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Journal of Orthopaedic Surgery (Hong... 2022Total knee arthroplasty is a commonly performed elective orthopaedic surgery. Patients may endure substantial knee swelling following surgery, which are attributable to... (Review)
Review
BACKGROUND
Total knee arthroplasty is a commonly performed elective orthopaedic surgery. Patients may endure substantial knee swelling following surgery, which are attributable to both effusion and edema. Studies have been aiming to identify an accurate and reliable method to quantify post-operative knee swelling to aid monitoring progress and treatment. The aim of this article was to review the means of clinically applicable measurements for knee swelling post TKA.
METHODS
The medical literature was searched using PubMed to search for articles published using the terms knee edema, effusion, swelling, knee arthroplasty, knee replacement, total knee arthroplasty, total knee replacement, TKA, TKR. Year of publication was not restricted. Only English language publications were included. Only full-text published articles from peer-reviewed journals were eligible for inclusion. The knee swelling measurement methods used in post TKA were reviewed.
RESULTS
Advancement in bioimpedance spectroscopy and handheld 3D scanning technology allows quick and precise quantification of knee swelling volume that the traditional clinical circumferential measurement and volumetric measurement lack. Handheld 3D scanning is also a potential tool to estimate the change of knee effusion volume and muscular volume after the surgery. Magnetic resonance imaging is accurate in effusion measurement but also the most time and resource demanding method.
CONCLUSION
Bioimpedance spectroscopy and 3D scanning technology can be the future tools for clinically measurement of knee swelling after total knee arthroplasty.
Topics: Arthroplasty, Replacement, Knee; Edema; Humans; Knee Joint; Lower Extremity; Postoperative Period
PubMed: 36122907
DOI: 10.1177/10225536221127668 -
British Journal of Clinical Pharmacology Aug 2021Many drugs are responsible, through different mechanisms, for peripheral oedema. Severity is highly variable, ranging from slight oedema of the lower limbs to anasarca... (Review)
Review
Many drugs are responsible, through different mechanisms, for peripheral oedema. Severity is highly variable, ranging from slight oedema of the lower limbs to anasarca pictures as in the capillary leak syndrome. Although most often noninflammatory and bilateral, some drugs are associated with peripheral oedema that is readily erythematous (eg, pemetrexed) or unilateral (eg, sirolimus). Thus, drug-induced peripheral oedema is underrecognized and misdiagnosed, frequently leading to a prescribing cascade. Four main mechanisms are involved, namely precapillary arteriolar vasodilation (vasodilatory oedema), sodium/water retention (renal oedema), lymphatic insufficiency (lymphedema) and increased capillary permeability (permeability oedema). The underlying mechanism has significant impact on treatment efficacy. The purpose of this review is to provide a comprehensive analysis of the main causative drugs by illustrating each pathophysiological mechanism and their management through an example of a drug.
Topics: Edema; Heart Failure; Humans; Lymphedema; Pharmaceutical Preparations; Vasodilation
PubMed: 33506982
DOI: 10.1111/bcp.14752 -
American Journal of Kidney Diseases :... Jan 2017Diuretic resistance is defined as a failure to achieve the therapeutically desired reduction in edema despite a full dose of diuretic. The causes of diuretic resistance... (Review)
Review
Diuretic resistance is defined as a failure to achieve the therapeutically desired reduction in edema despite a full dose of diuretic. The causes of diuretic resistance include poor adherence to drug therapy or dietary sodium restriction, pharmacokinetic issues, and compensatory increases in sodium reabsorption in nephron sites that are not blocked by the diuretic. To illustrate the pathophysiology and management of diuretic resistance, we describe a patient with nephrotic syndrome. This patient presented with generalized pitting edema and weight gain despite the use of oral loop diuretics. Nephrotic syndrome may cause mucosal edema of the intestine, limiting the absorption of diuretics. In addition, the patient's kidney function had deteriorated, impairing the tubular secretion of diuretics. He was admitted for intravenous loop diuretic treatment. However, this was ineffective, likely due to compensatory sodium reabsorption by other tubular segments. The combination of loop diuretics with triamterene, a blocker of the epithelial sodium channel, effectively reduced body weight and edema. Recent data suggest that plasmin in nephrotic urine can activate the epithelial sodium channel, potentially contributing to the diuretic resistance in this patient. This case is used to illustrate and review the mechanisms of, and possible interventions for, diuretic resistance.
