***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: AIM The aim of this study was to review published literature concerning the use of compression treatments in the management of venous and lymphatic diseases and establish where reliable evidence exists to justify the use of medical compression and where further research is required to address areas of uncertainty . METHODS The authors search ed medical literature data bases and review ed their own collection s of papers , monographs and books for papers providing information about the effects of compression and r and omized clinical trials of compression devices . Papers were classified in accordance with the recommendations of the GRADE group to categorize their scientific reliability . Further classification was made according to the particular clinical problem that was addressed in the papers . The review included papers on compression stockings , b and ages and intermittent pneumatic compression devices . RESULTS The International Compression Club met once in Vienna and corresponded by email in order to reach an agreement of how the data should be interpreted . A wide range of compression levels was reported to be effective . Low levels of compression 10 - 30 mmHg applied by stockings are effective in the management of telangiectases after sclerotherapy , varicose veins in pregnancy , the prevention of edema and deep vein thrombosis ( DVT ) . High levels of compression produced by b and aging and strong compression stockings ( 30 - 40 mmHg ) are effective at healing leg ulcers and preventing progression of post-thrombotic syndrome as well as in the management of lymphedema . In some areas no reliable evidence was available to permit recommendations of level of compression or duration of treatment . These included : management of varicose veins to prevent progression , following surgical treatment or sclerotherapy for varicose veins , and the level of compression required to treat acute DVT . CONCLUSION This review shows that whilst good evidence for the use of compression is available in some clinical indications , there is much still to be discovered . Little is know about dosimetry in compression , for how long and at what level compression should be applied . The differing effects of elastic and short-stretch compression are also little understood The application of intermittent pneumatic compression ( IPC ) as a part of complex decongestive physiotherapy ( CDP ) remains controversial . The aim of this study was to investigate whether the combination of IPC with manual lymph drainage ( MLD ) could improve CDP treatment outcomes in women with secondary lymphedema after breast cancer treatment . A r and omized study was undertaken with 13 subjects receiving MLD ( 60 min ) and 14 receiving MLD ( 30 min ) plus IPC ( 30 min ) followed by st and  ardized  components of CDP including multilayered compression b and aging , physical exercise , and skin care 10 times in a 2-week-period . Efficacy of treatment was evaluated by limb volume reduction and a subjective symptom question naire at end of the treatment , and one and two months after beginning treatment . The two groups had similar demographic and clinical characteristics .  Mean reductions in limb volumes for each group at the end of therapy , and at one and two months were 7.93 % and 3.06 % , 9.02 % and 2.9 % , and 9.62 % and 3.6 % , respectively ( p < 0.05 from baseline for each group and also between groups at each measurement ) . Although a significant decrease in the subjective symptom survey was found for both groups compared to baseline , no significant difference between the groups was found at any time point . The application of IPC with MLD provides a synergistic enhancement of the effect of CDP in arm volume reduction Background Prospect i ve investigations of complete decongestive lymphatic physiotherapy ( CDPT ) , including manual lymphatic drainage ( MLD ) , have vali date d the efficacy of these interventions for the initial reduction of edema and long-term maintenance of limb volume in lymphedema . However , CDPT dem and s substantial time and effort from patients to maintain these benefits ; the treatments are not always well-accepted , and patients may suffer from a deterioration in quality -of-life or a time-dependent loss of initial treatment benefits . A new device design ed for home use by the patient , the Flexitouch ™ , has been developed to mechanically simulate MLD . We have undertaken a prospect i ve , r and omized , crossover study of the efficacy of the Flexitouch ™ , when compared to massage , in the self-administered maintenance therapy of lymphedema . Methods A prospect i ve , r and omized , crossover study of maintenance therapy was performed in 10 patients with unilateral breast cancer-associated lymphedema of the arm . Each observation phase included self-administered treatment with the Flexitouch ™ or massage , 1 hour daily for 14 days , respectively , followed by crossover to the alternate treatment phase . Each treatment phase was preceded by a 1 week treatment washout , with use of garment only . The sequence of treatment was r and omly assigned . The potential impact of treatment modality on quality of life was assessed with serial administration of the SF-36 . Results Statistical analysis disclosed that the order of treatment had no outcome influence , permitting 10 comparisons within each treatment group . Post-treatment arm volume reduced significantly after the Flexitouch ™ , but not after self-administered massage . The patients ' mean weight decreased significantly with Flexitouch ™ use , but not with massage . The Flexitouch ™ device was apparently well-tolerated and accepted by patients . Serial SF-36 administration showed no deterioration in physical or psychosocial scores compared to baseline measurements ; there were no statistical differences in scores when the two treatment modalities were compared . Conclusion This short-term prospect i ve evaluation of the Flexitouch ™ suggests that the device may provide better maintenance edema control than self-adiminstered massage in breast cancer-associated lymphedema . The apparent ease of use and reliability of response to the device suggest that further broad-scale testing is warranted PURPOSE A prospect i ve evaluation was undertaken to assess the efficacy of intensive , short-term decongestive lymphatic therapy coupled with focused patient instruction in long-term self-care for the management of lymphedema . METHODS The therapeutic responses of 79 patients with lymphedema were analyzed prospect ively . Each patient received intensive , short-term decongestive lymphatic therapy , with quantification of the extent and durability of the clinical response . Decongestive lymphatic therapy was performed by therapists trained in these