Limb Compression Research Articles

Abstract 327: Efficacy of Lower Limb Compression in the Management of Vasovagal Syncope: A Randomized Crossover Study

Introduction: Vasovagal syncope (VS) is the most prevalent cause of transient loss of consciousness among the population. The treatment consists of lifestyle modifications and the use of a pacemaker in some subgroups of patients. The purpose of this study is to evaluate the effect of measures to compress the lower limbs in patients with recurrent episodes of VS submitted to the Tilt Test (TT). Methods and Results: Twenty patients, average age 30.5 years (15-75), 13 (65%) female, with a clinical diagnosis of VS and previous TT with a positive result and who had at least one episode of syncope during the last year were included in this placebo-controlled randomized cross-over study. The patients underwent two consecutive TT, at a one-hour interval, with and without compression by pneumatic compression boots with 40 mmHg at the heels and 30 mmHg for the legs. The blood pressure (BP) and heart rate (HR) of these patients were monitored continuously. The outcome assessor was blinded. The results of the TT were positive in 13 (65%) of the patients in the control groups and in 2 (10%) of the patients with compression (p<0.0001). Throughout the tests, the systolic BP measures were not different among the groups. On the other hand, the HR measures showed a difference only in the tilted position at two minutes, of 73±16 bpm in the control group and of 69±16 bpm (p=0.047) in the compression group. Conclusion: Compression of the lower limbs is very effective to render the TT negative in patients with a diagnosis of VS.

Nitrite reduces ischemia/reperfusion-induced muscle damage and improves survival rates in rat crush injury model

Nitrite is an intrinsic signaling molecule with potential therapeutic implications in mammalian ischemia/reperfusion (I/R) injury of the heart, liver, and kidney. Although limb muscle compression and subsequent reperfusion are the causative factors in developing crush syndrome (CS), there has been no report evaluating the therapeutic effects of nitrite on CS. We therefore tested whether nitrite could be a therapeutic agent for the treatment of CS. To create a CS model, anesthetized rats were subjected to bilateral hind limb compression with rubber tourniquets for 5 hours, followed by reperfusion for 0 hour to 6 hours while monitoring blood pressure. Saline for the CS group or sodium nitrite (NaNO(2)-100, 200, and 500 μmol/kg) for the nitrite-treated CS groups was intravenously administered immediately before reperfusion. Blood and tissue samples were collected for biochemical analysis. Tissue nitrite levels in injured muscles were significantly reduced in the CS group compared with the sham group during I/R injury. Nitrite administration to CS rats restored nitric oxide bioavailability by enhancing nitrite levels of the muscle, resulting in a reduction of rhabdomyolysis markers such as potassium, lactate dehydrogenase, and creatine phosphokinase. Nitrite treatment also reduced plasma levels of interleukin-6 and myeloperoxidase activities in muscle and lung tissues, finally resulting in a dose-dependent improvement of survival rate from 24% (CS group) to 36% (NaNO(2)-100 group) and 64% (NaNO(2)-200 and 500 groups). These results indicate that nitrite reduces I/R-induced muscle damage through its cytoprotective action and contributes to improved survival rate in a rat CS model.

Pregnancy and Successful Delivery in a Patient with Chronic Thromboembolic Pulmonary Hypertension (CTEPH) Previously Submitted to Pulmonary Endarterectomy (PEA)

