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Sample records for chronic leg ulcers

  1. Case 3: chronic venous leg ulcer.

    Science.gov (United States)

    Hämmerle, Gilbert

    2016-03-01

    A non-healing, sloughy venous leg ulcer quickly responded to topical treatment including octenilin Wound Gel and octenilin Wound Irrigation Solution. Full healing occurred within 6 weeks. PMID:26949848

  2. [When to worry about before a vascular chronic leg ulcer?].

    Science.gov (United States)

    Lazareth, I

    2016-09-01

    Leg ulcers are a chronic condition. Healing can be long for venous ulcers and the risk of complications is significant. Infection is the most severe complication and can occur in the form of easily diagnosed acute bacterial dermohypodermitis that generally responds well to antibiotic treatment if given at an appropriate dose or in the form of localized infection that is more difficult to diagnosis. Indeed, no consensus has been reached in the literature on the clinical criteria to retain for the diagnosis of localized infection. Similarly, the most appropriate treatment remains to be established. Local care would be a logical starting point, followed by systemic antibiotics if this approach is unsuccessful. Individual conditions also should be taken into consideration (immunodepression, severe arteriopathy warranting more rapid use of systemic antibiotics). The second most frequent complication is an allergic reaction to a topical agent used for wound care. The rate of sensitivization in patients with leg ulcers is high (60 %), although the rate is declining with modern dressings. No product can be considered perfectly safe for these polysensitized patients. Dermocorticoid therapy can be very effective. Allergology tests are needed. Certain leg ulcers require special care from diagnosis. An arterial origin must be suspected for deep, or necrotic ulcers. Arterial supply must be explored rapidly, followed by a revascularization procedure when necessary. Highly painful superficial extensive necrotic ulcers due to necrotic angiodermitis require hospital care for skin grafts that will control the antiodermitis and provide pain. Carcinoma should be suspected in cases of leg ulcers with an atypical localization exhibiting excessive budding. A biopsy is mandatory for leg ulcers with an unusual course (absence of healing despite well-conducted care).

  3. Diurnal variations in lower leg subcutaneous blood flow rate in patients with chronic venous leg ulcers

    DEFF Research Database (Denmark)

    Sindrup, J H; Kastrup, J; Kristensen, J K

    1991-01-01

    The blood flow rate in subcutaneous adipose tissue was measured on the lower legs of 11 patients with chronic lower-leg venous insufficiency and ulceration and in eight age-matched control subjects for 12-20 h, under ambulatory conditions, using the 133Xe wash-out technique with portable Cadmium...

  4. Onychomycosis in patients with chronic leg ulcer and toenail abnormalities.

    Science.gov (United States)

    Cabete, Joana; Galhardas, Célia; Apetato, Margarida; Lestre, Sara

    2015-01-01

    Nails have a limited number of reactive patterns to disease. Accordingly, toenail changes of different etiologies may mimic onychomycosis. OBJECTIVE To determine the prevalence of toenail onychomycosis among patients with leg ulcer and toenail abnormalities attending a dermatology clinic. METHODS A cross-sectional study was conducted through the analysis of clinical records and results of mycological examination. RESULTS A total of 81 patients were included, with a median age of 76.0 years. Most ulcers were of venous etiology, followed by those of mixed and arterial pathogenesis. The mycological evaluation confirmed the diagnosis of onychomycosis in 27.2% of the patients. The etiologic agent was a dermatophyte in 59.1% of isolates in nail samples, while Trichophyton interdigitale was the most frequent fungal species (40.9%). CONCLUSIONS Most toenail abnormalities in patients with chronic leg ulcer were not onychomycosis. This study highlights the importance of systematic mycological examination in these patients, in order to avoid overtreatment with systemic antifungals, unnecessary costs and side effects. PMID:25672317

  5. Onychomycosis in patients with chronic leg ulcer and toenail abnormalities*

    Science.gov (United States)

    Cabete, Joana; Galhardas, Célia; Apetato, Margarida; Lestre, Sara

    2015-01-01

    Nails have a limited number of reactive patterns to disease. Accordingly, toenail changes of different etiologies may mimic onychomycosis. OBJECTIVE To determine the prevalence of toenail onychomycosis among patients with leg ulcer and toenail abnormalities attending a dermatology clinic. METHODS A cross-sectional study was conducted through the analysis of clinical records and results of mycological examination. RESULTS A total of 81 patients were included, with a median age of 76.0 years. Most ulcers were of venous etiology, followed by those of mixed and arterial pathogenesis. The mycological evaluation confirmed the diagnosis of onychomycosis in 27.2% of the patients. The etiologic agent was a dermatophyte in 59.1% of isolates in nail samples, while Trichophyton interdigitale was the most frequent fungal species (40.9%). CONCLUSIONS Most toenail abnormalities in patients with chronic leg ulcer were not onychomycosis. This study highlights the importance of systematic mycological examination in these patients, in order to avoid overtreatment with systemic antifungals, unnecessary costs and side effects. PMID:25672317

  6. Allergic contact dermatitis to Plectranthus amboinicus masquerading as chronic leg ulcer.

    Science.gov (United States)

    Chang, Shyue-Luen; Chang, Ya-Ching; Yang, Chin-Hsun; Hong, Hong-Shang

    2005-12-01

    This report discusses a case of a 69-year-old woman who developed chronic non-healing leg ulcers after long-term topical use of Plectranthus amboinicus. The ulcer was proven to be allergic contact dermatitis to P. amboinicus by a patch test. The ulcer healed after discontinuation of P. amboinicus. To the best of our knowledge, this is the first reported case of allergic contact dermatitis to P. amboinicus masquerading as chronic leg ulcer. PMID:16364130

  7. Differential diagnosis of leg ulcers.

    Science.gov (United States)

    Pannier, F; Rabe, E

    2013-03-01

    Leg and foot ulcers are symptoms of very different diseases. The aim of this paper is to demonstrate the differential diagnosis of leg ulcers. The majority of leg ulcers occur in the lower leg or foot. In non-venous ulcers the localization in the foot area is more frequent. The most frequent underlying disease is chronic venous disease. In 354 leg ulcers, Koerber found 75.25% venous leg ulcers, 3.66% arterial leg ulcers, 14.66% ulcers of mixed venous and arterial origin and 13.5% vasculitic ulcers. In the Swedish population of Skaraborg, Nelzen found a venous origin in 54% of the ulcer patients. Each leg ulcer needs a clinical and anamnestic evaluation. Duplex ultrasound is the basic diagnostic tool to exclude vascular anomalies especially chronic venous and arterial occlusive disease. Skin biopsies help to find a correct diagnosis in unclear or non-healing cases. In conclusion, chronic venous disease is the most frequent cause of leg ulcerations. Because 25% of the population have varicose veins or other chronic venous disease the coincidence of pathological venous findings and ulceration is very frequent even in non-venous ulcerations. Leg ulcers without the symptoms of chronic venous disease should be considered as non-venous.

  8. Wound care matrices for chronic leg ulcers: role in therapy

    Directory of Open Access Journals (Sweden)

    Sano H

    2015-07-01

    Full Text Available Hitomi Sano,1 Sachio Kouraba,2 Rei Ogawa11Department of Plastic, Reconstructive, and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan; 2Sapporo Wound Care and Anti-Aging Laboratory, Sapporo, JapanAbstract: Chronic leg ulcers are a significant health care concern. Although deep wounds are usually treated by flap transfers, the operation is invasive and associates with serious complications. Skin grafts may be a less invasive means of covering wounds. However, skin grafts cannot survive on deep defects unless high-quality granulation tissue can first be generated in the defects. Technologies that generate high-quality granulation tissue are needed. One possibility is to use wound care matrices, which are bioengineered skin and soft tissue substitutes. Because they all support the healing process by providing a premade extracellular matrix material, these matrices can be termed “extracellular matrix replacement therapies”. The matrix promotes wound healing by acting as a scaffold for regeneration, attracting host cytokines to the wound, stimulating wound epithelialization and angiogenesis, and providing the wound bed with bioactive components. This therapy has lasting benefits as it not only helps large skin defects to be closed with thin skin grafts or patch grafts but also restores cosmetic appearance and proper function. In particular, since it acts as a layer that slides over the subcutaneous fascia, it provides skin elasticity, tear resistance, and texture. Several therapies and products employing wound care matrices for wound management have been developed recently. Some of these can be applied in combination with negative pressure wound therapy or beneficial materials that promote wound healing and can be incorporated into the matrix. To date, the clinical studies on these approaches suggest that wound care matrices promote spontaneous wound healing or can be used to facilitate skin grafting, thereby avoiding the need to use

  9. Chronic venous leg ulcers: is topical zinc the answer? A review of the literature

    OpenAIRE

    O'Connor, Siobhan; Murphy, Siobhan

    2014-01-01

    PURPOSE: To enhance the learner's competence with knowledge of research data on topical zinc for treatment of chronic leg ulcers. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to: ABSTRACT: Venous leg ulcers (VLUs) are chronic leg wounds that can have a debilitating effect on the physical a...

  10. Chronic venous leg ulcers – role of topical zinc

    Directory of Open Access Journals (Sweden)

    Maher SF

    2015-06-01

    Full Text Available Sara F Maher Physical Therapy Program, Department of Healthcare Sciences, Wayne State University, Detroit, MI, USA Abstract: Topical zinc has been used in the treatment of wounds for over 3,000 years, and is reported to have antiseptic, astringent, anti-inflammatory, antimicrobial, and wound healing properties. Fourteen studies were identified and reviewed, to assess the efficacy of this treatment modality as either a bandage or skin protectant in the treatment of venous ulcers. The authors of three studies reported improved healing time or success rate in wounds treated with zinc-based products. However, the authors of one study attributed the faster healing rate mainly to the extra compression (that improved venous blood return, delivered by the non-elastic paste bandage, and not by the zinc oxide alone. The quality of evidence is fair, as 50% of the studies were conducted prior to 2000 and 50% of the studies utilized fewer than 45 patients randomized to two or more groups. Other treatments have been reported to be more cost-effective than zinc, including hydrocolloids, four-layer compression systems, and CircAid Thera-boots. Finally, zinc was reported to be less comfortable, less easy to use, and caused increased pain, in comparison to other products on the market. This literature review, therefore, demonstrated that current evidence is insufficient to determine the effectiveness of zinc-based products in the treatment of venous wounds. Future research is needed focusing on larger, high-quality trials with an emphasis on quality of life issues and cost-effectiveness of treatment. Keywords: chronic wounds, leg ulcers, venous insufficiency, topical zinc

  11. Onychomycosis in Patients with Chronic Leg Ulcer and Toenail Abnormalities

    OpenAIRE

    Cabete, J.; Apetato, M; Galhardas, C; Lestre, S

    2015-01-01

    Nails have a limited number of reactive patterns to disease. Accordingly, toenail changes of different etiologies may mimic onychomycosis. OBJECTIVE To determine the prevalence of toenail onychomycosis among patients with leg ulcer and toenail abnormalities attending a dermatology clinic. METHODS A cross-sectional study was conducted through the analysis of clinical records and results of mycological examination. RESULTS A total of 81 patients were included, with a median age of 76.0 years. M...

  12. Klinefelter Syndrome With Leg Ulcers

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    Narendra G

    1999-01-01

    Full Text Available Leg ulcers are frequently caused by venous insufficiency, arterial insufficiency, neuropathy, or a combination of these factors. Klinefelter syndrome in association with chronic leg ulcers have been reported earlier. We report a case of Klinefelter syndrome with non- healing ulcer. The diagnosis of the Klinefelter syndrome was confirmed by karyotyping.

  13. Compression therapies for chronic venous leg ulcers: interventions and adherence

    Directory of Open Access Journals (Sweden)

    Latz CA

    2015-01-01

    Full Text Available Christopher A Latz,1 Kellie R Brown,2 Ruth L Bush11Texas A&M Health Science Center College of Medicine, Bryan, TX, USA; 2Medical College of Wisconsin, Milwaukee, WI, USAAbstract: Compression therapy has been the mainstay for the treatment of lower extremity edema, venous insufficiency, and particularly, venous ulcerative disease. Though modern surgical treatments exist, none are completely effective without good compressive options to allow for decreased swelling and better oxygenation of damaged tissues. This review article will describe the pathophysiology and presentation of lower extremity venous ulcerations, as well as current options for compression therapy. The benefits, along with the major pitfall of nonadherence, will also be discussed.Keywords: venous disease, chronic venous insufficiency, venous ulceration

  14. Management of leg ulcers

    OpenAIRE

    Sarkar, P; Ballantyne, S

    2000-01-01

    Leg ulcer is a leading cause of morbidity among older subjects, especially women in the Western world. About 400 years BC, Hippocrates wrote, "In case of an ulcer, it is not expedient to stand, especially if the ulcer be situated on the leg". Hippocrates himself had a leg ulcer. The best treatment of any leg ulcer depends upon the accurate diagnosis and the underlying aetiology. The majority of leg ulcers are due to venous disease and/or arterial disease, but the treatment of the underlying c...

  15. Quality of life in chronic leg ulcer patients. An assessment according to the Nottingham Health Profile.

    Science.gov (United States)

    Lindholm, C; Bjellerup, M; Christensen, O B; Zederfeldt, B

    1993-12-01

    Chronic leg ulcer is a disease of long duration, occurring predominantly in elderly people. Traditionally, little interest has been devoted to the study of the impact of this disease on life quality. In the present study the Nottingham Health Profile (NHP) was used to assess disease influence on six areas of daily life, namely: pain, physical mobility, sleep, energy, emotional reactions and social isolation. Standard questionnaires were distributed to patients with chronic leg ulcers of venous, arterial or mixed venous-arterial origin, treated at the Department of Dermatology. Complete data were obtained from 125 patients. The disease had a marked impact on the patient's subjectively perceived health. Males exhibited remarkably elevated scores, compared to the normative scores for men, especially in the areas of pain, emotional reactions, social isolation and physical restrictions. For women the impact of leg ulcer disease, although obvious, seems much less marked than for males. An exceptionally long median duration of leg ulcer disease was found among shop-assistants. It is possible that preventive measures should be undertaken in this group. The duration of leg ulcer disease did not seem to influence the quality of life. Patients with long disease duration in fact reported fewer problems than those with shorter duration, suggesting adaptive mechanisms. This study indicates that male leg ulcer patients should be more closely observed for symptoms of emotional stress, pain, social isolation and impaired physical mobility. More efforts should be made to alleviate pain. Above all this study underlines the importance of considering not only the ulcer but the whole patient. PMID:7906458

  16. Leg ulcers due to hyperhomocysteinemia

    OpenAIRE

    Krupa Shankar D; Akhib Syed

    2006-01-01

    Chronic leg ulcers are rare in young adults and generally indicate a vascular cause. We report a case of a 26-year-old man with leg ulcers of eight months duration. Doppler study indicated venous incompetence and a postphlebitic limb. However, as the distribution and number of ulcers was not consistent with stasis alone and no features of collagen vascular disease were noted, a hyperviscosity state was considered and confirmed with significantly elevated homocysteine level in the serum. Admin...

  17. Effect of Multi-layer Compression Bandage Systems on Leg Ulcers Associated with Chronic Venous Insufficiency

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    Hüseyin Kuplay

    2013-03-01

    Full Text Available Introduction: Venous leg ulcer is a major health problem in terms of high prevalence and high cost for treatment. Multi-layer compression bandage systems for venous leg ulcers are supposed to be the gold standard for the treatment of venous ulcers. The aim of the current study is to investigate the effectiveness of multi-layer compression bandage systems for the treatment of venous leg ulcers.Patients and Methods: Nineteen consecutive patients diagnosed to have leg ulcers were evaluated and four patients were excluded from the study due to the peripheral arterial disease. Fifteen patients, enrolled in the study, were classified according to CEAP classification and belonged to the same class. Betaven® multi-layer compression bandage was applied to patients. Patients were followed-up in terms of wound healing and reduction in wound diameter.Results: Twelve male and three female patients underwent multi-layer bandage system. Mean age of patients was 38.2 ± 4.2 years. Ulcer size was measured planimetrically and baseline ulcer size was 4-10 cm². The location of ulcer was on medial malloelus in seven patients, lateral malleolus in three patients, anterior surface of the leg in four patients and lateral side of the leg in one patient. Patients had chronic venous insuuficiency for a mean of 5.1 ± 2.1 years. CEAP classifications were C6, Ep, As2,3-p18, Pr2,3, 18. Each bandage was changed five days after application along with wound care. Mean duration of treatment was 6 ± 2 weeks. Complete healing of the venous ulcers occurred in all patients except for one. This patient was referred to plastic surgery clinic for reconstruction.Conclusion: Multi-layer compression bandage system is an effective method of treatment for venous leg ulcers associated with chronic venous insufficiency by reducing venous return and increasing intertitial tissue pressure. This effect occurred in the shortrun as well as with a low cost and prevented loss of labor.

  18. Chronic Leg Ulceration Associated with Polycythemia Vera Responding to Ruxolitinib (Jakafi®)

    OpenAIRE

    Shanmugam, Victoria K.; McNish, Sean; Shara, Nawar; Hubley, Katherine J.; Kallakury, Bhaskar; Dunning, David M.; Attinger, Christopher E.; Steinberg, John S.

    2013-01-01

    We present the case of a 63-year-old white male with bilateral chronic leg ulcers due to polycythemia vera and hydroxyurea therapy who demonstrated dramatic healing of his wounds in response to ruxolitinib (Jakafi®, Novartis), a novel Janus kinase-1 and -2 inhibitor. This patient’s wound had previously been refractory to multiple surgical interventions and immunosuppression. After the initiation of ruxolitinib, the patient underwent successful split-thickness skin grafting, with resultant hea...

  19. Leg ulcers due to hyperhomocysteinemia

    Directory of Open Access Journals (Sweden)

    Krupa Shankar D

    2006-01-01

    Full Text Available Chronic leg ulcers are rare in young adults and generally indicate a vascular cause. We report a case of a 26-year-old man with leg ulcers of eight months duration. Doppler study indicated venous incompetence and a postphlebitic limb. However, as the distribution and number of ulcers was not consistent with stasis alone and no features of collagen vascular disease were noted, a hyperviscosity state was considered and confirmed with significantly elevated homocysteine level in the serum. Administration of vitamins B1, B2, B6 and B12, trimethyl-glycine, mecobalamine, folic acid and povidone iodine dressings with culture-directed antibiotic therapy led to a satisfactory healing of ulcers over a period of one month. Hyperhomocysteinemia must be considered in the differential diagnosis of leg ulcers in young individuals.

  20. The Application of Negative Pressure Wound Therapy in the Treatment of Chronic Venous Leg Ulceration: Authors Experience

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    Marek Kucharzewski

    2014-01-01

    Full Text Available The aim of the study was to use negative pressure wound therapy (NPWT in patients with chronic venous leg ulceration. The authors present their experience in treatment of 15 patients whose average ulceration surface area was 62.6 cm2. In 10 patients, the ulcers healed within 6 weeks and in the remaining patients within 20 weeks. Based on the results obtained, the authors imply that NPWT is an effective method in the treatment of chronic venous leg.

  1. Success rate of split-thickness skin grafting of chronic venous leg ulcers depends on the presence of Pseudomonas aeruginosa

    DEFF Research Database (Denmark)

    Høgsberg, Trine; Bjarnsholt, Thomas; Thomsen, Jens Schiersing;

    2011-01-01

    regression analysis was carried out leaving P. aeruginosa as the only predictor left in the model (p¿=¿0.001). This study supports our hypothesis that P. aeruginosa in chronic venous leg ulcers, despite treatment, has considerable impact on partial take or rejection of split-thickness skin grafts....... that once chronic venous leg ulcers were colonized (weeks or months preoperatively) by P. aeruginosa, the success rate of skin grafting deteriorated despite aggressive treatment. To investigate this, a retrospective study was performed on the clinical outcome of 82 consecutive patients with chronic venous...

  2. Using a topical anaesthetic cream to reduce pain during sharp debridement of chronic leg ulcers.

    Science.gov (United States)

    Rosenthal, D; Murphy, F; Gottschalk, R; Baxter, M; Lycka, B; Nevin, K

    2001-01-01

    This multicentre, double-blind, placebo-controlled, parallel-group study assessed the efficacy and safety of using Emla (lignocaine/prilocaine) anaesthetic cream to achieve pain control during sharp debridement of chronic leg ulcers of arterial, venous or arteriovenous aetiology. A total of 101 patients (51 Emla, 50 placebo), aged 29-99 years, who had experienced pain associated with previous debridement were included. Patients with an amide anaesthetic allergy, anaesthetic diabetic ulcers, or ulcers > 50 cm2 were excluded. Debridement was initiated approximately 30 minutes after the application of a thick layer of Emla or placebo cream to an ulcer occluded with a plastic wrap. The patient and investigator assessed the pain associated with debridement on a 100 mm visual analogue scale (VAS). The median patient VAS scores were 18 mm and 53.5 mm in the Emla and placebo groups, respectively (p < 0.0001). The corresponding investigator values in the two groups were 20 mm and 49.5 mm, respectively (p = 0.004). Local reactions were mainly transient and mild, and were observed in roughly the same percentage of placebo and Emla-treated patients. After a 30-minute application Emla cream significantly reduced the pain of debridement compared with the placebo. PMID:12964231

  3. [QUALITY OF LIFE AND PSYCHOLOGICAL ASPECTS IN PATIENTS WITH CHRONIC LEG ULCER].

    Science.gov (United States)

    Situm, Mirna; Kolić, Maja; Spoljar, Sanja

    2016-03-01

    Wound represents a disruption of anathomic and physiologic continuity of the skin. Regarding to the healing process, wounds can be classified as acute or chronic wounds. Quality of life is primarily concerned with the impact of chronic wounds. A wound is considered chronic if healing does not occur within expected period of time regarding to its etiology and localization. Chronic wounds can be classified as typical and atypical. The majority of wounds (95 percent) are typical ones which include ischaemic, neurotrophic and hypostatic ulcer and two separate entities: diabetic foot and decubital ulcers. An 80 percent of chronic wounds localized on lower leg are result of chronic venous insufficiency, in 5-10 percent cause is of arterial etiology, whereas the remainder is mostly neuropathic ulcer. Chronic wounds represent a significant burden to patients, health care professionals and the entire health care system. Chronic wounds affect the elderly population and it is estimated that 1-2 percent of western population suffer from it. This estimate is expected to rise due to an increasing population of the elderly and the diabetic and obesity epidemic. The WHO definition of health is "A state of complite physical, mental and social well-being and not merely the absence of disease or infirmity". Based on this definition, quality of life in relation to health may be defined as "the functional effect of an illness and it's consequent therapy upon a patient, as perceived by the patient". The domains that contribute to this effect are physical, psychological and social functioning. The patient's own perceptions of an illness were found to play an important role in explainig quality of life. Chronic wounds significantly decrease the quality of life in a number of ways such as reduced mobility, pain, unpleasant odor, sleep disturbances, social isolation and frustration, and inability to perform everyday duties. Among the most common psychological reactions to chronic diseases

  4. Efficacy of autologous platelet-rich plasma in the treatment of chronic nonhealing leg ulcers

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    Shwetha Suryanarayan

    2014-09-01

    Full Text Available Aim: The aim was to evaluate the efficacy of platelet-rich plasma (PRP in the treatment of chronic nonhealing ulcers. Methods: A nonrandomized, uncontrolled study was performed on 24 patients with 33 nonhealing ulcers of various etiologies. All patients were treated with PRP at weekly intervals for a maximum of 6 treatments. At the end of the 6-week period, reduction in size of the ulcers (area and volume was assessed. Results: The mean age of the patients was 42.5 years (standard deviation [SD] 12.48. Of 33 ulcers, there were 19 venous ulcers, 7 traumatic ulcers, 2 ulcers secondary to pyoderma gangrenosum, 2 diabetic ulcers, 2 trophic ulcers, and 1 vasculitic ulcer. The mean duration of healing of the ulcers was 5.6 weeks (SD 3.23. The mean percentage of reduction in area and volume of the ulcers was 91.7% (SD 18.4% and 95% (SD 14%, respectively. About 100% resolution in the area was seen in 25 (76% of the ulcers and 100% reduction in volume was seen in 24 (73% of the ulcers at the end of the 6th treatment. Conclusion: Conventional therapies do not provide satisfactory healing for chronic nonhealing ulcers as they are not able to provide the necessary growth factors (GFs (platelet-derived GF, epidermal GF, vascular endothelial GF, etc. which are essential for the healing process. PRP is a safe, affordable, biocompatible, and simple office-based procedure for the treatment of nonhealing ulcers.

  5. Cost-effective use of silver dressings for the treatment of hard-to-heal chronic venous leg ulcers

    DEFF Research Database (Denmark)

    Jemec, Gregor B E; Kerihuel, Jean Charles; Ousey, Karen;

    2014-01-01

    AIM: To estimate the cost-effectiveness of silver dressings using a health economic model based on time-to-wound-healing in hard-to-heal chronic venous leg ulcers (VLUs). BACKGROUND: Chronic venous ulceration affects 1-3% of the adult population and typically has a protracted course of healing......, resulting in considerable costs to the healthcare system. The pathogenesis of VLUs includes excessive and prolonged inflammation which is often related to critical colonisation and early infection. The use of silver dressings to control this bioburden and improve wound healing rates remains controversial....... METHODS: A decision tree was constructed to evaluate the cost-effectiveness of treatment with silver compared with non-silver dressings for four weeks in a primary care setting. The outcomes: 'Healed ulcer', 'Healing ulcer' or 'No improvement' were developed, reflecting the relative reduction in ulcer...

  6. Transplantation of autologous keratinocyte suspension in fibrin matrix to chronic venous leg ulcers: improved long-term healing after removal of the fibrin carrier.

    NARCIS (Netherlands)

    Hartmann, A.; Quist, J.; Hamm, H.; Brocker, E.B.; Friedl, P.H.A.

    2008-01-01

    BACKGROUND: The transplantation of keratinocytes suspended in fibrin carrier represents a candidate regimen for chronic ulcer treatment in an outpatient setting. We evaluated the integration and survival of autologous individualized keratinocytes applied within fibrin matrix onto chronic venous leg

  7. Clinical performance of a new silver dressing, Contreet Foam, for chronic exuding venous leg ulcers

    DEFF Research Database (Denmark)

    Karlsmark, T; Agerslev, R H; Bendz, S H;

    2003-01-01

    : The clinical performance of Contreet Foam was studied for four weeks in 25 patients with moderately to highly exuding delayed-healing venous leg ulcers. Healing was assessed on a weekly basis with reference to the wound-bed tissue composition, degree of odour and pain, dressing performance and the dressing......'s effect on the peri-ulcer area. Blood samples were analysed for silver content. RESULTS: Twenty-three out of 25 patients completed the study. One ulcer healed and no wound infections occurred during the study period. A mean 56% reduction in ulcer area (from 15.6 to 6.9 cm2) was recorded during the four...... weeks, and there was a mean 25% reduction in granulation tissue from dull to healthy after one week. Wound odour reduced significantly after one week. Mean dressing wear time was 3.1 days, and there were only minimal incidences of leakage. Serum silver levels did not exceed reference values. CONCLUSION...

  8. Nutritional profile of older adults with chronic venous leg ulcers: a pilot study.

    Science.gov (United States)

    McDaniel, Jodi C; Kemmner, Kaitlyn G; Rusnak, Sarah

    2015-01-01

    The purpose of this cross-sectional descriptive pilot study was to describe daily intake of select nutrients important for efficient wound healing and general health in a sample of older adults (64.25 ± 9.49 years of age) with chronic venous leg ulcers (CVLUs; N = 12), compared to recommended dietary allowances (RDA). Anthropometric data were also collected. Compared to RDA, participants on average consumed lower vitamin C (60.03 ± 49.73 mg/d) and higher sodium (3197.07 ± 1455.04 mg/d), sugar (181.21 ± 115.45 g/d), and saturated fat (33.75 ± 1.06 g/d). They also demonstrated a relatively high plasma n-6/n-3 polyunsaturated fatty acid ratio, a biomarker of inflammation (11.25 ± 1.99). The mean body mass index indicated extreme obesity (41.48 ± 11.47). A multidisciplinary treatment approach that includes routine dietary assessments followed by tailored dietary interventions may improve wound healing and long-term health outcomes in this population. PMID:26141998

  9. An evaluation of short-stretch compression systems for chronic lower-limb leg ulcers.

    Science.gov (United States)

    Carr, Caryn; Shadwell, Janice; Regan, Pip; Hammett, Susan

    2015-03-01

    An evaluation of a new short-stretch compression system (CoFlex UBZ, TLC and TLC Lite, Aspen Medical Europe Ltd) was undertaken in four leg ulcer clinics. A total of 19 patients aged 42-93 years were treated for up to 4 weeks, or until healed. Collated data included age, underlying diseases, leg ulcer type, ulcer duration and current treatment. The evaluation included quality of life measurements, wear time, slippage, exudate strikethrough and pain using a numerical pain score. Patients were asked to document sleep patterns. Compression was applied according to clinical need. Inclusion criteria were non-healing wounds on the lower limb existing for more than 6 weeks that were suitable for compression. Exclusion criteria included patients with untreated peripheral disease, ankle-brachial pressure index (ABPI)<0.5 or those unable to consent. Staff were asked to rate performance, wear time, fluid handling and conformability. Wound tissue types improved significantly for n=16 (84%) patients. Pain scores reduced significantly by week 2, n=11 (58%) patient leg ulcers had improved, n=2 (11%) patients in standard compression noted a marked reduction in malodour and sloughy tissue. n=16 (84%) rated the overall performance as 'very good' or 'good'. A detailed cost analysis was undertaken on one patient, suggesting a potential cost saving of £186.92 per month and a cost efficiency saving of 43.4%. PMID:25757382

  10. Chronic venous ulceration of leg associated with peripheral arterial disease: an underappreciated entity in developing country.

    Science.gov (United States)

    Nag, Falguni; De, Abhishek; Hazra, Avijit; Chatterjee, Gobinda; Ghosh, Arghyaprasun; Surana, Trupti V

    2014-10-01

    Chronic venous ulcer can often be associated with asymptomatic peripheral arterial disease (PAD), which usually remains undiagnosed adding significantly to the morbidity of these patients. The Ankle-Brachial Pressure Index (ABPI) is suggested for PAD evaluation. Many PAD studies were conducted in western countries, but there is a scarcity of data on the prevalence of PAD in clinical venous ulcer patient in developing countries. We conducted a study in a tertiary care hospital of eastern part of India to find out the prevalence of PAD in venous ulcer patients, and also to find the sensitivity of ABPI as a diagnostic tool in these patients. We evaluated clinically diagnosed patients with venous ulcer using ABPI and Colour Doppler study for the presence of PAD. Possible associations such as age, sex, body mass index (BMI), smoking, hypertension and atherosclerosis were studied. All results were analysed using the software Statistica version 6. PAD was present in 23 (27·71%) patients. Older age, longer duration, smoking, high BMI and hypertension were found to be significantly associated with PAD. A very strong level of agreement was found between venous Doppler and ABPI. Assessment for the presence of PAD is important in all clinically diagnosed venous ulcer patients. ABPI being a simple, non-invasive outpatient department (OPD)-based procedure, can be routinely used in cases of venous ulcer to find out the hidden cases of PAD even in developing countries. PMID:23170845

  11. Extracellular matrix assessment of infected chronic venous leg ulcers: role of metalloproteinases and inflammatory cytokines.

