility and compared with WD volumetry by Lin's concordance correlation coefficient and Bland and Altman graphic analysis. RESULTS Automatic volume calculation from 3D laser scanning data failed in one patient with major lymphedema. Lin's concordance correlation coefficient was 0.99 and 0.98, respectively, for intraobserver no. 1 and no. 2, 0.98 for interobserver reproducibility, and 0.98 and 0.96, respectively, for observer no. 1 and observer no. 2 vs WD comparison. The 3D laser scanning yielded 1.99% precision. Accuracy was 3.12% for observer no. 1 and 2.71% for observer no. 2, laser scanning values being 90 mL higher than WD, which could be attributed to the different posture during measurement. CONCLUSIONS Three-dimensional laser scanning is accurate and reproducible, and appears suitable for the evaluation of limb volume in patients with CVI or lymphedema.
Collapse
Affiliation(s)
- Sandrine Mestre
- Internal and Vascular Medicine Department, Montpellier University Hospital, Montpellier, France; Dysfunctions of Vascular Interfaces Laboratory EA2992, Montpellier 1, University, Montpellier and Nimes, France.
| | - Florent Veye
- Montpellier Laboratory of Informatics, Robotics, and Microelectronics, Montpellier, France
| | - Antonia Perez-Martin
- Dysfunctions of Vascular Interfaces Laboratory EA2992, Montpellier 1, University, Montpellier and Nimes, France; Vascular Medicine Clinics and Laboratory, Nimes University Hospital, Nimes, France
| | - Thomas Behar
- Internal and Vascular Medicine Department, Montpellier University Hospital, Montpellier, France
| | - Jean Triboulet
- Montpellier Laboratory of Informatics, Robotics, and Microelectronics, Montpellier, France
| | | | - Christophe Demattei
- Biostatistics, Epidemiology, Public Health, and Medical Informatics, Nimes University Hospital, Nimes, France
| | - Isabelle Quéré
- Internal and Vascular Medicine Department, Montpellier University Hospital, Montpellier, France; Dysfunctions of Vascular Interfaces Laboratory EA2992, Montpellier 1, University, Montpellier and Nimes, France; Clinical Investigation Center, INSERM CIC 1001, Montpellier University Hospital, Montpellier, France
| |
Collapse
|
15
|
Belczak SQ, Sincos IR, Campos W, Beserra J, Nering G, Aun R. Veno-active drugs for chronic venous disease: A randomized, double-blind, placebo-controlled parallel-design trial. Phlebology 2013; 29:454-60. [PMID: 23761871 DOI: 10.1177/0268355513489550] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Our current understanding of the pathophysiology of chronic venous disease (CVD) suggests that veno-active drugs (VAD) can provide effective symptom relief. Few studies have conducted head-to-head comparisons of VAD and placebo while also assessing objective measures (such as water plethysmography findings and tibiotarsal joint range of motion) and patient-reported quality of life outcomes. OBJECTIVES To compare the effects of different VAD on limb volume reduction, tibiotarsal range of motion, and quality of life. METHODS 136 patients with CVD (CEAP grades 2-5) were randomly allocated into four groups to receive micronized diosmin + hesperidin, aminaphthone, coumarin + troxerutin, or placebo (starch). Patients were administered a questionnaire consisting of a quality of life (QoL) measure designed specifically for persons with CVD, and underwent tibiotarsal joint angle measurement and water plethysmography of the lower extremity before and 30 days after pharmacological intervention. Assessors were blind to the treatment groups. RESULTS Nine patients dropped out of the trial. Data collected from the 127 remaining patients was considered for statistical analysis. There were no differences in tibiotarsal joint range of motion. Volume reductions ≥100 mL were more frequent in the diosmin + hesperidin group than in any other group. QoL scores were best in the aminaphthone group, and between-group differences were found on individual analysis of questionnaire items. CONCLUSIONS Use of VAD was associated with significant improvements in QoL as compared with placebo. VAD may be effective for providing symptom relief in patients with CVD.