Topics: Drug Resistance; Edema; Humans; Male; Middle Aged; Nephrotic Syndrome; Sodium Potassium Chloride Symporter Inhibitors; Treatment Failure
PubMed: 27814935
DOI: 10.1053/j.ajkd.2016.08.027 -
Cell May 2020Swelling of the brain or spinal cord (CNS edema) affects millions of people every year. All potential pharmacological interventions have failed in clinical trials,...
Swelling of the brain or spinal cord (CNS edema) affects millions of people every year. All potential pharmacological interventions have failed in clinical trials, meaning that symptom management is the only treatment option. The water channel protein aquaporin-4 (AQP4) is expressed in astrocytes and mediates water flux across the blood-brain and blood-spinal cord barriers. Here we show that AQP4 cell-surface abundance increases in response to hypoxia-induced cell swelling in a calmodulin-dependent manner. Calmodulin directly binds the AQP4 carboxyl terminus, causing a specific conformational change and driving AQP4 cell-surface localization. Inhibition of calmodulin in a rat spinal cord injury model with the licensed drug trifluoperazine inhibited AQP4 localization to the blood-spinal cord barrier, ablated CNS edema, and led to accelerated functional recovery compared with untreated animals. We propose that targeting the mechanism of calmodulin-mediated cell-surface localization of AQP4 is a viable strategy for development of CNS edema therapies.
Topics: Animals; Aquaporin 4; Astrocytes; Brain; Brain Edema; Calmodulin; Central Nervous System; Edema; Male; Rats; Rats, Sprague-Dawley; Spinal Cord; Spinal Cord Injuries; Trifluoperazine
PubMed: 32413299
DOI: 10.1016/j.cell.2020.03.037 -
Phlebology Oct 2020Patients with lower limb edema are frequently referred to vascular specialists for evaluation. Multiple etiologies must be considered and often more than one cause may...
Patients with lower limb edema are frequently referred to vascular specialists for evaluation. Multiple etiologies must be considered and often more than one cause may be present. Notably, the role of lymphatic system regardless of the underlying pathology has been underestimated. A thorough history and physical examination and a carefully considered laboratory and imaging evaluation are critical in differentiating causes. In this opinion article, we propose a diagnostic algorithm that incorporates a systematic approach to the patient with leg swelling and provides an efficient pathway for the differential diagnosis for this problem.
Topics: Diagnosis, Differential; Diagnostic Imaging; Edema; Humans; Leg; Lymphedema
PubMed: 32631171
DOI: 10.1177/0268355520938283 -
ESC Heart Failure Oct 2020The presence of chronic heart failure (CHF) results in a significant risk of leg oedema. Medical compression (MC) treatment is one of the basic methods of leg oedema... (Review)
Review
The presence of chronic heart failure (CHF) results in a significant risk of leg oedema. Medical compression (MC) treatment is one of the basic methods of leg oedema elimination in patients with chronic venous disease and lymphedema, but it is not routinely considered in subjects with CHF-related swelling. In the study, an overview of the current knowledge related to the benefits and risk of using MC in the supportive treatment of leg oedema in CHF patients is presented. The available studies dedicated the comprehensive management of leg swelling using MC in CHF patients published in the English language literature till December 2019 were evaluated in term of the treatment efficacy and safety. In studies performed on CHF populations, manual lymphatic drainage, MC stocking, multilayer bandaged, as well as intermittent pneumatic compression or electric calf stimulations were used. The current evidence is based on non-randomized studies, small study cohorts, as well as very heterogenous populations. The use of the intermittent pneumatic compression in CHF patients significantly increases the right auricular pressure and mean pulmonary artery pressures as well as decreases systemic vascular resistance in most patients without the clinical worsening. The transient and rapid increase in the human atrial natriuretic peptide, after an application of the MC stocking in New York Heart Association (NYHA) class II patients was observed without clinical exacerbation. An application of the multilayer bandages in NYHA classes III and IV patients lead a significant increase in the right arterial pressure and lead to transient deterioration of the right and the left ventricular functions. In the manual lymphatic drainage study, aside from expected leg circumference reduction, no clinical worsening was observed. In a pilot study performed in a small cohort of CHF patients, electrical calf stimulation use resulted in a reduction in the lean mass of the legs without cardiac function worsening. The use of local leg compression can be considered stable CHF patients without decompensated heart function for both CHF-related oedema treatment and for treatment of the concomitant diseases leading to leg swelling occurrence. The use of MC in more severe classes of CHF (NYHA III and IV) should be the subject of future clinical studies to select the safest and most efficient compression method as well as to select the patients who benefit most from this kind of treatment.
