Edema and Related Medical Conditions

Comprehensive information on edema, swelling, treatment and medical conditions that can cause edema. For all articles, please click on "Archives"

Monday, September 28, 2009

Feasibility of treatment of lower limb edema with calf muscle pump stimulation in chronic heart failure.

Feasibility of treatment of lower limb edema with calf muscle pump stimulation in chronic heart failure.

Decker School of Nursing, Binghamton University, United States; Department of Bioengineering, Binghamton University, United States.

BACKGROUND: Persons with chronic heart failure may exhibit a decrease in functional ability related to lower extremity edema in spite of optimal diuretic therapy and salt restrictions.

AIM: The aim of this pilot prospective clinical study was to test the feasibility of using exogenous calf muscle pump stimulation to decrease lower leg edema and thus improve functional status and quality of life.

METHODS: Six subjects entered into this study and agreed to use the intervention 30min/day for one month. DXA was used to assess lower extremity composition.

RESULTS: Device use averaged approximately 1h/day and resulted in a reduction in the lean mass of the legs of 0.5kg (range=0.08-1.0L; p=0.03). Linear regression analysis of reduction of lower limb edema against daily usage suggests that increased utilization of calf muscle pump stimulation was associated with increased water losses, although this trend was not significant (R(2)=0.4, p=0.18).

CONCLUSION: This pilot indicates that exogenous calf muscle pump stimulation could be a useful and safe addition to the patients' treatment regimes, but further studies testing a more typical population with heart failure is warranted.

Science Direct

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Mesoglycan is a mucopolysaccharide complex that is extracted from calf aorta or synthetically created and taken in pill or capsule form as a dietary supplement. Mucopolysaccharides are long molecular chains of sugar. They are used by the body in the building of connective tissues, such as cartilage, tendons, and ligaments. The substance is related to the blood-thinning drug heparin, and the supplements glucosamine and chondroitin. Both are used to treat joint pain and arthritis.

What other names is Mesoglycan known by?

Aortic Glycosaminoglycans, Aortic GAGs, Glycosaminoglycans, Heparinoid Fraction, Heparinoids, Mucopolysaccharide, Sulfomucopolysaccharide.

What is Mesoglycan?

Mesoglycan is a substance obtained from cow lung or blood vessels (aorta), or pig intestine.

Possibly Effective for...

  • Treating poor circulation that can lead to varicose veins and other conditions.
  • Treating leg ulcers.
  • Reducing blood levels of certain fats called triglycerides.
  • Reducing pain when walking in people with a disease called peripheral arterial disease.
  • Improving thinking and quality of life in people with limited blood flow to the brain (cerebrovascular disease).

Possibly Ineffective for...

  • Preventing blood clots in the legs and lungs (deep vein thrombosis and pulmonary embolism).
  • Treating stroke.

Insufficient Evidence to Rate Effectiveness for...

  • Hemorrhoids, atherosclerosis (a type of heart disease), inflammation of blood vessels (vasculitis), and other conditions.

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Pharmacological treatment of mechanical edema: a randomized controlled trial about the effects of mesoglycan.

Pharmacological treatment of mechanical edema: a randomized controlled trial about the effects of mesoglycan.

Recovery and Rehabilitation Agency, University Hospital of Careggi, Florence, Italy

AIM: Mechanical edema (MO) is frequently found in a lot of the lower extremities' orthopedic diseases. In absence of deep vein thrombosis, MO is caused by the change in the dynamics of calf muscle pump with venous hypertension and by the change in capillary permeability which offsets the extra-vascular fluid balance resulting in edema formation. The correct treatment includes specific training for musculo-skeletal and gait recovery, together with medical treatment focused on venous endothelium. Little information is available about pharmacological treatment of this condition. Some studies suggest the efficacy of mesoglycan in venous pathology. Aim of this study was to evaluate the clinical efficacy of the pharmacological treatment (mesoglycan 50 mg p.o., twice a day) in patients affected by MO.

METHODS: Forty-four patients with MO, aged 20-89 years, were randomized in two treatment groups: specific physiotherapy (Fkt) alone or physiotherapy plus mesoglycan 50 mg twice a day, per os. The patients were evaluated before treatment (t0), and after 1 month of treatment (t1), measuring ankle joint range of motion (degrees), calf circumference and malleolar circumference (cm), pain Borg CR10 Scale and adapted lymphedema Weiss Scale. Statistical analysis was performed by the Pearson's c2 test and the Mann-Whitney-Wilcoxon test.