Collapse
Affiliation(s)
| | | | - Walter Campos
- Medical School of the University of São Paulo, São Paulo, SP, Brazil
| | - Julio Beserra
- General Hospital of Carapicuiba, São Camilo University Center, São Paulo, SP, Brazil
| | - Gilberto Nering
- São Camilo University Center, Academic League of Angiology and Vascular Surgery São Paulo, SP, Brazil
| | - Ricardo Aun
- Medical School of the University of São Paulo, São Paulo, SP, Brazil São Camilo University Center, Academic League of Angiology and Vascular Surgery São Paulo, SP, Brazil
| |
Collapse
|
16
|
Cataldo JL, de Godoy JMP, de Barros N. The use of compression stockings for venous disorders in Brazil. Phlebology 2011; 27:33-7. [PMID: 21765190 PMCID: PMC3257001 DOI: 10.1258/phleb.2011.010088] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective The aim of this study was to analyse the medical indication and the use of elastic compression stockings, and to assess patient adherence to treatment in different regions of Brazil. Method The prescription and clinical indication of elastic stockings were evaluated in a prospective, descriptive, cross-sectional, multicentre study for a population of private patients. In 2009, 3414 patients from 123 treatment centres in southern, south-eastern and north-eastern Brazil were evaluated using a questionnaire. The following variables were analysed: sociodemographic (gender, age, occupation and education), lifestyle (physical activity and time spent standing); classification of venous disease (CEAP [clinical, aetiological, anatomical and pathophysiological] classification – clinical criteria), indications for prescription, consumer behaviour (strength, acquisition and use of stockings) and criteria of satisfaction (improvement, duration of use, adherence). The effects of compression therapy were assessed at a follow-up visit approximately 30 days after starting treatment with the following items being assessed: complaints about pain, discomfort, burning sensation and oedema of the leg while using elastic stockings. Multivariate analysis was used to compare data with an alpha error of 5% (P value < 0.05) being considered acceptable. Results The average age increased with the severity of chronic venous insufficiency; the main indications used by physicians were leg pain and discomfort; 89.3% of patients bought stockings and thus started treatment with more than 90% of these reporting improvements in symptoms. Conclusion Elastic stockings are available to the Brazilian population, look acceptable at the time of purchase and provide good results; however, some limitations regarding their use need to be addressed.
Collapse
Affiliation(s)
- J L Cataldo
- Service of Peripheral Vascular Disease, University of Campinas UNICAMP, Brazil.
| | | | | |
Collapse
|
17
|
Belczak CEQ, de Godoy JMP, Cruz AF, Tyszca AL, Neto HJG, Caffaro RA. Lymphoscintigraphic findings: delayed oedema after great saphenous vein harvesting. Phlebology 2011; 26:185-90. [DOI: 10.1258/phleb.2010.010071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective The aim of this study was to identify lymphoscintigraphic changes associated with lower-extremity oedema after the harvesting of the saphenous vein using a series of short Q2 incisions for coronary bypass. Method Forty-four patients (32 males and 12 females) with a mean age of 62.7 ± 7.8 (47–75 years old) were evaluated in a retrospective, quantitative, cross-sectional study from June 2007 to January 2008, three to 188 months (mean: 46 months) after the surgical procedure. Assessment was by water displacement volumetry and lymphoscintigraphy of the lower limbs. Results expressed as means with standard deviations were compared employing the Student's t-test and the chi-square or Fisher's exact tests were used to compare data expressed as frequencies. An alpha error of 5% was considered acceptable ( P ≤ 0.05). Results The presence of dermal backflow, as identified by lymphoscintigraphy with an accumulation of radiotracer in the thoracic duct and popliteal lymph nodes was significantly greater on the operated side. Conclusion There was a significant association between dermal backflow and delayed oedema.
Collapse
Affiliation(s)
- C E Q Belczak
- Lymphovenous Rehabilitation of the Medicine, School, São Jose do Rio Preto (FAMERP), Brazil
| | - J M P de Godoy
- Department Cardiology and Cardiovascular Surgery of the Medicine, School, São José do Rio Preto (FAMERP) and CNPq (National Council for Research and Development), Brazil
| | - A F Cruz
- Diagnosis Nucleus of Maringá, Brazil
| | | | - H J G Neto
- Medical Sciences School of Santa Casa de São Paulo (FCMSCSP), Brazil
| | - R A Caffaro
- Medical Sciences School of Santa Casa de São Paulo (FCMSCSP), Brazil
| |
Collapse
|
18
|
Hirai M, Iwata H, Niimi K, Miyazaki K, Koyama A, Komatsubara R. Improvement of a three-dimensional measurement system for the evaluation of foot edema. Skin Res Technol 2011; 18:120-4. [PMID: 21429012 DOI: 10.1111/j.1600-0846.2011.00527.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND/AIMS This study investigated the accuracy and usefulness of a newly improved three-dimensional measurement system for measuring the volume and circumference at the foot as well as at the calf and ankle. METHODS Regarding the newly improved device, halogen light was projected from four directions instead of the conventional two directions. The circumference and volume were measured in the morning and evening with and without elastic stockings in 23 healthy subjects. RESULTS The average circumference at the foot calculated using the 'average method', in which the circumference of the foot was measured in 10 places every 1 mm and the values were averaged, significantly increased in the evening compared with in the morning. When stockings were applied, the significant differences in the circumference or volume between the morning and evening disappeared at all sites of the leg. CONCLUSION The newly improved three-dimensional measurement system incorporating the halogen light from four directions, in which the foot circumference was calculated using an 'average method', was reliable and useful for evaluating edema at the foot as well as at the calf and ankle. The beneficial effect of elastic stockings on edema prevention was observed at all sites of the leg.