Abstract 4329Chronic thromboembolic pulmonary hypertension (CTEPH) results from obstruction of the major pulmonary arteries by incompletely resolved or organized pulmonary emboli which have become incorporated into the pulmonary artery wall, eventually causing an increase in pulmonary vascular resistances. CTEPH is a condition that is recognised in an increased percentage of patients. Pulmonary endarterectomy (PEA) is recognized as being the only curative option for a subgroup of those patients, but anaesthesiologists and intensivists face many challenges in how they manage these patients perioperatively. Ultimately, it is the combination of skills in a multidisciplinary team that leads to a successful procedure and dramatically improves patient’s quality of life and life expectancy. Careful pre- and post-operative management is therefore essential for such a successful outcome following PEA. In 1994 in Pavia was started a program in which members of a multidisciplinary team work in close interaction with the aim of increase experience in the challenging problems these patients present in the evaluative, surgical, and post-operative phases of their care. Pregnancy in women with pulmonary hypertension (PH) is reported to carry a maternal mortality rate of 30–56%. No report is available on the management of pregnancy and delivery in patients with CTPH. We report our experience of the management of a pregnancy in a patient previously submitted to PEA in whom pressures decreased significantly but remained higher than normal due to partial intervention. EFS, 29 yrs, had first hemoptysis in 2001. Since then, she suffered effort dyspnea. A second hemoptysis occurred in 2004. She was admitted to hospital as having “Multiple foci pneumonia, with pulmonary hypertension of unclear origin”. In 2005 patient was admitted to a different hospital. A CT scan showed: “Congenital right pulmonary artery agenesia associated with bilateral multiple artero-venous malformations. NYHA Class III”. Patients was transferred to our hospital. Thrombophilic workout resulted negative. PaO2: 79.9 mmHg, pulmonary artery pressures (PAP): 130/60/13 mmHg, pulmonary vascular resistances (PVR): 1.083 dynes/sec/min−5. CT angio-scan: Severe dilation of the common pulmonary artery (34 mm). Right pulmonary artery visible only at proximal level. Bronchial artery dilation, bilaterally. V/Q scan: Absent visualization of the right pulmonary artery. Perfusion absent. Arteriography: Clearcut thrombosis of the right pulmonary artery (initial tract). Multiple typical CTPH lesions of the left pulmonary artery. Lower limb compression ultrasound (CUS): No sign of deep or superficial vein thrombosis. On 11 april, 2005 PEA was performed on the left side, with an attempt on the right side. No agenesia of the right pulmonary artery was found. Probable occlusion in early age, with evolution in fibrosis. Post surgery, PaO2: 94.3 mmHg, PAP: 53/32/15 mmHg, PVR: 453 dynes/sec/min−5. On September 16, 2005 she was pregnant, seventh week. After careful multidisciplinary counseling, patient decided to continue pregnancy. Anticoagulant treatment was switched from warfarin to low molecular weight heparin (LMWH), therapeutic dosage. Two days before elective delivery, LMWH was reduced to prophylactic dosages. On march 2, 2006 after an uncomplicated Caesarean section under general anesthesia, she delivered a healthy baby girl. During the following months, PAPs and functional parameters normalized. Patient is today in relatively good health. Is under oral vitamin K antagonists treatment. In 2007, being pregnant again, opted for therapeutic abortion. Maternal mortality in parturients with PAH or CTPH remains prohibitively high, despite lower death rates than previous decades. Early advice on pregnancy risks, including contraception, remains paramount. Women with PAH or CTPH who become pregnant warrant a multidisciplinary approach with consideration of appropriate therapies. Disclosures:No relevant conflicts of interest to declare.06.04.200511.04.05PEA18.04.200516.09.200514.02.200611.04.06Delivery05.08.2010PAP(s) (mmHg)130/60/13(Cath)53/32/15(Cath)50/-/-(Us)55/-/-(Us)35/-/-(Us)PVR(dynes/sec/cm-5)1083453–––Syst. PressureCO (L/min)4.25.1–––NYHACLASSIIIIIISymptomsDyspnea, EmoptysisEmoptysisEmoptysisModerate dyspnea–TreatmentnoneUFH/WarfWarf/UFHLMWHWarf

Insulin resistance increases risk of carpal tunnel syndrome: a case‐control study

Carpal tunnel syndrome (CTS) is one of the most common upper limb compression neuropathies. In only 50% of cases it is possible to identify a cause. Our objective was to determine the role of glucose metabolism abnormalities in idiopathic CTS. We identified 117 patients with idiopathic moderate or severe CTS and 128 controls. In all we evaluated glucose and insulin levels at fasting and after 2-h oral glucose tolerance test (2h-OGTT). In addition we determined insulin resistance (IR). Following OGTT the prevalence of glucose metabolism abnormalities was significantly higher in the CTS group (p = 0.001). IR was documented in 80% of patients, of whom 45% had impaired glucose tolerance, 14% newly diagnosed diabetes mellitus, and 20% IR only. Waist circumference and body mass index were also significantly increased in the CTS group. In this study, we focused on evidence that pre-diabetes may represent a risk factor for CTS. We proposed to determine IR as a rule in all patients with idiopathic CTS.

