Search Results (31)

Background: Klippel–Trenaunay syndrome (KTS) is a congenital vascular malformation syndrome characterized by low-flow vascular anomalies, including venous malformation (VM) and lymphatic involvement. These anomalies may lead to limb asymmetry due to soft tissue and/or bone overgrowth. Compression therapy using elastic garments is considered a conservative and minimally invasive first-line treatment option for KTS. However, the benefits of compression therapy for low-flow vascular malformations, particularly limb VMs, have not been sufficiently evaluated. This prospective, multi-center study assessed the efficacy and safety of compression therapy for KTS with VM. Methods: After measuring the affected limb, a custom-made elastic garment providing 30 mmHg of compression was manufactured (THUASNE, France). A total of 20 patients (7 male, 13 female; mean age: 10.9 years) underwent compression therapy for 26 weeks at four nationwide institutions in Japan. The primary outcome was the change in lower limb circumference. Secondary outcomes included pain, modified Rankin Scale (mRS) score, body water content, vital signs, changes in garment elasticity, and adverse events. Results: All 20 patients completed the study. At the study endpoint, the circumference ratio of the affected to unaffected limbs was significantly reduced at the superior end of the tibial tuberosity (p = 0.02) and the thinnest part of the ankle (p < 0.001). The elastic force of the garment declined by approximately 50% over 26 weeks. No serious adverse events related to the intervention were reported. Conclusions: Compression therapy using a custom-made elastic garment appears to be a safe and effective approach for managing limb overgrowth in patients with KTS and VM. To maintain the therapeutic effect, garment replacement is recommended at least every six months. Full article

Background and Objectives: Negative-pressure wound therapy (NPWT) expedites tissue repair, yet functional recovery depends on adjunct rehabilitation. Evidence from high-resource settings is difficult to translate to Romanian county hospitals, where advanced devices are scarce. The objective of this study is to determine whether two tiers of low-technology, therapist-delivered exercise improve mobility, oedema resolution, pain and quality-of-life (QoL) beyond NPWT alone in adults with acute lower-limb wounds. Methods: A single-centre, prospective observational study (January 2021–June 2024) enrolled 92 patients and randomised them unevenly into: Group A, NPWT only (n = 39); Group B, NPWT + routine physiotherapy (n = 33); Group C, NPWT + enhanced manual programme (n = 20). All received −125 mmHg continuous suction; rehabilitation started 48 h post-operation. Primary outcomes were ankle dorsiflexion and knee flexion at 12 weeks. Secondary outcomes included calf circumference, ultrasound oedema depth, Manual Muscle Testing (MMT), pain (VAS), analgesic use and SF-36 domains through 24 weeks. Results: Baseline characteristics were similar (p > 0.40). At 12 weeks dorsiflexion reached 20.1 ± 1.8° in Group C, surpassing Group B (18.4 ± 2.1°; p = 0.004) and Group A (16.0 ± 2.3°; p < 0.001). Knee flexion followed the same gradient (140.8 ± 3.2°, 137.6 ± 3.4°, 133.4 ± 3.8° respectively). Oedema depth fell fastest in Group C (0.4 ± 0.2 mm by day 42) versus B (0.6 ± 0.2 mm) and A (0.8 ± 0.3 mm). Week-12 MMT grade ≥ 4.5 was attained by 95% of Group C, 85% of B and 72% of A (χ² = 10.9, p = 0.004). VAS pain fell more steeply with each rehabilitation layer, paralleled by a stepwise decline in daily tramadol. All SF-36 domains were highest in Group C at 24 weeks (Physical Function 88.7 ± 4.8 vs. 85.1 ± 5.4 vs. 78.2 ± 5.9; p < 0.001). Mobility correlated positively with QoL (r = 0.66) and inversely with pain and oedema. Conclusions: In a resource-constrained Romanian setting, adding structured manual physiotherapy to NPWT produced meaningful functional and patient-centred gains, while an “enhanced” programme incorporating daily PNF and elastic-band strengthening delivered the largest observed benefit. These findings justify prioritising therapist-led interventions even where sophisticated equipment is unavailable. Full article

