A compression device versus compression stockings in long-term therapy of lower limb primary lymphoedema after liposuction.


  • 影响因子:1.59
  • DOI:10.12968/jowc.2020.29.1.28
  • 作者列表:"Karafa M","Karafová A","Szuba A
  • 发表时间:2020-01-02

OBJECTIVE:Primary lymphoedema is rare and in most cases develops in the lower extremities. In some cases, conservative treatment is insufficient and can be supported by surgical procedure. The aim of this case study was to show the difference in the effectiveness of a compression wrap device and compression stockings in the treatment of primary lymphoedema. METHOD:Before and after liposuction the patient was treated on an outpatient basis every day for three weeks. This consisted of complex decongestive therapy (CDT) including manual lymph drainage, tailored exercises, skin and nail care, compression therapy and intermittent pneumatic compression. After CDT, the patient was provided with a flat-knit compression garment. Measurements were taken at one week and at three months of wearing the compression garment. The oedema severity was measured by summary calculation method. For both healthy and swollen limbs, the sum of circumferences taken at nine fixed measuring points was determined. The difference between these sums expressed in percents was presented as a relative metric coefficient of leg lymphoedema (RMCL). RESULTS:At the start of therapy, the difference in circumference between the healthy and swollen limb was 21.85%. After CDT (RMCL: 13.46%), the patient was provided with a flat-knit compression stocking (class 3). After one week, the RMCL was 15.92%, while after three months RCML was 20.84%. Because fluid retention was observed the patient was again treated with CDT (RMCL: 13.89%). The patient was provided with compression stocking (class 4). After one week of wearing, the RMCL was 15.77%, while after three months RMCL was 20.26%. As the results proved unsatisfactory, the patient was treated with CDT (RMCL: 13.60%) and a combination of two class 4 compression stockings was used. After one week, RMCL was 14.91%, while after three months RMCL was 19.25%. As the effects of oedema reduction were insufficient, the patient was treated again with CDT (RMCL: 13.89%) and advised to replace one of the stockings with a CirAid device (adjustable compression wrap). After one week, RMCL was 14.18% and after three months RMCL was 14.76%. The patient then qualified for liposuction (RMCL: 7.81%). At three months after surgery, the compression stocking was replaced by an adjustable compression wrap, to reduce the difference in circumference between healthy and swollen limbs (from 21.85 % to 8.68%). CONCLUSION:This case study shows that in primary oedema one class of compression garment is not always sufficient, nor is the combination of two garments with varying degrees of compression. In some cases, the situation requires the use of non-elastic leg binders such as a CircAid device which, thanks to its greater stiffness, helps improve clinical outcomes.


目的: 原发性淋巴水肿是罕见的,在大多数情况下发生在下肢。在某些情况下,保守治疗是不够的,可以通过外科手术来支持。本病例研究的目的是显示压缩包裹装置和压缩长袜在治疗原发性淋巴水肿中的有效性差异。 方法: 抽脂前后,每天门诊治疗三周。这包括复杂的减充血疗法 (CDT),包括手动淋巴引流,量身定制的练习,皮肤和指甲护理,压缩疗法和间歇性气动压缩。CDT后,为患者提供平针织压缩服。在穿着压缩服装的一周和三个月时进行测量。通过汇总计算方法测量水肿严重程度。对于健康和肿胀的肢体,确定在九个固定测量点处获得的周长的总和。以百分比表示的这些总和之间的差异表示为腿淋巴水肿 (RMCL) 的相对度量系数。 结果: 在治疗开始时,健康肢体与肿胀肢体之间的周长差异为21.85%。CDT (RMCL: 13.46%) 后,为患者提供扁平针织压缩袜 (3级)。一周后,RMCL为15.92%,而三个月后,RCML为20.84%。由于观察到液体潴留,患者再次用CDT治疗 (RMCL: 13.89%)。为患者提供加压袜 (4级)。穿戴一周后,RMCL为15.77%,而三个月后,RMCL为20.26%。由于结果证明不令人满意,患者用CDT (RMCL: 13.60%) 治疗,并使用两种4类压缩长袜的组合。一周后,RMCL为14.91%,而三个月后,RMCL为19.25%。由于水肿减轻的效果不充分,患者再次接受CDT (RMCL: 13.89%) 治疗,并建议用CirAid装置 (可调节的压缩包装) 替换其中一个长袜。一周后,RMCL为14.18%,三个月后RMCL为14.76%。然后,患者有资格进行吸脂 (RMCL: 7.81%)。手术后三个月,用可调节的压缩包裹物代替压缩袜,以减少健康和肿胀肢体之间的周长差异 (从21.85% 到8.68%)。 结论: 该案例研究表明,在原发性水肿中,一类压缩服装并不总是足够的,两种服装的组合也不具有不同程度的压缩。在一些情况下,这种情况需要使用非弹性腿部粘合剂,例如圆环装置,由于其更大的刚度,有助于改善临床结果。



作者列表:["Lai B","Bond K","Kim Y","Barstow B","Jovanov E","Bickel CS"]