A unilateral accessory flexor carpi ulnaris muscle observed during cadaveric dissection

Musculature anomalies in the upper limb are common and may result in limb posture deformities or compression neuropathies. In this study, we describe a rare case of accessory flexor carpi ulnaris muscle observed during dissection of the forearm as part of a graduate gross anatomy course.

Characterization of Systemic and Histologic Injury After Crush Syndrome and Intervals of Reperfusion in a Small Animal Model

Prolonged compression of limb muscles and subsequent decompression are important in the development of crush syndrome (CS). We applied a simple rubber tourniquet to rat hind limbs to create a CS model. Anesthetized rats were subjected to bilateral hind limb compression for 5 hours followed by decompression and reperfusion for 0 hour, 1 hour, 3 hours, and 24 hours under monitoring of arterial blood pressure and electrocardiography. Blood and tissue samples were collected for histology, biochemical analysis, and tissue myeloperoxidase activity assessment. The survival rates of the CS-model groups remained at 100% until 3 hours, however, dropped to 25% at 24 hours after reperfusion mainly because of hyperkalemia and consequent hypotension observed at 1 hour and deteriorated at 3 hours after reperfusion. Rhabdomyolysis evaluated by circulating and histologic markers of injury was found as early as 1 hour and more marked at 3 hours, resulting in impaired renal function 24 hours after reperfusion. Myeloperoxidase activities increased with incremental periods after reperfusion not only in injured limb muscles but also in kidney and lung, suggesting an abnormal interaction between the vascular endothelium and circulating leukocytes after rhabdomyolysis, possibly causing subsequent multiple organ dysfunction frequently encountered in CS. The findings from this study demonstrate the feasibility of a novel small animal model of extremity crush injury. By using this model, the impact of incremental periods of reperfusion on mortality and remote organ dysfunctions can be characterized. Future studies are necessary to better define a threshold for this injury pattern and the impact of other factors underlying this syndrome.

Frequency, risk factors, and management of perigraft seroma after open abdominal aortic aneurysm repair

Perigraft seroma (PGS) causing enlargement of the native aneurysm sac after open abdominal aortoiliac aneurysm (AAA) repair is a rarely recognized complication with unknown clinical consequences. This study was undertaken to determine the frequency of PGS, identify associated risk factors, and review resulting complications and their management strategies. Charts of all patients who underwent open AAA repair at our institution from 1995 to 2009 and had at least one postoperative abdominal cross-sectional imaging study (the study subjects) were retrospectively reviewed. PGS was defined as a perigraft fluid collection present > 3 months postoperatively, ≥ 3-cm in diameter and having a radiodensity ≤ 25 Hounsfield units on computed tomography (CT). Patient records were reviewed for demographics, comorbidities, operative and postoperative variables, and long-term outcome. Of the 111 study subjects identified, 13 had aortic reconstruction with Dacron grafts and 98 with polytetrafluoroethylene (PTFE) grafts. Twenty patients (18%) had PGS, all of whom had PTFE grafts (20 of 98; 20.4%). Mean age was 68.5 years and mean aneurysm diameter preoperatively was 6.4 cm (range, 4.0-10.9 cm). The average time from AAA repair to PGS detection was 51 months (range, 4-156 months). PGS averaged 6.0-cm in diameter (range, 3.0-11.0 cm). Multivariate analysis revealed that the following factors were associated with PGS development: diabetes (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.1-21.2; P = .013), smoking (OR, 5.6; 95% CI, 0.73-33.74; P = .01), anticoagulation (OR, 7.2; 95% CI, 2.6-63.3; P = .003), bifurcated graft reconstruction (OR, 8.0; 95% CI, 2.6-94.1; P = .017), and left flank retroperitoneal approach for repair (OR, 7.1; 95% CI, 1.9-26.5; P = .003). Four patients (4 of 20; 20%) required intervention for PGS-related complications: 3 patients for symptomatic PGS expansion (1 patient with rupture) and 1 patient for acute limb ischemia secondary to graft limb compression and thrombosis. Two patients had open exploration, sac evacuation/reduction, and graft replacement with a Dacron graft: 1 patient for a ruptured aneurysm sac and 1 patient for persistent pain associated with sac enlargement. A third patient underwent a failed CT-guided drainage for abdominal pain and was subsequently treated with partial graft excision. The patient with acute limb ischemia was treated with catheter-directed thrombolysis and graft limb stenting. PGS after open AAA repair occurs more frequently than previously reported. Complications requiring intervention can occur in up to 20% of patients with PGS. A variety of treatment modalities can be used to deal with the complications. Earlier CT surveillance is advised after open AAA repair with a PTFE graft if symptoms are suggestive of PGS development.