Lower extremity lymphedema (LEL) requires precise limb measurements for treatment evaluation and compression garment design. Tape measurement (TM) is the standard method but is time-consuming. Smartphones with light detection and ranging (LiDAR) technology may offer fast and efficient alternatives for three-dimensional imaging and measurement. This study evaluated the accuracy, reliability, and time efficiency of LiDAR measurements compared with those of TM in patients with LEL. A healthy volunteer and 55 patients were included. Circumferences of the foot, ankle, calf, knee, and thigh and the volume were measured using TM and smartphones with LiDAR. The water displacement method was used to validate volume measurements. The measurement time, reliability, correlation, agreement, and systematic differences between the methods were assessed. LiDAR showed excellent reliability in the healthy volunteer (inter-rater intraclass correlation coefficients: 0.960–0.988) and significantly reduced the measurement time compared with TM (64.0 ± 15.1 vs. 115.3 ± 30.6 s). In patients with LEL, strong correlations and agreements were observed for ankle, calf, and knee measurements. However, foot and thigh measurements showed lower correlations and larger discrepancies. LiDAR has excellent accuracy and reliability in measuring the circumference and volume of the lower leg and has the potential to reduce the time required to acquire data. Limitations include lower accuracy for foot and thigh measurements and the current workflow complexity, which requires the use of multiple software tools. Full article

The aim of the study was to verify the relationship between musculoskeletal pain of elite Polish goalball players and selected physique and posture characteristics. We examined 12 players. The mean age was 21.8 ± 6.0 years, and a mean training experience of 6.3 ± 3.4 years. Physique (body mass, body height, waist circumference, fat tissue, fat-free soft tissue) and posture (thoracic kyphosis and lumbar lordosis) and range of motion (in the thoracic and lumbar regions) were assessed. The incidences and locations of musculoskeletal pain were identified using the Nordic Musculoskeletal Questionnaire, covering the period from the last seven days (NMQ-7) and six months (NMQ-6). Due to the small group size, non-parametric tests (Spearman’s rank correlation) were used. The significance level was set at p < 0.05. Players were more likely to report musculoskeletal pain in the last six months than in the previous week. Pain reported in both NMQ6 and NMQ7 was most common in the wrists/hands and lower back, and, in NMQ6, also in the shoulders and ankles/feet. There were significant negative correlations of total NMQ7 with lumbar lordosis angle in the habitual standing position (R = −0.6; p = 0.04), trunk flexion (R = −0.8, p = 0.002), and trunk extension (R = −0.6; p = 0.03), and a positive correlation with thoracic kyphosis angle in trunk flexion (R = 0.8, p = 0.005). There was a statistically significant, inversely proportional relationship of thoracic kyphosis angle values in the habitual position (R = −0.58; p = 0.049) and thoracic kyphosis angle THA in trunk flexion (R = −0.6; p = 0.038) with time of disability. Relationships between some body posture parameters and musculoskeletal pain in the studied athletes were also noted. Full article

Objectives: This study aims to compare the postoperative clinical outcomes of using non-elastic compression bandages versus elastic bandages after lateral ankle ligament repair. Methods: This retrospective study analyzed a total of 110 patients who underwent repair surgery for chronic lateral ankle ligament injuries. Based on the postoperative bandaging method, patients were divided into two groups: the non-elastic compression bandage group (Group NECB, 55 cases) and the elastic bandage group (Group EB, 55 cases). A comparison was made between the two groups of patients regarding postoperative ankle joint swelling, pain scores (VAS scores), ankle function (AOFAS Ankle–Hindfoot Scale), range of motion of the ankle joint, the incidence of perioperative complications (including subcutaneous ecchymosis, wound seepage, and events requiring loosening of the bandage due to pain), and the status of return to work postoperatively. Results: There were no significant differences between the two groups in terms of early postoperative ankle joint swelling or increased circumference (0.53 ± 1.47 cm vs. 1.08 ± 1.84 cm, p = 0.095) or VAS scores at 1 day (3.84 ± 2.14 vs. 3.63 ± 2.03, p = 0.595), 7 days (2.20 ± 1.89 vs. 1.78 ± 1.67, p = 0.216), 14 days (1.45 ± 1.56 vs. 0.97 ± 1.23, p = 0.075), or 3 months (1.27 ± 1.50 vs. 1.38 ± 1.76, p = 0.744). Both groups demonstrated comparable functional recovery based on AOFAS scores at 3 months (89.89 ± 8.08 vs. 90.05 ± 9.50, p = 0.926), ROM in all measured directions (p > 0.05), and return to work status (p = 0.567). However, the incidence of complications was significantly lower in Group NECB (3.6%) compared to Group EB (30.9%). The reported complications in Group EB were mainly related to postoperative subcutaneous ecchymosis and discomfort requiring bandage loosening. Conclusions: There is no difference between non-elastic compression bandaging with cotton padding and elastic bandaging in postoperative swelling, pain, and functional recovery. However, in reducing the incidence of postoperative skin adverse events, using non-elastic compression bandages with cotton padding proves to be more ideal as a bandaging method after lateral ankle ligament repair. Full article