    Science.gov (United States)

    Serra, Raffaele; Grande, Raffaele; Buffone, Gianluca; Molinari, Vincenzo; Perri, Paolo; Perri, Aldina; Amato, Bruno; Colosimo, Manuela; de Franciscis, Stefano

    2016-02-01

    Chronic venous ulcer (CVU) represents a dreaded complication of chronic venous disease (CVD). The onset of infection may further delay the already precarious healing process in such lesions. Some evidences have shown that matrix metalloproteinases (MMPs) are involved and play a central role in both CVUs and infectious diseases. Two groups of patients were enrolled to evaluate the expression of MMPs in infected ulcers and the levels of inflammatory cytokines as well as their prevalence. Group I comprised 63 patients (36 females and 27 males with a median age of 68·7 years) with infected CVUs, and group II (control group) comprised 66 patients (38 females and 28 males with a median age of 61·2 years) with non-infected venous ulcers. MMP evaluation and dosage of inflammatory cytokines in plasma and wound fluid was performed by means of enzyme-linked immunosorbent assay test; protein extraction and immunoblot analysis were performed on biopsied wounds. The first three most common agents involved in CVUs were Staphylococcus aureus (38·09%), Corynebacterium striatum (19·05%) and Pseudomonas aeruginosa (12·7%). In this study, we documented overall higher levels of MMP-1 and MMP-8 in patients with infected ulcers compared to those with uninfected ulcers that showed higher levels of MMP-2 and MMP-9. We also documented higher levels of interleukin (IL)-1, IL-6, IL-8, vascular endothelial growth factor and tumour necrosis factor-alpha in patients with infected ulcers with respect to those with uninfected ulcers, documenting a possible association between infection, MMP activation, cytokine secretions and symptoms. The present results could represent the basis for further studies on drug use that mimic the action of tissue inhibitors of metalloproteinases in order to make infected CVU more manageable.

  12. Success rate of split-thickness skin grafting of chronic venous leg ulcers depends on the presence of Pseudomonas aeruginosa: a retrospective study

    DEFF Research Database (Denmark)

    Høgsberg, Trine; Bjarnsholt, Thomas; Thomsen, Jens Schiersing;

    2011-01-01

    regression analysis was carried out leaving P. aeruginosa as the only predictor left in the model (p¿=¿0.001). This study supports our hypothesis that P. aeruginosa in chronic venous leg ulcers, despite treatment, has considerable impact on partial take or rejection of split-thickness skin grafts....... that once chronic venous leg ulcers were colonized (weeks or months preoperatively) by P. aeruginosa, the success rate of skin grafting deteriorated despite aggressive treatment. To investigate this, a retrospective study was performed on the clinical outcome of 82 consecutive patients with chronic venous...

  13. The terminal complement complex is generated in chronic leg ulcers in the absence of protectin (CD59)

    DEFF Research Database (Denmark)

    Balslev, E; Thomsen, H K; Danielsen, L;

    1999-01-01

    hypertension leg ulcers. The deposition of complement, plasma complement regulators and expression of membrane regulators were detected by immunohistochemical methods, including immunofluorescence with antibodies against C3d, the terminal complement complex (TCC), vitronectin, clusterin, decay......-accelerating factor (CD55) and protectin (CD59). Eleven frozen biopsies from ischaemic leg ulcers, 10 biopsies from venous hypertension leg ulcers, and 10 biopsies from normal skin were studied. In 9 of 11 ischaemic and in 5 of 10 venous hypertension leg ulcers, marked staining for TCC was found around...... the capillaries, most often at the ulcer margin. No TCC staining was found in normal skin. Staining for TCC was always accompanied by staining for clusterin and vitronectin and C3d. In normal skin, CD59 was found on the elastic fibers in the dermis, on the muscle coat, the Schwann sheath and acinar cells...

  14. The recalcitrant venous leg ulcer - A never ending story?

    NARCIS (Netherlands)

    S.W.I. Reeder (Suzan); M.B. Maessen-Visch (Birgitte); S.I. Langendoen; K.P. de Roos; H.A.M. Neumann (Martino)

    2013-01-01

    textabstractIntroduction: In general, four particular causes of recalcitrant venous leg ulcers may be distinguished. These are foot pump insufficiency, chronic venous compartment syndrome and non-re-canalized popliteal vein thrombosis. The fourth cause of recalcitrant venous leg ulcers is lipodermat

  15. FAQs on leg ulcer care.

    Science.gov (United States)

    Anderson, Irene; King, Brenda; Knight, Susan; Keynes, Milton

    In a webchat on leg ulcer management issues, hosted by Nursing Times, participants raised three key areas of care: the role of healthcare assistants in compression bandaging; reporting and investigating damage caused by compression therapy; and recommendations for dressings to be used under compression. This article discusses each of these in turn.

  16. Effect of helium neon laser therapy for enhancing healing of chronic leg ulcers on growth factors and oxidative status: Correlation with protein carbonyls

    International Nuclear Information System (INIS)

    To evaluate the effect of He:Ne laser irradiation on growth factors and oxidative stress during its biostimulatory effects on wound healing. Twenty two chronic leg ulcer patients, were exposed to three sessions per week of 632.8 nm2 He Ne laser irradiation at power output 10 mW and energy density of 1-4 J/cm2. Serum protein carbonyls, wound edge DNA, basic fibroblast growth factor (bFGF) and epidermal growth factor (BGF) were estimated in sera and tissue of each patient before and after the 8∼ session post He:Ne laser irradiation used for treatment of chronic leg ulcer. Laser irradiation decreased ulcer size in all of the treated patients. 65% of ulcers exhibited 100%, complete recovery and 35% of ulcers exhibited recovery below 80%. Biochemical investigations revealed significant increase in the levels of serum and tissue FGF, and EGF, while serum protein carbonyls were decreased. The decrease in serum protein carbonyls was inversely correlated with the percentage of ulcer healing, while the increase in tissue growth factors was positively correlated with the percentage of ulcer healing. There was no significant increase in the level of DNA after laser therapy. However, DNA-fragmentation before and after laser therapy revealed the presence of small DNA fractions ranging from 21 kb to less than 0.5 kb before laser therapy, which decreased in intensity or was completely eliminated after laser therapy. Me:Ne therapy is of great benefit in the treatment of chronic wounds and shades the light on the oxidative stress and growth factor status during the treatment of chronic leg ulcer with soft laser irradiation. (author)

  17. [Mixed leg ulcers].

    Science.gov (United States)

    Willenberg, Torsten

    2011-03-01

    Coexisting peripheral arterial disease is not uncommon (15 - 21 %) in patients with ulcera cruris primarily based on a venous etiology. Patient's history, clinical examination and detection of ABI as well as duplex scan will establish diagnosis of mixed arterial-venous ulcera. Clinical significance of coexisting arterial disease is often difficult to define and should be evaluated by a vascular specialist. The concept of treatment of mixed ulcers should always include the arterial component. Frequently peripheral arterial perfusion and healing can be improved by minimal invasive, endovascular revascularization. Compression therapy is the corner stone in treatment of venous disease and should be complemented by contemporary two piece graduated compression systems if ulcera are present. According to circumstances ablation of varicose veins must be considered. PMID:21360460

  18. The bacteriology of chronic venous leg ulcer examined by culture-independent molecular methods

    DEFF Research Database (Denmark)

    Thomsen, Trine R; Aasholm, Martin S; Rudkjøbing, Vibeke B;

    2010-01-01

    , such as 16S rRNA gene sequencing, fingerprinting, quantitative polymerase chain reaction, and fluorescence in situ hybridization. Each wound contained an average of 5.4 species but the actual species varied between wounds. The diversity determined by culture-based methods and the molecular biological methods...... was different. All the wounds contained Staphylococcus aureus, whereas Pseudomonas aeruginosa was in six out of 14 wounds. Molecular methods detected anaerobic pathogens in four ulcers that were not detected with anaerobic culture methods. Quantitative polymerase chain reaction was used to compare the abundance...... of S. aureus and P. aeruginosa at different locations in the ulcers and their numbers varied greatly between samples taken at different locations in the same ulcer. This should be considered when ulcers are investigated in routine clinical care. The differences between the results obtained with culture...

  19. Shewanella alga bacteremia in two patients with lower leg ulcers

    DEFF Research Database (Denmark)

    Domínguez, H.; Vogel, Birte Fonnesbech; Gram, Lone;

    1996-01-01

    The first Danish cases of Shewanella alga bacteremia in two patients with chronic lower leg ulcers are reported. Both patients were admitted to the hospital during the same month of a very warm summer and had been exposed to the same marine environment, thereby suggesting the same source of infec......The first Danish cases of Shewanella alga bacteremia in two patients with chronic lower leg ulcers are reported. Both patients were admitted to the hospital during the same month of a very warm summer and had been exposed to the same marine environment, thereby suggesting the same source......'Etoile, France), but further genetic and physiological analyses identified them as Shewanella alga....

  20. Clinical quality indicators of venous leg ulcers

    DEFF Research Database (Denmark)

    Kjaer, Monica L; Mainz, Jan; Soernsen, Lars T;

    2005-01-01

    and reliable evidence-based quality indicators of venous leg ulcer care. A Scandinavian multidisciplinary, cross-sectional panel of wound healing experts developed clinical quality indicators on the basis of scientific evidence from the literature and subsequent group nominal consensus of the panel......In the clinical setting, diagnosis and treatment of venous leg ulcers can vary considerably from patient to patient. The first step to reducing this variation is to document venous leg ulcer care through use of quantitative scientific documentation principles. This requires the development of valid......; an independent medical doctor tested the feasibility and reliability of these clinical indicators, assessing the quality of medical technical care on 100 consecutive venous leg ulcer patients. Main outcome measures were healing, recurrence, pain, venous disease diagnosis, differential diagnosis and treatment...

  1. Proliferation and mitogenic response to PDGF-BB of fibroblasts isolated from chronic venous leg ulcers is ulcer-age dependent

    DEFF Research Database (Denmark)

    Agren, M S; Steenfos, H H; Dabelsteen, S;

    1999-01-01

    factor-BB and levels ofplatelet-derived growth factor alpha-receptor and beta-receptor. Fibroblasts were obtained by an explant technique and expanded in vitro using fibroblast growth medium supplemented with 10% fetal bovine serum and used for the assays at their third passage. Growth of chronic wound...... from the oldest chronic wounds deviated substantially from those of acute wounds and normal dermis, and resembled in vitro aged or senescent fibroblasts. Mitogenic response of chronic wound fibroblasts to human recombinant platelet-derived growth factor-BB was also reduced with ulcer age....... No significant differences were found in the amount of either platelet-derived growth factor alpha-receptor or beta-receptor among the three groups. The features decreased growth related to ulcer age, altered morphology, and reduced response to platelet-derived growth factor, indicating that fibroblasts in some...

  2. Vascular leg ulcers: histopathologic study of 293 patients.

    Science.gov (United States)

    Misciali, Cosimo; Dika, Emi; Baraldi, Carlotta; Fanti, Pier Alessandro; Mirelli, Michele; Stella, Andrea; Bertoncelli, Marco; Patrizi, Annalisa

    2014-12-01

    Vascular leg ulcers remain a challenge for the modern health care, and a systematic pathological study on this kind of lesions has not been reported so far. A total of 293 consecutive white patients with chronic leg ulcers (present for a minimum of 6 months and up to several years) referred to the Wound Care Unit (Dermatology, University of Bologna) between March 2008 and June 2011. Thirty-four patients affected by other than vascular ulcers, neoplastic or inflammatory conditions, were excluded. The remaining 259 patients affected by vascular leg ulcers were enrolled in this study. Assessment of the patients general health, skin biopsy, and vascular Doppler of the lower limbs were performed to determine the etiology and to formulate an appropriate management plan, whereas 2 punch biopsies of 3 mm were performed on the border and on the bed of each ulcer. Doppler evaluation showed the presence of vascular hemodynamic impairment in 259 patients. Of these, 181 (69.9%) patients were affected by venous insufficiency, 58 (22.4%) by venous and arterial insufficiency, and 20 (7.7%) by arterial insufficiency. Histopathologic features revealed significant differences, thus, reflecting the clinicopathologic correlation with the underlying hemodynamic impairments. In conclusion, histopathologic and hemodynamic data correlation could provide the basis for future analysis of leg ulcers pathogenesis and may improve treatment protocols. We should underline that this observational study represents a single-institute experience and that larger series are needed to confirm our observations.

  3. Diabetic Leg Ulcers : Prevention and treatment

    OpenAIRE

    Kallio, Jukka-Pekka Viljami; Vanhainen, Aapo Valtteri

    2016-01-01

    Diabetic leg ulcers are a major complication of diabetes, and are one of the leading causes of hospitalization for diabetic patients. Diabetic foot ulcers often require specialized treatment and their prevention requires early, acute detection and intervention. The information regarding these issues can be varying and fragmented between many differing sources, possibly leading to different approaches to diabetic foot care between locations. The aim of this study was to find effective metho...

  4. Large leg ulcers due to autoimmune diseases

    OpenAIRE

    Rozin, Alexander P; Egozi, Dana; Ramon, Yehuda; Toledano, Kohava; Braun-Moscovici, Yolanda; Markovits, Doron; Schapira, Daniel; Bergman, Reuven; Melamed, Yehuda; Ullman, Yehuda; Balbir-Gurman, Alexandra

    2011-01-01

    Summary Background Large leg ulcers (LLU) may complicate autoimmune diseases. They pose a therapeutic challenge and are often resistant to treatment. To report three cases of autoimmune diseases complicated with LLU. Case Report Case 1. A 55-year old woman presented with long-standing painful LLU due to mixed connective tissue disease (MCTD). Biopsy from the ulcer edge showed small vessel vasculitis. IV methylprednisolone (MethP) 1 G/day, prednisolone (PR) 1mg/kg, monthly IV cyclophosphamide ...

  5. What's new: Management of venous leg ulcers: Treating venous leg ulcers.

    Science.gov (United States)

    Alavi, Afsaneh; Sibbald, R Gary; Phillips, Tania J; Miller, O Fred; Margolis, David J; Marston, William; Woo, Kevin; Romanelli, Marco; Kirsner, Robert S

    2016-04-01

    Venous leg ulcers account for approximately 70% of all leg ulcers and affect 2.2 million Americans annually. After a comprehensive patient and wound assessment, compression therapy remains the cornerstone of standard care. Adjuvant care with topical or systemic agents is used for wounds that do not heal within 4 weeks. Once healed, long-term compression therapy with stockings or surgical intervention will reduce the incidence of recurrence. This continuing medical education article aims to outline optimal management for patients with venous leg ulcers, highlighting the role of a multidisciplinary team in delivering high quality care. PMID:26979355

  6. Evaluation of clinical and laboratory correlates of sickle leg ulcers.

    Science.gov (United States)

    Madu, Anazoeze Jude; Ubesie, Agozie; Madu, Kenechi Anthony; Okwor, Bismarck; Anigbo, Chukwudi

    2013-01-01

    The exact mechanism for the occurrence of sickle leg ulcers (SLUs) has not been fully explained, although, popular opinion supports a multifactorial etio-pathogenetic process. Leg ulceration in sickle cell is a chronic and debilitating condition which is difficult to treat and may worsen the psychosocial impact of this illness. This study aims to evaluate the laboratory and clinical correlates of SLUs. One hundred sixty-seven patients who had been diagnosed with sickle cell anemia (homozygous S) had their steady-state hemoglobin concentration (Hb), hematocrit, white cell count, platelet count, serum bilirubin, and aspartate transaminase (AST) as well as frequency of crisis per annum evaluated with respect to their relationship to the occurrence of leg ulcers. They were aged 6-53 years (mean age 24.3 years), and prevalence of leg ulcer was found to be 2.75 per 1000 (2.54 per 1000 in females and 2.83 per 1000 in males). The independent sample t-test showed a significant difference in the serum AST levels in those with SLU (p = 0.029), though a positive correlation did not exist. Other predictors of disease severity found to have positive relationship with each other were the AST and total serum bilirubin 0.207 (p = 0.012); Hb and age 0.130 (p = 0.035); Hb and white cell count -0.159 (p = 0.010), white cell count and age -0.113 (p = 0.018). SLUs do not occur in patients with severe disease in sickle cell. The clinical and laboratory indicators of severe sickle cell disease do not correlate positively with the occurrence of SLU. Serum AST may have a relationship with leg ulceration in these patients. Environmental factors most likely play a major part in the etiopathogenesis of leg ulcer and this may require further studies in different sociocultural settings.

  7. [Innovative therapy for leg ulcers: Electrostimulation].

    Science.gov (United States)

    Maillard, H

    2015-01-01

    Chronic wounds can take a long time to heal despite appropriate therapy based upon aetiology and use of suitable dressings. The success of electrostimulation is based upon the existence within the skin of the endogenous currents involved in the wound healing process. Where skin continuity is broken by a wound, these electrical potentials are short-circuited, resulting in leakage of electrical current. Woundel(®) therapy is the only such treatment currently available in France and is based on the use of continuous pulsed current that generates an electrical field near the endogenous electrical fields. It utilises a console to deliver the electrical impulses, a dressing electrode and a dispersion electrode. The electrode dressing is left on the wound for 3 days, and venous compression bandaging may be applied to the leg, taking care to leave the connector free. Negative polarity stimulates migration of fibroblasts, resulting in elimination of fibrin. Positive polarity causes keratinocyte migration, which in turn leads to epidermisation. Electrostimulation is of recognised utility in the healing of chronic wounds: it has been assigned a high-level recommendation in the European and American guidelines for the treatment of venous ulcers and bedsores with proof level of A. Further, the analgesic effect of electrostimulation has been demonstrated in several studies. Electrostimulation is already well developed in France among wound specialists, but prospective studies are planned so that it may be used at patients' homes.

  8. Compression Stockings for Treating Venous Leg Ulcers

    Directory of Open Access Journals (Sweden)

    J. P. Benigni

    2013-01-01

    Full Text Available Background. In order to treat venous leg ulcers, it is recommended to use high pressure compression (30–40 mmHg at the ankle. Compression stockings which are not operator dependant could be the best option because of their pressure control. However 30–40 mmHg compression stockings are often hard to put on. Putting two lower pressure compression stockings over each other could be a good therapeutic alternative. Objectives. To compare the in vitro pressures given by the manufacturers of 2 antiulcer kits with the in vivo interface pressures measured in healthy subjects and to evaluate the stiffness and friction indices from those kits based on the interface pressure in order to assess their clinical properties. Material and Methods. Using a Kikuhime pressure device, interface pressure was measured in 12 healthy subjects at the reference point B1. One stiffness index (Static Stiffness Index (SSI and a friction index have been calculated. Results. Mediven Ulcer kit gets the recommended pressures whereas Jobst’s Ulcer Care kit does not for treating a venous leg ulcer. Jobst’s Ulcer Care transmits entirely the pressure in relation to a friction index close to 1. Conclusion. This antiulcer kit study underlines that in vivo and in vitro pressures can be different (Jobst’s Ulcer Care kit and Mediven Ulcer kit. In order not to lose pressure, it is important to take into account the friction index when superimposing two stockings.

  9. Estimating the Clinical Outcomes and Cost Differences Between Standard Care With and Without Cadexomer Iodine in the Management of Chronic Venous Leg Ulcers Using a Markov Model.

    Science.gov (United States)

    Nherera, Leo M; Woodmansey, Emma; Trueman, Paul; Gibbons, Garry W

    2016-06-01

    Chronic venous leg ulcers (VLUs) affect up to 1% of the adult population in the developed world and present a significant financial and resource burden to health care systems. Cadexomer iodine (CI) is an antimicrobial dressing indicated for use in chronic exuding wounds. The aim of this study was to estimate the cost utility of using CI + standard care (SC) - ie, high compression multicomponent bandaging including debridement - compared with SC alone in the management of chronic (>6 months' duration) VLUs from a payer's perspective. A Markov model was constructed to evaluate the cost and clinical benefits (healing and decreased infection rates) of the 2 treatment modalities over a 1-year period using data from 4 randomized, controlled clinical studies (RCTs) included in a recent Cochrane review and cost data from a recently published economic evaluation of VLUs. Costs were calculated using 2014 United States dollars; wound outcomes in- cluded complete healing in 212 patients reported in the Cochrane meta-analysis and quality-adjusted life years (QALYs), with utility values obtained from 200 patients with VLUs calculated using standard gamble. Treatment with CI over 1 year was $7,259 compared to $7,901 for SC. This resulted in a cost savings of $643/patient in favor of CI compared with SC. More patients treated with CI (61%) had their wounds healed compared to 54% treated with SC. Furthermore, patients treated with CI+SC experienced 6 additional ulcer-free weeks compared to persons treated with SC alone (ie, 25 ulcer- free weeks compared to 19 ulcer-free weeks, respectively). Overall, CI resulted in 0.03 more QALYs (ie, 0.86 QALYs compared to 0.83 for SC). The use of CI in addition to SC compared to SC alone over 52 weeks resulted in more wounds healed and more QALYs along with a decrease of overall costs The results of this study suggest CI is cost effective com- pared to SC alone in the management of patients with chronic VLUs. Prospective, controlled clinical

  10. Compression therapy of leg ulcers with PAOD.

    Science.gov (United States)

    Ladwig, Andrea; Haase, Hermann; Bichel, Jens; Schuren, Jan; Jünger, Michael

    2014-05-19

    Objectives: To assess the clinical safety of a new short-stretch 2-layer compression system (3M(tm) Coban(tm) 2 Lite) in patients with peripheral arterial occlusive disease (PAOD). This system combines a low resting pressure with a high working pressure. Methods: A pilot study was performed in 15 subjects with moderate PAOD, i.e. an ABPI of 0.5-0.8. Co-existing chronic venous insufficiency or leg ulcer was not mandatory. All subjects received the compression system which was reapplied at each study visit (days 1, 2, 3, 4, 7, 10, 14). The safety parameters were: sub-bandage pressure immediately after application, pressure-related skin damage, hypoxia-related pain, and adverse events. A product comfort questionnaire was completed at the last visit. Results: The average sub-bandage pressure of 30 mmHg defined by the protocol was achieved. No pressure-related skin damage or hypoxia-related pain was found. The reported adverse device effects were as expected for compression therapies, including dry skin and pruritus. The product comfort questionnaire completed by the subjects showed a good tolerability profile. Conclusion: The short-stretch 2-layer compression system (3M(tm) Coban(tm) 2 Lite) was safe and well tolerated in subjects with moderate PAOD. PMID:24843079

  11. What's new: Management of venous leg ulcers: Approach to venous leg ulcers.

    Science.gov (United States)

    Alavi, Afsaneh; Sibbald, R Gary; Phillips, Tania J; Miller, O Fred; Margolis, David J; Marston, William; Woo, Kevin; Romanelli, Marco; Kirsner, Robert S

    2016-04-01

    Leg ulcerations are a common problem, with an estimated prevalence of 1% to 2% in the adult population. Venous leg ulcers are primarily treated in outpatient settings and often are managed by dermatologists. Recent advances in the diagnosis and treatment of leg ulcers combined with available evidence-based data will provide an update on this topic. A systematized approach and the judicious use of expensive advanced therapeutics are critical. Specialized arterial and venous studies are most commonly noninvasive. The ankle brachial pressure index can be performed with a handheld Doppler unit at the bedside by most clinicians. The vascular laboratory results and duplex Doppler findings are used to identify segmental defects and potential operative candidates. Studies of the venous system can also predict a subset of patients who may benefit from surgery. Successful leg ulcer management requires an interdisciplinary team to make the correct diagnosis, assess the vascular supply, and identify other modifiable factors to optimize healing. The aim of this continuing medical education article is to provide an update on the management of venous leg ulcers. Part I is focused on the approach to venous ulcer diagnostic testing.

  12. Delivery of Compression Therapy for Venous Leg Ulcers

    DEFF Research Database (Denmark)

    Zarchi, Kian; Jemec, Gregor B E

    2014-01-01

    IMPORTANCE: Despite the documented effect of compression therapy in clinical studies and its widespread prescription, treatment of venous leg ulcers is often prolonged and recurrence rates high. Data on provided compression therapy are limited. OBJECTIVE: To assess whether home care nurses achiev...... with venous leg ulcers do not receive adequate compression therapy. Training programs that focus on practical bandaging skills should be implemented to improve management of venous leg ulcers....

  13. Quality of life in patients with leg ulcers or skin lesions – a pilot study

    OpenAIRE

    Szewczyk, Maria T.; Mościcka, Paulina; Jawień, Arkadiusz; Cwajda-Białasik, Justyna; Cierzniakowska, Katarzyna; Ślusarz, Robert; Hancke, Elżbieta

    2015-01-01

    Introduction Attempts to determine the quality of life are advisable in patients with ulcers as the group affected with this problem is relatively large. According to one Polish randomized trial, approximately 0.3–2% of the adult population suffers from active or healed venous ulcers. Aim To compare the quality of life of patients with leg ulcers of venous and arterial etiology and those with lower limb skin lesions due to chronic venous insufficiency. Material and methods This study included...

  14. Leg ulcers: a review of their impact on daily life.

    NARCIS (Netherlands)

    Persoon, A.; Heinen, M.M.; Vleuten, C.J.M. van der; Rooij, M.J.M. de; Kerkhof, P.C.M. van de; Achterberg, T. van

    2004-01-01

    BACKGROUND: Current nursing care for leg ulcer patients often focuses on wound care and providing compression therapy. Nurses perceive leg ulcer patients as 'under-served' with regard to problems patients experience in daily life. An overview of patient problems is a first and essential step in the

  15. Inter rater reliability of Pressure Ulcer Scale for Healing (PUSH in patients with chronic leg ulcers Confiabilidad inter-observadores del Pressure Ulcer Scale for Healing (PUSH en pacientes con úlceras crónicas en la pierna Confiabilidade interobservadores do Pressure Ulcer Scale for Healing (PUSH, em pacientes com úlceras crônicas de perna

    Directory of Open Access Journals (Sweden)

    Vera Lúcia Conceição de Gouveia Santos

    2007-06-01

    Full Text Available This study aimed to evaluate the inter rater reliability of the Pressure Ulcer Scale for Healing (PUSH, in its version adapted to the Portuguese language, in patients with chronic leg ulcers. Kappa index was used for the analysis. After accomplishing ethical issues, 41 patients with ulcers were examined. A total of 49% of the ulcers were located in the right leg and 36% of them were venous ulcers. The Kappa indices (0.97 to 1.00 obtained in the comparison between the observations of the clinical nurses and the stomal therapists for all sub-scales and for total score, confirmed the tool inter rater reliability, with statistical significance (pEl objetivo del estúdio fue probar la confiabilidad inter-observadores del Pressure Ulcer Scale for Healing (PUSH, en su versión adaptada al portugués, en pacientes con úlceras crónicas en la pierna. Para el análisis de concordancia se utilizó el Indice Kappa. Posterior a la aprobación del Comité de Ética, 41 pacientes con úlcera fueron examinados, siendo que 49% de las úlceras se localizaron a la derecha y 36% eran de etiología venosa. Los indices Kappa obtenidos (0,97 a 1,00, con un nivel significativo de pTestar a confiabilidade interobservadores do Pressure Ulcer Scale for Healing (PUSH, em sua versão adaptada para o português, em pacientes com úlceras crônicas de perna foi o objetivo deste estudo. Para a análise de concordância, utilizou-se o índice Kappa. Após aprovação pelo Comitê de Ética, pacientes com úlceras (41 úlceras foram examinados, sendo que 49% das úlceras localizavam-se à direita e 36% eram de etiologia venosa. Os índices Kappa obtidos (0,97 a 1,00, com significância estatística (p<0,001, ratificaram a confiabilidade interobservadores, ao ser obtida concordância de muito boa a total entre as observações de enfermeiros clínicos e especialistas em estomaterapia (padrão-ouro, para todas as subescalas do PUSH, como para o escore total. Esses resultados

  16. The wound/burn guidelines - 5: Guidelines for the management of lower leg ulcers/varicose veins.

    Science.gov (United States)

    Ito, Takaaki; Kukino, Ryuichi; Takahara, Masakazu; Tanioka, Miki; Nakamura, Yasuhiro; Asano, Yoshihide; Abe, Masatoshi; Ishii, Takayuki; Isei, Taiki; Inoue, Yuji; Imafuku, Shinichi; Irisawa, Ryokichi; Ohtsuka, Masaki; Ohtsuka, Mikio; Ogawa, Fumihide; Kadono, Takafumi; Kawakami, Tamihiro; Kawaguchi, Masakazu; Kono, Takeshi; Kodera, Masanari; Sakai, Keisuke; Nakanishi, Takeshi; Hashimoto, Akira; Hasegawa, Minoru; Hayashi, Masahiro; Fujimoto, Manabu; Fujiwara, Hiroshi; Maekawa, Takeo; Matsuo, Koma; Madokoro, Naoki; Yamasaki, Osamu; Yoshino, Yuichiro; Le Pavoux, Andres; Tachibana, Takao; Ihn, Hironobu

    2016-08-01

    Varicose veins are treated at multiple clinical departments, but as patients often visit the dermatology clinic first due to leg ulcers, the present Guidelines for the Management of Lower Leg Ulcers/Varicose Veins were prepared in consideration of the importance of the dermatologist's role. Also, the disease concept of chronic venous insufficiency or chronic venous disorders and the CEAP classification of these disorders are presented. The objective of the present guidelines is to properly guide the diagnosis and treatment of lower leg ulcers/varicose veins by systematically presenting evidence-based recommendations that support clinical decisions.

  17. [The treatment of malignant tumors on venous leg ulcers. Case presentation and literature review].