Comparison of the diagnostic performance of the original and modified Wells score in inpatients and outpatients with suspected deep vein thrombosis

Introduction The original and modified Wells score are widely used prediction rules for pre-test probability assessment of deep vein thrombosis (DVT). The objective of this study was to compare the predictive performance of both Wells scores in unselected patients with clinical suspicion of DVT. Methods Consecutive inpatients and outpatients with a clinical suspicion of DVT were prospectively enrolled. Pre-test DVT probability (low/intermediate/high) was determined using both scores. Patients with a non-high probability based on the original Wells score underwent D-dimers measurement. Patients with D-dimers < 500 μg/L did not undergo further testing, and treatment was withheld. All others underwent complete lower limb compression ultrasound, and those diagnosed with DVT were anticoagulated. The primary study outcome was objectively confirmed symptomatic venous thromboembolism within 3 months of enrollment. Results 298 patients with suspected DVT were included. Of these, 82 (27.5%) had DVT, and 46 of them were proximal. Compared to the modified score, the original Wells score classified a higher proportion of patients as low-risk (53 vs 48%; p < 0.01) and a lower proportion as high-risk (17 vs 15%; p = 0.02); the prevalence of proximal DVT in each category was similar with both scores (7-8% low, 16-19% intermediate, 36-37% high). The area under the receiver operating characteristic curve regarding proximal DVT detection was similar for both scores, but they both performed poorly in predicting isolated distal DVT and DVT in inpatients. Conclusion The study demonstrates that both Wells scores perform equally well in proximal DVT pre-test probability prediction. Neither score appears to be particularly useful in hospitalized patients and those with isolated distal DVT.

Root cause analysis of internal hernia and Roux limb compression after laparoscopic Roux-en-Y gastric bypass using observational clinical human reliability assessment

BackgroundInternal hernia (IH) and Roux limb compression (RC) are recognized complications after retrocolic laparoscopic Roux-en-Y gastric bypass for obesity. The aim of the present study was to systematically identify the surgical technical errors leading to these complications. MethodsAn observational clinical human reliability assessment approach was used to analyze the operating videos of 3 groups: an IH group (n = 12), a Roux compression group (n = 13), and a control group (no complications, n = 21). Two investigators, unaware of the outcomes, reviewed all videos, using special rating software. All errors were categorized using the external error mode system and further described if a direct consequential error (e.g., bleeding) was found. ResultsAn analysis of data showed that, on average, more errors occurred in the complication groups than in the control group (IH 5.85, Roux compression 3.54, control .90, P < .001). The strongest differences were found for missing intermesenteric stitches on both sides of the Roux limb. Logistic regression analysis showed that a missed stitch between the mesentery of the Roux limb and the transverse mesocolon was an independent predictor for IH (B = 1.727, P = .025). No technical or consequential errors could be identified as responsible for RC. ConclusionThe observational clinical human reliability analysis is a useful method to identify operative failure. For retrocolic, retrogastric laparoscopic Roux-en-Y gastric bypass, a systematic approach for the closure of the transverse mesenteric window might prevent IH complications.