Background/Objectives: Intermittent pneumatic impulse compression (IIC) is a well-established drainage treatment that reduces edema and enhances arterial blood flow. While widely utilized in various medical fields, its efficacy in dermatology, particularly for stasis dermatitis, remains underexplored. This study evaluates the effectiveness of IIC in inpatients with bilateral stasis dermatitis by comparing standard therapy alone versus standard therapy with additional IIC on one leg over five days. Methods: Seventeen patients from the Dermatology Department at University Hospital Duesseldorf were enrolled. Both legs received standard therapy, while one randomized leg received additional IIC for four hours daily. Measurements, including transcutaneous oxygen pressure (tcpO₂), leg circumference, and pain sensation, were taken at baseline, the first day post-IIC, and after five days. Statistical analysis included paired t-tests, with significance set at p < 0.05. Results: The IIC-treated legs exhibited significant improvements in tissue oxygen saturation (MD = 19.87 mmHg, SD = 27.82, p = 0.012) and reduced ankle circumference (MD = −2.125 cm, SD = 1.593, p < 0.0001). No significant changes were observed in tcpO₂ or circumference in the non-IIC-treated legs. Other leg circumference measurements (calf, above the knee) did not demonstrate significant improvements in either group. Pain levels remained stable under IIC therapy. Conclusions: This proof-of-concept study provides evidence supporting IIC as a beneficial adjunct therapy for stasis dermatitis, demonstrating significant edema reduction and enhanced oxygenation. Further investigations are warranted to confirm these findings and expand clinical applicability. Full article

Background and Objectives: Optimizing functional recovery alongside wound healing remains a challenge in acute wound management. Negative Pressure Wound Therapy (NPWT) is widely used to promote tissue regeneration and reduce edema, yet its impact on functional outcomes and quality of life is less explored. This study evaluates the effects of NPWT alone versus NPWT combined with physiotherapy, focusing on functional recovery and patient-reported outcomes. Materials and Methods: This prospective study included patients with acute wounds at the Timisoara County Emergency Clinical Hospital, treated between 2020 and 2024. Participants were divided into two groups: Group 1, receiving NPWT exclusively, and Group 2, undergoing NPWT combined with physiotherapy (Proprioceptive Neuro-muscular Facilitation, Kabat diagonals, manual lymphatic drainage, and proprioceptive exercises). Assessments included joint mobility (goniometry), edema (circumferential measurements), muscle strength (Manual Muscle Testing), and patient-reported outcomes using WHOQOL-BREF, SF-36, and HADS questionnaires. Results: Results demonstrated that, at 10 days, patients in the specialized physiotherapy group had significantly greater ankle dorsiflexion (18.10 ± 1.63°) compared to the classical group (10.05 ± 1.76°; p < 0.001). Knee flexion in the specialized group was 134.58 ± 5.15° versus 115.57 ± 5.32° in the classical group (p < 0.001). Edema circumference and depth were reduced in both groups, with minor but notable improvements in the specialized group at later follow-ups (p < 0.05). Self-reported quality of life (SF-36, WHOQOL-BREF) and mental health (HADS) scores were slightly better at 10 days in the specialized group, although differences diminished by 6 months. Conclusions: Combining NPWT with specialized physiotherapy techniques enhances functional recovery and quality of life in acute wound patients. These findings support the integration of multi-disciplinary rehabilitation to optimize patient outcomes. Full article