RESULTS: At the final evaluation of the objective and subjective parameters, the mesoglycan effect combined to the Fkt provided statistical differences on nearly all the parameters in comparison with the patients randomised to Fkt alone.

CONCLUSIONS: The present study suggest that mesoglycan treatment (50 mg p.o., twice a day) can improve the recovery of MO, and it is well tolerated by the patients. Specific physiotherapy remains the first treatment for the recovery of both muscular pump and correct walking, but the optimal treatment of MO seems to be a synergic approach, including both pharmacological and mobilization programs.

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Monday, September 21, 2009

Efficacy of intravitreal bevacizumab (Avastin) for short-term treatment of diabetic macular edema.

Efficacy of intravitreal bevacizumab (Avastin) for short-term treatment of diabetic macular edema.
Nagasawa T, Naito T, Matsushita S, Sato H, Katome T, Shiota H.
Department of Ophthalmology, Institute of Health Biosciences, the University of Tokushima Graduate School, Tokushima, Japan.

PURPOSE: To report the efficacy of intravitreal injections of bevacizumab for diabetic macular edema (DME) in the short-term.

DESIGN: Retrospective, noncomparative, interventional case series.

METHODS: Medical records of 20 eyes of 19 patients who underwent intravitreal injections of bevacizumab for persistent diabetic macular edema were reviewed retrospectively. All eyes received intravitreal injections of bevacizumab (1.25 mg/0.05 ml). The clinical course of best-corrected visual acuity (BCVA) using a logarithm of the minimum angle of resolution chart, and averaged foveal retinal thickness using an optical coherence tomography (OCT) were monitored for up to four weeks after the injection.

RESULTS: BCVA at one week improved by two lines or more in six eyes (30%) and in nine eyes (45%) at four weeks. However, no significant improvement in the mean BCVA from baseline was observed at one week (P>0.05) and four weeks (P>0.05). Mean retinal thicknesses (RT) were 411+/-170 mum at baseline, 349+/-102 microm at one week after the injection (P<0.05),>0.05). One week after the injection, significant regression of macular edema was seen. However, recurrence occurred at four weeks. No complications such as severe vision loss, endophthalmitis, or systemic events developed.

CONCLUSION: No changes in BCVA and RT were observed in the short-term observation after the intravitreal injection of bevacizumab for DME.

Journal of Medical Investigation

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Thursday, September 17, 2009



BRAND NAME(S): Zaroxolyn

One of the old fashion but quite effective diuretics in the treatment of generalized
edema is a medicine called metolazone. Presently, after experiencing severe lymphatic failure with bi-lateral lung edema, a history of lymphoma and contending with hereditary lymphedema radiology tests indicate almost no lymphatic flow through the thoracic duct or through the right side lymphatic drainage fields. Clearly, it is a matter of life for me to be able to somehow get rid of the massive amounts of fluid that is collecting in my body.

I must add however, that unless there is a life threatening co-morbidity, lymphedema patients should not be treated with

Very recently, my doctor put me on metolazone with incredible results.

What is metolazone?

Metolazone is a thiazide diuretic (water pill) that helps prevent your body from absorbing too much salt, which can cause fluid retention.

Metolazone treats fluid retention (edema) in people with
congestive heart failure, or a kidney disorder such as nephrotic syndrome. This medication is also used to treat high blood pressure (hypertension).

Metolazone may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about metolazone?

Do not use this medication if you are unable to urinate, or if you have severe liver disease.

Before using this medication, tell your doctor if you have liver disease, kidney disease, asthma, allergies, gout, diabetes, or an allergy to sulfa drugs.Avoid drinking alcohol, which can increase some of the side effects of metolazone.

Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor's instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.

There are many other medicines that can interact with metolazone. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.

If you are being treated for high blood pressure, keep using this medication even if you feel fine.

High blood pressure often has no symptoms.

What should I discuss with my doctor before taking metolazone?

Do not use this medication if you are allergic to metolazone, or if you have:
severe liver disease; or if you are unable to urinate.

If you have certain conditions, you may need a dose adjustment or special tests to safely take this medication. Before using metolazone, tell your doctor if you have:

kidney disease;
liver disease;
diabetes; or

an allergy to sulfa drugs.FDA pregnancy category B. This medication is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Metolazone can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take metolazone?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

To be sure this medication is not causing harmful effects, your blood will need to be tested on a regular basis. Do not miss any scheduled appointments.

Your blood and urine may both be tested if you have been vomiting or are dehydrated.

If you need to have any type of surgery, tell the surgeon ahead of time that you are taking metolazone. You may need to stop using the medicine for a short time.

