Impact of JOBST® Elvarex® knee and elbow functional zones on quality of life

Lymphoedema results from a failure of the lymphatic system. The consequences are swelling, skin and tissue changes and predisposition to infection. Lipoedema, however, results from the predisposition of an excessive number of fat cells in the lower limbs, typically from the ankle to the waist. Management for lymphoedema consists of volume reduction, reduction in shape distortion and improvement of skin condition. Treatment consists of a two-phase approach including an intensive and maintenance phase. The maintenance stage of treatment or self-care consists of skin care, exercise and compression garments. Case studies are presented featuring lower limb lymphoedema and upper limb lymphoedema and a patient affected by lipoedema. The case studies demonstrate how JOBST Elvarex custom-fit, flat-knit compression garments with knee and elbow functional zones enhances patient choice, garment suitability and potential for improved quality of life.

Case study: Obesity, genital oedema and lower limb compression bandaging

The purpose of this article is to present an evidence-based rationale for lymphoedema compression bandaging, one aspect of treatment for a patient with complex lower limb lymphoedema. The current health care climate requires treatment decisions to be transparent, based on the best available evidence. The challenge faced by community nurses is to formulate treatment plans which incorporate patients' preferences and best use limited resources provided by clinical environments. The article appraises research in order to formulate a suitable treatment plan and provides discussion and reflection regarding the challenges faced by the nursing profession in achieving evidence-based practice. Evidence-based practice is beneficial in formulating patient-centred and cost-effective treatment plans. Developing competence is not straightforward; however, clinical guidelines can provide much needed guidance.

Reevaluation of ethylene oxide hemolysis and irritation potential

The in vitro hemolytic and in vivo mucosal irritation potential of ethylene oxide (EO) was investigated with standard procedures used to determine the biocompatibility of medical devices. Test solutions containing EO at concentrations of 25, 50, 100, 250, 500, 1,250, 2,500, 5,000, or 10,000 microg/mL were prepared in saline to simulate a worst-case aqueous extraction of standard medical devices containing 125, 250, 500, 1,250, 2,500, 6,250, 12,500, 25,000, or 50,000 microg/g of EO, respectively. Concentrations of EO up to 500 microg/mL were not hemolytic ( < 5% hemolysis after a 4-h exposure), whereas > or =1250 microg/mL of EO resulted in significant hemolysis. Hamster cheek pouches exposed to cotton pellets saturated with EO at concentrations of up to 2500 microg/mL for 4 h with a recovery period of 14 days were without effects attributable to EO. However, at > or =5000 microg/mL of EO, significant histomorphological alterations of the buccal mucosa were observed and attributed to EO exposure. It was concluded that solutions of EO of up to 500 microg/mL representing an aqueous extract of a general medical device containing at least 2500 microg/g of EO residue do not result in significant hemolysis and irritation.

The use of discriminant analysis for examining the histological feathers of oral keratoses and lichen planus

In a retrospective survey of 235 cases in which the diagnosis on biopsy was lichen planus, keratosis or leukoplakia, the histological features were re-assessed as objectively as possible and without reference to the original diagnosis.The tissue changes were recorded under 39 headings, and many were assessed on a roughly quantitative basis. In addition, two clinical features were included; whether the biopsy was from the buccal mucosa (as opposed to some other intraoral site) and whether the lesions involved multiple intraoral sites. For each possible pair of diagnostic categories (keratosis and leukoplakia, lichen planus and keratosis, lichen planus and leukoplakia) the recorded findings were subjected to discriminant analysis in order to provide a quantitative assessment of the value of each individual feature for discriminating between the two diagnostic groups. The computer programme also provided for the application of these calculated values to yield a "score" for each case, and for an assessment of the significance of the separation of the diagnostic groups thus achieved. In general, the values calculated by the computer for the discriminatory value of each tissue change accorded with our subjective impressions, but a number of features that were given a relatively high value had not previously been recognized as important in differential diagnosisA discriminant analysis was also performed on those cases of leukoplakia known to have later developed a carcinoma, in comparison with the leukoplakia cases that did not develop carcinoma. High values were accorded mainly to the well-known features of epithelial atypia, but a similar high value was indicated for the presence of Russell bodies. we had not previously realized that the presence of Russell bodies was of prognostic significance in this context.When the total scores for the groups of cases were analysed, it was found that the separation of each pair of diagnostic groups was significant at the 1% level. The separation of leukoplakia cases that subsequently developed carcinoma, from those that did not develop carcinoma, was significant at the 5% level. In this latter analysis, a better separation might be achieved with larger numbers of cases, but there will always be the complicating factor that an unknown number of leukoplakia cases would develop carcinoma if the patient had received no treatment.

A computer-aided study on the tissue changes in oral keratoses and lichen planus, and an analysis of case groupings by subjective and objective criteria

In a retrospective survey of 235 cases in which the diagnosis on biopsy was lichen planus, keratosis or leukoplakia, the histological features were re-assessed in as objective a manner as possible. For each case, the tissue changes were recorded under 37 headings, without any attempt at interpretation. The information was then transferred to punched cards, and used for various types of computer-aided analysis. Firstly, the frequency with which each tissue change occurred was assessed for each diagnostic group, and the data presented also show how often each change occurred in those cases that subsequently developed a carcinoma.Re-analysis of the cases on the basis of short lists of tissue changes that were thought to characterize each diagnostic category showed, as expected, that many other factors must have played a part in the original diagnosis.Analysis of the histological findings on an objective basis, using a cluster analysis programme, provided an encouraging degree of separation into the diagnostic groups. When a number of known carcinoma cases were included in the cluster analysis as "markers", a small number of leukoplakia and keratosis cases were placed by the computer into the same cluster as these "markers". Of the original 187 cases originally diagnosed as leukoplakia or keratosis, 4.8% are known to have developed a carcinoma, but of the 11 cases the computer placed in the same cluster as the "marker" cases of carcinoma, 36% have subsequently developed carcinoma. Thus, in the cluster analyses, the computer is tending to "recognize" those cases that later developed carcinoma, and to separate them from the bulk of the cases in which malignant change has not occurred.