The Effects of a 4-Layer Compression Bandaging System on Skin Perfusion Pressure in Healthy Adults.

OBJECTIVE: Current practice precludes compression in patients with wounds and reduced arterial flow; however, this treatment may reduce edema and vascular resistance, thus improving distal circulation. The objective of this study was to determine the effects of compression on skin perfusion pressure (SPP), edema, and ankle range of motion. DESIGN: This was a quasi-experimental time series. SETTING: The study was conducted at The Center for Skin Integrity in Cheektowaga, New York. PARTICIPANTS: The study participants were 20 healthy adults, 10 in a younger age bracket (22.10 [SD, 2.77] years, 23.14 [SD, 5.03] kg/m) and 10 in an older age bracket (55.90 [SD, 4.48] years, 28.84 [SD, 4.83] kg/m). INTERVENTIONS: Sixty minutes of Profore Multi-layer Compression was performed. MAIN OUTCOME MEASURES: Precompression and postcompression measurements: SPP, Ankle Brachial Index, calf circumference (15 cm proximal to lateral malleolus), and static and dynamic ankle dorsiflexion range of motion (DF ROM) compared between young and older adults. MAIN RESULTS: There was a significant main effect for time for SPP (P = .049) and static (P = .02) and dynamic (P = .03) DF ROM. Skin perfusion pressure significantly increased at 40, 50, and 60 minutes of compression compared with precompression. Static and dynamic DF ROM significantly increased from precompression to postcompression. Although not statistically significant, calf circumference decreased by 6 cm in the older-adult group postcompression. CONCLUSION: A 4-layer compression dressing system improved SPP; this may be secondary to the decongestion of a proximal confined space. The 4-layer compression dressing also improves DF ROM postcompression and may reduce lower-extremity edema. Seeing these results in healthy participants suggests the need for future research in a patient population to determine if compression can be used to offload arterial structures and thus promote wound healing in patients.

Nodular lymphangitis: Report of a case with presentation of a diagnostic paradigm.

A 54-year-old man with asthma, mitral valve prolapse, and a back injury developed erythematous nodules that progressed along the lymphatic drainage of his right arm. Skin biopsy revealed granulomatous inflammation with microabscess formation. Culture confirmed Mycobacterium marinum infection. The patient was treated with clarithromycin, ethambutol, rifampin, and topical silver sulfadiazine. Oral doxycycline hyclate was later added because of slow healing. Mycobacterium marinum is one of a group of infectious agents that can cause nodular lymphangitis. Sporotrichoid lesions most commonly develop after cutaneous inoculation with Sporothrix schenckii, Leishmania species, Nocardia species, and Mycobacterium marinum. A thorough clinical history and physical examination can narrow the differential diagnosis by eliciting information about the etiologic setting, incubation time, clinical appearance of the lesions, and presence or absence of systemic involvement for each of the causative organisms. Skin biopsy and microbiological tissue cultures are essential for diagnostic confirmation. The differential diagnosis and a suggested diagnostic paradigm will be reviewed.

A randomized and blinded multicenter trial of high-dose fluconazole plus placebo versus fluconazole plus amphotericin B as therapy for candidemia and its consequences in nonneutropenic subjects.

A randomized, blinded, multicenter trial was conducted to compare fluconazole (800 mg per day) plus placebo with fluconazole plus amphotericin B (AmB) deoxycholate (0.7 mg/kg per day, with the placebo/AmB component given only for the first 5-6 days) as therapy for candidemia due to species other than Candida krusei in adults without neutropenia. A total of 219 patients met criteria for a modified intent-to-treat analysis. The groups were similar except that those who were treated with fluconazole plus placebo had a higher mean (+/- standard error) Acute Physiology and Chronic Health Evaluation II score (16.8+/-0.6 vs. 15.0+/-0.7; P=.039). Success rates on study day 30 by Kaplan-Meier time-to-failure analysis were 57% for fluconazole plus placebo and 69% for fluconazole plus AmB (P=.08). Overall success rates were 56% (60 of 107 patients) and 69% (77 of 112 patients; P=.043), respectively; the bloodstream infection failed to clear in 17% and 6% of subjects, respectively (P=.02). In nonneutropenic subjects, the combination of fluconazole plus AmB was not antagonistic compared with fluconazole alone, and the combination trended toward improved success and more-rapid clearance from the bloodstream.