Mechanical investigation of compression stockings and of their effects on the human leg. Étude mécanique des articles de contention et de leurs effets sur la jambe humaine.

Ce papier est une synthèse de différentes études apportant un regard scientifique sur la contention qui consiste à exercer des pressions sur la jambe humaine au moyen de chaussettes ou de bas afin de faciliter le reflux veineux. Il paraît évident que la répartition des pressions sur la jambe affecte le débit sanguin dans les veines. Néanmoins, la répartition conduisant à un débit veineux optimal est non triviale, et diffère en fonction de l'application : traitement médical ou récupération chez les sportifs. Afin d'améliorer les connaissances à ce sujet, un modèle numérique 2D a été mis en place pour calculer les champs de contraintes dans la jambe en prenant en compte le comportement mécanique réel des articles de contention et des tissus de la jambe. Des méthodes d'identification appropriées, basées soit sur le recalage de modèle et la corrélation d'images numériques (pour les articles de contention), soit sur le recalage de modèle par mise en correspondance locale non linéaire d'images fournies par l'IRM (pour les tissus internes de la jambe), ont été développées pour identifier ces paramètres de comportement. This paper presents a synthesis of different studies willing to bring a scientific insight into leg compression, which is the process of applying external compression forces onto the human leg with stockings or socks, for enhancing the venous flow. It seems obvious that the pressure distribution on the leg affects the blood flow in the veins. However, the pressure distribution that leads to the optimal blood flow is not trivial, and it is different with regard to the application: medical treatment or recovering after an effort in sports. In order to improve the scientific knowledge about this topic, a numerical 2D model was set up for computing stress fields inside the leg, accounting for the actual material properties of both the compression stocking and of the leg biological tissues. Suitable identification methods, based either on model updating from digital image correlation (for the compression stockings), or on image warping and model updating from MRI scans (for the internal leg tissues), were developed for retrieving these material properties

Etude mécanique des articles de contention et de leurs effets sur la jambe humaine. Mechanical investigation of compression stockings and of their effects on the human leg.

International audienceThis paper presents a synthesis of different studies willing to bring a scientific insight into leg compression, which is the process of applying external compression forces onto the human leg with stockings or socks, for enhancing the venous flow. It seems obvious that the pressure distribution on the leg affects the blood flow in the veins. However, the pressure distribution that leads to the optimal blood flow is not trivial, and it is different with regard to the application: medical treatment or recovering after an effort in sports. In order to improve the scientific knowledge about this topic, a numerical 2D model was set up for computing stress fields inside the leg, accounting for the actual material properties of both the compression stocking and of the leg biological tissues. Suitable identification methods, based either on model updating from digital image correlation (for the compression stockings), or on image warping and model updating from MRI scans (for the internal leg tissues), were developed for retrieving these material properties. ===================================================Ce papier est une synthèse de différentes études apportant un regard scientifique sur la contention qui consiste à exercer des pressions sur la jambe humaine au moyen de chaussettes ou de bas afin de faciliter le reflux veineux. Il paraît évident que la répartition des pressions sur la jambe affecte le débit sanguin dans les veines. Néanmoins, la répartition conduisant à un débit veineux optimal est non triviale, et diffère en fonction de l'application : traitement médical ou récupération chez les sportifs. Afin d'améliorer les connaissances à ce sujet, un modèle numérique 2D a été mis en place pour calculer les champs de contraintes dans la jambe en prenant en compte le comportement mécanique réel des articles de contention et des tissus de la jambe. Des méthodes d'identification appropriées, basées soit sur le recalage de modèle et la corrélation d'images numériques (pour les articles de contention), soit sur le recalage de modèle par mise en correspondance locale non linéaire d'images fournies par l'IRM (pour les tissus internes de la jambe), ont été développées pour identifier ces paramètres de comportement

[Booster study: comparative evaluation of a new concept of elastic stockings in mild venous insufficiency]