    Science.gov (United States)

    Lehnert, W; Kohl, K; Riebe, H; Jünger, M; Ladwig, A

    2008-11-01

    Malignant changes in persistent venous leg ulcers are a grave complication of chronic impaired wound healing. In our case, a venous leg ulcer had persisted on the right calf for 30 years. Exophytic tumors in the ulcer with frequent bleeding prompted biopsies. A squamous cell carcinoma was found, but only in the second biopsy. The surgical procedure was planned so that in a single session both the tumor and the underlying causes of the chronic venous insufficiency in the leg could be treated appropriately. Extirpation of the enlarged lymph nodes in the groin was combined with crossectomy and removal of the long saphenous vein, followed by circular radial excision of the ulcer scar fascia (fasciotomy). The excised tissue was examined histologically. Muscle biopsies were taken from the site of suspicious adhesions of the fascia to the calf muscle. The large, circular defects on the lower leg were covered with the appropriate dressing to condition the wound bed. After three weeks the well-granulated area was covered with meshed split skin grafts. During the operation and in the post-operative phase, machine-assisted and manual decongestion was performed, an established therapy for lymphedema, chronic venous insufficiency and chronic venous ulcers. PMID:18850078

  18. Improvement of wound healing by water-filtered infrared-A (wIRA in patients with chronic venous stasis ulcers of the lower legs including evaluation using infrared thermography

    Directory of Open Access Journals (Sweden)

    Hoffmann, Gerd

    2008-10-01

    Full Text Available Background: Water-filtered infrared-A (wIRA is a special form of heat radiation with a high tissue-penetration and with a low thermal burden to the surface of the skin. wIRA is able to improve essential and energetically meaningful factors of wound healing by thermal and non-thermal effects. Aim of the study: prospective study (primarily planned randomised, controlled, blinded, de facto with one exception only one cohort possible using wIRA in the treatment of patients with recalcitrant chronic venous stasis ulcers of the lower legs with thermographic follow-up. Methods: 10 patients (5 males, 5 females, median age 62 years with 11 recalcitrant chronic venous stasis ulcers of the lower legs were treated with water-filtered infrared-A and visible light irradiation (wIRA(+VIS, Hydrosun® radiator type 501, 10 mm water cuvette, water-filtered spectrum 550–1400 nm or visible light irradiation (VIS; only possible in one patient. The uncovered wounds of the patients were irradiated two to five times per week for 30 minutes at a standard distance of 25 cm (approximately 140 mW/cm2 wIRA and approximately 45 mW/cm2 VIS. Treatment continued for a period of up to 2 months (typically until closure or nearly closure of the ulcer. The main variable of interest was “percent change of ulcer size over time” including complete wound closure. Additional variables of interest were thermographic image analysis, patient’s feeling of pain in the wound, amount of pain medication, assessment of the effect of the irradiation (by patient and by clinical investigator, assessment of feeling of the wound area (by patient, assessment of wound healing (by clinical investigator and assessment of the cosmetic state (by patient and by clinical investigator. For these assessments visual analogue scales (VAS were used. Results: The study showed a complete or nearly complete healing of lower leg ulcers in 7 patients and a clear reduction of ulcer size in another 2 of 10

  19. ASSESSMENT OF EFFICACY OF TOPICAL PHENYTOIN SODIUM DRESSING AS COMPARED TO CONVENTIONAL MOIST DRESSING IN THE MANAGEMENT OF LEG ULCERS

    Directory of Open Access Journals (Sweden)

    Srikanth Reddy

    2015-10-01

    Full Text Available Chronic leg ulcers are one of the most common surgical conditions in surgical practice. From times immemorial, many methods have been tried to treat these types of ulcers. Many techniques have been tried over the centuries to aid in healing of chronic leg ulcers, but there exists no ideal dressing till date.(1 Phenytoin Sodium, a chemical used in management of Epilepsy, is known to produce gingival Hyperplasia, an indirect evidence to enhanced Fibroblastic activity. The present study was conducted to assess the efficacy of topical Phenytoin solution dressing as compared to conventional moist dressing in the healing process of chronic leg ulcers. Phenytoin Sodium being a cheap drug, is likely to cut down, the cost burden on the individual and the Society, if proven effective.

  20. Quality of life in patients with leg ulcers or skin lesions – a pilot study

    Science.gov (United States)

    Mościcka, Paulina; Jawień, Arkadiusz; Cwajda-Białasik, Justyna; Cierzniakowska, Katarzyna; Ślusarz, Robert; Hancke, Elżbieta

    2015-01-01

    Introduction Attempts to determine the quality of life are advisable in patients with ulcers as the group affected with this problem is relatively large. According to one Polish randomized trial, approximately 0.3–2% of the adult population suffers from active or healed venous ulcers. Aim To compare the quality of life of patients with leg ulcers of venous and arterial etiology and those with lower limb skin lesions due to chronic venous insufficiency. Material and methods This study included 90 consecutive patients with ulcers of venous (n = 30) or arterial etiology (n = 30), or patients with trophic disorders of the skin associated with chronic venous insufficiency (n = 30) treated at the Venous Ulceration Outpatient Clinic and at the Department and Clinic of General Surgery, Dr. J. Biziel Memorial University Hospital No. 2, in Bydgoszcz. This study was designed as a questionnaire survey and included the Skindex-29 instrument for the assessment of quality of life in patients with dermatological conditions. Results Overall, the global Skinndex-29 scores of all studied participants ranged between 37 and 136 points, 23.93 points on average. The analyzed groups of patients differed significantly with respect to the average level of the global quality of life determined using the Skindex-29 questionnaire. Conclusions Significant differences were observed in the global quality of life of patients who suffered from venous or arterial leg ulcers or skin lesions resulting from chronic venous insufficiency. PMID:26755912

  1. LEG ULCERS IN SICKLE CELL DISEASE: CURRENT PATTERNS AND PRACTICES

    OpenAIRE

    Delaney, Kara-Marie H.; Axelrod, Karen C.; Buscetta, Ashley; Hassell, Kathryn L.; Adams-Graves, Patricia E.; Seamon, Catherine; Kato, Gregory J.; Minniti, Caterina P.

    2013-01-01

    Leg ulcers are a debilitating complication of patients with sickle cell disease, and their frequency in North America was reported to be 2.5% by the Cooperative Study of Sickle Cell Disease more than 20 years ago. We sought to determine if the frequency of leg ulcers in sickle cell patients in the United States had declined and to assess which treatments providers use most commonly. We sent an e-mail survey to health professionals belonging to the national Sickle Cell Adult Provider Network. ...

  2. A Real World, Observational Registry of Chronic Wounds and Ulcers

    Science.gov (United States)

    2016-05-18

    Diabetic Foot; Varicose Ulcer; Pressure Ulcer; Surgical Wound Dehiscence; Vasculitis; Skin Ulcer; Leg Ulcer; Wounds and Injuries; Pyoderma; Peripheral Arterial Disease; Diabetic Neuropathies; Lymphedema; Venous Insufficiency; Diabetes Complications; Amputation Stump

  3. The impact of leg ulcers on patients' quality of life.

    Science.gov (United States)

    Charles, H

    1995-06-01

    The pain of leg ulceration can dominate patients' lives and can have serious psychological and social effects on patients' quality of life. A phenomenological approach was used in this study to obtain rich data on patients' experiences. A feeling of loss of control and lack of faith in the professionals treating the condition was found. PMID:7604055

  4. Clinical evaluation of leg ulcers in elderly patients

    Directory of Open Access Journals (Sweden)

    Jordana Prado Benevides

    2012-06-01

    Full Text Available The aim of this work was to perform a clinical evaluation of leg ulcers in elderly patients in a specialized clinic. An Exploratory-descriptive, cross-sectional research was carried out from August to November 2010, and the population consisted of elderly patients with leg ulcers assisted in the wound dressing room of the Surgery Ambulatory of a University Hospital in Fortaleza-CE, Brazil. Data were collected through interviews using a form. The study included 53 elderly, average age 69.3 years, 27 (51.0% time of ulcer ≥ 1 year, 34 (64.1% with ulcer location in Zone I, 53 (100 % with tissue loss, 40 (75.5% with necrosis, 43 (81.1% with infection and 32 (60.4% of those with exudate and odor, and 50.0% with 29 (54.7 % presence of pain. It was concluded that clinical assessment of leg ulcers is an important step during the approach to the patient and the choice of treatment what should be performed by a professional with competence on the subject.

  5. Critical Reviews: How we treat sickle cell patients with leg ulcers.

    Science.gov (United States)

    Minniti, Caterina P; Kato, Gregory J

    2016-01-01

    The past five decades have seen an improvement in the mortality and morbidity of sickle cell disease (SCD) because of prophylaxis against infectious complications, improved and expanded red cell transfusions, implementation of hydroxyurea therapy, and advances in supportive care. Now that the majority of patients in the western hemisphere reaches adulthood, end organ diseases are frequent, which include vasculopathic complications such as chronic leg ulcers. The management of patients with leg ulcers requires the hematologist to lead a team of health care professionals, and investigates the presence of associated, but potentially still occult signs of vasculopathy, such as pulmonary hypertension, renal disease, priapism and retinopathy. These complications may be asynchronous, and long term careful screening is indicated, in order to ensure early diagnosis and intervention. It is crucial to address both the immediate consequences of pain, infection and disability, and long term effects on quality of life, employment and stigma associated with chronic ulceration. Recent insights into their pathophysiology may have practical implications. We propose a holistic approach to the management of patients' physical and emotional problems and mechanisms of ulcers formation and delayed healing. An overview of topical and systemic therapies for chronic ulcers is given, with the understanding that wound care therapy is best left to the wound specialists, medical and surgical, with whom the hematologist must keep an open line of communication. In the absence of evidence-based guidelines, our opinion is based on both a critical review of the literature and our personal clinical and research experience. PMID:26257201

  6. Hereditary spherocytosis presenting as indolent leg ulcers

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    Muhammed K

    1997-01-01

    Full Text Available Indolent leg ulcertation, which is the rarest manifestation of hereditary spherocytosis, started at the age of 5 years affecting a 15-year-old boy and his mother is reported. Review of literature showed very few reports from India and abroad. The response to oral folic acid was excellent

  7. Comprehensive treatment of chronic venous leg ulcers%下肢慢性静脉溃疡的综合治疗

    Institute of Scientific and Technical Information of China (English)

    黄楷; 梁思华; 黄明清; 朱晓彤; 吴文洁; 黎洪浩

    2013-01-01

    Objective To discuss comprehensive surgery strategy of chronic venous ulcerations (CVU). Methods From July 2012 to January 2013,the clinical date of ten patients (10 limbs) with CVU treated in our hospital were reviewed. All cases received great saphenous vein high ligation and stripping, transilluminated powered phlebectomy (TIPP), subfascial endoscopic perforators surgery (SEPS) and foam sclerotherapy. Venous Clinical Severity Score (VCSS) was assessed preoperation and three months after surgery. Results Comprehensive surgery was performed successfully in all patients. VCSS was improved from preoperation(12.3 ± 2.06)to postoperation(9.6 ± 1.71). After (6.70±1.45) months follow-up, for all cases, pain relieved and no recurrence of varicose superficial veins presented. Moreover, ulceration healing happened in 8 cases, while, residual ulcerations presented in only 2 cases(diameter<2cm). No recurrence presented in healing ulcerations. Conclusion The comprehensive surgery strategy treating CVU is feasible and safe, with favourable short-term outcomes.%目的探讨下肢慢性静脉溃疡的综合治疗方法。方法回顾性分析2012年7月~2013年1月我科收治的10例下肢慢性静脉溃疡患者(10条患肢)的临床资料,均采用大隐静脉高位结扎加抽剥并联合应用透光曲张静脉刨吸术、泡沫硬化剂注射、腔镜深筋膜下交通静脉结扎术等方法处理小腿病灶。分别在术前及术后3个月对临床症状的改善情况采集数据,按临床严重程度评分(VCSS)方法进行评估。结果患者均成功实施联合手术治疗方案,在术后的VCSS评分项目中得到改善[(12.3±2.06)v s (9.6±1.71)]。随访(6.70±1.45)个月,疼痛较前均有缓解,未发现患肢有曲张浅静脉残余或复发,8例溃疡基本愈合,仅有2例还有残余溃疡,但都控制在2 cm内,已愈合的溃疡未见复发。结论下肢慢性静脉溃疡经正确选择联合治疗方案进

  8. Telemedicine: an innovative way of managing patients with leg ulcers.

    Science.gov (United States)

    Samad, Ajai; Hayes, Sue; Dodds, Simon

    2002-03-01

    The optimal management of patients with leg ulcers requires a multidisciplinary approach, with contributions from both community and hospital specialists to identify, investigate and treat the underlying causes, provide patient education, assess healing and dress the wounds, monitor outcome and prevent recurrence. However, current practice is impaired by the limited communication between community and hospital specialists. There are inconsistencies in methods of transferring and updating patient records between the hospital and the community, and this can lead to confusion over the diagnosis and appropriate management. Telemedicine, the electronic exchange of medical information at a distance, would appear to offer a way to establish an efficient and effective communication link between hospital and community specialists involved in the care of patients with leg ulcers. The authors of this article believe that modern information technology and the existing NHSnet information infrastructure could be employed to create such a link via electronic patient records.

  9. Involving patients with leg ulcers in developing innovations in treatment and management strategies.

    Science.gov (United States)

    McNichol, Elaine

    2014-09-01

    Securing greater patient and public involvement is a central theme of health policy in many countries ( Coulter, 2011 ) and is a growing health-care phenomenon ( Staniszewska et al, 2011 ; World Health Organization, 2011 ). The challenge is how to ensure these voices are heard among the plethora of 'professional' voices representing different stakeholders of provider organisations, higher education, health-care industries and governments. Historically, in the management of leg ulcers, the professional 'user' voice has had a stronger input than that of the patient. This article outlines an approach that addresses this by moving beyond the concept of 'involving' the patient to putting the patient voice first, so that it sets the direction and leads the process in identifying innovation priorities in the management and treatment of chronic leg ulcers.

  10. Ulcer-related problems and health care needs in patients with venous leg ulceration: a descriptive, cross-sectional study.

    NARCIS (Netherlands)

    Heinen, M.M.; Persoon, A.; Kerkhof, P.C.M. van de; Otero, M.; Achterberg, T. van

    2007-01-01

    BACKGROUND: Patients with leg ulceration often have long lasting and recurrent wounds. The treatment exists mainly of wound-care and compression therapy. International literature shows several indications of problems in relation to leg ulceration, but no studies were performed to give a comprehensiv

  11. Overview of guidelines for the prevention and treatment of venous leg ulcers: a US perspective

    Directory of Open Access Journals (Sweden)

    White-Chu EF

    2014-02-01

    Full Text Available E Foy White-Chu,1 Teresa A Conner-Kerr2 1Oregon Health and Science University, Portland VA Medical Center, Portland, OR, 2Winston-Salem State University, Department of Physical Therapy, Winston Salem, NC, USA Abstract: Comprehensive care of chronic venous insufficiency and associated ulcers requires a multipronged and interprofessional approach to care. A comprehensive treatment approach includes exercise, nutritional assessment, compression therapy, vascular reconstruction, and advanced treatment modalities. National guidelines, meta-analyses, and original research studies provide evidence for the inclusion of these approaches in the patient plan of care. The purpose of this paper is to review present guidelines for prevention and treatment of venous leg ulcers as followed in the US. The paper further explores evidence-based yet pragmatic tools for the interprofessional team to use in the management of this complex disorder. Keywords: venous insufficiency, varicose ulcer, wound, compression bandages

  12. Duration of wound fluid secretion from chronic venous leg ulcers is critical for interleukin-1α, interleukin-1β, interleukin-8 levels and fibroblast activation

    DEFF Research Database (Denmark)

    Zillmer, Rikke; Trøstrup, Hannah; Karlsmark, Tonny;

    2011-01-01

    Wound fluid collected from chronic wounds may be used as a simple gauge of the processes taking place in the tissue. There is lack of information on the optimal conditions for wound fluid procurement. We have studied possible diurnal variations and duration of wound fluid accumulation using reten...

  13. 下肢慢性静脉性溃疡病因学及治疗研究%Progress in the etiology and therapy of chronic venous leg ulcers

    Institute of Scientific and Technical Information of China (English)

    陈琉; 常李; 陈金鳌

    2012-01-01

    下肢慢性静脉性溃疡( CVLU)是下肢静脉功能不全的常见并发症.许多CVLU反复发作,久治不愈,形成难治性溃疡,成为临床治疗中的辣手问题.笔者就近年来CVLU病因学研究进展,分期疗法和个体化治疗方法进行评价及综述.%Chronic venous leg ulceration (CVLU) is a frequent complication of lower limb venous insufficiency. Many cases of CVLU, which are slow to heal and frequently recur, and finally develop into refractory ulcers, have become a difficult problem in clinical practice. This paper reviews the recent progress in the etiology of CVLU, and its staging and individualized treatment.

  14. Effects of low-frequency ultrasound on microcirculation in venous leg ulcers

    Directory of Open Access Journals (Sweden)

    Uwe Wollina

    2011-01-01

    Full Text Available Background: Therapeutic low-frequency ultrasound (US has been used for many years to improve wound healing in chronic wounds like venous leg ulcers. No human data are available for the possible effects of single US applications on microcirculation and their frequency-dependency. Aims: To investigated the role of therapeutic low-frequency US on microcirculation of venous leg ulcers in vivo. Patients and Methods: This is a pilot study on an inpatient basis. We use a newly developed low-frequency continuous-wave US-equipment composed of a US transducer based on piezo-fiber composites that allow the change of frequency. In this study, we apply US of 34 kHz, 53.5 kHz, and 75 kHz respectively. Twelve patients with chronic venous leg ulcers are analyzed. As an adjunct to good ulcer care, therapeutic US is applied, non-contacting, once a day, in a subaqual position for 10 minutes. Microcirculation is assessed in the ulcers adjacent to skin before US-therapy, immediately after the treatment and 30 minutes later. We use a micro-light guide spectrophotometer (O2C, LEA Medizintechnik GmbH, Gieίen, Germany for calculation of blood flow velocity, hemoglobin oxygen saturation (SCO 2 and relative hemoglobin concentration (rHb in 2 and 8 mm depth. Contact-free remission spectroscopy (SkinREM3, Color Control Chemnitz GmbH, Chemnitz, Germany allows contact free measurements in the VIS-NIR range of the spectrum (400 ± 1600 nm. Results: It is seen that therapeutic US is well tolerated. One patient dropped out from a treatment series since he developed erysipelas responding to standard antibiotic. Effects were seen at 34 kHz only. The SO 2 values increased after single US application. The values for rHb were higher in the superficial layer of the wound bed (depth 2 mm compared to deeper parts (8 mm depth. US treatment did not result in significant changes of rHb and blood cell velocity. The data obtained by remission spectroscopy disclose an increase of oxygenized

  15. The analgesic effect of electrostimulation (WoundEL®) in the treatment of leg ulcers.

    Science.gov (United States)

    Leloup, Pauline; Toussaint, Pascal; Lembelembe, Jean-Paul; Célérier, Philippe; Maillard, Hervé

    2015-12-01

    This study aims to demonstrate the analgesic efficacy of electrostimulation (ES), a recognised treatment for leg ulcers. Patients treated by ES for leg ulcers between 2011 and 2013 were included in the study. The pain score obtained with the numerical rating scale (NRS) was reported before the start of the ES (D0), after 3 days (D3) and 1 week following treatment initialisation. The analgesic treatments (AT) were reported at each assessment. Seventy-three patients were included (mean age 75·19 years): 31 venous leg ulcers, 21 mixed venous leg ulcers, 2 arterial ulcers, 17 hypertensive ischaemic ulcers, 1 Hydrea(®)-induced ulcer and an amputation stump ulcer. The NRS at D0 was on average 5·3 (median = 6) while it was 2·2 at D7 (median = 2), that is P < 0·001. The results were also significant between D0 and D3 (P < 0·001). A decrease in the number of AT used was observed between D0 (2·0 AT per patient on average) and D7 (1·7 AT on average) (P < 0·001). We also observed a decrease in the consumption of grade 3 analgesics on D0 and D7 (P = 0·03). This study demonstrates the rapid analgesic efficacy of ES in leg ulcers, with a clear impact on the NRS score and especially on the decrease in analgesic consumption.

  16. Comparing the efficacies of alginate, foam, hydrocolloid, hydrofiber, and hydrogel dressings in the management of diabetic foot ulcers and venous leg ulcers: a systematic review and meta-analysis examining how to dress for success.

    Science.gov (United States)

    Saco, Michael; Howe, Nicole; Nathoo, Rajiv; Cherpelis, Basil

    2016-01-01

    Diabetic foot ulcers and venous leg ulcers are chronic wounds frequently encountered by dermatologists. Choosing appropriate wound dressings can effectively promote wound healing and potentially reduce morbidity and financial burden experienced by patients. The objective of our systematic review and meta-analysis was to evaluate wound healing efficacies of synthetic active dressings in diabetic foot ulcer and venous leg ulcer management. For data collection, PubMed, Embase, Cochrane Library, CINAHL, and clinicaltrials.gov online databases were searched from database inception to 10 May 2015. Fixed and random effects modeling were used to calculate pooled risk ratios for complete ulcer healing from pairwise dressing comparisons. The results of our review showed moderate-quality level evidence that hydrogels were more effective in healing diabetic foot ulcers than basic wound contact dressings (RR 1.80 [95% CI, 1.27-2.56]). The other dressing comparisons showed no statistically significant differences between the interventions examined in terms of achieving complete diabetic foot ulcer healing. Non-adherent dressings were more cost-effective than hydrofiber dressings for diabetic foot ulcers in terms of mean total cost per patient of the dressings themselves. All venous leg ulcer pairwise dressing comparisons showed equivalent dressing efficacies in terms of promoting complete ulcer healing. Overall, most synthetic active dressings and traditional wound dressings are equally efficacious in treating diabetic foot ulcers and venous leg ulcers. For treating diabetic foot ulcers, hydrogels are more efficacious than basic wound contact dressings, and non-adherent dressings are more cost-effective than hydrofiber dressings. Ultimately, dressing choice should be tailored to the wound and the patient. PMID:27617934

  17. The use of biatain Ag in hard-to-heal venous leg ulcers

    DEFF Research Database (Denmark)

    Leaper, David; Münter, Christian; Meaume, Sylvie;

    2013-01-01

    Venous leg ulcers are common, troublesome, and their failure to heal is often related to a heavy bio-burden. Ionized silver has both anti-inflammatory and antimicrobial properties. The ulcer healing properties of the silver releasing foam dressing Biatain Ag has been examined in 4 randomized cont...

  18. Effect of collagen turnover and matrix metalloproteinase activity on healing of venous leg ulcers

    NARCIS (Netherlands)

    Meyer, F.J.; Burnand, K.G.; Abisi, S.; TeKoppele, J.M.; Els, B. van; Smith, A.

    2008-01-01

    Background: The presence of fibrous tissue in poorly healing venous leg ulcers suggests abnormal collagen metabolism. The aim was to determine whether there were differences in collagen turnover and matrix metalloproteinase (MMP) activity between ulcers that healed, those that did not heal and norma

  19. Supporting adherence and healthy lifestyles in leg ulcer patients: systematic development of the Lively Legs program for dermatology outpatient clinics.

    NARCIS (Netherlands)

    Heinen, M.M.; Bartholomew, L.K.; Wensing, M.J.P.; Kerkhof, P.C.M. van de; Achterberg, T. van

    2006-01-01

    OBJECTIVES: The objective of our project was to develop a lifestyle program for leg ulcer patients at outpatient clinics for dermatology. METHODS: We used the intervention-mapping (IM) framework for systematically developing theory and evidence based health promotion programs. We started with a need

  20. Diagnosing and managing venous leg ulcers in patients in the community.

    Science.gov (United States)

    Day, Julie

    2015-12-01

    Venous leg ulcers (VLUs) are a chronic condition affecting between 0.1% and 0.3% of the population in the UK. Healing rates are variable and recurrence rates are high. The diagnosis, assessment, and management of this patient group is primarily carried out in the community. Assessment of this patient group requires skill and competence to ensure a correct diagnosis is made. When carrying out the assessment, it is important to consider the patient's past medical history, medication, and allergies, as well as to record the ankle brachial pressure index (ABPI), pain level, palpation of pulses, and ankle joint movement, among other aspects of the assessment. VLUs heal with compression therapy, and practitioners should be knowledgeable about the various compression systems available in order to offer patients the most suitable and informed choices. PMID:26639070

  1. Low Circulating Protein C Levels Are Associated with Lower Leg Ulcers in Patients with Diabetes

    Directory of Open Access Journals (Sweden)

    K. Whitmont

    2013-01-01

    Full Text Available Activated protein C (APC promotes angiogenesis and reepithelialisation and accelerates healing of diabetic ulcers. The aim of this study was to determine the relationship between the incidence of lower leg ulcers and plasma levels of APC's precursor, protein C (PC, in diabetic patients. Patients with diabetes who had a lower leg ulcer(s for >6 months (n=36 were compared with age-, type of diabetes-, and sex-matched subjects with diabetes but without an ulcer (n=36, controls. Total PC was assessed using a routine PC colorimetric assay. There was a significantly (P<0.001 lower level of plasma PC in patients with ulcers (103.3 ± 22.7, mean ± SD compared with control (127.1±34.0 subjects, when corrected for age and matched for gender and type of diabetes. Ulcer type (neuropathic, ischaemic, or mixed was not a significant covariate for plasma PC levels (P=0.35. There was no correlation between PC levels and gender, type of diabetes, HbA1c, or C-reactive protein in either group. In summary, decreased circulating PC levels are associated with, and may predispose to, lower leg ulceration in patients with diabetes.

  2. Limits and possibilities experienced by nurses in the treatment of women with chronic venous ulcers

    Directory of Open Access Journals (Sweden)

    Marcelo Henrique da Silva

    2014-08-01

    Full Text Available Objective To understand the experiences and expectations of nurses in the treatment of women with chronic venous ulcers. Method Phenomenological research was based on Alfred Schütz, whose statements were obtained in January, 2012, through semi-structured interviews with seven nurses. Results The nurse reveals the difficulties presented by the woman in performing self-care, the perceived limitations in the treatment anchored in motivation, and the values and beliefs of women. It showed professional frustration because venous leg ulcer recurrence, lack of inputs, interdisciplinary work and training of nursing staff. There was an expected adherence to the treatment of women, and it emphasized the need for ongoing care, supported self-care and standard practices in treatment. Conclusion That treatment of chronic venous leg ulcers constitutes a challenge that requires collective investment, involving women, professionals, managers and health institutions.

  3. The silver-releasing foam dressing, Contreet Foam, promotes faster healing of critically colonised venous leg ulcers: a randomised, controlled trial

    DEFF Research Database (Denmark)

    Jørgensen, Bo; Price, Patricia; Andersen, Klaus E;

    2005-01-01

    weeks. Ulcer area and healing were assessed weekly. Odour, maceration, absorption capacity and leakage were evaluated at dressing changes. All adverse events were recorded. One hundred and twenty-nine patients were included (Contreet Foam: 65, Allevyn Hydrocellular: 64). The two groups were comparable......, Contreet Foam, compared with a traditional moist foam wound healing dressing in the treatment of critically colonised, chronic venous leg ulcers. The results of this randomised, controlled study suggest an important role of sustained silver-releasing dressings in the treatment of critically colonised...... chronic wounds....

  4. A systematic review on the impact of leg ulceration on patients' quality of life

    Directory of Open Access Journals (Sweden)

    Rieger Monika A

    2007-07-01

    Full Text Available Abstract Background A systematic review was conducted to analyse journal articles that describe or measure the impact of leg ulceration on patients' quality of life (QoL in order to improve the content of an educational programme that aims to enhance self-care agency in leg ulcer patients. Method Original articles published in English and German between 1990 and 2006 were included if the findings were analysed at the level of patients. Articles were excluded if (1 they investigated the impact of specific treatments or settings on QoL or (2 focused mainly on arterial ulcers or diabetic foot ulcers. Results Twenty-four original research articles met the inclusion criteria; 11 studies used a quantitative, 11 studies a qualitative, and 2 used a mixed method approach. The findings were collapsed into 5 core domains. Quantitative studies commonly investigated the parameters of pain, sleep, social isolation, and physical mobility. Patients had significantly more pain, more restrictions regarding social functioning, less vitality, and limitations with respect to emotional roles compared to the respective controls. Other problem areas identified were restrictions in work capacity, recreation, social interaction, psychological well-being, as well as problems caused by treatment regimes. Inconclusive results were obtained regarding pain intensity, physical restrictions, and gender effects. Limitations Numerous original studies neither undertook a differentiation of participants by ulcer aetiology nor did they analyse the results according to gender differences. Conclusion As leg ulceration has an impact on QoL, national guidelines on the treatment of leg ulceration need to more specifically address these far-ranging effects identified in this review.

  5. Randomized study assessing the influence of supervised exercises on ankle joint mobility in patients with venous leg ulcerations

    OpenAIRE

    Szewczyk, Maria T.; Jawień, Arkadiusz; Cwajda-Białasik, Justyna; Cierzniakowska, Katarzyna; Mościcka, Paulina; Hancke, Elżbieta

    2010-01-01

    Introduction The aim of the study was to assess the influence of a supervised programme of exercises on ankle joint mobility in patients with venous leg ulcerations. Material and methods The study was carried out between 2008 and 2009 at the Venous Ulcer Treatment Outpatient Clinic and Clinic of General and Vascular Surgery of the Dr Jan Biziel University Hospital no. 2 in Bydgoszcz. It was a randomized control study in which 32 patients with venous leg ulcerations were qualified. Patients wi...

  6. Anodyne therapy versus exercise therapy in improving the healing rates of venous leg ulcer

    Directory of Open Access Journals (Sweden)

    Emad T. Ahmed

    2013-06-01

    Full Text Available Objective: The purpose of this study was to determine the best physical therapy program to increase wound healing rates in patients suffering from venous leg ulcer. Methods: Forty patients who had venous leg ulcer for more than 4 weeks and not respondent well to medical treatment. Patients were classified into 4 equal groups 10 of each, Group (1: received 40 minute of monochromatic infrared energy (MIRE, Group (2: received 40 minutes of exercise program consisted of stretching and resisted exercise (RE, Group (3: received 20 minutes of exercise in addition to 20 minutes of resisted exercise (MIRE/RE, and group (4: control group which received conventional therapy of the ulcer. All groups received treatment 5days per week for 12days. Measurements of ulcer surface area and PUSH scale were conducted before treatment, post 6 days of treatment, and after 12 days of treatment. Results: The one way analysis of variance was used to compare ulcer surface area and PUSH score which revealed that both treatment groups (MIRE and RE had significant (P< 0.05 decrease in ulcer surface area and PUSH scale after 6 and 12days post application of treatment. On the other hand, the combination of MIRE and RE showed a highly significant decrease in ulcer surface area and PUSH score when compared with control or with individual treatment. Conclusion: The results of this study suggest that combination of MIRE to RE is more effective than individual treatment to enhance the healing rate of venous ulcer of the leg. [Int J Res Med Sci 2013; 1(3.000: 198-203

  7. [Treatment of patients with venous leg ulcers: what if compression therapy alone is no longer beneficial?

