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Compression is a treatment method which, applied to the body surface, exerts a pressure by means of elastic or inelastic material on the enveloped tissues. The resting pressure is conferred by the compression of tissues and the working pressure is a result of muscle activities on contention 1. Elastic stockings maintain a constant pressure on the limb and so muscle activity causes changes in the pressure, the working pressure 2. Elastic stockings are designed with the exerted pressure decreasing from the distal to proximal limits thereby favoring lymphovenous return. Recent Publications have reported that elastic stockings improve the hemodynamics of venous return during walking and that the habitual use of Class 1 elastic compression (10 to 15 mmHg) for a period of only 15 days is sufficient to provide a significant improvement of the symptoms and in the overall discomfort caused by pain, thereby improving the quality of life of patients 3,4. Over the long term, elastic compression stockings may even prevent post-thrombotic syndrome in patients with deep venous thrombosis (DVT) 5-7. On the other hand, there are warnings that signs and symptoms may not improve with the use of elastic stockings during exercising in patients suffering from deep venous thrombosis. Nowadays elastic stockings are indicated for a wide range of diseases in the clinical practice however their utilization demands care by the doctor when prescribing and by the patient whilst wearing.
ACESSARLymphedema is an accumulation of water, salts, electrolytes, high molecular weight proteins, and other elements in the interstitial space resulting from dynamic or mechanical changes of the lymphatic system which lead to a progressive increase in size of an extremity or body region with decreased functional and immune capacity and morphological changes [1]. Clinical staging takes into account the manifestation of the edema and the deformities observed. In grade I lymphedema, the swelling appears during the day and in grade II, the patient awakens with edema in the morning which normally worsens during the day. Grade III lymphedema is similar to grade II but more advanced and with worse deformities [2]. Severitymay be mild with a volume increase of up to 20% (compared to the normal contralateral leg), medium with increases of between 20% and 40%, or severe with increases of more than 40% [1, 2]. An association of therapies is recommended to treat lymphedema with lymph drainage, compression mechanisms, and exercising constituting the cornerstone of treatment [3–6].Management of lymphedema using drugs is also possible. The RAGodoy device, a Mechanical Lymphatic Therapy option that uses plantar flexion and extension movements, is a newaddition to the armory of lymphedema treatment [7, 8]. Several studies have shown its effectiveness in reducing the volume of legs [7]. The association of therapies is a clinical option, but it is essential to assess whether combinations provide a synergistic effect.
ACESSARUse of elastic stockings is one of themain clinical approaches to the treatment of venous edema and lymphedema [1, 2]. The pressures introduced by compression hosiery, muscle activity, the environmental temperature, and the integrity of joint mobility are factors that can interfere in reductions in edema and in maintaining the size of limbs [2–5]. Elastic stockings exert working and resting pressures at the interface between the stocking and the skin which decreases fromthe top of the thigh to the foot thus facilitating drainage of fluids even at rest. Muscular activity causes pulse wave-type variations in pressure, similar to what occurs in the venous systembymuscle contraction [6]. The integrity of the muscle “pumps” is crucial to effectively generate pressure gradients during activity [5, 6]. The best option is to continuously use elastic stockings throughout the day, but when this is not possible, their utilization during part of the day can be considered beneficial [7]. Care should be taken not only to use the correct size of stocking for each patient but also to avoid creases and folds as this may cause a tourniquet effect inhibiting venous return thereby aggravating the edema [8].
ACESSARThe aim of the current study is to report on the minimal surgical treatment of elephantiasis of the feet to facilitate the use of compression mechanisms. The cases of two patients with congenital lymphedema that evolved to elephantiasis involving the feet are reported. Intensive treatment of the lymphedema was performed with a significant reduction in size thus allowing a better identification of the limits of tissue masses for the surgical approach. This reduction enabled primary suturing of the lesions to be carried out and fast healing of the wounds. The surgery greatly improved large deformities of the toes and feet and facilitated further treatment of the lymphedema using bandaging. Thus, the skin was preserved, there was a reduction in the size of the feet, and the patients were able to start wearing shoes.
