Y Manjula1, V Kate, N Ananthakrishnan. 1. Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
Abstract
BACKGROUND: Lymphoedema is a major cause of morbidity in patients with lymphatic filariasis. There is no effective medical treatment and the results of surgery are uncertain. There are very few published studies assessing the volumetric response to the use of sequential intermittent pneumatic compression (SIPC) in patients. METHODS: A 12-celled instrument capable of providing sequential compression from the distal to proximal direction was used in 28 patients with unilateral grades II (n=17) and III (n=11) filarial lymphoedema in a planned 4-week session. The patients were followed up for 6 months after compression therapy by water displacement volumetry. RESULTS: We found that 12 patients with grade II filarial lymphoedema had >26% reduction in oedema volume immediately after compression, but this reduction (>26%) was maintained in only 7 at 6 months. The corresponding figures for grade III filarial lymphoedema were 6 and 4, respectively. The effect in grade III was less sustained than grade II. No complications attributable to SIPC were seen. An added advantage of SIPC was a significant decrease in attacks of adenolymphangitis after compression when compared to pre-compression frequency. These observations were seen even with non-compliance to both foot care measures and use of bandages to maintain reduction in oedema volume. CONCLUSION: SIPC reduces morbidity in filarial lymphoedema though the effect is not sustained. It is simple, easy to use and could form part of the morbidity control programme for lymphatic filariasis.
BACKGROUND: Lymphoedema is a major cause of morbidity in patients with lymphatic filariasis. There is no effective medical treatment and the results of surgery are uncertain. There are very few published studies assessing the volumetric response to the use of sequential intermittent pneumatic compression (SIPC) in patients. METHODS: A 12-celled instrument capable of providing sequential compression from the distal to proximal direction was used in 28 patients with unilateral grades II (n=17) and III (n=11) filarial lymphoedema in a planned 4-week session. The patients were followed up for 6 months after compression therapy by water displacement volumetry. RESULTS: We found that 12 patients with grade II filarial lymphoedema had >26% reduction in oedema volume immediately after compression, but this reduction (>26%) was maintained in only 7 at 6 months. The corresponding figures for grade III filarial lymphoedema were 6 and 4, respectively. The effect in grade III was less sustained than grade II. No complications attributable to SIPC were seen. An added advantage of SIPC was a significant decrease in attacks of adenolymphangitis after compression when compared to pre-compression frequency. These observations were seen even with non-compliance to both foot care measures and use of bandages to maintain reduction in oedema volume. CONCLUSION: SIPC reduces morbidity in filarial lymphoedema though the effect is not sustained. It is simple, easy to use and could form part of the morbidity control programme for lymphatic filariasis.