Health and economic benefits of advanced pneumatic compression devices in patients with phlebolymphedema

Objective

Phlebolymphedema (chronic venous insufficiency-related lymphedema) is a common and costly condition. Nevertheless, there is a dearth of evidence comparing phlebolymphedema therapeutic interventions. This study sought to examine the medical resource utilization and phlebolymphedema-related cost associated with Flexitouch (FLX; Tactile Medical, Minneapolis, Minn) advanced pneumatic compression devices (APCDs) relative to conservative therapy (CONS) alone, simple pneumatic compression devices (SPCDs), and other APCDs in a representative U.S. population of phlebolymphedema patients.

A model of blood interaction with optical-fluid guide for laser angioplasty

A mathematical model is developed to describe the flow and mixing of blood and optical fluid used in liquid-guided light for laser angioplasty. The model is based on a two-fluid formulation in which separate transport equations are solved for the blood and the optical fluid. Empirical relations, established in prior work, are used to represent interfluid transport of momentum. Both steady and phasic inflow conditions are considered. Parametric calculations are performed showing effect of relative flow rates of blood and optical fluid, on the mixing phenomena. The relative velocity considered (based on average blood velocity) ranged from 0.08 to 0.28 m/sec. No allowance has been made for ablation of the plaque. The predicted results include spatial distribution of the velocity field and the existence probabilities (volume fractions) that provide a measure of the extent of mixing between the fluids. It is found that the degree of mixing is adversely affected by the relative inflow velocity between blood and optical fluid and the pulsatility of blood inflow. Deep penetration of the optical fluid is predicted at high relative velocity and at the end of diastolic and early systolic stages of the cardiac cycle.     

Postoperative surgical‐site hemorrhage after kidney transplantation: incidence,risk factors,and outcomes

Studies investigating the incidence, risk factors, and outcomes of surgical‐site hemorrhage after kidney transplantation are limited. Patients who underwent a kidney transplant from 1 January 2000 to 30 September 2012 (followed until 31 December 2012) at Toronto General Hospital were included in this study. Postoperative surgical‐site hemorrhage was defined as a drop in hemoglobin ≥20 g/l over a 24‐hour period within 3 days of transplantation, followed by an ultrasound indicating a significant hematoma/collection. A total of 59 of 1203 (4.9%) kidney transplant recipients had postoperative surgical‐site hemorrhage. Most cases (89.8%) occurred within 1 day after transplantation. Living donor transplants [OR 0.30 (95% CI: 0.16, 0.55)] and higher recipient BMI [OR 0.54 per 10 kg/m² increase in BMI (95% CI: 0.30, 0.99)] were associated with a significantly lower risk of bleeding. Chronic preoperative anticoagulant usage led to an increased risk of bleeding but was not statistically significant [OR 1.75 (95% CI: 0.52, 5.88)]. Postoperative hemorrhage was associated with a higher risk of graft loss or death [HR 1.62 (95% CI: 1.01, 2.60)]. While the incidence of postoperative surgical‐site hemorrhage in kidney transplantation is relatively low, it may be associated with an increased risk of graft loss or death.     

Rectus sheath hematoma

Rectus sheath hematoma (RSH) is a known complication of anticoagulation therapy and a source of potential morbidity and mortality. Early diagnosis and appropriate treatment may help to prevent complications including hemodynamic instability, the abdominal compartment syndrome or multiorgan dysfunction. Although the diagnosis can be made clinically, it can be confirmed with computed tomography of the abdomen. Most patients can be managed conservatively; however, it is often necessary to suspend anticoagulation in the acute setting. Rectus sheath hematoma is not a contraindication to resuming anticoagulation once the hematoma has been adequately managed and the patient has returned to a stable clinical baseline.