Background Lipedema is characterized by the deposition of abnormal fat in the lower and upper limbs bilaterally. It is a disease with high prevalence and genetic characteristics. Non-specific and non-quantified increases in the thickness of the subcutaneous tissue have previously been demonstrated using magnetic resonance imaging and computed tomography. Objectives To evaluate the thickness of the dermis and subcutaneous tissue in predetermined areas as a distinguishing feature between individuals with and without lipedema using ultrasound. Methods Ultrasound images of 89 female patients were analyzed, including patients undergoing clinical investigation for venous insufficiency or lipedema who underwent ultrasound evaluations at our institution. Patients were divided in two groups: with lipedema clinically diagnosed and those without lipedema. They underwent a common Doppler protocol for venous mapping to assess venous insufficiency associated with the evaluation of dermis and subcutaneous thickness at pre-defined points of the lower limbs. Results There were 63 patients with lipedema. Anterior thigh, pre-tibial and lateral aspect of the leg and supra-just medial malleolar region were significantly different. Supra-just medial malleolar region was significantly different with BMI above 25. An optimal cutoff value was calculated for the ultrasound diagnosis of lipedema using thickness of the dermis and subcutaneous tissues. Conclusions Studied criteria allow use of simple and reproducible ultrasound cutoff values to diagnose lipedema in the lower limbs. Pre-tibial region thickness measurement, followed by thigh and lateral leg thickness are recommended for the ultrasound diagnosis of lipedema.

Asthma patients that depend on emergency department (ED) services are generally considered to have extremely poor disease control and prognosis. It is important to identify characteristics related to poor disease control and frequent visits to the ED to apply appropriate clinical management. This study comprised a cross-sectional survey of consecutive patients with asthma exacerbation (age > or = 12 years) presenting at the adult ED of a large, tertiary care, university-affiliated hospital over a 2-month period. The frequent visitors (FV) were defined by > or = 3 visits to the ED in the preceding year, and the occasional visitors (OV) by < or = 2 visits. Eighty-six patients (61 females and 25 males) were included in the study (mean age 38 +/- 18 years). Of these patients, 51.2% were FV and 48.8% were OV. Sixty-nine percent had annual income lower than A dollar 3000 and 66.3% had < or = 8 years of the formal education. Only 18.6% had used inhaled corticosteroids, 79.1% identified the asthma attack severity, 70.9% increased or initiated inhaled beta-agonist, 20.9% increased or initiated steroid therapy, and 55.8% had an asthma action plan for attack. The number of hospital admissions in past year (OR 4.3, P = .02), use of home nebulizer (OR 3.6, P = .05) and the lack of a written asthma action plan (OR 3.3, P = .03) were independently associated with frequent visits to the ED. We conclude that a substantial proportion of the patients that visit the ED are FV. These patients are more likely to have hospital admission in the past year, to use a home nebulizer, and to lack a written asthma action plan. They should be considered the most important target for asthma education.

Early identification of patients who need hospitalization or patients who should be discharged would be helpful for the management of acute asthma in the emergency room. The objective of the present study was to examine the clinical and pulmonary functional measures used during the first hour of assessment of acute asthma in the emergency room in order to predict the outcome. We evaluated 88 patients. The inclusion criteria were age between 12 and 55 years, forced expiratory volume in the first second below 50% of predicted value, and no history of chronic disease or pregnancy. After baseline evaluation, all patients were treated with 2.5 mg albuterol delivered by nebulization every 20 min in the first hour and 60 mg of intravenous methylprednisolone. Patients were reevaluated after 60 min of treatment. Sixty-five patients (73.9%) were successfully treated and discharged from the emergency room (good responders), and 23 (26.1%) were hospitalized or were treated and discharged with relapse within 10 days (poor responders). A predictive index was developed: peak expiratory flow rates after 1 h £0% of predicted values and accessory muscle use after 1 h. The index ranged from 0 to 2. An index of 1 or higher presented a sensitivity of 74.0, a specificity of 69.0, a positive predictive value of 46.0, and a negative predictive value of 88.0. It was possible to predict outcome in the first hour of management of acute asthma in the emergency room when the index score was 0 or 2.

Compression therapy is used to treat leg symptoms arising from chronic venous disease and lymphoedema. Heart failure, which is traditionally regarded as a contraindication for compression therapy, is prevalent among patients with such leg symptoms. This article aims to assess the evidence on the safety and effectiveness of compression therapy, as well as recommending the assessment and measures required when initiating compression therapy in patients with heart failure. Recent evidence suggests that initiating compression therapy in patients with stable and compensated heart failure is safe if appropriate precautionary measures are undertaken. However, there is still insufficient evidence to support the safety of compression therapy in patients with severe and decompensated heart failure. A standardised, evidence-based guideline on compression therapy in patients with heart failure will help medical and nursing professionals and improve informed consent for the patients.