If you are being treated for high blood pressure, keep using this medication even if you feel fine. High blood pressure often has no symptoms.Store the tablets at room temperature away from heat, light, and moisture.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include nausea, weakness, dizziness, dry mouth, thirst, muscle pain or weakness, feeling light-headed, or fainting.

What should I avoid while taking metolazone?

Avoid drinking alcohol, which can increase some of the side effects of metolazone.

Avoid using other medicines that make you light-headed (narcotic pain medication, muscle relaxers, and medicine for seizures). They can add to the side effects of metolazone. Tell your doctor if you regularly use any of these medicines, or any other blood pressure medications.

Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor's instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.


HOW TO USE: Take this medication by mouth with or without food, usually once daily, or as directed by your doctor. The dosage is based on your medical condition and response to therapy. It is best to take this medication early in the day, before 4-6PM, to prevent having to wake up during the night to urinate. Consult your doctor or pharmacist if you have questions about your dosing schedule. Use this medication regularly in order to get the most benefit from it. Remember to use it at the same time each day as directed. It is important to continue taking this medication even if you feel well. Most people with high blood pressure do not feel sick. Do not stop taking this medication without consulting your doctor. It may take up to 3-6 weeks to see a lowering of your blood pressure. Cholestyramine and colestipol can decrease the absorption of metolazone. If you are taking either of these drugs, separate metolazone from cholestyramine by at least 4 hours and from colestipol by at least 2 hours. Different brands of metolazone may not be equal. Do not switch to another brand without your doctor's approval. If your condition persists or worsens, contact your doctor or pharmacist.

SIDE EFFECTS: Dizziness, lightheadedness, headache, blurred vision, loss of appetite, stomach upset, diarrhea, or constipation may occur as your body adjusts to the medication. If any of these effects persist or worsen, notify your doctor or pharmacist promptly. This medication may lead to excessive loss of body water and minerals (including potassium). Tell your doctor immediately if you have any of these unlikely but serious symptoms of dehydration or mineral loss: muscle cramps or weakness, confusion, severe dizziness, unusual dry mouth or thirst, nausea or vomiting, fast/irregular heartbeat, unusual decrease in the amount of urine, fainting, seizures. Tell your doctor immediately if any of these unlikely but serious side effects occur: numbness/tingling of the arms/legs, decreased sexual ability, chest pain. Tell your doctor immediately if any of these highly unlikely but very serious side effects occur: persistent sore throat or fever, easy bleeding or bruising, stomach/abdominal pain, persistent nausea/vomiting, yellowing of eyes/skin. A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching, swelling, severe dizziness, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist.

PRECAUTIONS: Before taking metolazone, tell your doctor or pharmacist if you are allergic to it; or to sulfa medications; or if you have any other allergies. This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: severe kidney disease (inability to make urine or anuria). Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, liver disease, untreated mineral imbalance (e.g., sodium, potassium), gout, lupus. If you have diabetes, metolazone may worsen control of blood glucose levels. Monitor your blood glucose levels regularly and inform your doctor of the results. This drug may reduce the potassium levels in your blood. Ask your doctor about adding potassium to your diet. A potassium supplement may be prescribed by your doctor. This medication may make you more sensitive to the sun. Avoid prolonged sun exposure, tanning booths or sunlamps. Use a sunscreen and wear protective clothing when outdoors. Before having surgery, tell your doctor or dentist that you are taking this medication. This drug may make you dizzy or cause blurred vision; use caution engaging in activities requiring alertness such as driving or using machinery. Limit alcoholic beverages. To minimize dizziness and lightheadedness, get up slowly when rising from a seated or lying position. Caution is advised when using this drug in the elderly because they may be more sensitive to its effects, especially dizziness. Metolazone should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor. This drug passes into breast milk. Consult your doctor before breast-feeding.

DRUG INTERACTIONS: See also the How to Use section. This drug should not be used with the following medications because very serious interactions may occur: cisapride. If you are currently using any of these medications, tell your doctor or pharmacist before starting metolazone. Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: cholestyramine, colestipol, corticosteroids (e.g., prednisone), diazoxide, digoxin, lithium, nonsteroidal anti-inflammatory drugs (e.g., ibuprofen, indomethacin). Check the labels on all your medicines (e.g., cough-and-cold products, diet aids) because they may contain ingredients that could increase your blood pressure. Ask your pharmacist about the safe use of those products. This product can affect the results of certain lab tests (e.g., parathyroid function tests). Make sure laboratory personnel and your doctors know you use this drug. Do not start or stop any medicine without doctor or pharmacist approval.


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