International audienceBACKGROUND: Evaluate a new progressive concept of compression stockings in comparison with degressive compression stockings class 2 in patients with mild venous insufficiency without permanent oedema (class 1 of Porter's classification or C0s-C1s-C2s CEAP's classification). METHODS: The aim of this randomised, double-blind french, multicenter trial was to compare the efficacy and convenience of the new ES compared to conventional ES in patients with mild venous insufficiency for whom elastic compression by knee stockings was indicated. The primary endpoint was leg heaviness after 15 days of wearing ES. Secondary endpoints were discomfort and compliance. RESULTS: A total of 130 patients were included (progressive ES: 64; conventional ES: 66). Mean age was 43 years, 68% were women. Disappearance or major improvement of leg heaviness was observed in 73% of patients wearing progressive ES and 62.5% of those wearing conventional ES (difference = -10.5% [95% CI -26.7; +5.6]). This result met pre-specified statistical criteria for non-inferiority and was confirmed by per-protocol analysis. Ease of putting on ES and comfort were significantly better with progressive ES (p<0.0001), as was compliance (p=0.016). INTERPRETATION AND CONCLUSIONS: The Booster study is the first randomised, double-blind, multicentre trial evaluating a new concept of compression in mild venous insufficiency. The progressive ES is as efficient as degressive ES but it observance is better. This promising new concept deserves to be evaluated in other settings

Inefficacy of alcohol-based hand rub on mites in a patient with hyperkeratotic scabies

BACKGROUND: The World Health Organization is strongly promoting alcohol-based hand rubs to interrupt transmission of pathogens within the healthcare environment, and in some hospitals they are being recommended in cases of scabies. However, there are no studies that demonstrate the efficacy of such hand rubs against scabies. AIM: To evaluate the viability of Sarcoptes scabiei after the application of various topical antiseptics used for hand hygiene, and the effect of hand washing on the number of parasites present on the skin surface of a patient with scabies. METHODS: We applied three different topical antiseptics (two alcohol-based and one povidone-iodine-based) to the skin of one hand that was affected by scabies, and took a skin scraping of each area to evaluate the viability of the mites over time. A skin scraping of a control area without antiseptic application was also taken. We also tested the antiseptics directly on the mites. Statistical comparison between the percentages of vital mites in the different samples was assessed using the χ(2) test. We also captured a dermoscopic image of the other hand before and after hand washing to count the number of parasites on the skin surface. RESULTS: Topical antiseptics did not reduce the number of living mites compared with control skin, and hand washing did not reduce the number of parasites on the skin surface. CONCLUSIONS: Application of topical antiseptics does not reduce the viability of S. scabiei, and is therefore unable to prevent the transmission of scabies. The usefulness of hand washing in preventing transmission of scabies to new subjects remains to be investigated

A randomized double-blind trial of upward progressive versus degressive compressive stockings in patients with moderate to severe chronic venous insufficiency

BackgroundThe present randomized double-blind multicenter study was designed to assess the efficacy of a progressive compressive stocking (new concept with maximal pressure at calf), compared to a degressive compressive stocking graded 30 mm Hg, evaluating the improvement of lower leg symptoms of chronic venous insufficiency (CVI) in ambulatory patients with moderate to severe chronic venous disease.MethodsBoth gender outpatients presenting symptomatic moderate to severe CVI were eligible for a treatment by compressive stockings. Patients were randomly assigned to receive either degressive compressive stockings (30 mm Hg at ankle, 21 mm Hg at upper calf) or progressive compressive stockings (10 mm Hg at ankle, 23 mm Hg at upper calf). The primary outcome, evaluated after 3 months, was a composite success outcome, including improvement of pain or heavy legs without onset of either ulcer, deep or superficial vein thrombosis of the lower limbs, or pulmonary embolism. The ease of application of the compressive stockings reported by patients was one of secondary outcome.ResultsOverall, 401 patients (199 in the progressive compressive stocking group and 202 in the degressive compressive stocking group) were randomized by 44 angiologists in France. Among them, 66% were classified in the C3 CEAP category. The rate of success was significantly higher in the progressive compressive stocking group compared to the degressive compressive stocking group (70.0% vs 59.6%; relative risk, 1.18; 95% confidence interval, 1.02-1.37; P = .03). This was mainly due to more frequent symptom improvement in the progressive compressive stocking group. The compressive stockings were considered easy to apply by 81.3% of patients in the progressive compressive stocking group vs 49.7% of patients in the degressive compressive stocking group (P < .0001). The rate of related serious adverse events was low and similar in both groups.ConclusionsThis trial has demonstrated that progressive compressive stockings are more effective than usual degressive compressive stockings in the improvement of pain and lower leg symptoms in patients with CVI. Moreover, progressive compressive stockings were easier to apply, raising no safety concern at 3 months

Role of reflectance confocal microscopy and optical coherence tomography as aids in the diagnosis of pemphigoid gestationis

7sinonenoneCouzan, C; Cinotti, E; Labeille, B; Habougit, C; Douchet, C; Cambazard, F; Perrot, J-LCouzan, C; Cinotti, Elisa; Labeille, B; Habougit, C; Douchet, C; Cambazard, F; Perrot, J. L