ACESSARthe world causing signs and symptoms that lead to disablement from work and loss of quality of life [1, 2]. However the symptoms reported by patients are not always exclusively due to venous diseases. Therefore, a differential diagnosis must be made, in particular in respect to orthopedic alterations especially those involving the feet [2]. Another condition thatmay cause or aggravate the symptoms is the external environment due to gravitational pressure and temperature. It has been reported that individuals working in specific positionsmay feel leg pain, have a bloated feeling, have a feeling of heaviness, and have several other disturbing sensations [3]. These symptoms can be relieved with the use of elastic stockings and compression with bandages [3–6].
ACESSARThe aim of this study was to investigate the rate of occupational leg swelling depending on the time period of the working day. Volumetric variations of the legs of 70 hospital employees, enrolled in three groups, were evaluated. Group I: 35 morning shift workers; Group II: 35 afternoon shift workers; and Group III: 15 individuals randomly selected from Groups I and II, who were evaluated on the day they worked 12 hours consecutively. Volumetry was performed before and after each shift for both legs of the participants in Groups I and II. For Group III volumetry was performed early in the morning, at noon and in the evening. For statistical analysis, the Student’s t-test and Mann-Whitney test were used with an alpha error of 5% being considered acceptable (P value , 0.05). Significant increases in volume were recorded for the limbs in all three groups (P value, 0.001). On comparing Groups I and II, the accumulation of fluids was significantly higher in the morning than in the afternoon (P value , 0.003). Asymptomatic workers may present with oedema of the legs during their work with the rate of oedema being different for morning and afternoon shifts. The possibility of wearing compression stockings should be considered for this type of work.
ACESSARRapid cardiovascular adjustment is essential to avoid orthostatic hypotension in the passage from the decubitus to the standing position; a response is required within seconds [1, 2]. Orthostatic hypotension is defined as a drop of at least 20mmHg of systolic pressure or 10 mmHg of diastolic pressure within three minutes when changing from the supine or sitting position to the standing position [3]. Dizziness, blurred vision, weakness, nausea, palpitations, headache, syncope, and chest pains are the most commonly reported symptoms. Ineffective adrenergic vasoconstriction provides an inadequate response to adjust the systemic arterial pressure [4]. Studies suggest that orthostatic stress evokes regional differences in cerebral blood flow with possible differences in the carotid dynamics between the two vascular brain regions leading to acute changes in blood pressure [5, 6]. Graduated compression stockings might affect the sympathoadrenergic variability and heart rate variability in response to rest and after strenuous exercise by individuals in wheelchairs with spinal cord injury [7].
ACESSARThe objective of this study is to describe a new compression mechanism in the treatment of lymphedema of the penis and scrotum and the ensuing sexual rehabilitation. The patient, a 58‑year‑old man, had edema of the penile and scrotal region as a result of surgery of the pancreas and spleen and chemotherapy. The patient complained of pain, discomfort, and difficulties to walk and urinate. A clinical diagnosis of lymphedema of the penis and scrotum was reached. Treatment involved the continuous use of a cotton‑polyester compression garment for the region together with thorough hygiene skin care. The swelling reduced significantly within a week to almost a normal aspect which was accompanied by clinical improvements of the symptoms. The reduction in penile edema allowed sexual rehabilitation even though erectile dysfunction required the use of a specific medication (sildenafil). In conclusion, simple and low‑cost options can improve lymphedema of the penis and scrotum and allow sexual rehabilitation.
ACESSARThe objective of current study was to evaluate if day‐to‐day activities can exert an influence on the treatment of patients that use elastic stockings. Working pressures during day‐to‐day activities were evaluated. Five male and five female individuals, with ages varying from 36 to 47 years old, participated in the study. They were requested to continue with routine day‐to‐day activities during the evaluation period. Sigvaris® 30/40 mmHg elastic stockings were utilized. An apparatus that assesses the pressure at half‐second intervals, either dynamically or under static conditions was employed. The individuals were monitored for variable lengths of time of from one to three hours and at the end of data collection, the measurements were expressed as pressures at half‐second intervals in the form of a graph. Pressure variations were identified in accordance to the muscle activity, mainly when the calf muscle was involved. Day‐to‐day activities have a great influence on the variations of working pressure in individuals using elastic stockings and so, the stockings are useful as an adjuvant form of therapy in patients with venolymphatic diseases.
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