Objectives: This study examined the association between sarcopenic obesity and arterial stiffness using bioelectrical impedance analysis (BIA). Methods: This retrospective cross-sectional study included 20,601 Korean adults from January 2016 to December 2023. Sarcopenia was defined as height-adjusted appendicular skeletal muscle mass [(ASM/height²) <5.7 in women and <7.0 in men] using BIA. Obesity was defined by body mass index or waist circumference. Arterial stiffness was assessed by measuring brachial-ankle pulse wave velocity (baPWV). The participants were categorized into four groups: normal, sarcopenia, obesity, and sarcopenic obesity. The baPWV values were compared among the four groups to investigate the association between sarcopenic obesity and arterial stiffness using adjusted multivariate analyses. Results: The mean baPWV of the sarcopenic obesity group was higher (p < 0.001) than that of the other groups. The odds ratio for having high baPWV (>1800 cm/s) in the sarcopenic obesity group was 2.40 (95% CI, 1.07–5.38) after adjusting for age, sex, exercise, smoking, heavy alcohol consumption, hypertension, and dyslipidemia. Conclusions: Sarcopenic obesity was independently associated with increased arterial stiffness. Full article

Objectives: The aim of the study was to examine the relationship between the Mediterranean diet (MD) and vascular stiffness and metabolic syndrome (MetS), as well as its components in individuals over the age of 65, overall and by sex. Methods: The subjects of the study were people over 65 years of age, with a full record of all variables analyzed from the EVA, MARK, and EVIDENT studies. Data from 1280 subjects with a mean age of 69.52 ± 3.58 years (57.5% men) were analyzed. The MD was recorded with the validated 14 item MEDAS questionnaire. MetS was defined following the guidelines of the joint scientific statement from the Programa Nacional de Educación sobre el Colesterol III. Vascular stiffness was evaluated with the VaSera VS-1500^® device by measuring the cardio-ankle vascular index (CAVI) and the brachial-ankle pulse wave velocity (baPWV). Results: The mean MEDAS score was 6.00 ± 1.90, (5.92 ± 1.92 in males, 6.11 ± 1.88 in females; p = 0.036). CAVI: 9.30 ± 1.11 (9.49 ± 1.05 males, 9.03 ± 1.13 females; p = <0.001). baPWV: 15.82 ± 2.56 (15.75 ± 2.46 males, 15.92 ± 2.68 females; p = <0.001). MetS was found in 51% (49% males, 54% females; p = 0.036). Subjects with MetS had lower MD adherence and higher vascular stiffness values than subjects without MetS. Overall, we found a negative association with MD score and the number of MetS components (β = −0.168), with glycemia (β = −0.007), triglycerides (β = −0.003), waist circumference (β = −0.018), CAVI (β = −0.196) and baPWV (β = −0.065), and a positive association with HDL cholesterol (β = 0.013). Regarding sex, associations followed the same direction but without reaching statistical significance with blood glucose and triglycerides in females and with HDL cholesterol and waist circumference in males. Conclusions: The results indicate that greater adherence to the Mediterranean diet decreases vascular stiffness and the percentage of subjects with MetS, although results differed in the association with MetS components by sex. Full article

The principal purpose of this study is to determine the prevalence of peripheral arterial disease (PAD), as well as the principal associated risk factors, in patients registered in the IDON-PAD database. PAD is a condition characterized by the narrowing or blockage of arteries in the body’s extremities due to plaque buildup, leading to reduced blood flow and tissue ischemia. While PAD primarily affects the lower extremities, it can lead to symptoms such as intermittent claudication and, in severe cases, ulcers and amputations. Risk factors for PAD are numerous and cumulative, including smoking, age over 50, type 2 diabetes mellitus, and hypertension. The prevalence of PAD increases with age, with rates ranging from 2.5% in those over 50 to 60% in those over 85, varying by ethnicity and study population. Diabetic patients face a higher risk of PAD-related complications and have lower success rates with revascularization procedures. The diagnosis of PAD traditionally relied on physical examination and symptoms, but the Ankle–Brachial Index is now a standard diagnostic tool due to its non-invasive nature and reliability. In Mexico, the prevalence of PAD is estimated at 10%, with significant risk factors being the duration of diabetes, hypertension, hypertriglyceridemia, and smoking. Notably, 70% of PAD cases are asymptomatic, emphasizing the importance of proactive screening. This study aimed to determine the prevalence of PAD and associated risk factors in diabetic patients aged 40 and above. The prevalence was found to be 11.2%, with high-risk waist circumference, elevated triglycerides, positive Edinburgh questionnaire, and weak pulses as significant predictors. The detection and management of PAD in diabetic patients require a comprehensive approach, including lifestyle modifications and regular screenings. Prevention strategies should focus on controlling risk factors, including obesity, hypertension, and dyslipidemia. In conclusion, PAD is a prevalent yet underdiagnosed condition in diabetic patients, necessitating proactive screening and comprehensive management to mitigate associated risks and improve patient outcomes. The principal limitation of this study is that, as it uses a cross-sectional methodology and is not an experimental study, although we can establish the prevalence of PAD as well as the associated risk factors, we cannot define causality or determine the hazard ratio for each of these factors. Special thanks to Dr. Leobardo Sauque Reyna and all participants for their contribution to this research. Full article

