Prospective multicentre observational study of lymphedema therapy: POLIT study.

OBJECTIVE: Lymphedema treatment is based on Decongestive Lymphedema Therapy (DLT) with an intensive phase followed by a long-term maintenance phase. This study aimed to observe volume variation over the intensive phase and 6 months later. METHODS: Prospective multicentre observational study of patients with unilateral lymphedema. The primary objective was to assess lymphedema volume variation between baseline, the end of intensive phase and 6 months later. Secondary objectives were to assess the frequency of heaviness limiting limb function and treatments safety predictors for volume reduction. RESULTS: Three hundred and six patients (89.9% women; 59.9±14.3 years old) with upper/lower (n=184/122) limb lymphedema were included. At the end of the intensive phase, median excess lymphedema volume reduction was 31.0% (41.7-19.9) followed by a 16.5% (5.9-42.3) median increase over the 6-month maintenance period phase. Previous intensive treatment was the only significant predictor of this response. As compared to baseline, heaviness limiting limb use was much less frequently reported at the end of the reductive phase (75.5% versus 42.3% respectively), and was more frequent at the end of the maintenance phase (62.6%). The most frequent adverse events reported were skin redness and compression marks (18.4 and 15.7% of patients, respectively). Blisters requiring treatment stoppage were rare (1.4%). CONCLUSIONS: Intensive phase decreases lymphedema volume and heaviness limiting limb function. The benefit is partially abolished after the first 6 months of maintenance. There is a need to consider how to provide optimal patient care for the long-term control of lymphedema.

Criteria predictive of limb viability at 1 year in patients with chronic severe ischemia--TcPO2 and demographic parameters.

Following an earlier study, the investigators sought to identify and define objective prognostic criteria of viability at 1 year of a limb with severe chronic ischemia. A study was undertaken in 116 patients (118 limbs) (74 men and 42 women), with a mean age of 71.9 years for men and 81.6 years for women. Static transcutaneous oxygen pressure (TcPO2) was measured with a verticalization sensitization test and inhalation of oxygen on JO and viability of the limb noted 1 year later. Logistic analysis was made of 13 oximetry parameters and two demographic parameters (age and gender). Results were analyzed in absolute terms and by tissue oxygenation ratio (TOR) (ratio between absolute TcPO2 at the foot and at a chest reference electrode). Six factors appeared to be prognostic factors of limb viability at 1 year, statistically significant at 6% according to threshold values: age, verticalization TcPO2, TcPO2 after 1 minute's inhalation of oxygen, TcPO2 after 4 minutes' inhalation of oxygen, and slope of TcPO2 and slope of TOR between 1 and 4 minutes' inhalation. A 1 year viability index integrating these criteria is suggested.

[Respective evaluations of mechanical and vascular factors in the pathogenesis of neuroacropathy]. / Evaluations respectives des composantes mécanique et vasculaire dans la pathogénie des neuroacropathies.

The purpose of this study was to determine the respective contributions of microcirculatory dysfunction and mechanical stresses to the pathogenesis of neurogenic trophic lesions. All patients with polyneuropathy complicated by cutaneous or osteoarticular trophic lesions (perforating forefoot ulcers, neurogenic osteoarthropathy) were eligible for the study. Patients with vascular, articular or neurological disorders other than the polyneuropathy were excluded. Digital photoplethysmography was used to evaluate microcirculatory reactivity. Electronic podometry was performed for static and dynamic foot pressure studies. A technetium-99m bone scan was done to look for evidence of neurogenic osteoarthropathy. The study included 35 patients (16 with alcohol abuse, 7 with diabetes mellitus, 10 with both disorders, one with Charcot-Marie-Tooth disease, and one with neuropathy of unknown etiology). Cutaneous or osteoarticular trophic lesions were correlated with the presence of static podoscopic abnormalities (dynamic abnormalities apparently had no influence per se). Digital vasoplegia was found in 8 of 35 patients (23%) and was closely correlated (p < 0.0001) with severity of the osteoarthropathy. These data suggest that mechanical factors play the central role in the production of neurogenic trophic lesions and that microcirculatory dysfunction may be a marker for severe neurogenic osteoarthropathy rather than a causative factor.

[Gritti's amputation in vascular surgery]. / L'amputation de Gritti en chirurgie vasculaire.

Gritti's amputation was performed in 35 patients, mean age 71 years, with vascular disease of leg. There was no immediate postoperative mortality. Of twenty patients fitted with an appliance using a specific technique, only one had a poor functional result. The results obtained in this preliminary series were compared with those after amputations and knee disarticulations. They showed that Gritti's amputation should be considered for patients with arteritis when a functional knee is impossible to conserve.