Nonhealing Ulcer: Acroangiodermatitis of Mali

An 18-year-old male presented with a nonhealing wound on left lower limb, pain and swelling over multiple joints, weight loss, and yellowish discoloration of eyes and urine for the past 4 years. On examination, the patient had pallor, icterus, and generalized lymphadenopathy with a nonhealing unhealthy ulcer over left medial malleolus. He had deformed joints with hepatomegaly and splenomegaly. His laboratory investigations were positive for antinuclear antibody (ANA) and anticardiolipin antibody (ACLA). Synovial fluid analysis showed inflammatory findings. Biopsy of margin of the ulcer showed findings consistent with Acroangiodermatitis of Mali. The patient was treated with disease-modifying antirheumatic drugs (DMARDs) and aspirin for juvenile idiopathic arthritis and secondary antiphospholipid antibody syndrome (APS), respectively. The ulcer was managed conservatively with systemic antibiotics and topical steroids along with limb elevation and compression elastic stockings. The patient's symptoms improved significantly, and he is in our followup.

Lower limb compression garment improves recovery from exercise-induced muscle damaged in young, active females

Lower limb compression garment improves recovery from exercise-induced muscle damaged in young, active females

Identifying Patients at High Risk for Deep Vein Thrombosis (DVT) After Acute Stroke Using Clinical and Laboratory Predictors.

AbstractAbstract 3825The national Venous Thromboembolism prevention programme in England emphasises reducing hospital-associated thrombosis by ensuring adequate prophylaxis, but this is problematic in stroke patients due to poor uptake of pharmacological prophylaxis and lack of evidence for mechanical measures. Our prospective study aimed to develop clinical and laboratory predictors of thrombosis in patients after acute stroke. Participants were recruited within 48 hours of admission to the Acute Stroke Centre at King's College Hospital London UK, between June 2009 and June 2010. 142 participants were recruited with complete data available from 86 participants. Racial distribution was as follows: 75% Caucasian, 19% African/Caribbean, 6% Asian. Mean age was 69 years (SD15) and 45/86 (52%) were female. 73 strokes were ischaemic and 13 haemorrhagic. In the ischaemic stroke group, 33 of 73 (45%) were thrombolysed as per National stroke strategy. Baseline demographic data and clinical evaluation using the NIH Stroke Scale (NIHSS) and Barthel Index (BI) were recorded. Analysis of prothrombotic markers was performed including D-dimer (DD), Clauss fibrinogen (CFIB) and thrombin generation (TG) measured by calibrated automated thrombography (CAT). The TG assay measured kinetics in platelet poor plasma including lag time (LT) - time taken to generate 10nM of thrombin; time to peak (TTP) - time in reach maximum TG; peak thrombin generation (PTG)- maximum thrombin concentration; and endogenous thrombin potential (ETP) - area under the curve (expressed in nmol/L of thrombin). In the second week all laboratory tests were repeated and lower limb compression ultrasound scan (CUSS) performed. 18/86 (20.9%) had objectively confirmed DVT (5 proximal and 13 distal). 4 DVTs (2 proximal and 2 distal) occurred in patients with haemorrhagic stroke, and 14 DVTs (3 proximal and 11 distal) occurred in patients with ischaemic stroke. Both BI (p=0.02) and body mass index (p=0.05) but not NIHSS (p=0.13) were associated with DVT. TG assay parameters and CFIB were not associated with the risk of DVT. Elevated DD was significantly associated with DVT development both at baseline (DD 2425 ng/ml vs 1010 ng/ml, p=0.0010) and at week 2 (DD 2770 ng/ml vs 830 ng/ml, P<0.001). A subsequent analysis examining the effects of NIHSS, BI and DD using multiple logistic regression, indicated that only DD at baseline was significantly associated with DVT. After adjusting for the effect of this variable, no other variables were found to be significant. ROC curves were used to determine the optimum cut-off for each of the three key variables (NIHSS, BI and DD). The results indicated that the area under the ROC curve (AUC) was greatest for DD (0.77), followed by BI (0.70), and NIHSS (0.62). The best predictive performance for DVT was for DD, with the cut-off of 1230 ng/ml providing a sensitivity of 88% and a specificity of 64%. Limitations of the analysis include the relatively small number of DVT cases and further patients will be accrued before the study is complete. In conclusion, the incidence of DVT after stroke remains high (20.9%) despite the trend towards more aggressive treatment with thrombolysis. BI and DD (but not NIHSS, TG and CFIB) are important predictors of DVT in this population, and are of potential use in identifying high-risk patients for thromboprophylaxis following acute stroke. Disclosures:No relevant conflicts of interest to declare.