    NARCIS (Netherlands)

    Montfrans, C. van; Boer, E.M. de; Jansma, E.P.; Gibbs, S.; Mekkes, J.R.; Vleuten, C.J.M. van der; Maessen-Visch, M.B.

    2013-01-01

    - Non-healing venous leg ulcers are a cumbersome problem for the patient and the physician.- Adequate compression therapy that reduces venous pressure is the cornerstone of treatment.- For each patient treatment of superficial venous insufficiency should be considered.- Adjuvant surgical, physical o

  8. Myeloid Sarcoma Developing in Prexisting Hydroxyurea-Induced Leg Ulcer in a Polycythemia Vera Patient

    Directory of Open Access Journals (Sweden)

    Hatim Nafil

    2013-01-01

    Full Text Available Myeloid sarcoma (MS is an extramedullary tumour consisting of myeloblasts or immature myeloid cells located in an extramedullary site. It may occur at presentation of AML, at relapse, or prior to the onset of frank leukemia. We report a rare case of MS developing in prexisting Hydroxyurea-induced leg Ulcer in a 70-year-old woman.

  9. Myeloid Sarcoma Developing in Prexisting Hydroxyurea-Induced Leg Ulcer in a Polycythemia Vera Patient

    OpenAIRE

    Hatim Nafil; Illias Tazi; Lahoucine Mahmal

    2013-01-01

    Myeloid sarcoma (MS) is an extramedullary tumour consisting of myeloblasts or immature myeloid cells located in an extramedullary site. It may occur at presentation of AML, at relapse, or prior to the onset of frank leukemia. We report a rare case of MS developing in prexisting Hydroxyurea-induced leg Ulcer in a 70-year-old woman.

  10. Venous leg ulcer patient priorities and quality of care: results of a survey

    DEFF Research Database (Denmark)

    Kjaer, Monica Linda; Mainz, Jan; Sorensen, Lars Tue;

    2004-01-01

    A comprehensive patient evaluation of quality of care encompasses assessment and patient-rated prioritization of the various provisions of care. One hundred consecutive venous leg ulcer patients treated in a multidisciplinary wound healing center were invited to participate in a cross...... leg ulcer care, as provided in a multidisciplinary wound healing center, was assessed as satisfactory by patients, but areas for improvement - notably, cooperation between healthcare sectors and continuity of care - were observed.......-sectional study to assess the quality of and assign priority to 28 aspects of medical technical, interpersonal, and organizational care. The response rate to the mailed questionnaire and follow-up telephone survey was 80%. Almost half (46%) of patients (median age 76 years, range 30 to 92) had an ulcer history...

  11. Fibrinogen adsorption--a new treatment option for venous leg ulcers?

    Science.gov (United States)

    Stücker, M; Moll, C; Rudolph, T; Robak-Pawelczyk, B; Jünger, M; Schultz-Ehrenburg, U; Altmeyer, P

    2003-08-01

    The initial element in the causation of venous ulceration is a disturbance of venous blood flow that leads to an increase in venous pressure. Eventually, however, it is the microcirculatory consequences of venous hypertension that lead to trophic skin changes and finally to ulceration. A reduction in blood viscosity results in an improvement at the microcirculatory level. The elimination of fibrinogen from plasma improves blood viscosity. This case report concerns a 75-year-old woman with venous ulcers of both legs (left lower leg: deep ulceration with a surface area of 3 x 5 cm; right lower leg: superficial, confluent ulceration with a total surface area of 5 x 10 cm). The patient underwent 20 sessions of fibrinogen adsorption, while simultaneously continuing with a regimen of conservative measures (activated charcoal cloth dressing with silver, calcium alginate dressings and short-stretch compression bandages). Following binding to a peptide (Gly-Pro-Arg-Pro-Lys), fibrinogen and fibrin were specifically removed from the patient's plasma: her fibrinogen concentration was lowered from an original mean level of 310 mg/dl (SD +/- 104 mg/dl) to 136 mg/dl (SD +/- 54 mg/dl), and there was no return to the baseline concentration by the time of the next fibrinogen adsorption session. In response to this treatment the patient's ulcers healed rapidly within 9 weeks. Dizziness and hematomas at the vascular access sites in both antecubital fossae were reported as adverse effects. A fall in hematocrit was also noted (before treatment 37% +/- 1%; after treatment 35% +/- 2%). This may have been caused by hemodilution due to the procedure and to cell losses during blood-plasma separation, a phenomenon that is known to occur during apheresis. This case report suggests that fibrinogen adsorption is low in adverse effects and is a useful addition to the range of treatments available for ulcers of venous etiology. PMID:14524041

  12. Venous leg ulcers: Summary of new clinical practice guidelines published August 2014 in the Journal of Vascular Surgery.

    Science.gov (United States)

    Widener, Jeanne M

    2015-06-01

    The Society for Vascular Surgery (SVS) and the American Venous Forum (AVF) published guidelines for the management of venous leg ulcers in August 2014. The goal of this article (Part 2) is to summarize the guidelines that address diagnosis and treatment recommendations published jointly by the SVS and AVF that may affect the nursing practice of vascular nurses. Specific sections include wound evaluation, therapies used on the wound bed itself, compression, and operative or endovascular management. Part 1, published elsewhere in this issue, addressed the epidemiology and financial impact of ulcers, venous anatomy, pathophysiology of venous leg ulcer development, clinical manifestations, and prevention of venous leg ulcers. These 2 parts together provide a comprehensive summary of the joint SVS and AVF guidelines for care of venous leg ulcers.

  13. Comparison of dextranomer and streptokinase-streptodornase in the treatment of venous leg ulcers and other infected wounds.

    Science.gov (United States)

    Hulkko, A; Holopainen, Y V; Orava, S; Kangas, J; Kuusisto, P; Hyvärinen, E; Ervasti, E; Silvennoinen, E

    1981-01-01

    The clinical efficacy of dextranomer (Debrisan) and streptokinase-streptodornase (Varidase) was compared in a controlled randomized in-patient study. There were two patient groups: Group A consisting of 28 patients with a total of 31 venous leg ulcers and Group B consisting of 56 patients with other infected wounds (posttraumatic and postoperative wounds, amputation stumps, burn wounds, arteriosclerotic ulcers, decubital ulcers, ulcers due to bone disease, rheumatic ulcers, ulcers due to erysipelas and wounds of mixed aetiology). Both agents have a good cleansing effect as well as a good effect on infection and wet necrosis. Dextranomer stimulates the formation of granulation tissue faster than streptokinase-streptodornase. PMID:6172073

  14. The venous leg ulcer quality of life (VLU-QoL) questionnaire: development and psychometric validation.

    Science.gov (United States)

    Hareendran, Asha; Doll, Helen; Wild, Diane J; Moffatt, Christine J; Musgrove, Elaine; Wheatley, Carolyn; Franks, Peter J

    2007-01-01

    To develop and validate a disease-specific quality of life (QoL) measure, based on the conceptual model of the SKINDEX-29 for patients with a chronic venous leg ulcer (VLU), in-depth interviews, and focus groups of patients (n=36) with VLU were used to generate VLU-specific items. These items were added to selected SKINDEX-29 items that were adapted for use in VLU. Further samples of VLU patients were used for item reduction (n=124) and to assess the psychometric properties of the new tool (n=120). The final VLU-QoL contained 34 items: 17 items adapted from the SKINDEX-29 and 17 VLU-specific items. Factor analysis of the items confirmed the existence of three hypothesized domains: Activities (12 items), Psychological (12 items), and Symptom Distress (10 items). Reliability in terms of internal consistency and test-retest reliability was found to be good. The measure was also found to be valid and responsive to clinical change. The VLU-QoL has good psychometric properties. The instrument's sensitivity to differences in clinical outcome and responsiveness to change in clinical parameters makes it a useful tool to assess the outcomes of treatment from the patients' perspective. PMID:17650089

  15. A prospective case series evaluating the safety and efficacy of the Klox BioPhotonic System in venous leg ulcers

    Directory of Open Access Journals (Sweden)

    Nikolis A

    2016-09-01

    Full Text Available Andreas Nikolis,1 Doria Grimard,2 Yves Pesant,3 Giovanni Scapagnini,4 Denis Vézina5 1Division of Plastic Surgery, Victoria Park Research Centre, Montreal, 2Q&T Research Chicoutimi, Chicoutimi, 3St-Jerome Medical Research Inc., St-Jerome, Quebec, Canada; 4Department of Medicine and Health Sciences, School of Medicine, University of Molise, Campobasso, Italy; 5Klox Technologies, Laval, Quebec, Canada Purpose: To investigate the safety and efficacy of the BioPhotonic System developed by Klox Technologies in a case series of ten patients with venous leg ulcers.Patients and methods: Ten patients with chronic venous leg ulcers, having failed on at least one previous therapy, were enrolled into this case series.Results: Nine patients were evaluable for efficacy. A response (defined as decrease in wound surface area was observed in seven patients (77.8%. Of these, four patients (44.4% achieved wound closure on average 4 months (127.5 days following the beginning of the treatment. Two patients did not respond to the investigational treatment. Quality of life improved over time throughout the study. Compliance was excellent, with 93.2% of visits completed as per protocol. Safety was unremarkable, with only four treatment-emergent-related adverse events, for which no specific intervention was required.Conclusion: The BioPhotonic System was shown to be safe and extremely well tolerated. It also demonstrated potential in terms of wound closure, wound surface area decrease, and wound bed preparation. Keywords: biophotonics, light, photobiomodulation, venous leg ulcers

  16. Dr.Dong Demao's Experience in Treating Chronic Ulcerative Colitis

    Institute of Scientific and Technical Information of China (English)

    徐凌云

    2004-01-01

    @@ Chronic ulcerative colitis (chronic non-specific ulcerative colitis) is a kind of non-specific inflammation occurred in the colonic mucosa layers. As a lingering and troublesome condition that often attacks people aged 20-40, it is characterized by recurrent diarrhea, abdominal pain, pus- and mucus-stained stools in clinic.

  17. Systematic review of economic evaluations of human cell-derived wound care products for the treatment of venous leg and diabetic foot ulcers

    OpenAIRE

    Langer Astrid; Rogowski Wolf

    2009-01-01

    Abstract Background Tissue engineering is an emerging field. Novel bioengineered skin substitutes and genetically derived growth factors offer innovative approaches to reduce the burden of diabetic foot and venous leg ulcers for both patients and health care systems. However, they frequently are very costly. Based on a systematic review of the literature, this study assesses the cost-effectiveness of these growth factors and tissue-engineered artificial skin for treating chronic wounds. Metho...

  18. Compression for Primary Prevention, Treatment, and Prevention of Recurrence of Venous Leg Ulcers: An Evidence-and Consensus-Based Algorithm for Care Across the Continuum.

    Science.gov (United States)

    Ratliff, Catherine R; Yates, Stephanie; McNichol, Laurie; Gray, Mikel

    2016-01-01

    Chronic venous insufficiency is a prevalent disease that frequently leads to development of venous leg ulcers. While a number of evidence-based clinical practice guidelines have been developed that provide guidance for clinicians when caring for patients with chronic venous insufficiency, they lack adequate detail concerning selection and application of compression for prevention and management of venous leg ulcers. In order to address this need, the WOCN Society appointed a task force to develop an algorithm for compression for primary prevention, treatment, and prevention of recurrent venous leg ulcers in persons with chronic venous insufficiency. The task force used findings from a scoping literature review to identify current best evidence needed to support decision points and pathways within the algorithm. In addition, the task force convened a panel of 20 clinicians and researchers with expertise in lower extremity venous disorders in order to establish consensus around pathways and decision points within the algorithm lacking robust evidence. Following initial construction of the algorithm, a second interdisciplinary group of expert clinicians established content validity and provided additional qualitative feedback used to complete final revisions of the algorithm. This article reviews the process used to create this landmark algorithm, including generation of the evidence- and consensus-based statements used in its construction, the various pathways, and rich supplemental materials embedded within the algorithm, and the process used to establish content validity. PMID:27163774

  19. Compression for Primary Prevention, Treatment, and Prevention of Recurrence of Venous Leg Ulcers: An Evidence-and Consensus-Based Algorithm for Care Across the Continuum.

    Science.gov (United States)

    Ratliff, Catherine R; Yates, Stephanie; McNichol, Laurie; Gray, Mikel

    2016-01-01

    Chronic venous insufficiency is a prevalent disease that frequently leads to development of venous leg ulcers. While a number of evidence-based clinical practice guidelines have been developed that provide guidance for clinicians when caring for patients with chronic venous insufficiency, they lack adequate detail concerning selection and application of compression for prevention and management of venous leg ulcers. In order to address this need, the WOCN Society appointed a task force to develop an algorithm for compression for primary prevention, treatment, and prevention of recurrent venous leg ulcers in persons with chronic venous insufficiency. The task force used findings from a scoping literature review to identify current best evidence needed to support decision points and pathways within the algorithm. In addition, the task force convened a panel of 20 clinicians and researchers with expertise in lower extremity venous disorders in order to establish consensus around pathways and decision points within the algorithm lacking robust evidence. Following initial construction of the algorithm, a second interdisciplinary group of expert clinicians established content validity and provided additional qualitative feedback used to complete final revisions of the algorithm. This article reviews the process used to create this landmark algorithm, including generation of the evidence- and consensus-based statements used in its construction, the various pathways, and rich supplemental materials embedded within the algorithm, and the process used to establish content validity.

  20. Educational challenges and requirements for managing leg ulcers in the community.

    LENUS (Irish Health Repository)

    Martin, Fiona

    2014-06-01

    The significant impact of leg ulcers upon quality of life and disease burden cannot be overemphasised, with the financial and economic impact from an individual, local and national perspective being widely acknowledged. This article attempts to highlight issues relating to education in leg ulcer management while identifying some current and emerging challenges faced in this area by professionals. With regard to education, formal training and perception of professionals, the provision of more specialised and focused training, increased use of patient-related outcome measures and the concept of knowledge brokering have been identified as important aspects in the planning and further development of education. Issues in the domains of community nursing, technology, pain management, nursing diagnosis, availability of research and recurrence were also highlighted.

  1. Combined use of an ibuprofen-releasing foam dressing and silver dressing on infected leg ulcers

    DEFF Research Database (Denmark)

    Jorgensen, B.; Gottrup, F.; Karlsmark, T.;

    2008-01-01

    OBJECTIVE: To investigate the effect and safety of an ibuprofen-releasing foam (Biatain-Ibu, Coloplast A/S) combined with an ionised silver-releasing wound contact layer (Physiotulle Ag, Coloplast A/S) on painful, infected venous leg ulcers. METHOD: This open non-comparative study involved 24...... patients with painful, exuding, locally infected, and stalled venous leg ulcers. Persistent pain and pain at dressing change were monitored using a 11-point numerical box scale (NBS). The composition of the wound bed, the dressing combination's ability to absorb exudate and minimise leakage, ibuprofen...... content in the exudate, reduction in wound area and adverse effects were also recorded. RESULTS: Persistent wound pain decreased from a mean of 6.3 +/- 2.2 to 3.0 +/- 1.7 after 12 hours and remained low thereafter. Pain at dressing change also decreased and remained low. Forty-eight hours after the first...

  2. Efficacy and Safety of Rituximab in the Treatment of Vasculitic Leg Ulcers Associated with Hepatitis C Virus Infection

    Directory of Open Access Journals (Sweden)

    Fabio Bonilla-Abadía

    2012-01-01

    Full Text Available Vasculitic leg ulcers are a cutaneous manifestation of hepatitis C virus (HCV infection often associated with cryoglobulinemia. Their treatment is difficult and is based on steroids and immunosuppressive drugs with an erratic response and a high probability of adverse reaction. We report three patients with vasculitic leg ulcers associated with hepatitis C virus infection who were treated successfully with rituximab. The pain control and healing were achieved quickly. No adverse effects with rituximab in these patients were presented.

  3. [Iodine-induced hyperthyroidism after cadexomer iodine treatment of leg ulcers].

    Science.gov (United States)

    Michanek, A; Hansson, C; Berg, G; Månesköld-Claes, A

    1998-12-01

    The article consists in two case reports of eldery patients who developed hyperthyroidism after cadexomer iodine treatment of small leg ulcers. The first was an 87-year-old woman who developed anxiety, hoarseness and tachycardia after five months treatment of a 12 cm2 leg ulcer with 350 g cadexomer iodine. Her serum level of free thyroxine (FT4) was 23.1 pmol/l (normal range, 11.7-28.0), and that of thyroid-stimulating hormone (TSH) 0.01 mIU/l (normal range, 0.1-3.0). She had had a nodular goitre for thirty years. The second was an 86- year-old woman who developed depression and confusion after three months' treatment of an 8 cm2 leg ulcer with 170 g cadexomere iodine. Her serum level of FT4 was 30.0 pmol/l, and that of TSH 0.005 mIU/l. Both patients underwent Tc99m pertechnetate scanning and iodine uptake measurement with a view to treating the hyperthyroidism with radio-iodine. However, as iodine uptake was inhibited in both cases, radio-iodine treatment was impossible, and symptomatic treatment and antithyroid drugs had to be used. Thus, it is concluded that topical treatment with cadexomer iodine can induce hyperthyroidism difficult to manage clinically as the treatment options are limited, which should be borne in mind when cadexomer iodine treatment is considered. PMID:9889495

  4. A prospective randomised trial of four-layer versus short stretch compression bandages for the treatment of venous leg ulcers.

    OpenAIRE

    Scriven, J. M.; Taylor, L. E.; Wood, A. J.; Bell, P R; Naylor, A. R.; London, N. J.

    1998-01-01

    This trial was undertaken to examine the safety and efficacy of four-layer compared with short stretch compression bandages for the treatment of venous leg ulcers within the confines of a prospective, randomised, ethically approved trial. Fifty-three patients were recruited from a dedicated venous ulcer assessment clinic and their individual ulcerated limbs were randomised to receive either a four-layer bandage (FLB)(n = 32) or a short stretch bandage (SSB)(n = 32). The endpoint was a complet...

  5. Self-monitoring of lower leg skin temperature: accuracy of self-reported data and adherence to a cooling protocol for the prevention of venous leg ulcers

    Directory of Open Access Journals (Sweden)

    Kelechi TJ

    2015-12-01

    Full Text Available Teresa J Kelechi, Mohan Madisetti, Martina Mueller, Mary Dooley, Margaret Prentice College of Nursing, Medical University of South Carolina, Charleston, SC, USA Background: For intervention studies that require the use of participant self-reports, the quality and accuracy of recorded data and variability in participant adherence rates to the treatment can cause significant outcome bias.Purpose: To assess the quality and accuracy of participant documentation of daily self-monitoring of leg skin temperature, adherence to a graduated cooling treatment protocol to prevent venous leg ulcers, and the potential for bias in treatment effect in a randomized controlled trial that included a population with chronic venous disease.Methods: Individuals were randomized to a leg cooling intervention or placebo treatment group to daily self-monitor and record lower leg skin temperature over a 9-month period on monthly paper study logs. Returned study logs for the first 100 completed participants (n=54 cooling intervention, n=46 control were reviewed for quality and accuracy. Adherence was determined from evaluating the accuracy of participant documentation. To examine potential outcome bias in treatment effect, mean between group and within group comparisons of the before and after treatment differences were conducted using an intention-to-treat (ITT versus a modified intention-to-treat (mITT analysis approach with an 85% accuracy cut-off rate. Data were collected in 2011–2014.Results: Of the expected 900 study logs, 91.8% (826/900 were returned and 8.2% (74/900 were not. Non-mutually exclusive main error types in returned documentation included: 59.2% (489/826 white-outs, cross-off and/or overwrites, 34.9% (288/826 entries omitted, 29.4% (243/826 no performance of daily self-monitoring, 28.7% (237/826 no performance of the treatment intervention per the prescribed protocol regime, 26.8% (221/826 extraneous data, 8.6% (71/826 suspected fabrication, and 7

  6. Management of Patients With Venous Leg Ulcers: Challenges and Current Best Practice.

    Science.gov (United States)

    Franks, Peter J; Barker, Judith; Collier, Mark; Gethin, Georgina; Haesler, Emily; Jawien, Arkadiusz; Laeuchli, Severin; Mosti, Giovanni; Probst, Sebastian; Weller, Carolina

    2016-06-01

    Introduction It is well documented that the prevalence of venous leg ulcers (VLUs) is increasing, coinciding with an ageing population. Accurate global prevalence of VLUs is difficult to estimate due to the range of methodologies used in studies and accuracy of reporting. (1) Venous ulceration is the most common type of leg ulceration and a significant clinical problem, affecting approximately 1% of the population and 3% of people over 80 years of age (2) in westernised countries. Moreover, the global prevalence of VLUs is predicted to escalate dramatically, as people are living longer, often with multiple comorbidities. Recent figures on the prevalence of VLUs are based on a small number of studies, conducted in Western countries, and the evidence is weak. However, it is estimated that 93% of VLUs will heal in 12 months, and 7% remain unhealed after five years. (3) Furthermore, the recurrence rate within 3 months after wound closure is as high as 70%. (4) (-6) Thus, cost-effective adjunct evidence-based treatment strategies and services are needed to help prevent these ulcers, facilitate healing when they occur and prevent recurrence. The impact of a VLU represents social, personal, financial and psychological costs on the individual and further economic drain on the health-care system. This brings the challenge of providing a standardised leg ulcer service which delivers evidence-based treatment for the patient and their ulcer. It is recognised there are variations in practice and barriers preventing the implementation of best practice. There are patients not receiving appropriate and timely treatment in the initial development of VLUs, effective management of their VLU and preventing recurrence once the VLU has healed. Health-care professionals (HCPs) and organisations must have confidence in the development process of clinical practice guidelines and have ownership of these guidelines to ensure those of the highest quality guide their practice. These systematic

  7. Chronic ringworm infestation and Marjolin’s ulcer, an association unknown in the literature

    Directory of Open Access Journals (Sweden)

    Mohammad Ashraf

    2010-06-01

    Full Text Available We report here a case of Marjolin’s ulcer developing in a long-standing, inadequately treated, chronic ringworm infestation of the lower limb. A 35-year-old female patient with a ten-year history of a chronic ringworm infest­ation had developed a non-healing ulcer in an area of infestation on the right leg. A biopsy revealed well-differentiated squamous cell carcinoma associated with the ringworm infection. A below-knee amputation followedby an inguinal block dissection was performed. We conclude that proper and timely treatment of fungal infections of the skin is needed to allow for healing of dermal infections and thus the prevention of the disastrous consequences. Recurrent mechanical trauma from scratching of the affected area, leading to occult malignancy, may occur in a small number of patients.

  8. A prospective randomised trial of four-layer versus short stretch compression bandages for the treatment of venous leg ulcers.

    Science.gov (United States)

    Scriven, J M; Taylor, L E; Wood, A J; Bell, P R; Naylor, A R; London, N J

    1998-05-01

    This trial was undertaken to examine the safety and efficacy of four-layer compared with short stretch compression bandages for the treatment of venous leg ulcers within the confines of a prospective, randomised, ethically approved trial. Fifty-three patients were recruited from a dedicated venous ulcer assessment clinic and their individual ulcerated limbs were randomised to receive either a four-layer bandage (FLB)(n = 32) or a short stretch bandage (SSB)(n = 32). The endpoint was a completely healed ulcer. However, if after 12 weeks of compression therapy no healing had been achieved, that limb was withdrawn from the study and deemed to have failed to heal with the prescribed bandage. Leg volume was measured using the multiple disc model at the first bandaging visit, 4 weeks later, and on ulcer healing. Complications arising during the study were recorded. Data from all limbs were analysed on an intention to treat basis; thus the three limbs not completing the protocol were included in the analysis. Of the 53 patients, 50 completed the protocol. At 1 year the healing rate was FLB 55% and SSB 57% (chi 2 = 0.0, df = 1, P = 1.0). Limbs in the FLB arm of the study sustained one minor complication, whereas SSB limbs sustained four significant complications. Leg volumes reduced significantly after 4 weeks of compression, but subsequent volume changes were insignificant. Ulcer healing rates were not influenced by the presence of deep venous reflux, post-thrombotic deep vein changes nor by ulcer duration. Although larger ulcers took longer to heal, the overall healing rates for large (> 10 cm2) and small (10 cm2 or less) ulcers were comparable. Four-layer and short stretch bandages were equally efficacious in healing venous ulcers independent of pattern of venous reflux, ulcer area or duration. FLB limbs sustained fewer complications than SSB. PMID:9682649

  9. Cost-effectiveness of treating vascular leg ulcers with UrgoStart(®) and UrgoCell(®) Contact.

    Science.gov (United States)

    Augustin, Matthias; Herberger, Katharina; Kroeger, Knut; Muenter, Karl C; Goepel, Lisa; Rychlik, Reinhard

    2016-02-01

    Although chronic wounds have a high socio-economic impact, data on comparative effectiveness of treatments are rare. UrgoStart(®) is a hydroactive dressing containing a nano-oligosaccharide factor (NOSF). This study aimed at evaluating the cost-effectiveness of this NOSF-containing wound dressing in vascular leg ulcers compared with a similar neutral foam dressing (UrgoCell(®) Contact) without NOSF. Cost-effectiveness analysis from the perspective of the German statutory health care system was performed using a decision tree model for a period of 8 weeks. Cost and outcome data were derived from the clinical study 'Challenge' suggesting a response rate (≥40% wound size reduction) of UrgoStart(®) of 65·6% versus 39·4% for the comparator. In the treatment model, effect-adjusted costs of €849·86 were generated after 8 weeks for treatment with UrgoStart(®) versus €1335·51 for the comparator resulting in an effect-adjusted cost advantage of €485·64 for UrgoStart(®) . In linear sensitivity analyses, the outcomes were stable for varying assumptions on prices and response rates. In an 8-week period of treatment for vascular leg ulcers, UrgoStart(®) shows superior cost-effectiveness when compared with the similar neutral foam dressing without any active component (NOSF). As demonstrated within a randomised, double-blind clinical trial, UrgoStart(®) is also more effective in wound area reduction than the neutral foam dressing. Wound healing was not addressed in this clinical trial. Follow-up data of 12 months to allow for reulceration assessment were not generated.

  10. Using horsechestnut seed extract in the treatment of venous leg ulcers: a cost-benefit analysis.

    Science.gov (United States)

    Leach, Matthew J; Pincombe, Jan; Foster, Gigi

    2006-04-01

    Venous leg ulcers affect approximately 0.6% of the western population, consuming millions of healthcare dollars every year. To determine whether an alternative venous ulcer treatment using horsechestnut seed extract-- Aesculus hippocastanum-- and conventional therapy involving dressings and compression was more cost-effective than using conventional therapy alone, a 12-week cost-benefit analysis of horsechestnut seed extract therapy was conducted. The study, using data from a 12-week prospective, randomized, placebo-controlled trial conducted in South Australia in 2002-2004, involved 54 patients with venous ulceration who received treatment through a large South Australian district nursing service. Taking into account the cost of horsechestnut seed extract, dressing materials, travel, staff salaries, and infrastructure for each patient, horsechestnut seed extract therapy combined with conventional therapy was found to be more cost-effective than conventional therapy alone with an average savings of AUD 95 in organizational costs and AUD 10 in dressing materials per patient. This study confirms that dressing change frequency has a significant impact on the total cost of wound care and suggests that district nursing service operation efficiency may be enhanced through the use of horsechestnut seed extract as a result of less frequent nursing visits. Further study of this treatment modality is warranted. PMID:16636364

  11. Systematic review of economic evaluations of human cell-derived wound care products for the treatment of venous leg and diabetic foot ulcers

    Directory of Open Access Journals (Sweden)

    Langer Astrid

    2009-07-01

    Full Text Available Abstract Background Tissue engineering is an emerging field. Novel bioengineered skin substitutes and genetically derived growth factors offer innovative approaches to reduce the burden of diabetic foot and venous leg ulcers for both patients and health care systems. However, they frequently are very costly. Based on a systematic review of the literature, this study assesses the cost-effectiveness of these growth factors and tissue-engineered artificial skin for treating chronic wounds. Methods On the basis of an extensive explorative search, an appropriate algorithm for a systematic database search was developed. The following databases were searched: BIOSIS Previews, CRD databases, Cochrane Library, EconLit, Embase, Medline, and Web of Science. Only completed and published trial- or model-based studies which contained a full economic evaluation of growth factors and bioengineered skin substitutes for the treatment of chronic wounds were included. Two reviewers independently undertook the assessment of study quality. The relevant studies were assessed by a modified version of the Consensus on Health Economic Criteria (CHEC list and a published checklist for evaluating model-based economic evaluations. Results Eleven health economic evaluations were included. Three biotechnology products were identified for which topical growth factors or bioengineered skin substitutes for the treatment of chronic leg ulceration were economically assessed: (1 Apligraf®, a bilayered living human skin equivalent indicated for the treatment of diabetic foot and venous leg ulcers (five studies; (2 Dermagraft®, a human fibroblast-derived dermal substitute, which is indicated only for use in the treatment of full-thickness diabetic foot ulcers (one study; (3 REGRANEX® Gel, a human platelet-derived growth factor for the treatment of deep neuropathic diabetic foot ulcers (five studies. The studies considered in this review were of varying and partly low

  12. Multiple bacterial species reside in chronic wounds

    DEFF Research Database (Denmark)

    Gjødsbøl, Kristine; Christensen, Jens Jørgen; Karlsmark, Tonny;

    2006-01-01

    The aim of the study was to investigate the bacterial profile of chronic venous leg ulcers and the importance of the profile to ulcer development. Patients with persisting venous leg ulcers were included and followed for 8 weeks. Every second week, ulcer samples were collected and the bacterial s...

  13. Calcificación distrófica en úlceras de la extremidad inferior Dystrophic calcification in leg ulcers

    Directory of Open Access Journals (Sweden)

    Daniel Chaverri Fierro

    2011-09-01

    Full Text Available La calcificación patológica entendida como depósito anormal de sales de calcio en los tejidos, es un proceso frecuente que ocurre en diversas situaciones patológicas bien conocidas como la hipercalcemia, la insuficiencia renal, el hiperparatiroidismo o en la patología valvular cardíaca. Sin embargo, este fenómeno, es todavía un gran desconocido en el campo de las heridas crónicas a juzgar por la escasa literatura existente al respecto. En este artículo se analiza en detalle este proceso y mostramos nuestra experiencia al respecto en el manejo de esta situación poco frecuente en el paciente con úlceras en la extremidad inferior.The pathological calcification known as an abnormal deposit of calcium salts into the tissues is a frequent process that we can find in several well known pathological situations as hypercalcaemia, renal insufficiency, hyperthyroidism or heart valve disease. However, this phenomenon is still a great unknown in the chronic wounds attending to the few existing literature. In this article we analyze this process in detail and we show our experience in this so infrequent situation in patients with chronic leg ulcers.