This study aimed to investigate whether baroreflex sensitivity (BRS) could serve as a reliable metric for assessing cardiovascular autonomic neuropathy (CAN) and concurrently act as a surrogate biomarker for evaluating the severity of arterial stiffness and CAN in individuals diagnosed with type 2 diabetes mellitus (T2DM). Participants underwent brachial–ankle pulse wave velocity (baPWV) as well as autonomic function evaluations encompassing the Sudoscan-based modified composite autonomic scoring scale (CASS), baroreflex sensitivity, and heart rate variability in time domains and frequency domains. Linear regression analysis was performed to evaluate the influence of independent variables on baPWV and modified CASS. Participants with higher baPWV values were older, with longer diabetes duration, lower body weight, body mass index, waist circumference, elevated systolic and diastolic blood pressure, and mean arterial blood pressure. They also exhibited a higher prevalence of retinopathy as the underlying disease and reduced estimated glomerular filtration rate. Multiple linear regression analysis revealed that age and BRS were significantly associated with baPWV while diabetes duration, UACR, and BRS were significantly associated with modified CASS. Our study confirms the significant association of BRS with baPWV and modified CASS in T2DM, highlighting its pivotal role in linking microvascular and macrovascular complications. This supports BRS as a surrogate marker for assessing both the severity of arterial stiffness and cardiovascular autonomic neuropathy in T2DM, enabling the early identification of complications. Full article

This prospective, observational, multicenter study assessed the tolerance of Dobenox Forte^®, the first approved over-the-counter product containing calcium dobesilate, in 1795 outpatients with chronic venous disease (CVD) in daily clinical practice. In addition, the effectiveness (decrease in circumferences of a more affected limb at the ankle and middle part of the calf, and changes in the severity of CVD signs) was assessed. No adverse events related to use of the preparation were reported in a period of 64 ± 20 days. Dobenox Forte^® use was associated with a reduction in calf circumference by 13.1 mm (95%CI: 12.2–14.1) and in ankle circumference by 9.7 mm (95%CI: 9.2–11.0) in patients reporting swelling of the lower legs (60.0% of the cohort). A reduction in calf and ankle circumference by at least 1 cm was achieved in 34.9% and 24.9% of patients, respectively. The percentages of patients reporting moderate to very severe lower limb heaviness decreased from 96.6% to 56.0%, calf cramps decreased from 91.0% to 41.0%, calf pain decreased from 89.2% to 43.7%, swelling decreased from 86.1% to 38.8%, and burning sensation that worsens when standing decreased from 79.0% to 33.7%. The medicinal product Dobenox Forte^® is well tolerated by patients and seems to effectively reduce the symptoms of CVD. Full article