Multicenter randomized trial comparing compression with elastic stocking versus bandage after surgery for varicose veins

Postoperative limb compression is widely used after venous surgery to prevent thromboembolism and to reduce hemorrhage, edema, hematoma, and pain. Only limited studies have been published regarding the most adequate postoperative compression therapy after varicose vein surgery. This study evaluated the effectiveness of a new stocking kit used for postoperative limb compression. The study compared the clinical practicability, ease to use, effectiveness, and safety of a postoperative stocking system (23 to 32 mmHg at the ankle) with compression bandages (control group). This prospective, randomized, open-label clinical trial, was performed in three Italian centers specializing in venous surgery. Sixty consecutive patients (classification CEAP C₂,(S)) underwent unilateral varicose vein surgery at one of the three centers. After surgery, patients were randomized for postoperative compression therapy with a new stocking system (Sigvaris Postoperative Kit; Ganzoni Sigvaris Corp, Winterthur, Switzerland) or standard stretch bandages (30 patients per group). Primary end points were incidence of venous thromboembolism, hemorrhage, limb hematoma, or edema. No episodes of venous thromboembolism were observed. The mean area of thigh hematoma on postoperative days 7 and 14 was 75.70 cm² and 2.93 cm², respectively, for the stocking group, and 92.97 cm² and 5.42 cm² for the bandage group (not significant). On postoperative day 7, edema was found in 50% of the patients wearing bandages and in 20% of the patients wearing the stocking kit, which was a significant reduction. No statistical difference was recorded for postoperative pain; however, better patient acceptance and quality of life after the operation were recorded in the stocking group. Patients can be effectively treated with the Sigvaris Postoperative Kit. Patients treated with stockings have less edema compared with standard bandaging, and the application of the stocking kit improves patient quality of life and compliance with postoperative compression therapy.

Efficacy of Lower Limb Compression and Combined Treatment of Manual Massage and Lower Limb Compression on Symptoms of Exercise-Induced Muscle Damage in Women

Strategies to manage the symptoms of exercise-induced muscle damage (EIMD) are widespread, though are often based on anecdotal evidence. The aim of this study was to determine the efficacy of a combination of manual massage and compressive clothing and compressive clothing individually as recovery strategies after muscle damage. Thirty-two female volunteers completed 100 plyometric drop jumps and were randomly assigned to a passive recovery (n = 17), combined treatment (n = 7), or compression treatment group (n = 8). Indices of muscle damage (perceived soreness, creatine kinase activity, isokinetic muscle strength, squat jump, and countermovement jump performance) were assessed immediately before and after 1, 24, 48, 72, and 96 hours of plyometric exercise. The compression treatment group wore compressive tights for 12 hours after damage and the combined treatment group received a 30-minute massage immediately after damaging exercise and wore compression stockings for the following 11.5 hours. Plyometric exercise had a significant effect on all indices of muscle damage (p < 0.05). The treatments significantly reduced decrements in isokinetic muscle strength, squat jump performance, and countermovement jump performance and reduced the level of perceived soreness in comparison with the passive recovery group (p < 0.05). The addition of sports massage to compression after muscle damage did not improve performance recovery, with recovery trends being similar in both treatment groups. The treatment combination of massage and compression significantly moderated perceived soreness at 48 and 72 hours after plyometric exercise (p < 0.05) in comparison with the passive recovery or compression alone treatment. The results indicate that the use of lower limb compression and a combined treatment of manual massage with lower limb compression are effective recovery strategies following EIMD. Minimal performance differences between treatments were observed, although the combination treatment may be beneficial in controlling perceived soreness.

The Effectiveness of Compression Garments and Lower Limb Exercise on Post-exercise Blood Pressure Regulation in Orthostatically Intolerant Athletes