  14. Investigation of the effect of deprivation on the burden and management of venous leg ulcers: a cohort study using the THIN database.

    Directory of Open Access Journals (Sweden)

    Emily S Petherick

    Full Text Available There has been limited examination of the contribution of socio-economic factors to the development of leg ulcers, despite the social patterning of many underlying risk factors. No previous studies were found that examined social patterns in the quality of treatment received by patients with leg ulcers.Using The Health Improvement Network (THIN database we identified a cohort of over 14000 patients with a diagnosis of venous leg ulceration, prospectively recorded between the years 2001 and 2006, with linked area-level socio-economic information (Townsend deprivation quintile. We assessed socio-economic differences in the incidence and prevalence of leg ulcers using negative binomial regression. Socio-economic differences in two key areas of guideline recommended leg ulcer management, arterial Doppler assessment and compression bandaging, were assessed using multilevel regression.The risk of incident venous leg ulceration increased for patients living in areas of higher deprivation, even after adjustment for known risk factors age and gender. Overall reported rates of Doppler assessment and provision of compression therapy were low, with less than sixteen per cent of patients having a database record of receiving these recommended diagnostic and treatment options. Patients diagnosed with incident venous leg ulcers living in the most deprived areas were less likely to receive the recommended Doppler-aided assessment for peripheral vascular disease than patients living in the least deprived areas (odds ratio 0.43, 95% confidence interval 0.24-0.78. Documented provision of compression therapy did not vary with deprivation.A socio-economic gradient in venous leg ulcer disease was observed. The overall rates of people with venous leg ulcers who were documented as receiving guideline recommended care (2001-2006 were low. Reported use of Doppler ultrasound assessment was negatively associated with socio-economic status. These findings suggest that the

  15. A Multicenter Randomized Controlled Trial Comparing Treatment of Venous Leg Ulcers Using Mechanically Versus Electrically Powered Negative Pressure Wound Therapy

    OpenAIRE

    Marston, William A.; Armstrong, David G.; Reyzelman, Alexander M.; Kirsner, Robert S.

    2015-01-01

    Objective: This study compares two different negative pressure wound therapy (NPWT) modalities in the treatment of venous leg ulcers (VLUs), the ultraportable mechanically powered (MP) Smart Negative Pressure (SNaP®) Wound Care System to the electrically powered (EP) Vacuum-Assisted Closure (V.A.C.®) System.

  16. Point Injection for 43 Cases of Chronic Ulcerative Colitis

    Institute of Scientific and Technical Information of China (English)

    ZHU Yue-ping

    2003-01-01

    Pishu ( BL 20), Dachangshu ( BL 25), Zusanli (ST 36), and Shangjuxu (ST 37) were selected to treat chronic ulcerative colonitis in 43 cases by point injection with placental tissue fluid and the curative effect was compared with that of west medicine plus enema in 22 cases (control group). It showed that there was a significant difference in short-term total effective rate between the two groups. It suggested that point therapy was effective.

  17. Bidirectional Crosstalk between Stress-Induced Gastric Ulcer and Depression under Chronic Stress

    OpenAIRE

    Shuang Zhang; Zhiwei Xu; Yan Gao; Yonghong Wu; Zhihui Li; Haifeng Liu; Chenggang Zhang

    2012-01-01

    Stress contributes to a variety of diseases and disorders such as depression and peptic ulcer. The present study aimed to investigate the correlation between stress ulcer and depression in pathogenesis and treatment by using chronic stress depression (CSD), chronic psychological stress ulcer (CPSU) and water immersion restrain stress models in rats. Our data showed that the ulcer index of the animals after CSD exposure was significantly higher than that of controls. Depression-like behaviors ...

  18. Restless Legs Syndrome in Patients With Chronic Kidney Disease.

    Science.gov (United States)

    Novak, Marta; Winkelman, John W; Unruh, Mark

    2015-07-01

    Symptoms of restless legs syndrome (RLS) are common in patients with chronic kidney disease (CKD) on dialysis; symptoms of RLS are estimated to affect up to 25% of patients on dialysis when the international RLS diagnostic criteria are applied. RLS is a neurologic disorder with a circadian rhythmicity characterized by an overwhelming urge to move the legs during rest, which can be relieved temporarily by movement. RLS has been associated with an increase in sleep disturbance, higher cardiovascular morbidity, decreased quality of life, and an increased risk of death in patients with CKD. Although the exact pathophysiology of RLS is unknown, it is thought to involve an imbalance in iron metabolism and dopamine neurotransmission in the brain. The symptoms of moderate to severe RLS can be treated with several pharmacologic agents; however, data specific to patients on dialysis with RLS are lacking. The purpose of this article is to examine the relationship between, and complications of, RLS and CKD both in dialysis and nondialysis patients, and discuss the treatment options for patients on dialysis with RLS.

  19. Factors influencing the implementation of a lifestyle counseling program in patients with venous leg ulcers: a multiple case study

    Directory of Open Access Journals (Sweden)

    van de Glind Irene M

    2012-10-01

    Full Text Available Abstract Background Implementation of lifestyle interventions in patient care is a major challenge. Understanding factors that influence implementation is a first step in programs to enhance uptake of these interventions. A lifestyle-counseling intervention, Lively Legs, delivered by trained nurses, can effectively improve the lifestyle in patients with venous leg ulcers. The aim of this study was to identify factors that hindered or facilitated implementation of this intervention in outpatient dermatology clinics and in home care. Methods A mixed-methods multiple case study in five purposefully selected healthcare settings in the Netherlands was conducted. Measurements to identify influencing factors before and after implementation of Lively Legs included interviews, focus groups, questionnaires, and nurses’ registration. Analyses focused on qualitative data as the main data source. All data were compared across multiple cases to draw conclusions from the study as a whole. Results A total of 53 patients enrolled in the Lively Legs program, which was delivered by 12 trained nurses. Barriers for implementation were mainly organizational. It was difficult to effectively organize reaching and recruiting patients for the program, especially in home care. Main barriers were a lack of a standardized healthcare delivery process, insufficient nursing time, and a lack of motivated nurses to deliver the program. Facilitating factors were nurse-driven coordination of care and a standardized care process to tie Lively Legs into, as this resulted in better patient recruitment and better program implementation. Conclusions This study identified a range of factors influencing the implementation of a lifestyle-counseling program, mainly related to the organization of healthcare. Using a case study method proved valuable in obtaining insight into influencing factors for implementation. This study also shed light on a more general issue, which is that leg ulcer

  20. A novel, non-invasive diagnostic clinical procedure for the determination of an oxygenation status of chronic lower leg ulcers using peri-ulceral transcutaneous oxygen partial pressure measurements: Results of its application in chronic venous insufficiency (CVI [Ein neues, nicht-invasives, klinisch-diagnostisches Verfahren zur Ermittlung eines Sauerstoff-Status chronischer Unterschenkelgeschwüre mit peri-ulzeralen transkutanen Sauerstoffpartialdruck-Messungen: Ergebnisse der Anwendungen bei chronisch-venöser Insuffizienz (CVI

    Directory of Open Access Journals (Sweden)

    Barnikol, Wolfgang K. R.

    2012-06-01

    Full Text Available [english]
    The basis for the new procedure is the simultaneous transcutaneous measurement of the peri-ulceral oxygen partial pressure (tcPO, using a minimum of 4 electrodes which are placed as close to the wound margin as possible, additionally, as a challenge the patient inhales pure oxygen for approximately 15 minutes. In order to evaluate the measurement data and to characterise the wounds, two new oxygen parameters were defined: (1 the oxygen characteristic (K-PO, and (2 the oxygen inhomogeneity (I-PO of a chronic wound. The first of these is the arithmetic mean of the two lowest tcPO measurement values, and the second is the variation coefficient of the four measurement values. Using the K-PO parameter, a grading of wound hypoxia can be obtained. To begin with, the physiologically regulated (and still compensated hypoxia with K-PO values of between 35 and 40 mmHg is distinguished from the pathological decompensated hypoxia with K-PO values of between 0 and 35 mmHg; the first of these still stimulates self-healing (within the limits of the oxygen balance. The decompensated hypoxia can be (arbitrarily divided into “simple” hypoxia (Grade I, intense hypoxia (Grade II and extreme hypoxia (Grade III, with the possibility of intermediate grades (I/II and II/III.Measurements were carried out using the new procedure on the skin of the right inner ankle of 21 healthy volunteers of various ages, and in 17 CVI (chronic venous insufficiency wounds. Sixteen of the 17 CVI wounds (i.e., 94% were found to be pathologically hypoxic, a state which was not found in any of the healthy volunteers. The oxygen inhomogeneity (I-PO of the individual chronic wounds increased exponentially as a function of the hypoxia grading (K-PO, with a 10-fold increase with extreme hypoxia in contrast to a constant value of approximately 14% in the healthy volunteers. This pronounced oxygen inhomogeneity explains inhomogeneous wound healings, resulting in the so

  1. Keratinocyte Migration, Proliferation, and Differentiation in Chronic Ulcers From Patients With Diabetes and Normal Wounds

    OpenAIRE

    Usui, Marcia L.; Mansbridge, Jonathan N.; Carter, William G.; Fujita, Mayumi; Olerud, John E

    2008-01-01

    Epithelialization of normal acute wounds occurs by an orderly series of events whereby keratinocytes migrate, proliferate, and differentiate to restore barrier function. The keratinocytes in the epidermis of chronic ulcers fail to execute this series of events. To better understand the epithelial dynamics of chronic ulcers, we used immunohistochemistry to evaluate proliferation, differentiation, adhesion, and migration in keratinocytes along the margin of chronic ulcers from patients with dia...

  2. A review of the relationship between leg power and selected chronic disease in older adults

    DEFF Research Database (Denmark)

    Strollo, S. E.; Caserotti, Paolo; Ward, R. E.;

    2015-01-01

    OBJECTIVE: This review investigates the relationship between leg muscle power and the chronic conditions of osteoarthritis, diabetes mellitus, and cardiovascular disease among older adults. Current literature assessing the impact of chronic disease on leg power has not yet been comprehensively...... characterized. Importantly, individuals with these conditions have shown improved leg power with training. METHODS: A search was performed using PubMed to identify original studies published in English from January 1998 to August 2013. Leg power studies, among older adults ≥ 50 years of age, which assessed......), diabetes mellitus (n=5), and cardiovascular disease (n=6). Studies generally supported associations of lower leg power among older adults with chronic disease, although small sample sizes, cross-sectional data, homogenous populations, varied disease definitions, and inconsistent leg power methods limited...

  3. 生肌玉红膏促进下肢慢性溃疡肉芽生长257例的临床多中心对照研究%Estimation of Granulation Growth by Scores System on the Treatment of 257 Cases of Chronic Lower Leg Ulcer Patients with Traditional Chinese Medicine of ShengJi Yuhong Gao: A Multicenter, Double-blinded RCT

    Institute of Scientific and Technical Information of China (English)

    王江涛; 张晓清; 姚昶

    2012-01-01

      Objective A multicenter, double-blinded RCT study was designed to provide the type 2 clinical evidence of Traditional Chinese Medicine of ShengJi Yuhong Gao on the treatment of chronic lower leg ulcer by total therapeutic effect judgement and lower leg measure tool scores system. Methods 257 cases of chronic lower leg ulcer patients were applied randomly on the experimental and controlled groups by the third institute of data management, followed by the standardized clinical pathway of eliminating necrotic tissues, external applying of ShengJi Yuhong Gao or the blinded-controlled agency of petrolatum oil gauze on the wound and filled out all the records on each designed clinical report case. All results were transported to the data management through web instantly after the case finished. The data were disclosed under supervising by the third institute of data management and the results were analyzed afterwards. Results After unblinding, there are accordant distributions on the gender composition, etiology, the course, wound part and the area of wound. The healing rates of experimental group were up to 28.46% as well as the positive effective rates of 46.34%, comparing to the control group which only reached to one-third percentage of experimental group with P value of less than 0.0001. The growing situations of wound granulation evaluated by lower leg measure tool scores system showed that the modification of wound color changed earlier than the proliferation of wound granulation. After 14 days of treatment, the proliferation scores of wound granulation in the experimental group were significant better than the results of control group with P value less than 0.05, whereas of experimental group showed better results than those of control group as early as 7 days of treatment with P value less than 0.03. Conclusion The effects of improving wound healing of chronic lower leg ulcer by way of topical applying with Shengj Yuhong Gao are significant. The medicine

  4. Exostectomy for chronic midfoot plantar ulcer in Charcot deformity

    DEFF Research Database (Denmark)

    Laurinaviciene, R.; Kirketerp-Moeller, K.; Holstein, Per Evald

    2008-01-01

    Charcot midfoot ulcers are rare and very difficult to heal, with surgery being an option. This retrospective study assessed healing rates, complications, and the incidence of re-ulceration and other foot ulcer problems following exostectomies Udgivelsesdato: 2008/2...

  5. 77 FR 24718 - Scientific Information Request on Chronic Venous Ulcers Treatments

    Science.gov (United States)

    2012-04-25

    ... HUMAN SERVICES Agency for Healthcare Research and Quality Scientific Information Request on Chronic... for Scientific Information Submissions. SUMMARY: The Agency for Healthcare Research and Quality (AHRQ) is seeking scientific information submissions from manufacturers of chronic venous ulcer...

  6. Objective evaluation for venous leg ulcer-related nociceptive pain using thermography

    Directory of Open Access Journals (Sweden)

    Goto T

    2014-08-01

    Full Text Available Taichi Goto,1 Ayumi Naito,1,2 Nao Tamai,1 Gojiro Nakagami,1 Makoto Mo,3 Hiromi Sanada1 1Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan; 2Fujisawa City Hospital, Fujisawa, Kanagawa, Japan; 3Department of Cardiovascular Surgery, Yokohama Minami Kyosai Hospital, Yokohama, Kanagawa, Japan Purpose: We aimed to identify distinguishing characteristics in thermographic images of venous leg ulcer (VLU, for objective evaluation of VLU-related nociceptive pain. Patients and methods: Secondary analysis was performed, using existing data obtained from April to November 2010, for patients with VLU. Thermographic images of wounds and their surrounding area were classified according to the periwound temperature pattern as "normal temperature" or "high temperature". These results were compared with the self-reported pain intensity assessed by the short-form McGill Pain Questionnaire. Cohen's kappa coefficients were used to evaluate the interrater reliability for temperature assessment, and Wilcoxon rank sum test was used to compare pain intensities between the two groups. Results: Among 39 thermographic examinations in eight patients, 22 were classified into the high-temperature group and 17 into the normal-temperature group. Kappa coefficients for the temperature classification were 0.90 between the wound, ostomy, and continence nurse and a wound care specialist, and 0.90 between the wound, ostomy, and continence nurse and a graduate student. The pain rating index (Z=−2.981, P=0.003, sensory pain (Z=−3.083, P=0.002, affective pain (Z=−2.764, P=0.006, and present pain intensity (Z=−2.639, P=0.006 ratings were significantly higher in the high-temperature group than in the normal-temperature group, but the visual analog scale (Z=−0.632, P=0.527 was not significantly different between the two groups. Conclusion: Thermographic pattern may reflect VLU

  7. A retrospective, quality improvement review of maggot debridement therapy outcomes in a foot and leg ulcer clinic.

    Science.gov (United States)

    Campbell, Noreen; Campbell, Donna

    2014-07-01

    Maggot debridement is the deliberate use of larvae known to consume only necrotic tissue. A retrospective quality improvement analysis of maggot debridement therapy (MDT) was conducted among patients with devitalized tissue or gangrene attending a Canadian foot and leg ulcer clinic who received MDT between January 2001 and June 2006. MDT was applied every 48 hours until >90% of necrotic tissue was debrided. The authors identified MDT patients in the clinic database and reviewed their medical records for age, gender, presence of diabetes or peripheral arterial disease (PAD), type of wound, number of maggot applications required, wound outcomes, and nursing visit costs (week before, during, and after MDT) and noted patient experiences. Records of 68 patients (average age 71, range 22 to 95, years) were identified and abstracted. Of those, 44% had leg ulcers and 67% had both diabetes and PAD. The majority (39, 58%) of wounds required three debridement sessions. All but one patient achieved debridement of >90% of necrotic tissue in 2 to 10 days. Most wounds (56) healed with follow-up moist wound care. Only one patient withdrew from MDT. No other patient or safety concerns were documented. Total nursing visits for all patients the week before and then after MDT were 307 and 102, respectively. These findings confirm results of previous reports about the effectiveness of MDT for wound debridement. Randomized, controlled clinical studies are needed to confirm the efficacy and cost-effectiveness of MDT compared to other debridement modalities.

  8. Nursing diagnoses in patients with chronic venous ulcer: observational study

    Directory of Open Access Journals (Sweden)

    Glycia de Almeida Nogueira

    2015-06-01

    Full Text Available This study aimed to analyze nursing diagnoses in people with chronic venous ulcer. An observational, descriptive, quantitative research conducted in an ambulatory specialized in wound treatment, with a non-probabilistic sample of 20 patients.  Data collection was performed in an institutional form denominated Assessment Protocol for Clients with Tissue Lesions. Diagnoses were established by consensus among four researchers with experience in nursing diagnoses and wound treatments. From data analysis, 16 diagnoses were identified, with 100% of participants presenting: Impaired tissue integrity, Ineffective peripheral tissue perfusion, Risk of infection, Impaired physical mobility and Ineffective health self-control. These diagnoses are found in Safety/Protection, Activity/Rest and Health promotion domains, which from the clinical practice stand point should be priority focuses in nursing intervention and assessment.

  9. Genetic alterations in benign lesions: Chronic gastritis and gastric ulcer

    Institute of Scientific and Technical Information of China (English)

    Ana Cristina Gobbo César; Marília de Freitas Calmon; Patrícia Maluf Cury; Alaor Caetano; Aldenis Albaneze Borim; Ana Elizabete Silva

    2006-01-01

    AIM: To investigate the occurrence of chromosome 3, 7,8, 9, and 17 aneuploidies, TP53 gene deletion and p53 protein expression in chronic gastritis, atrophic gastritis and gastric ulcer, and their association with H pylori infection.METHODS: Gastric biopsies from normal mucosa (NM,n = 10), chronic gastritis (CG,n =38), atrophic gastritis (CAG, n=13) and gastric ulcer (GU, n = 21) were studied using fluorescence in situ hybridization (FISH) and immunohistochemical assay. A modified Giemsa staining technique and PCR were used to detect H pylori. An association of the gastric pathologies and aneuploidies with H pylori infection was assessed.RESULTS: Aneuploidies were increasingly found from CG (21%) to CAG (31%) and to GU (62%), involving mainly monosomy and trisomy 7, trisomies 7 and 8, and trisornies 7, 8 and 17, respectively. A significant association was found between H pylori infection and aneuploidies in CAG (P= 0.0143) and GU (P= 0.0498). No TP53 deletion was found in these gastric lesions, but p53-positive immunoreactivity was detected in 45% (5/11) and 12% (2/17) of CG and GU cases, respectively. However, there was no significant association between p53 expression and H pylori infection.CONCLUSION: The occurrence of aneuploidies in benign lesions evidences chromosomal instability in early stages of gastric carcinogenesis associated with H pylori infection, which may confer proliferative advantage. The increase of p53 protein expression in CG and GU may be due to overproduction of the wild-type protein related to an inflammatory response in mucosa.

  10. Chronic Venous Disease under pressure

    NARCIS (Netherlands)

    S.W.I. Reeder (Suzan)

    2013-01-01

    textabstractIn chapter 1 we provide a general introduction of this thesis. Chronic venous disease (CVD) is a common medical condition that affects 2-64% of the worldwide population and leads to leg ulcers in 1% of the Western population. Venous leg ulceration (VLU) has an unfavorable prognosis with

  11. EP4 agonist alleviates indomethacin-induced gastric lesions and promotes chronic gastric ulcer healing

    Institute of Scientific and Technical Information of China (English)

    Guang-Liang Jiang; Wha Bin Im; Yariv Donde; Larry A Wheeler

    2009-01-01

    AIM: To investigate EP4-selective agonist effect on indomethacin-induced gastric lesions and on the spontaneous healing of chronic gastric ulcers. METHODS: In a mouse model of gastric bleeding with high dose of indomethacin (20 mg/kg), an EP4-selective agonist was administered orally. Stomach lesions and gastric mucous regeneration were monitored. In a mouse model of chronic gastric ulcer induced by acetic acid, EP4 agonist effect on the healing of chronic gastric ulcer was evaluated in the presence or absence of low dose indomethacin (3 mg/kg). In cultured human gastric mucous cells, EP4 agonist effect on indomethacininduced apoptosis was assessed by flow cytometry. RESULTS: The EP4-selective agonist reduced high dose indomethacin-induced acute hemorrhagic damage and promoted mucous epithelial regeneration. Low-dose indomethacin aggravated ulcer bleeding and inflammation, and delayed the healing of the established chronic gastric ulcer. The EP4 agonist, when applied locally, not only offset indomethacin-induced gastric bleeding and inflammation, but also accelerated ulcer healing. In the absence of indomethacin, the EP4 agonist even accelerated chronic gastric ulcer healing and suppressed inflammatory cell infiltration in the granulation tissue. In vitro , the EP4 agonist protected human gastric mucous cells from indomethacin-induced apoptosis. CONCLUSION: EP4-selective agonist may prevent indomethacin-induced gastric lesions and promote healing of existing and indomethacin-aggravated gastric ulcers, via promoting proliferation and survival of mucous epithelial cells.

  12. Glucose metabolism in chronic diabetic foot ulcers measured in vivo using microdialysis

    DEFF Research Database (Denmark)

    Simonsen, L; Holstein, P; Larsen, K;

    1998-01-01

    Ten subjects with diabetes mellitus and unilateral chronic foot ulcer were investigated. Local tissue concentrations of glucose and lactate were measured using the microdialysis method at a distance of 0.5-1 cm from the edge of the ulcer and in normal skin in the contralateral foot. Subcutaneous ...

  13. Targeting Cx43 and N-cadherin, which are abnormally upregulated in venous leg ulcers, influences migration, adhesion and activation of Rho GTPases.

    Directory of Open Access Journals (Sweden)

    Ariadna Mendoza-Naranjo

    Full Text Available BACKGROUND: Venous leg ulcers can be very hard to heal and represent a significant medical need with no effective therapeutic treatment currently available. PRINCIPAL FINDINGS: In wound edge biopsies from human venous leg ulcers we found a striking upregulation of dermal N-cadherin, Zonula Occludens-1 and the gap junction protein Connexin43 (Cx43 compared to intact skin, and in stark contrast to the down-regulation of Cx43 expression seen in acute, healing wounds. We targeted the expression of these proteins in 3T3 fibroblasts to evaluate their role in venous leg ulcers healing. Knockdown of Cx43 and N-cadherin, but not Zonula Occludens-1, accelerated cell migration in a scratch wound-healing assay. Reducing Cx43 increased Golgi reorientation, whilst decreasing cell adhesion and proliferation. Furthermore, Connexin43 and N-cadherin knockdown led to profound effects on fibroblast cytoskeletal dynamics after scratch-wounding. The cells exhibited longer lamelipodial protrusions lacking the F-actin belt seen at the leading edge in wounded control cells. This phenotype was accompanied by augmented activation of Rac-1 and RhoA GTPases, as revealed by Förster Resonance Energy Transfer and pull down experiments. CONCLUSIONS: Cx43 and N-cadherin are potential therapeutic targets in the promotion of healing of venous leg ulcers, by acting at least in part through distinct contributions of cell adhesion, migration, proliferation and cytoskeletal dynamics.

  14. Goal setting and lifestyle changes in a nurse-led counselling programme for leg ulcer patients: an explorative analysis of nursing records.

    NARCIS (Netherlands)

    Glind, I.M. van de; Heinen, M.M.; Evers, A.W.; Achterberg, T. van

    2015-01-01

    AIMS AND OBJECTIVES: To describe goals set in individual nurse-led lifestyle counselling sessions in leg ulcer patients, and to explore patient and goal characteristics in relation to health behaviour change. BACKGROUND: Goal setting is increasingly used in nurse-led counselling programmes, but the

  15. Crossectomy and Foam Sclerotherapy of the Great Saphenous Vein versus Stripping of Great Saphenous Vein and Varicectomy in the Treatment of the Legs Ulcers

    Directory of Open Access Journals (Sweden)

    Alvaro Delgado-Beltran

    2013-01-01

    Full Text Available Objective. To show our results in the surgical treatment of legs varicose ulcers, with crossectomy and foam sclerotherapy (CAFE of the great saphenous vein (GSV in group I and stripping of GSV and varicectomy in group II. Methods. 35 patients with active venous leg ulcers were recruited and treated. They were collected in two groups. Group I were treated by crossectomy and foam sclerotherapy of the GSV and group II were treated by stripping of GSV and varicectomy. The healing time of the ulcer and the complications were recorded after the procedure in the follow-up visits. Results. 29 out of the 35 patients completed the follow-up. There were eight cases of incomplete healing of the leg ulcer, 4 in group I (19.04% and 4 in group II (40%, P<0.05. The average rate of healing in group I was 0.38 cm/day and 0.13 in group II, P<0.05. Conclusion. CAFE technique of the great saphenous vein in the treatment of 6 CEAP patients is a procedure that improves the rate of ulcer healing as compared to these two groups. It is a safe and reliable minimally invasive method, with less morbidity.

  16. Epidemiology of chronic wound patients and relation to serum levels of mannan-binding lectin

    DEFF Research Database (Denmark)

    Bitsch, Mikael; Laursen, Inga; Engel, Anne-Mari;

    2009-01-01

    consecutive patients with chronic foot and leg ulcers. A clinical classification of wound- aetiology was performed, and mannan-binding lectin was measured in the sera of patients and healthy controls. The patients presented with 639 wounds altogether; diabetic foot ulcers (309), venous leg ulcers (188...

  17. Expression of natural antimicrobial peptide β-defensin-2 and Langerhans cell accumulation in epidermis from human non-healing leg ulcers

    Directory of Open Access Journals (Sweden)

    Urszula Wojewodzka

    2011-08-01

    Full Text Available Chronic wounds like venous calf and diabetic foot ulcers are frequently contaminated and colonized by bacteria and it remains unclear whether there is sufficient expression of defensins and recruitment of epidermal Langerhans cells in the margin of ulcer compared to normal skin. The aim of this study was to examine immunohistochemically the expression of β-defensin-2 (hBD2, GM-CSF, VEGF growth factors and accumulation of CD1a+ Langerhans cells (LC in epidermis from chronic skin ulcers and to compare it to normal skin from the corresponding areas. Studies were carried out in 10 patients with diabetic foot, 10 patients with varicous ulcers of the calf and 10 patients undergoing orthopedic surgery (normal skin for control. Biopsy specimens were immunostained using specific primary antibodies, LSAB+ kit based on biotin-avidinperoxidase complex technique and DAB chromogen. Results were expressed as a mean staining intensity. Statistical analysis of staining showed significantly higher staining of hBD2 in both normal and ulcerated epidermis from foot sole skin compared to calf skin (normal and ulcerated, p<0.05. Chronic ulcers showed the same expression of hBD2 as normal skin. There was significantly lower accumulation of CD1a+ LC in normal epidermis from foot sole skin compared to normal calf skin (p<0.05. Accumulation of CD1a+ LC and GM-CSF upregulation at the border area of diabetic foot ulcer and reduction of LC concentration at the margin of venous calf ulcer compared to normal skin were observed. It seems that normal calf and sole epidermis is, unlike in the mechanisms of innate immunity, influenced by the different keratinocyte turnover and bacterial flora colonizing these regions. Insufficient upregulation of hBD2 in both diabetic foot and venous calf ulcers may suggest the pathological role of this protein in the chronicity of ulcers.

  18. Topical Administration of Pirfenidone Increases Healing of Chronic Diabetic Foot Ulcers: A Randomized Crossover Study

    Directory of Open Access Journals (Sweden)

    Marcela Janka-Zires

    2016-01-01

    Full Text Available Only 30 percent of chronic diabetic foot ulcers heal after 20 weeks of standard treatment. Pirfenidone is a drug with biological, anti-inflammatory, and antifibrotic effects. The aim of this study was to evaluate the effect of topical pirfenidone added to conventional treatment in noninfected chronic diabetic foot ulcers. This was a randomized crossover study. Group 1 received topical pirfenidone plus conventional treatment for 8 weeks; after this period, they were switched to receive conventional treatment only for 8 more weeks. In group 2, the order of the treatments was the opposite. The end points were complete ulcer healing and size reduction. Final data were obtained from 35 ulcers in 24 patients. Fifty-two percent of ulcers treated with pirfenidone healed before 8 weeks versus 14.3% treated with conventional treatment only (P=0.025. Between 8 and 16 weeks, 30.8% ulcers that received pirfenidone healed versus 0% with conventional treatment (P=0.081. By week 8, the reduction in ulcer size was 100% [73–100] with pirfenidone versus 57.5% with conventional treatment [28.9–74] (P=0.011. By week 16, the reduction was 93% [42.7–100] with pirfenidone and 21.8% [8–77.5] with conventional treatment (P=0.050. The addition of topical pirfenidone to conventional treatment significantly improves the healing of chronic diabetic noninfected foot ulcers.

  19. Topical Administration of Pirfenidone Increases Healing of Chronic Diabetic Foot Ulcers: A Randomized Crossover Study

    Science.gov (United States)

    Janka-Zires, Marcela; Uribe-Wiechers, Ana Cecilia; Juárez-Comboni, Sonia Citlali; López-Gutiérrez, Joel; Escobar-Jiménez, Jarod Jazek; Gómez-Pérez, Francisco J.

    2016-01-01

    Only 30 percent of chronic diabetic foot ulcers heal after 20 weeks of standard treatment. Pirfenidone is a drug with biological, anti-inflammatory, and antifibrotic effects. The aim of this study was to evaluate the effect of topical pirfenidone added to conventional treatment in noninfected chronic diabetic foot ulcers. This was a randomized crossover study. Group 1 received topical pirfenidone plus conventional treatment for 8 weeks; after this period, they were switched to receive conventional treatment only for 8 more weeks. In group 2, the order of the treatments was the opposite. The end points were complete ulcer healing and size reduction. Final data were obtained from 35 ulcers in 24 patients. Fifty-two percent of ulcers treated with pirfenidone healed before 8 weeks versus 14.3% treated with conventional treatment only (P = 0.025). Between 8 and 16 weeks, 30.8% ulcers that received pirfenidone healed versus 0% with conventional treatment (P = 0.081). By week 8, the reduction in ulcer size was 100% [73–100] with pirfenidone versus 57.5% with conventional treatment [28.9–74] (P = 0.011). By week 16, the reduction was 93% [42.7–100] with pirfenidone and 21.8% [8–77.5] with conventional treatment (P = 0.050). The addition of topical pirfenidone to conventional treatment significantly improves the healing of chronic diabetic noninfected foot ulcers. PMID:27478849

  20. Role of free tissue transfer in management of chronic venous ulcer

    Directory of Open Access Journals (Sweden)

    Reddy K

    2004-01-01

    Full Text Available Most of the venous ulcers will heal with the treatment of primary venous problem. But a few patients will have refractory, recurrent chronic venous ulcers causing inconvenience to the patients in terms of loss of productive working hours. There is no standard method available for treatment of this chronic problem. Our modality of treatment includes wide excision of ulcer, ligation of incompetent perforators and coverage of defect with well vascularized tissue by free tissue transfer. We have analyzed this form of treatment in five patients with satisfactory result.