Topics: Edema; Heart Failure; Humans; Leg; Pilot Projects; Pressure
PubMed: 32710511
DOI: 10.1002/ehf2.12848 -
Acta Bio-medica : Atenei Parmensis Jan 2022The Kinesio Taping (KT) is being increasingly applied in physical therapy and rehabilitation. The aim of this study was to evaluate the effect of KT on an early... (Randomized Controlled Trial)
Randomized Controlled Trial
The effectiveness of Kinesio Taping in improving pain and edema during early rehabilitation after Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized, Control Study.
BACKGROUND AND AIM
The Kinesio Taping (KT) is being increasingly applied in physical therapy and rehabilitation. The aim of this study was to evaluate the effect of KT on an early rehabilitation program, in combination with the standard protocol after ACL reconstruction (ACLR).
METHODS
This study enrolled 52 male patients, aged 18 to 45 years, who underwent ACLR with doubled gracilis and semitendinosus tendon (DGST) autograft. The patients were randomized into 2 groups: Group A (the control group) which received a standard rehabilitation protocol, and Group B (the experimental group), which had the same rehabilitation protocol plus the KT application. Pain intensity, range of motion, edema, thigh circumference, Tegner-Lysholm Scale and KOOS scale were measured at the second and fourth week follow-ups.
RESULTS
Patients in the experimental group showed significant results during the second week for both pain and edema reduction compared to the control group (p< 0.05). After 4 weeks of rehabilitation, pain intensity in the two groups was similar (n.s.), while edema reduction in the experimental group showed a significant result compared to the control group (p< 0.05). Nevertheless, the other outcomes did not show significant differences.
CONCLUSIONS
The application of KT after ACLR contributed to relieve pain and reduce edema in the early postoperative rehabilitation period. Other potential benefits of KT on muscle activation and strength should be investigated through a longer follow-up and a targeted test.
Topics: Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Edema; Humans; Knee Joint; Male; Pain; Prospective Studies; Treatment Outcome
PubMed: 35075087
DOI: 10.23750/abm.v92i6.10875 -
Journal of Clinical Hypertension... May 2022Dihydropyridine calcium channel blockers (DHPCCBs) are widely used to treat hypertension and chronic coronary artery disease. One common adverse effect of DHPCCBs is... (Meta-Analysis)
Meta-Analysis
Dihydropyridine calcium channel blockers (DHPCCBs) are widely used to treat hypertension and chronic coronary artery disease. One common adverse effect of DHPCCBs is peripheral edema, particularly of the lower limbs. The side effect could lead to dose reduction or discontinuation of the medication. The combination of DHPCCBs and renin-angiotensin system blockers has shown to reduce the risk of DHPCCBs-associated peripheral edema compared with DHPCCBs monotherapy. We performed the current systematic review and network meta-analysis of randomized controlled trials (RCTs) to estimate the rate of peripheral edema with DHPCCBs as a class and with individual DHPCCBs and the ranking of the reduction of peripheral edema. The effects of renin-angiotensin system blockers on DHPCCBs network meta-analysis were created to analyze the ranking of the reduction of peripheral edema. A total of 3312 publications were identified and 71 studies with 56,283 patients were included. Nifedipine ranked highest in inducing peripheral edema (SUCRA 81.8%) and lacidipine (SUCRA 12.8%) ranked the least. All DHPCCBs except lacidipine resulted in higher relative risk (RR) of peripheral edema compared with placebo. Nifedipine plus angiotensin receptor blocker (SUCRA: 92.3%) did not mitigate peripheral edema and amlodipine plus angiotensin-converting enzyme inhibitors (SUCRA: 16%) reduced peripheral edema the most. Nifedipine ranked the highest and lacidipine ranked the lowest amongst DHPCCBs for developing peripheral edema when used for cardiovascular indications. The second or higher generation of DHPCCBs combination with ACEIs or ARBs or diuretics lowered the chance of peripheral edema development compared to single DHPCCB treatment.