techniques . The mean ( + /-SD ) duration of therapy was 8+/-3 days . Instruction in self-management techniques was incorporated into the therapeutic regimen by day 3 of the patient 's treatment . The mean period of follow-up was 38+/-52 days . Changes in the volume of the affected limb were assessed with a geometric approximation derived from serial measurements of circumference along the axis of the limb . RESULTS The mean short-term reduction in limb volume was 44%+/-62 % of the excess volume in the upper extremities and 42%+/-40 % in the lower extremities . At follow-up , these results were adequately sustained : mean long-term excess volume reductions of 38%+/-56 % ( upper extremities ) and 41%+/-27 % ( lower extremities ) were observed . CONCLUSION Decongestive lymphatic therapy , combined with long-term self-management , is efficacious in treating patients with lymphedema of the extremity Sequential Intermittent Pneumatic Compression ( SIPC ) is an accepted method for treatment of peripheral lymphedema . This prospect i ve study evaluated the effect in 11 patients of a single session of SIPC on both lymphedema volume of the leg and isotope  lymphography ( 99Tc dextran ) before SIPC  ( control ) and 48 hours later after a 3 hour session of SIPC . Qualitative analysis of the 2 lymphoscintigrams ( LS ) was done by image interpretation by 3 physicians on a blind study protocol . The LS protocol attributed an index score based on the following variables : appearance , density and number of lymphatics , dermal backflow and collateral lymphatics in leg and thigh , visualization and intensity of popliteal and inguinal lymph nodes . Volume of the leg edema was evaluated by measuring limb circumference before and after SIPC at 6 design ated sites . Whereas there was a significant reduction of circumference in the leg after SIPC ( p<0.05 ) , there was no significant difference in the index scores of the LS before and after treatment . This acute or single session SIPC suggests that compression increased transport of lymph fluid ( i.e. , water ) without comparable transport of macromolecules ( i.e. , protein ) . Alternatively , SIPC reduced lymphedema by decreasing blood capillary filtration ( lymph formation ) rather than by accelerating lymph return thereby restoring the balance in lymph kinetics responsible for edema in the first place BACKGROUND Two phase II clinical studies used an experimental , multi-chambered compression device with different cuff pressure combinations in subjects with leg edema and chronic venous insufficiency . The objective of each study was to evaluate the safety and the relative effects of different cuff pressure combinations to determine if edema reduction was dose-dependent . METHODS Each study enrolled adults with chronic ( > or=6 weeks ) venous edema corresponding to CEAP C(3)-C(5 ) . The test device could apply different pressures at the foot , gaiter , mid-calf , and upper-calf . In the first study , the following six sustained pneumatic compression ( SPC ) profiles were applied for six hours each : 20 , 30 , and 40-mm Hg at the gaiter with graduated SPC ( ie , lower pressures at the calf ) ; and 20 , 30 , and 40-mm Hg at the gaiter with nongraduated SPC ( ie , the same pressures at the calf ) . In the second study , the following three intermittent pneumatic compression ( IPC ) profiles were applied for two hours each : 40 , 50 , and 60-mm Hg at the gaiter with graduated IPC ( ie , lower pressures at the calf ) . Each study included a baseline profile with no compression and two-day intervals between profiles . Leg volume was measured before and after compression using the water-displacement method . RESULTS A dose-response relationship was observed between increased SPC/IPC pressures and reduced limb edema . Limb volume was reduced most effectively with the highest pressures of 40-mm Hg nongraduated SPC and 60-mm Hg graduated IPC ( 136 mL and 87 mL , respectively ) ; however , some subjects reported discomfort with these profiles . Limb volume was reduced by more than 100 mL with 30 to 40-mm Hg graduated SPC and by 69 mL with 50-mm Hg graduated IPC , and subjects rated these profiles as comfortable or very comfortable . Of the 28 study participants ( 12 SPC , 16 IPC ) , two subjects reported pain with 60-mm Hg IPC ; no other adverse events were reported with SPC or IPC . CONCLUSION Pneumatic compression was safe and well-tolerated , with a dose-response relationship between increased SPC/IPC pressures and reduced leg edema . To our knowledge , this is the first study to demonstrate a dose-relationship in compression therapy : higher pressures are associated with greater volume reduction in subjects with chronic venous edema The cycle time and number of chambers in the pneumatic sleeve may influence the outcome of lymphedema therapy with intermittent compression devices . The aim of our study was to assess efficacy of several commonly used different IPC protocol s on edema volume reduction in women with postmastectomy lymphedema . Fixty-seven ( 57 ) women with secondary arm lymphedema ( age 39 - 80 ) were selected to the study . Women were r and omly assigned to two study groups with different IPC cycle times : I--90:90s and II--45:15s . Both groups were then r and omly divided into two subgroups with different sleeves : A--1 chamber sleeve ( 28 women ) and B--3 chamber sleeve ( 29 women ) . All women underwent IPC treatment for 5 weeks , 5 times a week for 1 hour ( 25 sessions ) . Arm volume measurements were performed before and after each IPC session . Significant reduction of edema volume was observed in all therapeutic subgroups , regardless of cycle times and number of chambers . In the group with short IPC cycle , better efficacy was noticed with 3-chamber sleeve . IPC is an effective method of volume reduction in women with postmastectomy arm lymphedema regardless of cycle times and number of sleeve chambers Acute ischaemia in the tibial compartments is a recognized complication of fractures , vascular injury , vascular surgery , crush injuries and burns . The tissue pressure was measured in the first week after injury and the effect of diuretics has been evaluated in a double-blind r and omized manner . The pressure in the anterior tibial compartment was measured in the first week after injury in a double-blind r and omized manner in 40 patients who had sustained either accidental or surgical injury of the leg . The pressure in the group treated with placebos increased by 20 per cent in the first 24 hours , whereas the pressure fell by 25 per cent in those treated with diuretics . Diuretic treatment is recommended for patients with injury of the lower limbs 
    Output:
    
In select patients , IPC use may provide an acceptable home-based treatment modality in addition to wearing compression garments