  1. Tryptophan free diet delays healing of chronic gastric ulcers in rat.

    Science.gov (United States)

    Konturek, P C; Burnat, G; Brzozowski, T; Zopf, Y; Konturek, S J

    2008-08-01

    Melatonin (MT) is an ubiquitous molecule, representing one of the phylogenetically oldest signaling mechanisms. Our previous studies demonstrated that MT and its precursor L-tryptophan (L-Trp) show strong protective effect on gastric mucosa. The aim of the present study was: 1) to assess the effect of MT and L-Trp on healing of chronic gastric ulcer and accompanying changes in gastric mucosal blood flow (GBF); 2) to study the effect of MT and L-Trp on expression of iNOS. cNOS and HSP70 in ulcerated mucosa; 3) to compare the effect of L-Trp free and L-Trp rich diet on ulcer healing and gene expression of proinflammatory cytokines such as tumor necrosis factor-alpha (TNF-alpha), superoxide dismutase (SOD), cyclooxygenase-2 (COX-2) and NFkappaB-p65 protein expression in ulcer area and intact non-ulcerated. Chronic ulcers were induced in Wistar rats by Okabe's modification of acetic acid method. Rats with chronic gastric ulcers were divided in following treatment groups: 1) vehicle (saline); 2) MT (20mg/kg-d i.p.) and 3) L-Trp (100 mg/kg i.p.). The expression of iNOS, cNOS and HSP70 protein was measured by Western blot. In separate experiments, the influence of commercially available (Bio-Serv, USA) L-Trp free diet (TFD) was compared to the L-Trp rich diet (TRD) on the course of ulcer healing was assessed. The ulcer area was measured by planimetry. The expression of TNFalpha, COX-2 and SOD mRNA in ulcerated mucosa was analyzed by RT-PCR method. MT and its precursor L-Trp significantly accelerated ulcer healing. Healing ulcerated mucosa showed increased protein expression of iNOS and HSP70 as compared to intact gastric mucosa. TFD in contrast to normal diet significantly attenuated the ulcer healing, whereas the TRD exerted opposite effects and significantly accelerated ulcer healing. This last effect was accompanied by significant decrease of TNF-alpha mRNA expression and expression of NFkB-p65 in gastric mucosa. We conclude that: 1) MT and its precursor L

  2. The Canadian Bandaging Trial: Evidence-informed leg ulcer care and the effectiveness of two compression technologies

    Directory of Open Access Journals (Sweden)

    Hopman Wilma M

    2011-10-01

    Full Text Available Abstract Background Objective: To determine the relative effectiveness of evidence-informed practice using two high compression systems: four-layer (4LB and short-stretch bandaging (SSB in community care of venous leg ulcers. Design and Setting: Pragmatic, multi-centre, parallel-group, open-label, randomized controlled trial conducted in 10 centres. Cognitively intact adults (≥18 years referred for community care (home or clinic with a venous ulceration measuring ≥0.7cm and present for ≥1 week, with an ankle brachial pressure index (ABPI ≥0.8, without medication-controlled Diabetes Mellitus or a previous failure to improve with either system, were eligible to participate. Methods Consenting individuals were randomly allocated (computer-generated blocked randomization schedule to receive either 4LB or SSB following an evidence-informed protocol. Primary endpoint: time-to- healing of the reference ulcer. Secondary outcomes: recurrence rates, health-related quality of life (HRQL, pain, and expenditures. Results 424 individuals were randomized (4LB n = 215; SSB n = 209 and followed until their reference ulcer was healed (or maximum 30 months. An intent-to-treat analysis was conducted on all participants. Median time to ulcer healing in the 4LB group was 62 days [95% confidence interval (CI 51 to 73], compared with 77 days (95% CI 63 to 91 in the SSB group. The unadjusted Kaplan-Meier curves revealed the difference in the distribution of cumulative healing times was not significantly different between group (log rank χ2 = 0.001, P = 0.98 nor ulcers recurrence (4LB, 10.1%; SSB, 13.3%; p = 0.345. Multivariable Cox Proportional Hazard Modeling also showed no significant between-bandage differences in healing time after controlling for significant covariates (p = 0.77. At 3-months post-baseline there were no differences in pain (no pain: 4LB, 22.7%; SSB, 26.7%; p = 0.335, or HRQL (SF-12 Mental Component Score: 4LB, 55.1; SSB, 55.8; p = 0.615; SF

  3. Amelogenin, an extracellular matrix protein, in the treatment of venous leg ulcers and other hard-to-heal wounds: Experimental and clinical evidence  ||FREE PAPER||

    Directory of Open Access Journals (Sweden)

    Marco Romanelli

    2008-06-01

    Full Text Available Marco Romanelli1, Valentina Dini1, Peter Vowden2, Magnus S Ågren31Department of Dermatology, University of Pisa, Pisa, Italy; 2Vascular Unit, Bradford Royal Infirmary, Bradford, United Kingdom; 3Department of Surgery K, Bispebjerg Hospitals, Copenhagen University Hospital, Copenhagen, DenmarkAbstract: Amelogenins are extracellular matrix proteins that, under physiological conditions, self-assemble into globular aggregates up to micron-sizes. Studies with periodontal fibroblasts indicate that attachment to these structures increases the endogenous secretion of multiple growth factors and cell proliferation. Pre-clinical and clinical studies indicate that cutaneous wounds benefit from treatment with amelogenins. A randomized controlled trial (RCT involving patients with hard-to-heal venous leg ulcers (VLUs (ie, ulcers with a surface area ≥10 cm2 and duration of ≥6 months showed that the application of amelogenin (Xelma®, Molnlycke Health Care, Gothenburg, Sweden as an adjunct treatment to compression results in significant reduction in ulcer size, improvement in the state of ulcers, reduced pain, and a larger proportion of ulcers with low levels of exudate, compared with treatment with compression alone. Amelogenin therapy was also shown to be safe to use in that there were no significant differences in adverse events noted between patients treated with amelogenin plus compression and those treated with compression alone. Case study evaluations indicate that the benefits of amelogenin therapy demonstrated in the RCT are being repeated in “real life” situations and that amelogenin therapy may also have a role to play in the treatment of other wound types such as diabetic foot ulcers.Keywords: extracellular matrix, amelogenin, venous leg ulcers, diabetic foot ulcers, pyoderma gangrenosum

  4. Predictors of diabetic foot and leg ulcers in a developing country with a rapid increase in the prevalence of diabetes mellitus.

    Directory of Open Access Journals (Sweden)

    Kumarasinghe A Sriyani

    Full Text Available OBJECTIVE: To identify the socio demographic, life style and foot examination related predictors of diabetic foot and leg ulcers with a view to develop a screening tool appropriate for the use in an outpatient setting. RESEARCH DESIGN AND METHODS: This cross sectional study included type 2 diabetes mellitus (DM patients; 88 subjects with leg and foot ulcers and 80 non ulcer controls. Socio demographic data and life style factors were documented. Foot was examined for skin changes and structural abnormalities. Distal peripheral neuropathy was assessed by pressure sense, vibration sense and joint position sense. Multivariate analysis by logistic regression was used to determine the significant predictors in screening for foot ulcers. RESULTS: Education of grade 6 and below (OR--1.41, 95% CI; 1.03-4.68, low income (OR--23.3, 95% CI; 1.5-34.0, impaired vibration sense (OR--24.79, 95% CI; 9.3-66.2, abnormal monofilament test on first (OR--1.69, 95% CI; 1.36-16.6, third (OR--3.4, 95% CI; 1.1-10.6 and fifth (OR--1.8, 95% CI; 1.61-12.6 toes are found to be predictors of increased risk whereas incidental diagnosis of DM (OR--0.03, 95% CI; 0.003-0.28, wearing covered shoes (OR--0.003, 95% CI; 0.00-0.28, presence of normal skin color (OR--0.01, 95% CI; 0.001-0.14 and normal monofilament test on first metatarsal head (OR--0.10, 95% CI; 0.00-0.67 are protective factors for ulcers. CONCLUSIONS: Ten independent risk and protective factors identified in this study are proposed as a simple screening tool to predict the risk of developing leg and foot ulcers in patients with DM.

  5. Economic benefit of a polyacrylate-based hydrogel compared to an amorphous hydrogel in wound bed preparation of venous leg ulcers

    Directory of Open Access Journals (Sweden)

    Kaspar D

    2015-04-01

    Full Text Available Daniela Kaspar,1 Jörg Linder,1 Petra Zöllner,1 Ulrich Simon,2 Hans Smola1,31Medical Competence Centre, Paul Hartmann AG, Heidenheim, Germany; 2Scientific Computing Centre, Ulm University, Ulm, Germany; 3Department of Dermatology, University of Cologne, Cologne, GermanyObjective: To assess the cost-effectiveness of a polyacrylate (PA-based hydrogel compared to an amorphous hydrogel in wound bed preparation for venous leg ulcers.Method: A cost-effectiveness analysis was undertaken alongside a multicenter, randomized controlled trial performed in France. A total of 75 patients with venous leg ulcers extensively covered with fibrin and necrotic tissue were randomized to a PA-containing hydrogel or an amorphous hydrogel. Wounds were treated for 14 days and costs were estimated from the German payer's perspective. Medical costs included study treatment, wound treatment supply, and labor time. The clinical benefit was expressed as the number of patients with wounds >50% covered with granulation tissue within 14 days. The incremental cost-effectiveness ratio (ICER was expressed as the additional cost spent with >50% granulation tissue per day per patient within 14 days of leg ulcer care.Results: Because of individual pricing of wound dressings in hospitals, cost data were derived from the outpatient sector. A total of 33 patients were treated using the PA-based hydrogel and 37 patients using the amorphous hydrogel. The estimated total direct costs per patient and per 14 days of therapy were €306 for both treatment groups. However, with the PA-based hydrogel, 2.5 additional days with wounds covered >50% with granulation tissues were gained within 14 days of leg ulcer care compared to the comparator. The ICER was €0 per additional day spent with >50% granulation tissue.Conclusion: Although there were a greater number of dressing changes in the PA-based hydrogel treatment, the total treatment cost for 14 days of leg ulcer care was the same for both

  6. Iron status and chronic kidney disease predict restless legs syndrome in an older hospital population.

    LENUS (Irish Health Repository)

    Quinn, Colin

    2011-03-01

    Iron deficiency is important in the pathogenesis of restless legs syndrome (RLS), and serum ferritin measurement, using a cutoff of 45-50ng\\/ml, is widely recommended as the optimal screening test for iron deficiency in RLS. Serum ferritin often increases with inflammation, and a higher cutoff may be better in those with acute and chronic inflammatory conditions, including those with chronic kidney disease (CKD).

  7. Effect of sialoadenectomy and synthetic human urogastrone on healing of chronic gastric ulcers in rats

    DEFF Research Database (Denmark)

    Poulsen, Steen Seier; Nexø, Ebba

    1986-01-01

    The effect of extirpation of the submandibular glands, an exocrine organ for epidermal growth factor/urogastrone (EGF/URO), and the effect of oral administration of synthetic human (EGF/URO) on healing of chronic gastric ulcers in rats has been investigated. Removal of the submandibular glands...... delayed healing of chronic gastric ulcers when examined after 50, 100, and 200 days. Oral administration of synthetic human EGF/URO stimulated gastric ulcer healing when examined after 25 and 50 days of treatment. The effect of synthetic human EGF/URO was comparable with that of cimetidine. The combined...... administration of synthetic human EGF/URO and cimetidine further increased healing of gastric ulcers compared with administration of each substance. Neither synthetic human EGF/URO, nor removal of the submandibular glands had any influence on gastric acid secretion. This study showed that the submandibular...

  8. Intervention with Formulated Collagen Gel for Chronic Heel Pressure Ulcers in Older Adults with Diabetes.

    Science.gov (United States)

    Agosti, Jennifer K; Chandler, Lois A

    2015-11-01

    Chronic pressure ulcers (PrUs), ulcers that fail to progress through the expected phases of wound healing in a timely fashion, are not only a concern for the patients afflicted with them, but are also a significant burden for the long-term-care facilities in which patients reside. The heel is the second most common location for PrUs. Morbidity and mortality rates for heel PrUs, particularly in the diabetic population, are alarming. Therefore, a consistently effective, cost-conscious, and user-friendly topical treatment for heel ulcers would be welcomed by patients and clinicians. This article describes a marked and rapid improvement in wound granulation in 3 older adult patients following weekly treatment for 8 weeks of chronic (≥1-year duration) heel ulcers with an easy-to-use, cost-effective, topical, formulated collagen gel. PMID:26479694

  9. Citric acid treatment of chronic nonhealing ulcerated tophaceous gout with bursitis.

    Science.gov (United States)

    Nagoba, Basavaraj S; Punpale, Ajay; Poddar, Ashok; Suryawanshi, Namdev M; Swami, Ganesh A; Selkar, Sohan P

    2013-12-01

    The ulceration associated with gout tophi is very difficult to treat because of impaired and halted local inflammatory response resulting from the gout treatment regimen. We report chronic nonhealing tophaceous gout with bursitis in an 80-year-old male, not responding to conventional treatment modality for months together. This nonhealing ulcer was treated successfully with local application of 3% citric acid ointment for 22 days.

  10. Dipeptidyl Peptidase 4 Inhibition May Facilitate Healing of Chronic Foot Ulcers in Patients with Type 2 Diabetes

    OpenAIRE

    Angela Della Corte; Ferdinando Campitiello; Raffaele Canonico; Antonello Petrella; Pasquale Petronella; Franca Ferraraccio; Pasquale Gualdiero; Vincenzo Padovano; Ornella Carbonara; Michelangela Barbieri; Pasquale Paolisso; Maria Rosaria Rizzo; Ferdinando Carlo Sasso; Raffaele Marfella; Giuseppe Paolisso

    2012-01-01

    The pathophysiology of chronic diabetic ulcers is complex and still incompletely understood, both micro- and macroangiopathy strongly contribute to the development and delayed healing of diabetic wounds, through an impaired tissue feeding and response to ischemia. With adequate treatment, some ulcers may last only weeks; however, many ulcers are difficult to treat and may last months, in certain cases years; 19–35% of ulcers are reported as nonhealing. As no efficient therapy is available, it...

  11. Crohn's disease but not chronic ulcerative colitis induces the expression of PAI-1 in enteric neurons

    DEFF Research Database (Denmark)

    Laerum, O.D.; Illemann, M.; Skarstein, A.;

    2008-01-01

    by immunohistochemical techniques. RESULTS: PAI-1 was found in a subset of neurons primarily located in the submucosal plexus of the small and large intestine in 24 of 28 cases (86%) with Crohn's disease, but in none of 17 cases with chronic ulcerative colitis and other severe inflammatory conditions in the intestinal......OBJECTIVES: Chronic inflammation of the intestinal wall is the common characteristic of Crohn's disease and ulcerative colitis; disorders, which in some cases can be difficult to distinguish. The inflammation also affects the local neuronal plexuses of the enteric nervous system. It is known....... CONCLUSIONS: PAI-1-positive neurons in inflammatory bowel disease are linked to chronic inflammation in Crohn's disease, implying PAI-1 as a potential parameter for the differential diagnosis between Crohn's disease and ulcerative colitis. The findings also suggest that PAI-1 in neurons is related to pain...

  12. Transversal escharotomies: a new surgical technique adjuvant in the treatment of chronic ulcers with non-arterial etiology in the lower limbs Escarotomias transversais: uma nova opção cirúrgica adjuvante no tratamento de úlceras crônicas de etiologia não arterial em membros inferiores

    OpenAIRE

    Mário Augusto Silva Freitas; Maria do Carmo Cardia Julião

    2006-01-01

    PURPOSE: Propose a new and alternative surgical procedure in order to aid on treatments of chronic ulcers with non-arterial etiology in the lower limbs, especially those that reoccurs and accomplish of dermatosclerosis and skin contractures determining ankle and foot limits. METHODS: It describes a medical case regarding a female, 54 years old, with a pre-existing ulcer (sixteen years) on her left leg. Despite of conventional treatments such as curatives, compressive therapy and surgeries, th...

  13. [The use of the multivitamin preparation Supradin in treating patients with chronic gastritis and peptic ulcer].

    Science.gov (United States)

    Novoderzhkina, Iu G; Cherentsov, A M

    1992-08-01

    The content of ascorbin acid and thiamin was assessed in the food ration of 36 patients with chronic gastritis and ulcer disease. By the end treatment including dietotherapy these vitamins showed a deficit. Correction of this deficit of the above mentioned vitamins with a polyvitamine drug "Supradin" allowed to improve significantly the biochemical indices and availability of ascorbic acid and thiamin in patients with chronic gastritis and ulcer disease. The treatment produced a favourable effect on the clinical course of the disease, reduction of the pain syndrome and earlier recovery. PMID:1475934

  14. Comparison of knee-high Mediven ulcer kit and Mediven Plus compression stockings: measurement of leg volume, interface pressure and static stiffness index changes

    Directory of Open Access Journals (Sweden)

    Győző Szolnoky

    2013-06-01

    Full Text Available Ulcer stockings are produced to have higher interface pressure and easier application compared to those of classic medical compression stockings. We aimed to compare volume decrease, pressure loss and stiffness index of a classical medical compression stocking and an ulcer stocking of the same interface pressure range in 10 patients with bilateral venous and 10 persons with lymphatic insufficiency. Interface pressure measurement in supine and standing positions and optoelectronic volumetry served for primary outcome variables. Both stockings were capable of inducing remarkable gradual volume reductions in different time points except classic stocking at 2 h in phleboedema care. Ulcer stocking pressures in lymph- and phleboedema were highly superior. In lymphedema a gradual interface pressure loss was attributed to both stockings regardless of body positions. Static stiffness indices did not differ statistically except classic stocking at baseline (P=0.0312 and 2 h (P=0.0082 comprising venous edema patients. Both stockings acted similarly but ulcer stocking had considerably higher interface pressures in each measurement and raised stiffness indices initially and the two-layer system facilitates donning therefore ulcer stocking could serve an alternative of classic medical compression stocking even in the treatment of leg edema.

  15. Bidirectional crosstalk between stress-induced gastric ulcer and depression under chronic stress.

    Directory of Open Access Journals (Sweden)

    Shuang Zhang

    Full Text Available Stress contributes to a variety of diseases and disorders such as depression and peptic ulcer. The present study aimed to investigate the correlation between stress ulcer and depression in pathogenesis and treatment by using chronic stress depression (CSD, chronic psychological stress ulcer (CPSU and water immersion restrain stress models in rats. Our data showed that the ulcer index of the animals after CSD exposure was significantly higher than that of controls. Depression-like behaviors were observed in rat after CPSU exposure. Fluoxetine hydrochloride significantly reduced the ulcer index of rats exposed to CPSU stress, while ranitidine inhibited depression-like behavior of the animals in CSD group. The ulcer index of rats administered with mifepristone after CPSU stress was markedly reduced compared to CPSU group, although there was no significant difference in the depression-like behavior between mifepristone-treated CSD group and naive controls. We also found that the rats exposed to CPSU or CSD stress displayed a lower level of corticosterone than naive controls, however, the acute stress (AS group showed an opposite result. Additionally, in order to study the relevance of H(2 receptors and depression, we treated the CSD group with cimetidine and famotidine respectively. The data showed that cimetidine inhibited depression-like behavior in CSD rats, and famotidine had no impact on depression. Overall our data suggested that the hypothalamic-pituitary-adrenal (HPA axis dysfunction may be the key role in triggering depression and stress ulcer. Acid-suppressing drugs and antidepressants could be used for treatment of depression and stress ulcer respectively. The occurrence of depression might be inhibited by blocking the central H(2 receptors.

  16. Oral administration of synthetic human urogastrone promotes healing of chronic duodenal ulcers in rats

    DEFF Research Database (Denmark)

    Poulsen, Steen Seier; Nexø, Ebba

    1986-01-01

    The effect of oral administration of synthetic human epidermal growth factor/urogastrone (EGF/URO) on healing of chronic duodenal ulcers induced by cysteamine in rats was investigated and compared with that of cimetidine, a H2-receptor antagonist. After 25 and 50 days of treatment, synthetic human...... EGF/URO significantly increased healing of chronic duodenal ulcers to the same extent as cimetidine. Combined treatment with synthetic human EGF/URO and cimetidine for 25 days was more effective than synthetic human EGF/URO given alone, whereas combined treatment for 50 days was significantly more...... effective than cimetidine alone. These results show that a combination of an agent inhibiting gastric acid secretion and the cytoprotective and growth-stimulating peptide EGF/URO seems to be more effective with regard to duodenal ulcer healing than individual administration of the two substances. Synthetic...

  17. Wound Chronicity, Inpatient Care, and Chronic Kidney Disease Predispose to MRSA Infection in Diabetic Foot Ulcers

    Science.gov (United States)

    Yates, Christopher; May, Kerry; Hale, Thomas; Allard, Bernard; Rowlings, Naomi; Freeman, Amy; Harrison, Jessica; McCann, Jane; Wraight, Paul

    2009-01-01

    OBJECTIVE To determine the microbiological profile of diabetes-related foot infections (DRFIs) and the impact of wound duration, inpatient treatment, and chronic kidney disease (CKD). RESEARCH DESIGN AND METHODS Postdebridement microbiological samples were collected from individuals presenting with DRFIs from 1 January 2005 to 31 December 2007. RESULTS A total of 653 specimens were collected from 379 individuals with 36% identifying only one isolate. Of the total isolates, 77% were gram-positive bacteria (staphylococci 43%, streptococci 13%). Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from 23%; risk factors for MRSA included prolonged wound duration (odds ratio 2.31), inpatient management (2.19), and CKD (OR 1.49). Gram-negative infections were more prevalent with inpatient management (P = 0.002) and prolonged wound duration (P < 0.001). Pseudomonal isolates were more common in chronic wounds (P < 0.001). CONCLUSIONS DRFIs are predominantly due to gram-positive aerobes but are usually polymicrobial and increase in complexity with inpatient care and ulcer duration. In the presence of prolonged duration, inpatient management, or CKD, empiric MRSA antibiotic cover should be considered. PMID:19587371

  18. Chronic Ulceration and Sinus Formation due to Foreign Body

    DEFF Research Database (Denmark)

    Hansen, Karin Birgitte; Gottrup, Finn

    2015-01-01

    Foreign bodies like residues of suture or mesh may lead to a foreign body reaction, cavity formation and continuous secretion and perhaps ulceration. We present a more than 9 years long medical record of a 49 year old man after a simple surgical procedure. The background was a sinus formation gen...... in these cases. The knowledge of the foreign body reaction in tissue continuously needs to be reestablished in the health care system especially in areas, where implantation of foreign material is used....

  19. Multiple chronic non-specific ulcer of small intestine characterized by anemia and hypoalbuminemia

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    A female patient with anemia and hypoalbuminemia was admitted to our hospital due to an over 20-year history of recurrent dizziness,fatigue and ankle edema.She was diagnosed as multiple chronic nonspecific ulcer of the small intestine characterized by non-specific histology and persistent gastrointestinal bleeding.

  20. Research status of wound assessment and nursing intervention for venous leg ulcer%下肢静脉溃疡伤口评估及护理干预研究现状

    Institute of Scientific and Technical Information of China (English)

    宋江艳; 于卫华; 王胜琴; 余梅

    2013-01-01

    The study reviewed the research status quo of assessment and nursing intervention on wound in patients with venous leg ulcer.It analyzed the assessment status quo of wound in patients with venous leg ulcer from aspects of cognition on venous leg ulcer and assessment method and tools of wound in patients with venous leg ulcer;and it analyzed problems existing in intervention for venous leg ulcer wound from aspects of medical treatment and nursing intervention.Thus it put forward thinking and outlook which reflected the wound care specialist features in patients with venous leg ulcers and to realize the systematic and normative wound assessment and care interventions for patients with venous leg ulcers.%综述了下肢静脉溃疡伤口的评估和护理干预两方面的研究现状.从医务人员及病人对下肢静脉溃疡认知、下肢静脉溃疡伤口评估方法及工具等方面分析下肢静脉溃疡伤口的评估现状;从医疗处理和护理干预两方面分析下肢静脉溃疡伤口干预存在的问题.提出体现下肢静脉溃疡伤口护理专科特色,实现下肢静脉溃疡伤口评估和护理干预系统性和规范性的思考和展望.

  1. Why chronic wounds will not heal: a novel hypothesis

    DEFF Research Database (Denmark)

    Bjarnsholt, Thomas; Kirketerp-Moller, K.; Jensen, P.O.;

    2008-01-01

    The present paper presents a hypothesis aimed at explaining why venous leg ulcers, pressure ulcers, and diabetic foot ulcers develop into a chronic state. We propose that the lack of proper wound healing is at least in part caused by inefficient eradication of infecting, opportunistic pathogens...

  2. Cutaneous diffuse large B-cell lymphoma of the leg associated with chronic lymphedema.

    Science.gov (United States)

    González-Vela, M Carmen; González-López, Marcos A; Val-Bernal, J Fernando; Fernández-Llaca, Héctor

    2008-02-01

    Development of malignant tumors is a rare but well known complication in chronic lymphedema (CL). We report herein a cutaneous diffuse large B-cell lymphoma of the leg associated with CL. An 89-year-old man presented with multiple cutaneous lesions on his right limb that showed a CL. Dermatological examination disclosed multiple violaceous, firm, slightly infiltrated nodules on the anterior aspect of the leg and the dorsum and sole of the foot. A biopsy of one nodule of the leg disclosed a diffuse large B-cell lymphoma, type of the legs. There was no evidence of lymphadenopathy on computed tomography (CT) scans of the chest, abdomen, and pelvis. A bone marrow aspiration and biopsy showed normal results. The patient was treated with local radiotherapy at a dose of 40 Gy, obtaining a highly significant, almost complete, clinical remission. A literature search identified 11 additional cases of primary cutaneous lymphoma associated with CL. An inadequate lymphatic drainage may make the lymphedematous region an immunologically vulnerable area, predisposing to neoplasia. PMID:18211492

  3. Preventing Ischial Pressure Ulcers: III. Clinical Pilot Study of Chronic Neuromuscular Electrical Stimulation

    Directory of Open Access Journals (Sweden)

    Hilton M. Kaplan

    2011-01-01

    Full Text Available Objective: BIONs™ (BIOnic Neurons are injectable, wireless microstimulators that make chronic BION Active Seating (BAS possible for pressure ulcer prevention (PUP. Neuromuscular electrical stimulation (NMES produces skeletal motion and activates trophic factors, counteracting three major etiological mechanisms leading to pressure ulcers (PUs: immobility, soft-tissue atrophy, and ischemia. Companion papers I and II reviewed prior experience with NMES for PUP, and analyzed the biomechanical considerations, respectively. This paper presents a treatment strategy derived from this analysis, and the clinical results of the first three cases.

  4. Chronic ulcers and myasis as ports of entry for Clostridium tetani

    Directory of Open Access Journals (Sweden)

    Greco Jiuseppe Benitivoglio

    2001-01-01

    Full Text Available Evaluating tetanus immune status is not yet the usual clinical practice regarding patients with chronic ulcers or myasis. However, of 858 tetanus patients at Hospital Couto Maia (Salvador, Bahia, Brazil aged 1 year or above, 2 had pressure ulcers and 17 had chronic ulceration of the lower limbs where these skin lesions were the ports of entry for Clostridium tetani. In these 19 cases, the following predisposing factors were described: venous insufficiency (n=6, sickle cell anemia (n=2, Hansen's disease (n=1, malnutrition (n=1, diabetes mellitus (n=1, trauma (n=1 and unknown factors (n=7. In 6 other cases, in addition to the Hansen's disease patient, the port of entry for tetanus was the site of extraction of Tunga penetrans larvae. In these 25 cases, the majority of patients (68% were over 40 years old (17/25 and all of these patients stated that they had either not followed a tetanus toxoid vaccination regimen (19/25, or had partially completed such a regimen, or did not give precise information (6/25. Among the same series studied, over half (52% of the patients died (13/25. We conclude that tetanus prevention must be included in the treatment of chronic skin ulcer patients, vaccination coverage should be increased among older people, and strategies aimed at improving coverage for all age groups must be reviewed.

  5. Split thickness skin grafts for the treatment of non-healing foot and leg ulcers in patients with diabetes: a retrospective review

    OpenAIRE

    John J. Anderson; Wallin, Kelly J.; Spencer, Loren

    2012-01-01

    We retrospectively reviewed 107 diabetic patients who received a split thickness skin graft (STSG) for treatment of a non-healing diabetic foot or leg ulcer to describe healing times based on patient characteristics, comorbidities or complications. The minimum follow-up was 6 months from the time of STSG application. The mean time to healing among all patients was 5.1 weeks (3 to 16 weeks). The mean healing time for patients with complications was 12.0 weeks (10 to 16 weeks) while the mean he...