Topics: Antihypertensive Agents; Calcium Channel Blockers; Dihydropyridines; Edema; Humans; Hypertension; Network Meta-Analysis; Nifedipine
PubMed: 35234349
DOI: 10.1111/jch.14436 -
American Journal of Hematology Oct 2021Thrombocytopenia, anasarca, fever, reticulin fibrosis, renal insufficiency, and organomegaly (TAFRO) syndrome is a heterogeneous entity manifesting with a constellation...
Validated international definition of the thrombocytopenia, anasarca, fever, reticulin fibrosis, renal insufficiency, and organomegaly clinical subtype (TAFRO) of idiopathic multicentric Castleman disease.
Thrombocytopenia, anasarca, fever, reticulin fibrosis, renal insufficiency, and organomegaly (TAFRO) syndrome is a heterogeneous entity manifesting with a constellation of symptoms described above that can occur in the context of idiopathic multicentric Castleman disease (iMCD) as well as infectious diseases, malignancies, and rheumatologic disorders. So, iMCD-TAFRO is an aggressive subtype of iMCD with TAFRO syndrome and often hyper-vascularized lymph nodes. Since we proposed diagnostic criteria of iMCD-TAFRO in 2016, we have accumulated new insights on the disorder and additional cases have been reported worldwide. In this systematic review and cohort analysis, we established and validated a definition for iMCD-TAFRO. First, we searched PubMed and Japan Medical Abstracts Society databases using the keyword "TAFRO" to extract cases. Patients with possible systemic autoimmune diseases and hematologic malignancies were excluded. Our search identified 54 cases from 50 articles. We classified cases into three categories: (1) iMCD-TAFRO (TAFRO syndrome with lymph node histopathology consistent with iMCD), (2) possible iMCD-TAFRO (TAFRO syndrome with no lymph node biopsy performed and no other co-morbidities), and (3) TAFRO without iMCD or other co-morbidities (TAFRO syndrome with lymph node histopathology not consistent with iMCD or other comorbidities). Based on the findings, we propose an international definition requiring four clinical criteria (thrombocytopenia, anasarca, fever/hyperinflammatory status, organomegaly), renal dysfunction or characteristic bone marrow findings, and lymph node features consistent with iMCD. The definition was validated with an external cohort (the ACCELERATE Natural History Registry). The present international definition will facilitate a more precise and comprehensive approach to the diagnosis of iMCD-TAFRO.
Topics: Castleman Disease; Edema; Fibrosis; Humans; Lymph Nodes; Renal Insufficiency; Thrombocytopenia
PubMed: 34265103
DOI: 10.1002/ajh.26292 -
Pain Research & Management 2019In this study, we compared the effects of intermittent pneumatic compression along with conventional treatment with cold-pack treatment along with conventional treatment... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
In this study, we compared the effects of intermittent pneumatic compression along with conventional treatment with cold-pack treatment along with conventional treatment on clinical outcomes in patients with knee osteoarthritis.
METHODS
Eighty-nine patients with knee osteoarthritis participated in this study. One group received ultrasound, transcutaneous electrical nerve stimulation, electrical stimulation, exercise, and cold packs. The second group received ultrasound, transcutaneous electrical nerve stimulation, electrical stimulation, exercise, and intermittent pneumatic compression. Range of motion, muscle strength, knee swelling, pain intensity, and functional status were measured at baseline and 4th week.
RESULTS
We found significant improvements in range of motion, muscle strength, pain intensity, and functional status after the treatment in both groups ( < 0.05). When comparing the effects of these two treatment programs, it was observed that the intermittent pneumatic compression treatment group had a better outcome in terms of knee swelling (=0.028).
CONCLUSIONS
According to the results, we could report that intermittent pneumatic compression therapy in addition to conventional treatment has significant positive effects on clinical outcomes in patients with knee osteoarthritis. We could also report that intermittent pneumatic compression therapy along with conventional treatment is superior to cold-pack therapy along with conventional treatment in terms of knee swelling in patients with knee osteoarthritis. This trial is registered with NCT03806322.
Topics: Aged; Combined Modality Therapy; Cryotherapy; Edema; Exercise Therapy; Female; Humans; Intermittent Pneumatic Compression Devices; Male; Middle Aged; Osteoarthritis, Knee; Single-Blind Method; Transcutaneous Electric Nerve Stimulation; Treatment Outcome; Ultrasonic Therapy
PubMed: 31191790
DOI: 10.1155/2019/8514808