Orthostatic intolerance (OI) may occur postexercise in normotensive individuals due to gravitational stress and removal of muscle pump. Six subjects performed 3 maximal bouts of exercise associated with (1) no intervention (CONTROL) (initial trial), (2) with use of lower limb compression garment (TROU), and (3) lower limb exercise (HEEL). In each trial, 10 minutes of supine rest was followed by 10 minutes of standing before and immediately after maximal exercise. All subjects were OI during the CONTROL trial. In the TROU trial, the compression garment was worn during the supine and standing phases. In the HEEL trial, heel raises were performed every 60 seconds during standing periods. Systolic blood pressure and heart rate were continuously recorded, and stroke, cardiac output, and total peripheral resistance were estimated (PortAPres, TNO Biomedical Instrumentation, Amsterdam, the Netherlands). Positional changes were compared preexercise and postexercise in CONTROL, TROU, and HEEL via 2-way analysis of variance. All 6 subjects experienced OI in the CONTROL trial, but this was reduced to 2 after the HEEL and 1 after the TROU. Minor increases in systolic blood pressure (CONTROL, 3 +/- 11; TROU, 12 +/- 18; HEEL, 7 +/- 15 mm Hg) and heart rate (CONTROL, 10 +/- 12; TROU, 16 +/- 8; HEEL, 15 +/- 13 beats.min) were observed, but total peripheral resistance did not alter significantly during orthostasis postexercise (CONTROL, 0.462 +/- 0.351; TROU, 0.325 +/- 0.212; HEEL, 0.746 +/- 0.412 medical units). It seems that simple methods/practices adopted by athletes can have a positive impact on OI.

Characteristics of crush syndrome caused by prolonged limb compression longer than 24 h in the Sichuan earthquake

BackgroundTo assess the characteristics, treatment and outcome of patients with crush syndrome caused by prolonged limb compression longer than 24 h in the Sichuan earthquake.MethodsFollowing the Sichuan earthquake, 2728 patients...

Acute Effects Of Cyclic Limb Compressions on mRNA Expression Of Angiogenic Factors In Skeletal Muscle

Muscle contraction and therapeutic application of external pneumatic limb compression produces cyclic deformations and changes in shear-stress in the vasculature embedded in skeletal muscle. These mechanical forces are well known stimuli for angiogenic growth factor release in skeletal muscle. PURPOSE: We tested the hypothesis that acute application (150 min) of cyclic leg compressions in a rat model up-regulates factors involved in angiogenesis in skeletal muscle. METHODS: To explore the impact of different pressures and frequency of compressions, rats were divided into 4 groups: 120mmHg (2s inflation/2s deflation), 200mmHg (2s inflation/2s cuff deflation), 120mmHg (4s inflation/16s deflation) and control (no intervention). Intermittent pneumatic compressions were achieved by cyclically inflating/deflating a small cuff wrapped around the rat calf using a cuff inflator unit (Hokanson E20, Bellevue, WA, USA). Blood flow and leg oxygenation (Study 1, n=17) and the mRNA expression (RT-PCR) of angiogenic mediators in the rat tibialis anterior (TA) muscle (Study 2, n=16) were assessed after a single bout of IPC. RESULTS: In all three groups exposed to the intervention, a modest hyperemia (∼37% above baseline) between compressions and a slight, non-significant increase in leg oxygen consumption (∼30%) was observed during IPC. Compared to the control group, vascular endothelial growth factor (VEGF) and monocyte chemotactic protein-1 (MCP-1) mRNA increased significantly (p<0.05) only in the rats exposed to the higher frequency on compressions (2s/2s). CONCLUSIONS: These findings show that application of intermittent leg compressions and the accompanying stretch/deformation of the vasculature as well as changes in leg hemodynamics augment the mRNA content of key angiogenic factors in skeletal muscle. Importantly, the magnitude of changes in mRNA expression appeared to be modulated by the frequency of compressions, such that a higher frequency evoked the most robust changes in VEGF and MCP-1. Support: NIH Grants RR-18276, HL-36088 and ACSM Foundation Research Grant.

Lower limb compression garment improves recovery from exercise-induced muscle damage in young, active females