Collapse
Affiliation(s)
- M Hirai
- Department of Vascular Surgery, Tohkai Hospital, Nagoya, Japan.
| | | | | | | | | | | |
Collapse
|
19
|
Raju S, Oglesbee M, Neglén P. Iliac vein stenting in postmenopausal leg swelling. J Vasc Surg 2010; 53:123-30. [PMID: 21030197 DOI: 10.1016/j.jvs.2010.07.068] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 07/22/2010] [Accepted: 07/28/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND Leg swelling in menopausal women is well known. Prevailing concept in primary care is that it is polycentric and a treatable cause may not be found. Patients are placed on empiric diuretics often without benefit. Our clinical experience indicates that iliac venous vein obstruction is the core cause; a variety of secondary factors common in postmenopausal women precipitate symptoms. PATIENTS AND METHODS A total of 163 limbs in 150 postmenopausal women (≥ 55 years of age) with leg swelling unresponsive to conservative therapy underwent intravascular ultrasound-guided iliac vein stenting over an 11-year period. Preoperative investigations included duplex, airplethysmography, venous pressure tests, contrast studies, and lymphangiography. The postmenopausal group constituted 9% of all limbs (n = 1760) stented for chronic venous disease (CVD) during the same period and 18% of those stented for swelling (n = 922). Median age was 67 (range, 55-92) and left-to-right ratio 2:1. RESULTS Iliac vein obstruction was "primary" (nonthrombotic) in 65% and postthrombotic in 35% of limbs; 35% of limbs had obstruction only and 65% combined obstruction/reflux. Lymphatic dysfunction was present in 21% of the limbs. Mean intravascular ultrasound area stenosis was 68% ± 22 SD. Mean follow-up was 22 months (± 26 SD) (range, 1-113 months). Secondary stent patency (6 years) was 100% in primary and 91% in postthrombotic limbs; overall 98%. Swelling improved significantly (P < .0001) from preoperative grade 2.5 (± 0.8 SD) to postoperative grade 1.2 (1.2 SD). Associated pain also improved significantly (P < .0001) from preoperative visual analog scale 3.5 (± 3 SD) to postoperative 0.9 (2.1 ± SD). Quality-of-life (CIVQ) scores improved significantly in every category and overall (P < .0001). CONCLUSIONS Patients with postmenopausal leg swelling often have obstructive venous pathology even though suggestive venous history and other signs are often absent. Morbidity arises from painful swelling that affects mobility, quality of life, and ability of self-care at later stages of life. Outpatient percutaneous iliac vein stenting affords substantial symptom relief and improvement in quality-of-life measures. Recognition of the clinical complex as a distinct entity of venous origin may lead to greater awareness and effective treatment.
Collapse
Affiliation(s)
- Seshadri Raju
- The Rane Center at the River Oaks Hospital, Flowood, Mississippi, USA.
| | | | | |
Collapse
|
20
|
de Godoy JMP, Braile DM, Perez FB, Godoy MDFG. Effect of walking on pressure variations that occur at the interface between elastic stockings and the skin. Int Wound J 2010; 7:191-3. [PMID: 20602649 DOI: 10.1111/j.1742-481x.2010.00673.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The aim of this work was to dynamically study pressure variations exerted by elastic compression stockings during walking. While study participants walked, the pressure variations at the interface between elastic stockings and the skin were measured dynamically. Three healthy individuals wearing 10/20 and 20/30 elastic compression stockings manufactured by Sigvaris((R)) (Jundiai, São Paulo-Brazil) were requested to walk along a course for ten times at a constant speed. For every event, an apparatus specifically developed for the study and programmed to take readings at half-second intervals was used to measure the pressure exerted by the elastic stockings. The pressure exerted by the 10/20 stockings varied between 5 and 32 mmHg and for the 20/30 stockings it varied from 10 to 52 mmHg. Elastic stockings with larger pressures generate larger pressure variations during muscle activity (P-value < 0.001). In conclusion, muscle movements during walking cause the pressure exerted by elastic stockings on the leg to vary; thus, the pressure is not constant but has peaks and troughs according to the type of muscle movement and the gradient of the stockings.
Collapse
Affiliation(s)
- José Maria Pereira de Godoy
- Department of Cardiology and Cardiovascular Surgery, Medicine School of São José do Rio Preto-FAMERP, São Paulo, Brazil.
| | | | | | | |
Collapse
|