METHODS:BACKGROUND:People with Parkinson's disease experience numerous barriers to exercise participation at fitness facilities. Advances in tele-monitoring technologies create alternative channels for managing and supervising exercise programmes in the home. However, the success of these programmes will depend on participants' perceptions of using the technology and their exercise adherence. Thus, this pilot explored the uptake and implementation of two common methods of Internet-exercise training in Parkinson's disease. METHODS:Twenty adults with Parkinson's disease were randomized into either: telecoach-assisted exercise (TAE) or self-regulated exercise (SRE) groups. Both groups received the same eight-week exercise prescription (combined strength and aerobic exercise) and telehealth system that streamed and recorded vital signs and exercise data. TAE participants exercised under a telecoach's supervision via videoconferencing. SRE participants independently managed their exercise training. Quantitative data were described and qualitative data underwent thematic analysis. RESULTS:Quantitative results demonstrated that TAE participants achieved strong attendance (99.2%), whereas SRE participants demonstrated 35.9% lower attendance, 48% less total time exercising, and 74.5% less time exercising at moderate intensity. Qualitatively, TAE participants reported overtly favourable programme experiences and that assistance from a telecoach enhanced their exercise motivation. SRE participants noted several challenges that impeded adherence. CONCLUSION:Findings demonstrate that adults with Parkinson's disease acknowledge benefits of exercising through a telehealth system and are open to utilizing this channel as a means of exercise. However, human-interactive support may be required to overcome unique impediments to participation. Study findings warrant validation in larger trials that can transfer the success of TAE towards more scalable methods of delivery.

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作者列表:["Laustsen S","Oestergaard LG","van Tulder M","Hjortdal VE","Petersen AK"]

METHODS:INTRODUCTION:Cardiac rehabilitation improves physical capacity, health-related quality of life, and reduces morbidity and mortality among cardiac patients. Telemonitored exercise-based cardiac rehabilitation may innovate existing programmes and increase participation rates. OBJECTIVE:The purpose of this study was to investigate if telemonitored exercise-based cardiac rehabilitation improves physical capacity, muscle endurance, muscle power, muscle strength and health-related quality of life in cardiac patients. METHODS:A follow-up study on moderate risk patients with ischaemic heart and heart valve disease referred to a 12-week telemonitored exercise-based cardiac rehabilitation intervention at Aarhus University Hospital (Denmark). Participants were encouraged to exercise 60 min three times weekly with moderate/high intensity for 20 min per session. Intensity and duration of training sessions were visualised on a smartphone and uploaded to a website. Participants received individual feedback from physiotherapists on their training efforts by telephone/email. Outcome measures were changes in physical capacity (peak oxygen uptake), muscle endurance, power, and strength, and health-related quality of life between baseline end of telemonitored exercise-based cardiac rehabilitation intervention, and at six and 12 months after end of telemonitored exercise-based cardiac rehabilitation. RESULTS:Thirty-four participants completed telemonitored exercise-based cardiac rehabilitation. We identified a significant increase in peak oxygen uptake of 10%, in muscle endurance of 17%, in muscle power of 7%, and in muscle strength of 10% after the telemonitored exercise-based cardiac rehabilitation programme. Health-related quality of life was significantly improved by 19% in the physical and 17% in the mental component scores. We found no significant improvement in peak oxygen uptake between baseline and 12 months follow-up, but a significant improvement in muscle endurance (0.3 watts/kg, 95% confidence interval; 0.2-0.4), muscle power (0.4 watts/kg; 0.2-0.5), muscle strength (0.5 N/m/kg; 0.1-0.9), physical health-related quality of life (five points; 2-8) and mental health-related quality of life (six points; 3-9). DISCUSSION:This study demonstrated that the self-elected type of physical exercise in cardiac rehabilitation with telemonitoring improved all outcome measures both on the short and long-term, except for peak oxygen uptake at 12 months follow-up.

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作者列表:["Liu Q","Dai Z","Wu J","Ji S","Bai J","Jiang R"]

METHODS::Objective: The purpose of this study was to explore the feasibility and clinical applicability of a modified type V resection method for malignant bone tumors of the proximal humerus. Methods: The relevant anatomic MRI data from 30 normal adult shoulder joints were measured to analyze the feasibility of the modified type V resection method for malignant bone tumors of the proximal humerus. Sixteen patients with malignant bone tumors of the proximal humerus were treated with modified radical resection between March 2012 and April 2017. Recurrence of tumor was evaluated after surgery, and shoulder function was assessed according to the Enneking skeletal muscle tumor function scoring system. Results: Radiographic results showed that the modified type V resection method was feasible, and within the allowable range of the maximum longitudinal diameter (<29.8 mm) and depth (<4 mm). Surgery was successfully completed in all 16 cases, and pathological examination suggested that the purposes for radical resection had been achieved. All patients were followed up over 3-49 months (mean, 15.6 months). One patient had local recurrence at 12 months after surgery, and we performed upper limb amputation. The remaining 15 patients had good prosthesis survival. At the final follow-up, shoulder joint function had recovered compared with preoperative levels, with a mean Enneking score of 25.8 points (range, 24-27 points). Conclusion: Modified type V resection may be feasible for treating tumors of the proximal humerus, maintaining good early shoulder function.

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