  6. Clinical evaluation of the efficacy and safety of a medical device in various forms containing Triticum vulgare for the treatment of venous leg ulcers – a randomized pilot study

    Directory of Open Access Journals (Sweden)

    Romanelli M

    2015-05-01

    Full Text Available Marco Romanelli,1 Michela Macchia,1 Salvatore Panduri,1 Battistino Paggi,1 Giorgio Saponati,2 Valentina Dini1 1Wound Healing Research Unit, Dermatology Division, Department of Clinical and Experimental Medicine, University of Pisa, 2ISPharm srl, Lucca, Italy Abstract: This study was carried out to assess the efficacy and tolerability of the topical application of an aqueous extract of Triticum vulgare (TV in different vehicles (cream, impregnated gauzes, foam, hydrogel, and dressing gel for the treatment of venous lower leg ulcers. Fifty patients were randomized to receive one of the five investigational vehicles. Treatment was performed up to complete healing or to a maximum of 29 days. The wound size reduction from baseline was the primary efficacy variable, which was measured by means of a noninvasive laser scanner instrument for wound assessment. In all groups, apart from the foam group, a similar trend toward the reduction of the surface area was observed. The cream showed the greatest effect on the mean reduction of the lesion size. At last visit, six ulcers were healed: two in the cream group, three in the gauze group, and one in the dressing gel group. In the patients treated with the cream, the gauzes, the hydrogel, and the dressing gel, the reduction of lesion size was 40%–50%; the reduction was smaller in the foam group. No impact in terms of age on the healing process was found. The Total Symptoms Score decreased in all groups during the study; a greater efficacy in terms of signs/symptoms was observed in the patients treated with the gauzes. In the dressing gel group, one patient had an infection of the wound after 3 weeks of treatment and 2 of colonization, leading to a systemic antibiotic treatment. The events were judged as nonrelated to the device used. On the basis of the results, it could be argued that the medical device may be useful in the treatment of chronic venous ulcers. Keywords: venous leg ulcers, Triticum vulgare

  7. Morphologic features of chronic hepatitis associated with primary sclerosing cholangitis and chronic ulcerative colitis

    Energy Technology Data Exchange (ETDEWEB)

    Ludwig, J.; Barham, S.S.; LaRusso, N.F.; Elveback, L.R.; Wiesner, R.H.; McCall, J.T.

    Histologic, ultrastructural, chemical, and statistical methods were used to study liver biopsy and autopsy specimens from 43 patients who had primary sclerosing cholangitis (PSC), with or without chronic ulcerative colitis (CUC), and from 19 patients who had CUC without PSC. In all study groups, essentially the same abnormalities were found in the hepatic parenchyma outside the major bile ducts, although nondiagnostic tissue samples were observed also. Specimens from patients with extrahepatic PSC were indistinguishable from those patients with combined extra- and intrahepatic PSC. Common findings included periductal fibrosis and inflammation, portal edema and fibrosis, focal proliferation of bile ducts and ductules, focal bile duct obliteration and loss of bile ducts, copper deposition, and cholestasis. Proliferation of bile ducts in some portal tracts and obliteration or absence of bile duct in others were the most characteristic changes. In most specimens, inflammatory changes appeared mild, yet biliary cirrhosis had developed in 34% of the patients. Specimens from patients with PSC, with or without CUC, more often contained bile and strikingly increased stainable copper (Grades 2 and 3) than did specimens from patients with CUC without PSC. Hepatic copper contents, measured by atomic absorption spectrophotometry, also were higher in specimens from patients with PSC. Study of PCS specimens by transmission electron microscopy and by energy-dispersive X-ray microanalysis revealed that most copper was sequestered in lipolysosomes. The recognition of strikingly similar morphologic features in many liver specimens from patients with either PSC or CUC or both suggests that the causes of these conditions are closely related.

  8. Combined use of fenestrated-type artificial dermis and topical negative pressure wound therapy for the venous leg ulcer of a rheumatoid arthritis patient.

    Science.gov (United States)

    Morimoto, Naoki; Kuro, Atsuyuki; Yamauchi, Takashi; Horiuchi, Ai; Kakudo, Natsuko; Sakamoto, Michiharu; Suzuki, Kenji; Kusumoto, Kenji

    2016-02-01

    We report a case of circumferential venous leg ulcer in a rheumatoid arthritis patient. Mesh skin grafting was performed in another hospital, but the graft failed and the patient was referred to our hospital. This ulcer was treated by the combination therapy of a fenestrated-type artificial dermis with negative pressure wound therapy (NPWT) and secondary mesh grafting using our 'grip tape technique'. NPWT was started at -100 mmHg and continued until the formation of dermis-like tissue. A section stained using haematoxylin and eosin and an anti-αSMA (α smooth muscle actin) immunohistological section of the biopsy from dermis-like tissue showed an abundant infiltration of fibroblasts and capillary formation beneath the fenestration of the silicone sheet. Threefold mesh skin grafting was subsequently performed and it was taken up completely. The fenestrated-type artificial dermis in combination with NPWT produced good results without infection in the treatment of complex wounds. In addition, our 'grip tape technique' was useful to apply polyurethane foam to the entire surface of the lower leg. PMID:25650053

  9. Autologous stem cell therapy to treat chronic ulcer in heifer- A case study

    Directory of Open Access Journals (Sweden)

    Jayakrushna Das

    Full Text Available Aim: The study was conducted to reveal the efficacy of Bone marrow derived mesenchymal stem cells (BM-MSCs based therapy in healing of chronic non-healing and ulcerative wound in bovine species. Materials and Methods: One 2 years old Jersey heifer affected with chronic ulcerative wound involving full thickness skin and under lying muscle at dorsal side of lumbar region since four months at the time of presentation. Bone marrow was collected from tibia, cultured and grown and after achievement of optimum confluence it was applied at the site. Different parameters of clinical, physiological, haematological, biochemical, histochemical, histological, tensile strength and photographic evaluations were done during the study period. Results: The estimated values of above mentioned parameters on zero day and after healing (18 days showed significant difference (P<0.05 in relation to collagen content, tensile strength and physical characteristics of wound like extent of wound, size of wound, type of exudates and photography. But clinical, haematological and biochemical data showed no significant difference. Conclusion: The BM-MSCs were the main pioneers to bring the chronic ulcerative wound towards healing. The procedure is simple, safe and effective in bringing out healing without showing any adverse effect on host. [Vet World 2012; 5(12.000: 771-774

  10. Biochemical association of metabolic profile and microbiome in chronic pressure ulcer wounds.

    Directory of Open Access Journals (Sweden)

    Mary Cloud B Ammons

    Full Text Available Chronic, non-healing wounds contribute significantly to the suffering of patients with co-morbidities in the clinical population with mild to severely compromised immune systems. Normal wound healing proceeds through a well-described process. However, in chronic wounds this process seems to become dysregulated at the transition between resolution of inflammation and re-epithelialization. Bioburden in the form of colonizing bacteria is a major contributor to the delayed headlining in chronic wounds such as pressure ulcers. However how the microbiome influences the wound metabolic landscape is unknown. Here, we have used a Systems Biology approach to determine the biochemical associations between the taxonomic and metabolomic profiles of wounds colonized by bacteria. Pressure ulcer biopsies were harvested from primary chronic wounds and bisected into top and bottom sections prior to analysis of microbiome by pyrosequencing and analysis of metabolome using 1H nuclear magnetic resonance (NMR spectroscopy. Bacterial taxonomy revealed that wounds were colonized predominantly by three main phyla, but differed significantly at the genus level. While taxonomic profiles demonstrated significant variability between wounds, metabolic profiles shared significant similarity based on the depth of the wound biopsy. Biochemical association between taxonomy and metabolic landscape indicated significant wound-to-wound similarity in metabolite enrichment sets and metabolic pathway impacts, especially with regard to amino acid metabolism. To our knowledge, this is the first demonstration of a statistically robust correlation between bacterial colonization and metabolic landscape within the chronic wound environment.

  11. Peripheral ulcerative keratitis associated with chronic malabsorption syndrome and miliary tuberculosis in a child

    Directory of Open Access Journals (Sweden)

    Tarun Arora

    2015-01-01

    Full Text Available A 16-year-old girl presented with pain, redness, watering, and blurring of vision in her right eye. Slit lamp examination revealed the presence of peripheral ulcerative keratitis (PUK and nodular scleritis. On clinical examination, the patient had stunted growth, low body mass index, and enlarged axillary nodes. Giardia cysts were present in the stool sample and histopathology of axillary lymph nodes showed caseating necrosis suggestive of tuberculosis (TB. A diagnosis of PUK with chronic malabsorption syndrome secondary to giardiasis and miliary TB was made. Oral metronidazole, anti-tubercular treatment, high protein diet and vitamin supplements were started. Topical steroids were started for peripheral ulcerative lesions following, which the PUK resolved.

  12. Effect of antisecretory agents and vagotomy on healing of "chronic" cysteamine-induced duodenal ulcers in rats

    DEFF Research Database (Denmark)

    Poulsen, Steen Seier

    1986-01-01

    Penetrated cysteamine-induced duodenal ulcers in rats have a very prolonged course of healing. In this study, it was investigated how much the healing of these ulcers is accelerated by some treatments. The treatments included omeprazole, cimetidine, and truncal vagotomy. In addition, the effect...... of omeprazole and cimetidine on gastric acid secretion was investigated in chronic gastric fistula rats. After 25 days of treatment, significantly more rats in the treated groups had healed ulcers than in the control group. There was little further improvement up to 100 days of treatment, and the difference...... between treated and untreated groups decreased. The morphology of healing ulcers in treated and untreated rats was also compared. In controls, there was a simultaneous regeneration of mucosa and the submucosal Brunner's glands from the edges of the ulcer, the slow proliferation rate of the latter probably...

  13. Smoking, Chronic Wound Healing, and Implications for Evidence-Based Practice

    OpenAIRE

    McDaniel, Jodi C.; Browning, Kristine K.

    2014-01-01

    Chronic wounds are rising in prevalence and creating significant socioeconomic burdens for patients and healthcare systems worldwide. Therefore, it is now more important than ever that clinicians follow evidence-based guidelines for wound care when developing personalized treatment plans for their patients with chronic wounds. Evidence-based guidelines for treating venous leg ulcers, diabetic foot ulcers, and pressure ulcers, the 3 main categories of chronic wounds, focus primarily on biologi...

  14. Unna Boot in Venous Ulcer Treatment: Evaluation of 30 patients

    OpenAIRE

    Acıpayam, Mehmet; Zor, M. Hakan; Altınay, Levent; Uncu, Hasan; Halıcı, Ümit

    2013-01-01

    Aim: We aim to evaluate the results of the Unna boot practice with this prospective study. Material and Methods: This study included a total of 30 patients (1 female, 29 male; ages 23–56, mean 33.5) admitted to outpatient clinic with chronic venous leg ulcers. All patients were treated with Unna's boot. This treatment combined with oral calcium dobesilat 500 mg tabletorally twice a day. As the ulcer was healing, the treatment continued with calcium dobesilate tablets and compres...

  15. Topical Administration of a Connexin43-based peptide Augments Healing of Chronic Neuropathic Diabetic Foot Ulcers: A Multicenter, Randomized Trial

    OpenAIRE

    Grek, Christina L.; Prasad, G.M.; Viswanathan, Vijay; Armstrong, David G.; Gourdie, Robert G.; Ghatnekar, Gautam S.

    2015-01-01

    Nonhealing neuropathic foot ulcers remain a significant problem in individuals with diabetes. The gap-junctional protein connexin43 (Cx43) has roles in dermal wound healing and targeting Cx43 signaling accelerates wound reepithelialization. In a prospective, randomized, multi-center clinical trial we evaluated the efficacy and safety of a peptide mimetic of the C-terminus of Cx43, ACT1, in accelerating the healing of chronic diabetic foot ulcers (DFUs) when incorporated into standard of care ...

  16. Etiology and pathogensis of chronic venous ulcer of lower extremities%下肢静脉性溃疡相关病因及其发生机制的研究

    Institute of Scientific and Technical Information of China (English)

    查斌山; 朱化刚

    2010-01-01

    Venous leg ulceration is a common, debilitating chronic condition, which is the most severe complications of chronic venous insufficiency. The persistent venous hypertension is the primary cause of ve-nous ulcer, and leukocyte activation plays a key role in the formation of venous ulcers,and other related fac-tors such as heart disease also play an important role in the development of varicose to ulceration.%慢性静脉性溃疡是下肢慢性静脉功能不全中最严重的最难治的并发症.持续性的静脉高压是引起静脉性溃疡的主要原因;白细胞激活在静脉性溃疡的形成中起关键作用;心脏病等相关因素在静脉曲张向溃疡发展的过程中亦发挥着重要作用.

  17. Open label trial of granulocyte apheresis suggests therapeutic efficacy in chronically active steroid refractory ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    Wolfgang Kruis; Robert L(o)fberg; Axel Dignass; Elisabeth Steinhagen-Thiessen; Julia Morgenstern; Joachim M(o)ssner; Stephan Schreiber; Maurizio Vecchi; Alberto Malesci; Max Reinshagen

    2005-01-01

    AIM:To study the efficacy, safety, and feasibility of a granulocyte adsorptive type apheresis system for the treatment of patients with chronically active ulcerative colitis despite standard therapy.METHODS: An open label multicenter study was carried out in 39 patients with active ulcerative colitis (CAI6-8) despite continuous use of steroids (a minimum total dose of 400 mg prednisone within the last 4 wk).Patients received a total of five aphereses using a granulocyte adsorptive technique (Adacolumn(R), Otsuka Pharmaceutical Europe, UK). Assessments at wk 6 and during follow-up until 4 mo comprised clinical (CAI) and endoscopic (EI) activity index, histology, quality of life(IBDQ), and laboratory tests.RESULTS: Thirty-five out of thirty-nine patients were qualified for intent-to-treat analysis. After the apheresis treatment at wk 6, 13/35 (37.1%) patients achieved clinical remission and 10/35 (28.6%) patients had endoscopic remission (CAI<4, EI<4). Quality of life (IBDQ) increased significantly (24 points, P<0.01)at wk 6. Apheresis could be performed in all but one patient. Aphereses were well tolerated, only one patient experienced anemia.CONCLUSION: In patients with steroid refractory ulcerative colitis, five aphereses with a granulocyte/monocyte depleting filter show potential short-term efficacy. Tolerability and technical feasibility of the procedure are excellent.

  18. Prevalence of Restless Leg Syndrome and Related Factors in Patients under Chronic Hemodialysis

    Directory of Open Access Journals (Sweden)

    Reza Bidaki

    2014-09-01

    Full Text Available Restless leg syndrome (RLS or Ekbom syndrome is a sensory motor disorder with shaking legs and sometimes other parts of body. This unpleasant sensation is more common during sitting and lying particularly in the knees, ankles and depth of internal surface of legs [1].

  19. Clinical unity and community empowerment: the use of smartphone technology to empower community management of chronic venous ulcers through the support of a tertiary unit.

    LENUS (Irish Health Repository)

    Quinn, Edel Marie

    2013-01-01

    Chronic ulcers affect roughly 60,000 Irish people, at a total cost of €600,000,000, or €10,000 per patient annually. By virtue of their chronicity, these ulcers also contribute a significant burden to tertiary outpatient vascular clinics.

  20. Abordagem de pacientes com úlcera da perna de etiologia venosa Management of patients with venous leg ulcer

    Directory of Open Access Journals (Sweden)

    Luciana Patrícia Fernandes Abbade

    2006-12-01

    Full Text Available Úlceras venosas são comuns na população adulta, causando significante impacto social e econômico devido a sua natureza recorrente e ao longo tempo decorrido entre sua abertura e cicatrização. Quando não manejadas adequadamente, as úlceras venosas têm altas taxas de falha de cicatrização e recorrência. Apesar da elevada prevalência e da importância da úlcera venosa, ela é freqüentemente negligenciada e abordada de maneira inadequada. Esta revisão discute abordagem diagnóstica e terapêutica das úlceras venosas. O diagnóstico clínico baseia-se em história e exame físico, com ênfase nos sinais e sintomas associados e palpação dos pulsos dos membros inferiores. A ultra-sonografia Doppler deve ser utilizada para determinar o índice pressórico entre o tornozelo e o braço, e exames não invasivos, como o duplex scan, devem ser realizados para avaliar o sistema venoso superficial, profundo e perfurante. Para abordagem terapêutica são fundamentais os diagnósticos clínico e laboratorial corretos, além do diagnóstico e tratamento adequados das complicações das úlceras crônicas. Os esforços devem ser direcionados para a cicatrização da úlcera e, posteriormente, para evitar as recidivas. O grande avanço no conhecimento da fisiopatogenia das úlceras venosas tem permitido o desenvolvimento de novas modalidades de tratamento clínico e cirúrgico.Venous ulcers are common in adult population. They cause significant socioeconomic impact due to recurrence and the long interval between onset and healing. If venous ulcers are not appropriately managed, they present high rates of healing failure and recurrence. Despite their high prevalence and importance, venous ulcers are often neglected and inadequately managed. This review discusses diagnosis and therapy of lower limb venous ulcers. Clinical diagnosis is based on history and physical examination, emphasizing associated signs and symptoms, and pulse palpation of lower

  1. Dipeptidyl Peptidase 4 Inhibition May Facilitate Healing of Chronic Foot Ulcers in Patients with Type 2 Diabetes

    Directory of Open Access Journals (Sweden)

    Raffaele Marfella

    2012-01-01

    Full Text Available The pathophysiology of chronic diabetic ulcers is complex and still incompletely understood, both micro- and macroangiopathy strongly contribute to the development and delayed healing of diabetic wounds, through an impaired tissue feeding and response to ischemia. With adequate treatment, some ulcers may last only weeks; however, many ulcers are difficult to treat and may last months, in certain cases years; 19–35% of ulcers are reported as nonhealing. As no efficient therapy is available, it is a high priority to develop new strategies for treatment of this devastating complication. Because experimental and pathological studies suggest that incretin hormone glucagon-like peptide-1 may improves VEGF generation and promote the upregulation of HIF-1α through a reduction of oxidative stress, the study evaluated the effect of the augmentation of GLP-1, by inhibitors of the dipeptidyl peptidase-4, such as vildagliptin, on angiogenesis process and wound healing in diabetic chronic ulcers. Although elucidation of the pathophysiologic importance of these aspects awaits further confirmations, the present study evidences an additional aspect of how DPP-4 inhibition might contribute to improved ulcer outcome.

  2. Dipeptidyl peptidase 4 inhibition may facilitate healing of chronic foot ulcers in patients with type 2 diabetes.

    Science.gov (United States)

    Marfella, Raffaele; Sasso, Ferdinando Carlo; Rizzo, Maria Rosaria; Paolisso, Pasquale; Barbieri, Michelangela; Padovano, Vincenzo; Carbonara, Ornella; Gualdiero, Pasquale; Petronella, Pasquale; Ferraraccio, Franca; Petrella, Antonello; Canonico, Raffaele; Campitiello, Ferdinando; Della Corte, Angela; Paolisso, Giuseppe; Canonico, Silvestro

    2012-01-01

    The pathophysiology of chronic diabetic ulcers is complex and still incompletely understood, both micro- and macroangiopathy strongly contribute to the development and delayed healing of diabetic wounds, through an impaired tissue feeding and response to ischemia. With adequate treatment, some ulcers may last only weeks; however, many ulcers are difficult to treat and may last months, in certain cases years; 19-35% of ulcers are reported as nonhealing. As no efficient therapy is available, it is a high priority to develop new strategies for treatment of this devastating complication. Because experimental and pathological studies suggest that incretin hormone glucagon-like peptide-1 may improves VEGF generation and promote the upregulation of HIF-1α through a reduction of oxidative stress, the study evaluated the effect of the augmentation of GLP-1, by inhibitors of the dipeptidyl peptidase-4, such as vildagliptin, on angiogenesis process and wound healing in diabetic chronic ulcers. Although elucidation of the pathophysiologic importance of these aspects awaits further confirmations, the present study evidences an additional aspect of how DPP-4 inhibition might contribute to improved ulcer outcome.

  3. Effect of omeprazole and cimetidine on healing of chronic gastric ulcers and gastric acid secretion in rats

    DEFF Research Database (Denmark)

    Poulsen, Steen Seier

    1988-01-01

    The effect of omeprazole and cimetidine on healing of chronic gastric ulcers and gastric acid secretion was investigated in rats. The effect of three doses of omeprazole given orally once daily for 25 days was investigated. In controls median ulcer healing was 19.6% after 25 days. Omeprazole...... increased median ulcer healing from 36% at 145 mumole/kg/day to 80% at 580 mumole/kg/day. Basal and pentagastrin stimulated gastric acid secretion decreased dose-dependently by nearly 90% at a dose of 580 mumole/kg/day 22-24 hr after the last dose of omeprazole. Cimetidine given twice daily, in a dose...... that initially inhibits gastric acid secretion by 95%, reduced acid secretion by only 50% 11 hr after the last dose. Median ulcer healing after treatment with cimetidine for 25 days was 41%. This study demonstrates that omeprazole has a more long-acting inhibitory effect on gastric acid secretion compared...

  4. Chronic Ulcers in Thromboangiitis Obliterans (Buerger's Disease: Updating Epidemiology, Physiopathology, and Bosentan—A Novel Strategy of Therapy

    Directory of Open Access Journals (Sweden)

    Ignacio López de Maturana

    2013-01-01

    Full Text Available Thromboangiitis obliterans (TAO or Buerger's disease is associated with both distal ulcers in the extremities and the possibility of amputation. The only treatment that has been shown to be effective in TAO is complete abstention from smoking. In spite of this, the disease progresses in up to 30 percent of cases and finally results in limb amputation. Only a few pharmacological and surgical options are available to date to improve healing ulcers in TAO. The efficacy of prostaglandin analogues is controversial. This paper summarizes the current evidence for medical treatment with bosentan in chronic ulcers in TAO patients. These available data up to date allow us to conclude that the beneficial effects of bosentan on improving endothelial function, inflammatory processes, and selective vasodilatation of damaged vessels result in a clinical enhancement regarding healing and preventive digital ulcers in such patients. In any case, these promising findings have to be confirmed with larger randomised trials.

  5. Venous ulcers - self-care

    Science.gov (United States)

    Risk factors for venous ulcers include: Varicose veins History of blood clots in the legs ( deep vein thrombosis ) Blockage of the lymph vessels , which causes fluid to build up in the legs Older age, being female, or ...

  6. Synergistic action of famotidine and chlorpheniramine on acetic acid-induced chronic gastric ulcer in rats

    Institute of Scientific and Technical Information of China (English)

    Zhen Qin; Chao Chen

    2005-01-01

    AIM: To assess the synergistic action of famotidine (FMD)and chlorpheniramine (CPA) on acetic acid-induced chronic gastric ulcer in rats.METHODS: Chronic gastric lesions were induced in male Sprague-Dawley (SD) rats by serosal application of the acetic acid. Forty SD rats were randomly divided into blank group (n = 8), control group (n = 8), FMD group (n= 8), CPA group (n = 8), and FMD+CPA group (n = 8).Each group was given intraperitoneally (i.p.) 0.5 mL/100g distilled water, 9 g/L NaCl saline, 4 mg/kg FMD, 10mg/kg CPA, 4 mg/kg FMD+10 mg/kg CPA, respectively,daily for 10 d. On d 10, ulcer area was determined by planimetry. The level of myeloperoxidase (MPO) in the liver homogenation was determined by biochemical methods and the plasma levels of 6-ketoprostaglandin F1 alpha (6-keto-PGF1a)and IL-8 were determined by radioimmunoassay.RESULTS: The synergistic effects of FMD+CPA group on the lesion, IL-8, 6-keto-PGF1a and MPO were confirmed.The effect of FMlD+CPA group was significantly different as compared to the control and FMD groups. The lesion (mm2) was reduced from 40.18±2.6 in control group to 6.83±2.97 in PMD+CPA group, P<0.01, and from 32.9±3.27 in FMD group to 6.83±2.97 in pMlD+CPA group,P<0.01. The plasma levels of IL-8 decreased from 0.69±0.11 ng/L in control group to 0.4±0.04 ng/L in PMD+CPA group, P<0.01, and from 0.51±0.08 ng/L in FMD group to 0.4±0.04 ng/L in PMD+CPA group, P<0.05. The level of 6-keto-PGF1a increased from 7.55±1.65 ng/L in control group to 16.62±0.97 ng/L in PMD+CPA group, P<0.01,and from 13.15±1.48 ng/L in FMD group to 16.62±0.97ng/L in PMD+CPA group, P<0.05. The levels of MPO in the liver homogenate decreased from 9.12±2.05 u/Lin control group to 4.33±0.95 u/L in PMD+CPA group,P<0.01, and from 8.3±1.29 u/L in FMD group to 4.33±0.95 u/L, P<0.01.CONCLUSION: The synergistic action of FMD and CPA on acetic acid-induced chronic gastric ulcer in rats decreases the incidence of ulcer and also enhances the

  7. Assay of gastrin and somatostatin in gastric antrum tissues of children with chronic gastritis and duodenal ulcer

    Institute of Scientific and Technical Information of China (English)

    Xiao-Zhi Xie; Zhi-Guang Zhao; Dan-Si Qi; Zong-Min Wang

    2006-01-01

    AIM: To study the expressions of gastrin (GAS) and somatostatin (SS) in gastric antrum tissues of children with chronic gastritis and duodenal ulcer and their role in pathogenic mechanism.METHODS: Specimens of gastric antrum mucosa from 83 children were retrospectively analyzed. Expressions of GAS and SS in gastric antrum tissues were assayed by the immunohistochemical En Vision method.RESULTS: The expressions of GAS in chronic gastritis Hp+ group (group A), chronic gastritis Hp- group (group B), the duodenal ulcer Hp+group (group C), duodenal ulcer Hp- group (group D), and normal control group (group E) were 28.50+4.55, 19.60+2.49, 22.69+2.71,25.33 + 4.76, and 18.80 + 2.36, respectively. The value in groups A-D was higher than that in group E. The difference was not statistically significant. The expressions of SS in groups A-E were 15.47 + 1.44, 17.29 + 2.04,15.30 + 1.38, 13.11 + 0.93 and 12.14 + 1.68, respectively.The value in groups A-D was higher than that in group E.The difference was also not statistically significant.CONCLUSION: The expressions of GAS and SS are increased in children with chronic gastritis and duodenal ulcer.

  8. Chronic low back pain patients with accompanying leg pain : The relationship between pain extent and pain intensity, disability and health status

    NARCIS (Netherlands)

    Prins, Maarten R.; van der Wurff, Peter; Groen, Gerbrand J.

    2013-01-01

    Accompanying leg pain is commonly observed in patients with chronic low back pain (CLBP) and is assumed to be an indicator for the disorder severity. However, it is still unknown whether it is possible to estimate a patient's functional status by the extent of leg pain present. In a post rehabilitat

  9. IS PEPTIC ULCER WITH HELICOBACTER INFEC¬TION THE CAUSE OF CHRONIC URTICARIA?

    Directory of Open Access Journals (Sweden)

    A. Farhoudi

    2000-01-01

    Full Text Available Helicobacter pylori, the most important cause of gastritis and peptic ulcer, has recently been associated with several extradigestive diseases. The aim of this study was to assess the prevalence of Helicobacter pylori infection and effects of bacterium eradication in 50 patients affected by idiopathic chronic urticaria. Helicobacter pylori was assessed by serology or biopsy and urease test or 13C urea breath test. Amoxicillin, bismuth subcitrate (Denol, metronidazole and cimetidine were given to infected patients for 2 weeks. The results of therapy were assessed by urea breath test six weeks after therapy. In response to treatment urticaria clinically regressed in 16 out of 24 patients (66.6%. Thus bacterium eradication was associated with a remission of urticaria symptoms, suggesting a possible role in the pathogenesis of this disorder.

  10. A STUDY OF NEGATIVE PRESSURE WOUND THERAPY: VACUUM ASSISTED CLOSURE IN CHRONIC NON-HEALING ULCERS

    Directory of Open Access Journals (Sweden)

    Dhamotharan Senraman

    2016-06-01

    Full Text Available BACKGROUND This study evaluates the advantage of Negative Pressure Wound Therapy-Vacuum Assisted Closure over Conventional Dressing in the management of chronic non-healing ulcers. METHODS From June 2014 to June 2015, 50 patients were selected (25 cases and 25 controls. After wound debridement, VAC dressing is applied. Pre VAC and post VAC culture and sensitivity is taken. Dressing is given for 72 hours and intermittent suction is given for 10 mins. in an hour, daily for 12 hours with negative pressure ranging from 100 to 125 mmHg. Rest of the time drain of the VAC dressing is connected to the Romovac suction drain. Doppler study to assess the vascularity of the limb before the procedure and X-ray is taken to rule out osteomyelitis. Control group patients are given conventional dressings. RESULTS The gender, age and ulcer distributions were almost equal in the case and control groups and were found to be statistically insignificant. Duration of hospital stay in days was found to be statistically significant between groups. Majority (52% of cases left hospital within 3 weeks’ time, while a major chunk (88% of control population stayed more than 3 weeks. VAC dressing shows better results in patients with normal Doppler study. VAC dressing have better results in patients with 48% undergoing split skin grafting and less rate (8% of amputation as against none undergoing split skin grafting and 24% needing amputation in the control group. Patients with sterile pre-VAC culture were not turning unsterile after VAC, but 90% unsterile turns sterile after VAC. CONCLUSION NPWT is a novel technique for managing an open wound by submitting the wound either to intermittent or continuous subatmospheric pressure. Here, we did a study to study the advantage of vacuum assisted closure over conventional dressing in the management of chronic non-healing ulcers and concluded that VAC decreases hospital stay, improves pus culture sterility, has better result in

  11. Impact of Restless Legs Syndrome on the Sleep Quality in Chronic Obstructive Pulmonary Disease

    Directory of Open Access Journals (Sweden)

    Erdal İn

    2016-04-01

    Full Text Available Objective: It is well known that various sleep disorders are common in cases of chronic obstructive pulmonary disease (COPD. However, restless legs syndrome (RLS has not been extensively studied in these patients. The aim of the current study was to investigate the prevalence of RLS and its impact on sleep quality in patients with COPD. Methods: The study included a total of 50 patients with COPD with a mean age of 67.2±7.7 years; 39 (78% were male. The RLS diagnosis was made based on the questionnaire items standardized by the International RLS study group. Dyspnea severity (mMRC, quality of life (CAT, sleep quality [Pittsburgh sleep quality index (PSQI], and daytime sleepiness [Epworth sleepiness scale (ESS] were evaluated using certain specific questionnaires. The subjects were studied in two groups: RLS-positive and RLS-negative groups. Results: In the study population, RLS was detected in 17 (34% patients. It was found that the RLS-positive subjects had a longer disease duration (p=0.006, a higher hospital admission rate (p=0.008, and lower spirometric values (p=0.023 for FVC; p=0.001 for FEV1. The CAT score was significantly higher in the RLS-positive group (p=0.019. The RLS-positive group had higher PSQI and ESS scores (p<0.001 for both. There were negative correlations between PSQI, ESS scores, and spirometric measures (FVC and FEV1, whereas PSQI and ESS scores had positive correlations with disease duration, mMRC, and CAT scores. Conclusion: In our study, it was observed that RLS is a common condition in patients with COPD. As the duration and severity of COPD increases, RLS becomes more prevalent and sleep quality deteriorates.