This study aimed to investigate the efficacy of lower limb compression as a recovery strategy following exercise-induced muscle damage (EIMD). Seventeen female volunteers completed 10 x 10 plyometric drop jumps from a 0.6-m box to induce muscle damage. Participants were randomly allocated to a passive recovery (n = 9) or a compression treatment (n = 8) group. Treatment group volunteers wore full leg compression stockings for 12 h immediately following damaging exercise. Passive recovery group participants had no intervention. Indirect indices of muscle damage (muscle soreness, creatine kinase activity, knee extensor concentric strength, and vertical jump performance) were assessed prior to and 1, 24, 48, 72, and 96 h following plyometric exercise. Plyometric exercise had a significant effect (p < or = 0.05) on all indices of muscle damage. The compression treatment reduced decrements in countermovement jump performance (passive recovery 88.1 +/- 2.8% vs. treatment 95.2 +/- 2.9% of pre-exercise), squat jump performance (82.3 +/- 1.9% vs. 94.5 +/- 2%), and knee extensor strength loss (81.6 +/- 3% vs. 93 +/- 3.2%), and reduced muscle soreness (4.0 +/- 0.23 vs. 2.4 +/- 0.24), but had no significant effect on creatine kinase activity. The results indicate that compression clothing is an effective recovery strategy following exercise-induced muscle damage.

Ease of Application of Medical Compression-stocking Systems for the Treatment of Venous Ulcers

Objective To evaluate the ease of application of two-piece, graduated, compression systems for the treatment of venous ulcers. Methods Four kits used to provide limb compression in the management of venous ulcers were evaluated. These have been proven to be non-inferior to various types of bandages in clinical trials. The interface pressure exerted above the ankle by the under-stocking and the complete compression system and the force required to pull the over-stocking off were assessed in vitro. Ease of application of the four kits was evaluated in four sessions by five nurses who put stockings on their own legs in a blinded manner. They expressed their assessment of the stockings using a series of visual analogue scales (VASs). Results The Sigvaris Ulcer X ® kit provided a mean interface pressure of 46 mmHg and required a force in the range of 60–90 N to remove it. The Mediven ® ulcer kit exerted the same pressure but required force in the range of 150–190 N to remove it. Two kits (SurePress ® Comfort and VenoTrain ® Ulcertec) exerted a mean pressure of only 25 mmHg and needed a force in the range of 100–160 N to remove them. Nurses judged the Ulcer X and SurePress kits easiest to apply. Application of the VenoTrain kit was found slightly more difficult. The Mediven kit was judged to be difficult to use. Conclusions Comparison of ease of application of compression-stocking kits in normal legs revealed marked differences between them. Only one system exerted a high pressure and was easy to apply. Direct comparison of these compression kits in leg-ulcer patients is required to assess whether our laboratory findings correlate with patient compliance and ulcer healing.

Comparative research of blood pressure measured by monitor between different lying positions and time of upper limb compression

Objective To make a comparative research of blood pressure measured by monitor between different lying positions and time of upper limb compression.Methods The blood pressure of brachial arteries in the right upper limbs of 90 patients, in different lying positions, was measured by monitor.Results In the supine position, average systolic blood pressure of the patients was (123.34±19.56)mmHg;in the right lateral position for 30 minutes and 60 minutes, average systolic blood pressure were (124.34 ± 18.43) mmHg and (124.40±18.30) mmHg respectively, without statistical significance compared with the supine position (P ＞ 0.05 ) .In the supine position, average diastolic blood pressure was (76.16 ± 10.34) mmHg;in the right lateral position for 30 minutes and 60 minutes, average diastolic blood pressure were (74.52 ±9.62) mmHg and (75.55 ±9.60) mmHg respectively, without statistical significance compared with the supine position (P＞0.05) .In the supine position, average systolic blood pressure was ( 125.34 ± 19.60) mmHg;in the left lateral position for 30 minutes and 60 minutes, average systolic blood pressure were (113.01 ± 21.13) mmHg and (113.03 ± 21.14) mmHg respectively, with statistical significance compared with the supine position ( P ＜ 0.05 );in the left lateral position for 30 minutes and 60 minutes, average diastolic blood pressure were (60.56 ± 11.08 ) mmHg and (60.54 ± 11.05 ) mmHg respectively, with statistical significance compared with the supine position ( P ＜ 0.05 ) .Conclusions When measuring the blood pressure of brachial arteries in the right upper limbs of the patients by monitor, there is no obvious change in the right lateral position for 30 minutes and 60 minutes and in the supine position.The average systolic blood pressure (14.47 mmHg) and average diastolic blood pressure ( 14.17 mmHg) in the left lateral position are much lower than those in the supine position. Key words: Monitor; Measurement; Comparative research; Blood pressure