A Compression Kit of a Stocking and Three Superimposed Leggings Is Easy to Don and Dose Adjustable

BACKGROUND

Forty percent of patients with chronic venous insufficiency (CVI) do not wear their indicated and prescribed compression stockings. Difficulties in donning and a feeling of constraint are the most common reasons for non-adherence.

OBJECTIVE

The aim was to develop a compression stocking system that is easy to don and dose adjustable.

METHODS

A modular compression stocking kit composed of an understocking and three superimposable leggings (SLLLs) was developed. Substocking pressures (P) at the thinnest part above the ankle (cB level) were 17 mm (understocking) + 15 + 10 + 10 mmHg (3 superimposed leggings; Hatra method). Twenty healthy subjects and 20 patients over 65 years with CVI donned the SLLL compression kit. P was measured in vivo (Picopress method) at the transition of the Achilles tendon to the calf muscle (level cB1) during rest and ankle movements (DSI; dynamic stiffness index) and compared with a strong compression stocking of 40 mmHg (S40).

RESULTS

Twenty (20/20) patients aged over 65 with CVI (C4-6) successfully donned the SLLL compression kit without aid, compared with 12 (12/20) who were able to don the S40 without aid (p = .02). In vivo resting P at level cB1 was 34.3 mmHg (SLLL) compared with 37.3 mmHg (S40) (p = .1). The DSI was 16.1 (SLLL) compared with 17.9 (p = .79; S40; CVI group).

CONCLUSION

The physical properties of the SLLL compression stocking kit correspond to the characteristics of a strong stocking at rest and exercise (DSI). The donning success rate is excellent (100%). A further potential advantage is that the SLLL leg compression kit is dose adjustable, according to indication or patient tolerance. Wearing comfort over periods of several days and clinical effectiveness need to be investigated in future trials.

[Gastrointestinal hemorrhage in a 74-year-old man after abdominal aortic aneurysm surgery. 74-year-old married, retired patient]

Bei einem Patienten mit erstmaligem Frischblutabgang ab ano und Status nach Rohrprothesenimplantation wegen gedeckt rupturiertem Bauchaortenaneurysma wird eine aorto-duodenale Fistel gefunden. Die Abklärungsschritte sowie das Krankheitsbild werden anhand des Falles besprochen.

[61-year-old patient with long-term diarrhea and reactive depressive mood disorder]

Unser Fallbericht beschreibt nahezu exemplarisch das Krankheitsbild einer kollagenen Kolitis mit teils episodenhaft auftretenden, zuletzt persistierenden wässrigen Diarrhoen ohne Blut- oder Schleimbeimengungen. Die möglichen Auslöser waren eine dauerhafte NSAR- und Simvastatin-Medikation einerseits und eine abgelaufene Yersinien-Infektion andererseits. Eine chronische Diarrhoe, bei der eine infektiöse Genese und eine chronisch-entzündliche Darmerkrankung ausgeschlossen werden kann, sollte den behandelden Arzt immer auch an das Vorliegen einer mikroskopischen, insbesondere kollagenen Kolitis denken lassen. Die differentialdiagnostische Fehldiagnose «Reizdarm» oder «funktionelle Darmbeschwerden (Colon irritabile)» kann in solchen Fällen eine langjährige Morbidität, unter Umständen mit reaktiver Depression wie in diesem Fall, hervorrufen. Für den endoskopisch tätigen Gastroenterologen unterstreicht der hier vorgestellte Fallbericht die Notwendigkeit der Entnahme von Biopsien aus dem gesamten Kolonrahmen zur histologischen Aufarbeitung, auch bei makroskopisch blanden Schleimhautbefunden.

Equine leucocyte antigen system. IV. Recombination within the major histocompatibility complex (MHC)

A case of recombination between the putative class I ELA antigen series and the structure(s) governing mixed lymphocyte reactivity in an informative horse family is described. The results of serological typing, 'lysostripping' and mixed lymphocyte culture tests strongly suggest that the recombination took place between two loci and is not intragenic. An alloantigenic membrane structure, provisionally called B1, which does not belong to the known ELA series, was also involved in the cross-over. The B1 antigen resembles the class II gene products of other species in two respects: it is not present on platelets, and alloantiserum with specificity for B1 inhibits the stimulatory effect of B1-carrying cells in mixed lymphocyte cultures. The B1 antigen does not follow the classical distribution, however, being expressed on both B and T lymphocytes. The finding of separate loci for the first series of ELA antigens and the MLR governing structure(s) demonstrates the similarity of the genetic organization of the horse MHC to that in other species.