Muscle strength is routinely measured in patients with neuromuscular disorders by hand-held dynamometry incorporating a wireless load cell to evaluate disease severity and therapeutic efficacy, with magnitude of effect often based on normative reference values. While several hand-held dynamometers exist, their interchangeability is unknown which limits the utility of normative data. We investigated the variability between six commercially available dynamometers for measuring the isometric muscle strength of four muscle groups in thirty healthy individuals. Following electro-mechanical sensor calibration against knowns loads, Citec, Nicholas, MicroFET2, and Commander dynamometers were used to assess the strength of ankle dorsiflexors, hip internal rotators, and shoulder external rotators. Citec, Jamar Plus, and Baseline Hydraulic dynamometers were used to capture hand grip strength. Variability between dynamometers was represented as percent differences and statistical significance was calculated with one-way repeated measures ANOVA. Percent differences between dynamometers ranged from 0.2% to 16%. No significant differences were recorded between the Citec, Nicholas, and MicroFET2 dynamometers (p > 0.05). Citec grip strength measures differed to the Jamar Plus and Baseline Hydraulic dynamometers (p < 0.01). However, when controlling for grip circumference, they were comparable (p > 0.05). Several hand-held dynamometers can be used interchangeably to measure upper and lower limb strength, thereby maximising the use of normative reference values. Full article

Type 2 diabetes mellitus (T2DM) significantly increases the risk of atherosclerotic cardiovascular disease. Ankle brachial index (ABI) and carotid artery stenosis are non-invasive indicators of generalized atherosclerosis. This study aimed to explore the risk factors for ABI and carotid artery stenosis and discover which factors simultaneously influence both conditions in T2DM. The study included a total of 101 patients with T2DM. ABI was performed via Doppler ultrasound, and both common carotid arteries were examined via ultrasound to obtain the percentage of carotid artery stenosis. A negative correlation was noted between the ABI and the percentage of carotid artery stenosis (p = 0.043). ABI correlated significantly negatively with waist circumference (p = 0.031), total cholesterol (p = 0.003), low-density lipoprotein (LDL) cholesterol (p = 0.003), and C-reactive protein (CRP) (p = 0.017), whereas the percentage of carotid artery stenosis correlated with the smoking habit (p = 0.017) and CRP (p = 0.042). The best model for predicting the ABI value (R² = 0.195) obtained from stepwise regression analysis included waist circumference, LDL cholesterol, triglycerides, and CRP, while the best model for the percentage of the carotid artery stenosis (R² = 0.112) included smoking and CRP. CRP influenced the ABI value with a negative parameter estimate of −0.008962 (p = 0.053) and the percentage of the carotid artery stenosis with a positive parameter estimate of 0.443655 (p = 0.006) relative to a one-unit change of it, presenting the negatively significant impact of CRP on the association between carotid artery stenosis and low ABI. Our results suggest that CRP is the most important risk factor that connects ABI and carotid artery stenosis, which are important non-invasive indicators of generalized atherosclerosis in T2DM. Full article

Inflammation, being a typical response to vascular tissue alterations, induces variations in tissue oxygen diffusion pressure. Diabetic microangiopathy, an inflammatory process, is characterized by an increase in vascular flow at rest, reduced venous and arteriolar responses, and increased capillary permeability, resulting in oedema development, decreased transcutaneous oxygen pressure, and increased transcutaneous carbon dioxide pressure. This phenomenon potentially hampers ulcer healing. Although the figure-of-eight method has proven to be a reliable, valid, quick, and efficient test for assessing foot and ankle measurements in patients with oedema and compromised skin integrity, it has not been studied in patients with diabetic foot. The aim of this study was to determine and compare the intra- and inter-observer variabilities of the figure-of-eight method in patients with diabetic foot. A prospective observational and cross-sectional study was undertaken, involving sixty-one subjects from a specialized Diabetic Foot Unit. Three investigators with varying levels of experience independently measured the subjects to assess both intra-observer and inter-observer variability. The evaluation was conducted using the Intraclass Correlation Coefficient (ICC). In the statistical analysis, an ICC of 0.93, adjusted using a 95% confidence interval (CI), was obtained for inter-observer reliability ICC, indicating excellent reliability among observers. Furthermore, an ICC of 0.98 with a 95% CI was obtained for the intra-observer reliability analysis, indicating excellent reliability. The results support using this test during the clinical management of oedema in patients with diabetic foot. The absence of an objective, fast, and readily available diagnostic method for oedema in diabetic foot patients in clinical practice might pose a limitation. Subsequent research should tackle this issue and explore the correlation between ankle perimeter measurements and other clinical outcomes in diabetic foot patients, including wound healing and quality of life. Full article