  12. Aerobic Exercise Improves Signs of Restless Leg Syndrome in End Stage Renal Disease Patients Suffering Chronic Hemodialysis

    Directory of Open Access Journals (Sweden)

    Mojgan Mortazavi

    2013-01-01

    Full Text Available Background. Restless leg syndrome (RLS is one of the prevalent complaints of patients with end stage renal diseases suffering chronic hemodialysis. Although there are some known pharmacological managements for this syndrome, the adverse effect of drugs causes a limitation for using them. In this randomized clinical trial we aimed to find a nonpharmacological way to improve signs of restless leg syndrome and patients’ quality of life. Material and Methods. Twenty-six patients were included in the study and divided into 2 groups of control and exercise. The exercise group used aerobic exercise during their hemodialysis for 16 weeks. The quality of life and severity of restless leg syndrome were assessed at the first week of study and final week. Data were analyzed using SPSS software. Results. The difference of means of RLS signs at the first week of study and final week was in exercise group and in control group. There was not any statistical difference between control group and exercise group in quality of life at the first week of study and final week. Conclusions. We suggest using aerobic exercise for improving signs of restless leg syndrome, but no evidence was found for its efficacy on patient’s quality of life.

  13. Polymicrobial nature of chronic diabetic foot ulcer biofilm infections determined using bacterial tag encoded FLX amplicon pyrosequencing (bTEFAP.

    Directory of Open Access Journals (Sweden)

    Scot E Dowd

    Full Text Available BACKGROUND: Diabetic extremity ulcers are associated with chronic infections. Such ulcer infections are too often followed by amputation because there is little or no understanding of the ecology of such infections or how to control or eliminate this type of chronic infection. A primary impediment to the healing of chronic wounds is biofilm phenotype infections. Diabetic foot ulcers are the most common, disabling, and costly complications of diabetes. Here we seek to derive a better understanding of the polymicrobial nature of chronic diabetic extremity ulcer infections. METHODS AND FINDINGS: Using a new bacterial tag encoded FLX amplicon pyrosequencing (bTEFAP approach we have evaluated the bacterial diversity of 40 chronic diabetic foot ulcers from different patients. The most prevalent bacterial genus associated with diabetic chronic wounds was Corynebacterium spp. Findings also show that obligate anaerobes including Bacteroides, Peptoniphilus, Fingoldia, Anaerococcus, and Peptostreptococcus spp. are ubiquitous in diabetic ulcers, comprising a significant portion of the wound biofilm communities. Other major components of the bacterial communities included commonly cultured genera such as Streptococcus, Serratia, Staphylococcus and Enterococcus spp. CONCLUSIONS: In this article, we highlight the patterns of population diversity observed in the samples and introduce preliminary evidence to support the concept of functional equivalent pathogroups (FEP. Here we introduce FEP as consortia of genotypically distinct bacteria that symbiotically produce a pathogenic community. According to this hypothesis, individual members of these communities when they occur alone may not cause disease but when they coaggregate or consort together into a FEP the synergistic effect provides the functional equivalence of well-known pathogens, such as Staphylococcus aureus, giving the biofilm community the factors necessary to maintain chronic biofilm infections

  14. Contagem de plaquetas e caracterização clínica de úlceras de perna anticardiolipinas positivas Platelet count and clinical profile of anticardiolipin positive leg ulcers

    Directory of Open Access Journals (Sweden)

    Thelma Laroka Skare

    2009-10-01

    Full Text Available OBJETIVO: Estudar a prevalência de anticorpos anticardiolipinas em pacientes com úlceras venosas, diabéticas e arteriais e verificar se a contagem de plaquetas, antecedentes obstétricos e de trombose venosa profunda e achados de livedo reticularis ao exame físico servem como marcadores para os casos positivos. MÉTODOS: Estudaram-se 151 pacientes com úlcera de perna (81 com úlceras venosas, 50 com úlceras diabéticas e 20 com úlceras arteriais e 150 controles. Pesquisou-se, nos dois grupos, a presença de anticorpos anticardiolipina IgG e IgM e contagem de plaquetas. No grupo úlcera foram coletados dados de antecedentes de trombose venosa profunda e de abortamentos e os pacientes foram examinados para presença de livedo reticularis. Os dados obtidos foram agrupados em tabelas de frequência e contingência utilizando-se dos testes de Fisher e qui-quadrado para variáveis nominais e de Mann-Whitney e Kruskall-Wallis para as numéricas. Adotou-se significância de 5%. RESULTADOS: Encontrou-se prevalência de anticorpos anticardiolipina de 7.2% (n=12 no grupo com úlceras e de 1.3% (n=2 no controle (p=0.01. As úlceras de perna anticardiolipinas positivas não diferiram daquelas sem anticardiolipinas quanto ao gênero do paciente (p=0.98 e história de trombose prévia (p=0.69, abortamentos anteriores (p=0.67 e contagens de plaquetas (p=0.67. Só dois pacientes tinham livedo reticularis não permitindo inferências estatísticas a respeito deste dado. CONCLUSÃO: Existe aumento de prevalência de anticorpos anticardiolipinas nos portadores de úlceras de perna em relação à população geral. As características clínicas das úlceras anticardiolipinas positivas e a contagem de plaquetas não auxiliam na identificação desses pacientes.OBJECTIVE: To study the prevalence of anticardiolipin antibodies in patients with venous, diabetic and arterial leg ulcers and to verify if platelet count, previous history of venous thrombosis

  15. A STUDY OF EFFICACY OF TOPICAL INSULIN THERAPY IN THE TREATMENT OF CHRONIC DIABETIC FOOT ULCERS

    Directory of Open Access Journals (Sweden)

    Mahidhar Reddy

    2015-08-01

    Full Text Available Chronic wounds are an economic burden to the patient as they put him out of work and consume quality working days. Local insulin therapy is an innovative method in wound care which accelerates wound healing by increasing angiogenesis and granulation tissue formation. This study aims to evaluate its efficacy. OBJECTIVES: To study the efficacy of topical use of insulin in terms of (1 Rate of wound healing (2 Hospital stay. MATERIALS AND METHODS: This is a prospective study carried out in a tertiary health care center in 46 patients after taking informed and written consent. All patients who were satisfying inclusion and exclusion criteria were randomised into two groups A and B. Local insulin therapy was given to group A and normal saline dressing were done to group B. Size and depth were recorded at the start of the treatment and every week thereafter during the period of study. Strict glycemic control was maintained. Results were compared at complete wound healing or at the end of 8 weeks which was earlier. RESULTS: Improvement of the wound in the form of diameter and depth is seen. Significantly increased proliferation of granulation tissue is noticed in most of the patients belonging to group A, that is who received local insulin therapy. CONCLUSION: Local insulin therapy appears to be an efficacious method in the treatment of chronic diabetic foot ulcers and is safe and effective without any systemic side effects. It significantly reduces the hospital stay

  16. Clinical and immunological features of chronic non-specific non-ulcerative colitis in infants.

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    Marushko RV

    2013-04-01

    Full Text Available Objective: To study the activity of cytokines for determination of their pathogenic role and effective action of the individual factors of the immune system in infants with chronic non&specific non&ulcerative colitis (CNNC. Patients and methods. It is studied 60 children in the age from 1 to 3 years with CNNC, who were under hospitalization. The control group consisted of 30 apparently healthy children of appropriate age. Immunological status of children was evaluated on the base of determination of cytokine concentration in the blood serum by the method of Enzyme-Immuno-Sorbent-Assay. Results. It is found that during the CNNC in infants and the concentration and ratio of the different groups of cytokines in the blood serum undergoes significant changes — increasing the concentration of pro&inflammatory cytokines (IL&1α, IL&6, IL&8, TNF-α and decreases the level of inflammatory cytokines (IL-4 is the IL-10, wherein the content growth factors is changing — by increased hepatocytes growth factor and reduced intestinal trefoil factor. Conclusions. Found changes of cytokines state can be regarded as a violation of the immunoregulatory mechanisms that is the basis of pathogenesis of the formation of a chronic inflammatory process in the infant's intestine.

  17. Steps Toward Creating A Therapeutic Community for Inpatients Suffering from Chronic Ulcers: Lessons from Allada Buruli Ulcer Treatment Hospital in Benin

    Science.gov (United States)

    Amoussouhoui, Arnaud Setondji; Johnson, Roch Christian; Sopoh, Ghislain Emmanuel; Agbo, Ines Elvire; Aoulou, Paulin; Houezo, Jean-Gabin; Tingbe-Azalou, Albert; Boyer, Micah; Nichter, Mark

    2016-01-01

    Background Reducing social distance between hospital staff and patients and establishing clear lines of communication is a major challenge when providing in-patient care for people afflicted by Buruli ulcer (BU) and chronic ulcers. Research on hospitals as therapeutic communities is virtually non-existent in Africa and is currently being called for by medical anthropologists working in the field of health service and policy planning. This paper describes a pioneering attempt to establish a therapeutic community for patients suffering from BU and other chronic ulcers requiring long term hospital care in Benin. Methods A six-month pilot project was undertaken with the objectives of establishing a therapeutic community and evaluating its impact on practitioner and patient relations. The project was designed and implemented by a team of social scientists working in concert with the current and previous director of a hospital serving patients suffering from advanced stage BU and other chronic ulcers. Qualitative research initially investigated patients’ understanding of their illness and its treatment, identified questions patients had about their hospitalization, and ascertained their level of social support. Newly designed question–answer health education sessions were developed. Following these hospital wide education sessions, open forums were held each week to provide an opportunity for patients and hospital staff to express concerns and render sources of discontent transparent. Patient group representatives then met with hospital staff to problem solve issues in a non-confrontational manner. Psychosocial support for individual patients was provided in a second intervention which took the form of drop-in counseling sessions with social scientists trained to serve as therapy facilitators and culture brokers. Results Interviews with patients revealed that most patients had very little information about the identity of their illness and the duration of their

  18. Comparison of silver sulfadiazine, povidone-iodine and physiologic saline in the treatment of chronic pressure ulcers.

    Science.gov (United States)

    Kucan, J O; Robson, M C; Heggers, J P; Ko, F

    1981-05-01

    The presence of bacteria and local infection is an important factor in the local management of chronic pressure ulcers. For successful closure of the ulcer, the bacterial count should be 10(5) or less per gram of tissue in the granulating wound. In a prospective randomized study of 45 (eventually 40) hospitalized patients, silver sulfadiazine (Silvadene) cream and povidone-iodine (Betadine) solution were compared to physiologic saline for effectiveness in preparing pressure ulcers for closure. Quantitative bacteriologic techniques on tissue biopsy specimens were used for objective evaluation. In 100 percent of the ulcers treated with silver sulfadiazine cream (15 patients) the bacterial counts were reduced to 10(5) or less per gram of tissue within the three-week test period, compared to 78.6 percent in those treated with saline (14 patients) and 63.6 percent in those treated with povidone-iodine solution (11 patients). Moreover, the ulcers treated with silver sulfadiazine cream responded more rapidly, with one-third showing bacterial levels of less than 10(5) within three days, and half within a week. PMID:7014694

  19. Three cousins with chronic foot ulcers from late-onset hereditary sensory and autonomic neuropathies type 2 (HSAN2).

    Science.gov (United States)

    Aghaei, Shahin; Pakmanesh, Kambiz

    2006-02-28

    The hereditary sensory and autonomic neuropathies (HSAN) are a group of rare disorders characterized by prominent sensory and autonomic neuropathy without motor involvement. We report three male cousins with chronic foot ulcers, all were affected with late-onset HSAN type 2 (HSAN2). In view of the history of consanguinity and male sex, X-linked recessive transmission was likely in our patients. According to the authors' knowledge this is the first report of HSAN2 from Iran.

  20. Effects of acetylsalicylic acid (ASA), ASA plus L-glutamine and L-glutamine on healing of chronic gastric ulcer in the rat.

    Science.gov (United States)

    Okabe, S; Takeuchi, K; Honda, K; Takagi, K

    1976-01-01

    A chronic gastric ulcer model was produced in rats by the subserosal injection of 20% acetic acid solution (0.015 ml) in order to examine whether (1) acetylsalicylic acid (ASA) irritates the chronic gastric ulcer in active or healed or diminished stage, (2) L-glutamine, given together with ASA, inhibits the adverse effect of ASA. Oral ASA 200 mg/kg/day, given in two divided doses for 10 consecutive days, apparently delayed the healing of the gastric ulcer and irritated the healed ulcer to reulcerate. L-Glutamine, 1,500 mg/kg/day, which was given together with ASA in two divided doses, markedly protected the gastric ulcer both in active and healed stages from the deleterious activity of ASA. PMID:955326

  1. The Association of Helicobacter pylori Eradication with the Occurrences of Chronic Kidney Diseases in Patients with Peptic Ulcer Diseases

    Science.gov (United States)

    Wang, Jiunn-Wei; Hsu, Chien-Ning; Tai, Wei-Chen; Ku, Ming-Kun; Hung, Tsung-Hsing; Tseng, Kuo-Lun; Yuan, Lan-Ting; Nguang, Seng-Howe; Liang, Chih-Ming; Yang, Shih-Cheng; Wu, Cheng-Kun; Hsu, Pin-I; Wu, Deng-Chyang; Chuah, Seng-Kee

    2016-01-01

    The association of Helicobacter pylori eradication with the occurrence of renal dysfunction in patients with peptic ulcer diseases is still unclear. This study aimed to clarify the relevance of H. pylori eradication to the occurrence of chronic kidney diseases in patients with peptic ulcer diseases. Data that were available from 2000–2011 were extracted from the National Health Insurance Research Database in Taiwan, and all patients with peptic ulcer diseases (n = 208 196) were screened for eligibility. We divided randomly selected patients into an H. pylori eradication cohort (cohort A, n = 3593) and matched them by age and sex to a without H. pylori eradication cohort (cohort B, n = 3593). Subgroup analysis was further performed for H. pylori eradication within ≤ 90 days of the diagnosis date (early eradication, n = 2837) and within 91–365 days (non-early eradication, n = 756). Cox proportional hazards regression analysis was used to estimate the association of H. pylori eradication with the risk of developing chronic kidney diseases and mortality. We observed that there were more patients suffering from chronic kidney disease in cohort B than in the early eradication subgroup of cohort A (8.49% vs. 6.70%, respectively, p = 0.0075); the mortality rate was also higher in cohort B (4.76% vs. 3.70%, respectively, p = 0.0376). Old age, pulmonary disease, connective tissue disorders, and diabetes were risk factors for chronic kidney diseases but early H. pylori eradication was a protective factor against chronic kidney diseases (hazard ratio: 0.68, 95% confidence interval: 0.52–0.88, p = 0.0030), and death (hazard ratio: 0.69, 95% confidence interval: 0.49–0.96, p = 0.0297). In conclusion, our findings have important implications suggesting that early H. pylori eradication is mandatory since it is associated with a protective role against the occurrence of chronic kidney diseases. PMID:27764171

  2. Helicobacter pylori virulence factors in duodenal ulceration: A primary cause or a secondary infection causing chronicity

    Institute of Scientific and Technical Information of China (English)

    Frank I Tovey; Michael Hobsley; John Holton

    2006-01-01

    Reports from countries with a high prevalence of Helicobacter pylori (H pylori) infection do not show a proportionately high prevalence of duodenal ulceration,suggesting the possibility that H pylori cannot be a primary cause of duodenal ulceration. It has been mooted that this discrepancy might be explained by variations in the prevalence of virulence factors in different populations. The aim of this paper is to determine whether the published literature gives support to this possibility. The relevant literature was reviewed and analyzed separately for countries with a high and low prevalence of H pylori infection and virulence factors. Although virulent strains of H pylori were significantly more often present in patients with duodenal ulcer than without the disease in countries with a low prevalence of H pyloriinfection in the population, there was no difference in the prevalence of virulence factors between duodenal ulcer, non- ulcer dyspepsia or normal subjects in many countries, where the prevalence of both H pylori infection and of virulence factors was high.In these countries, the presence of virulence factors was not predictive the clinical outcome. To explain the association between virulence factors and duodenal ulcer in countries where H pylori prevalence is low,only two papers were found that give little support to the usual model proposed, namely that organisms with the virulence factors are more likely than those without them to initiate a duodenal ulcer. We offer an alternative hypothesis that suggests virulence factors are more likely to interfere with the healing of a previously produced ulcer. The presence of virulence factors only correlates with the prevalence of duodenal ulcer in countries where the prevalence of H pylori is low. There is very little evidence that virulence factors initiate duodenal ulceration, but they may be related to failure of the ulcer to heal.

  3. Restless legs syndrome in patients on chronic hemodialysis in a Brazilian city: frequency, biochemical findings and comorbidities

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    Goffredo Filho Gilberto S.

    2003-01-01

    Full Text Available OBJECTIVE: To evaluate the frequency of restless legs syndrome (RLS in patients with chronic renal failure (CRF in Petrópolis, Brazil, and investigate associations between the syndrome and: demographic characteristics, biochemical variables and comorbidities. METHOD: A cross-sectional study in which we interviewed 176 patients on dialytic therapy based on criteria elaborated by the International Restless Legs Syndrome Study Group, and compared data of patients with and without RLS. RESULTS: The frequency was 14.8 %. There were no significant differences between the two groups in demographic and biochemical variables investigated (iron, creatinine, intact parathyroid hormone, hemoglobin, calcium, phosphate. We found no association between RLS and the most common comorbidities, except for chronic glomerulonephritis (CGN (OR = 3.84, p < 0.01. CONCLUSION: In the studied population RLS is a common disorder, and is not associated with the investigated biochemical abnormalities. A higher frequency of RLS in subjects with CGN is a finding that needs further investigation.

  4. 介入联合微创手术治疗下肢混合型血管性溃疡%Combination of interventional therapy and minimally invasive surgery for treatment of lower leg mixed vascular ulcers

    Institute of Scientific and Technical Information of China (English)

    袁链; 尹立伟; 张小明

    2012-01-01

    Objective: To investigate the effective methods for treatment of the lower leg vascular ulcers caused by mixed vascular etiologies.Methods: Endovascular therapy combined with minimally invasive surgery were performed in 22 patients with mixed vascular ulcers of the lower leg who were admitted from October 2008 to October 2011. The occluded segments of lower limb arteries of the patients were recanalized by balloon dilatation angioplasty and stents implantation, and their lower limb venous incompetences were treated with high ligation and stripping of the great saphenous vein as well as ligation of the perforator veins near the ulcers via small incision, respectively.Results: The ulcers in all of the patients were healed quickly and completely, and the average time of healing was 28 d. The follow-up period ranged from 6 to 28 months, and no recurrence was noted. Conclusion: Combination of endovascular treatment and minimally invasive surgery is effective for treatment of lower leg mixed vascular ulcers, and is recommend for use.%目的:探索下肢混合型血管性溃疡的有效治疗方法.方法:对2008年10月-2011年10月收治的22例下肢混合型血管性溃疡患者采用介入联合微创手术治疗.分别采用球囊扩张成形术和支架植入术开通患者下肢动脉闭塞段,小切口大隐静脉高位结扎剥脱及溃疡周围交通静脉缝扎术等治疗患者下肢静脉功能不全.结果:全部患者溃疡迅速彻底愈合,平均愈合时间28 d.随访6~28个月,无复发病例.结论:介入联合微创手术治疗下肢混合型血管性溃疡疗效确切显著,值得推荐.

  5. Spinal manipulation and home exercise with advice for subacute and chronic back-related leg pain

    DEFF Research Database (Denmark)

    Bronfort, Gert; Hondras, Maria; Schulz, Craig A;

    2014-01-01

    BACKGROUND: Back-related leg pain (BRLP) is often disabling and costly, and there is a paucity of research to guide its management. OBJECTIVE: To determine whether spinal manipulative therapy (SMT) plus home exercise and advice (HEA) compared with HEA alone reduces leg pain in the short and long...... (difference, 7 percentage points [CI, -2 to 15]; P = 0.146). Nearly all secondary outcomes improved more with SMT plus HEA at 12 weeks, but only global improvement, satisfaction, and medication use had sustained improvements at 52 weeks. No serious treatment-related adverse events or deaths occurred....... LIMITATION: Patients and providers could not be blinded. CONCLUSION: For patients with BRLP, SMT plus HEA was more effective than HEA alone after 12 weeks, but the benefit was sustained only for some secondary outcomes at 52 weeks. PRIMARY FUNDING SOURCE: U.S. Department of Health and Human Services....

  6. Fototerapia (LEDs 660/890nm no tratamento de úlceras de perna em pacientes diabéticos: estudo de caso Phototherapy (LEDs 660/890nm in the treatment of leg ulcers in diabetic patients: case study

    Directory of Open Access Journals (Sweden)

    Débora Garbin Minatel

    2009-07-01

    Full Text Available Avaliou-se a fototerapia na cicatrização de úlceras de perna (UP mistas em dois pacientes diabéticos (tipo 2, hipertensos. O aparelho apresentava sonda 1 (S1 (1 LED de 660nm, 5mW aplicado em 3 UP e sonda 2 (S2 (32 LEDs de 890nm e 4 LEDs de 660nm, 500mW em 6 UP. Após antissepsia,úlceras foram tratadas com sondas a 3J/cm2, 30seg, 2x/semana seguido pelo curativo diário com sulfadiazina de prata a 1% por 12 semanas. Pela análise com software Image J®, as UP com S2 tiveram índices de cicatrização médios de 0,6; 0,7 e 0,9 enquanto S1 foi de 0,2; 0,4 e 0,6 no 30º, 60º e 90º dias, respectivamente. A fototerapia acelerou a cicatrização das úlceras de perna em pacientes diabéticos.This study evaluated the use of phototherapy in the healing of mixed leg ulcers in two diabetic patients (type 2 with arterial hypertension. The device had probe 1 (one 660nm LED, 5mW applied in 3 ulcers and probe 2 (32 890nm LEDs associated with 4 660nm LEDs, 500mW in 6 ulcers. After asepsis, ulcers were treated with probes to 3 J/cm2, 30sec per point, twice a week, followed by topical daily dressing with 1% silver sulphadiazine during 12 weeks. The following analyses of ulcers with software Image J showed that probe 2 presented mean healing rates of 0.6; 0.7 and 0.9, whereas probe 1 had 0.2;0.4 and 0.6 at 30, 60 and 90 days, espectively. Phototherapy accelerated wound healing of leg ulcers in diabetic patients.

  7. Avaliação das limitações de úlcera venosa em membros inferiores Evaluation of limitations of venous ulcers in legs

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    Célia Regina Lopes

    2013-03-01

    Full Text Available CONTEXTO: A insuficiência venosa crônica tem um impacto socioeconômico considerável nos países ocidentais devido à alta prevalência, custo das investigações e tratamento e à perda de dias trabalhados. O questionário de qualidade de vida Short Form Health Survey (SF-36, bem como a análise da ativação muscular e mobilidade da articulação tibiotársica, é um instrumento utilizado para a sua mensuração. OBJETIVO: Avaliar as limitações osteomusculares e as alterações na qualidade de vida em portadores de úlcera venosa em membros inferiores. MÉTODOS: Foram estudados dez pacientes com úlceras classificadas com Classificação de Doença Venosa Crônica (CEAP: Clinica, Eliologia, Anatomia e Fisiopatologia 6, que responderam ao questionário SF36 e à escala analógica de dor e realizaram a goniometria, força muscular e eletromiografia. RESULTADOS: A idade média do grupo estudado foi 67,4 (±11,7, sendo 70% dos casos do sexo feminino. Não houve correlação significativa entre dor amplitude do movimento (ADM, força muscular, eletromiografia (EMG e o tamanho da lesão. Entretanto, houve correlação entre o perfil psicológico do SF-36 e o domínio de atividades motoras, bem como do perfil psicológico com as atividades sociais e percepção de si mesmo. Também houve diferença significativa na avaliação eletromiográfica dos músculos estudados. CONCLUSÃO: A presença de úlcera venosa em membros inferiores pode gerar limitações e alterações na qualidade de vida destes indivíduos. O aspecto psicossocial demonstrou-se preponderante sobre o aspecto motor, aumentando as restrições nas atividades de vida diária.BACKGROUND: : The chronic venous insufficiency has a considerable socioeconomic impact in western countries because of high prevalence, treatment and research cost, and loss of days worked. The health survey questionnaire Short Form Health Survey (SF36, as well as the analysis of muscle activation and mobility

  8. Effects of laser therapy on chronic skin ulcers healing interventions for Sudanese patients

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    Abdelrazig M. Abdelbagi

    2015-12-01

    Results: Utilization of laser dosage (energy density of 40 J/cm2 and 1.6 w/cm2 power density of the wavelength 820 nm and 30 J/cm2 energy density and power density of 0.24 w/cm2 of 780 nm wavelength, in addition to energy density of 8 J/cm2 and power density of 0.24 w/cm2 and 0.40 w/cm2 and energy density of 1.6 J/cm2 for the 675 wavelength was applied. In this study, we used the bio-stimulation effect of LLLT to enhance healing through immune modulation. However, the application of low level diode laser in the treatment of diabetic wounds can be accompanied by low energy density and short wavelength to give better results in a short time and a good diagnostic accuracy for its potentiality in the field. Conclusions: Consequently, the brown skins in Sub-Saharan region for different tissues of Sudanese diabetic patients of chronic skin ulcer can be treated with different wavelengths and energy relative to tissues softening and laser parameters of that optimum values were obtained. The assessment of skin regeneration using laser therapy expose that the quality of growth, the reasonable period of healing and decreases the risk skin infection were achieved. The process of diabetic wounds curing and de-pigmentation, potential resident of decreasing pain and an efficient adjunct to a standard wound management was obtained. [Int J Res Med Sci 2015; 3(12.000: 3720-3725

  9. Multidisciplinary and comprehensive approaches to optimal management of chronic pressure ulcers in the elderly

    Directory of Open Access Journals (Sweden)

    Jaul E

    2014-05-01

    Full Text Available Efraim Jaul Skilled Geriatric Nursing Department, Herzog Memorial Hospital, Affiliated to the Hebrew University Hadassah Medical School, Jerusalem, Israel Abstract: The occurrence of pressure ulcers (PUs is common and poses serious problems for the frail elderly, with implications for functional disability and reduced quality of life. PUs are preventable in a majority of cases. The increase in PU occurrence, however, appears regardless of higher awareness in prevention and improvement through utilization of pressure relieving devices. Multiple changes in the elderly body systems occur over time including aging, multiple chronic conditions, and functional impairment, potentially culminating in the final pathways of geriatric syndrome, unless awareness to the development of PUs is reversible and prevented. The assumption is that the development of PUs is based on multifactorial causes (extrinsic and intrinsic factors; thus, the optimal management for elderly patients requires a comprehensive approach in all medical settings (community, hospital, and at the long term care [LTC] level. Comprehensiveness signifies looking beyond the wounds, assisting the patient through both local (wound and systemic (medical condition treatment, using a strategy of prevention and supporting quality of life. Within the multidisciplinary involvement team approach, each professional discipline contributes its own task in coordination with other disciplines to address PU prevention, assessment, and treatment. The entire medical staff and the multidisciplinary team work together and communicate frequently in order to prevent, halt at an early stage, and provide healing in a timely fashion. Limiting the formation of PUs is facilitated through early identification, treating contributing causes, eliminating all unnecessary medications, instituting supportive interventions which include the family. Understanding the relationship between the formation of PUs and the

  10. Ulcerative lupus vulgaris over nose, leading to cosmetic deformity.

    Science.gov (United States)

    Nair, Pragya A; Mehta, Malay J; Patel, Bhumi B

    2015-01-01

    Lupus vulgaris (LV), is a chronic and progressive form of secondary cutaneous tuberculosis. In India, it is commonly seen over buttocks, thighs, and legs whereas involvement of nose is quite rare. Ulcerative variant particularly over nose causes destruction of cartilage, leading to irreversible deformities and contracture. High-index of suspicion is required for early diagnosis and prevention of cosmetic deformity. A case of LV over nose in a young male with ulceration is reported who responded well to anti-tubercular therapy, but left with scarring of nose, which could have been prevented if adequate awareness regarding extra-pulmonary cases would have been practiced.

  11. The diagnostic value of MRI scans for the diagnosis of chronic exertional compartment syndrome of the lower leg

    International Nuclear Information System (INIS)

    Objective. A prospective descriptive study to determine the value of magnetic resonance imaging (MRI) as an aid in diagnosing (chronic) exertional compartment syndrome.Design and patients. MRI was performed in 21 patients (41 anterior compartments) with chronic compartment syndrome at rest and following physical exercise. Median (T2-weighted) signal intensity on the MRI scan was determined in the anterior and the (superficial) posterior compartment of the lower leg before and after exercise. Postexercise increases in the signal intensity in these two compartments were compared. After fasciotomy, a second MRI scan was performed in 13 patients (25 anterior compartments) on the basis of the same protocol. MR studies were performed in 12 normal controls (24 anterior muscle compartments) on the basis of the same protocol.Results. T2-weighted signal intensity increased by 27.5% (range 13.6-38.6%) following exercise in the anterior compartment of patients with a chronic compartment syndrome. In the posterior compartment this increase amounted to 4.25% (range 0-10.2%). Following fasciotomy, the increase in the anterior compartment was 4.1% (range 1.0-5.2%), while the increase in the posterior compartment amounted to 5.6% (range 0-11.0%), In normal controls, the increase in the anterior compartment was 7.6% (range 0-9.1%), while in the posterior compartment it was 4.0% (range 0-7.2%).Conclusions. In patients with a chronic compartment syndrome, the affected (anterior) compartment shows a statistically significant increase in (T2-weighted) signal intensity during exercise compared with both the (superficial) posterior compartment and the anterior compartment of normal controls. This effect disappeared after fasciotomy. In view of the substantial increase in T2-weighted signal intensity, MRI can be used in diagnosing chronic compartment syndrome. (orig.)

  12. Measurement of the healing ability of ischemic ulcers in the lower limbs in chronic arterial obstructive disease using 201Tl-Cl

    International Nuclear Information System (INIS)

    Evaluation of the healing ability of ischemic ulcers by a method involving measurement of the ulcer index (U. I.) and mean ulcer index of toes (mU. I.) using 201Tl-Cl before and after the treatment of chronic arterial obstructive disease accompanied by ischemic ulcer was studied. The lesions consisted of 56 ulcers in 41 limbs. Reactive hyperemia following avascularization stress was used for measurement, and U. I. was determined according to the method of Siegel et al. For cases with toe ulcers, the mU. I. was measured from plantar scintigrams, twice under stress and upon redistribution after 3 hours' rest. The following results were obtained. 1) The healing ability of the cases with a U. I. value of more than 1.4 was good, but even among cases with a pretreatment U. I. of 0.9 - 1.4, ulcer healing was also good in cases in which the U. I. was maintained above 1.4 as a result of various treatments. 2) Significant increases in U. I. were observed in the arterial reconstruction group after treatment, compared to the conservative treatment group and the lumbar sympathectomy group. 3) The healing ability was good in cases with an mU. I. of more than 1.2 at stress except for 2 ASO cases complicated by diabetes. 4) Although it was difficult to prognosticate the healing ability of cases with an mU. I. of less than 1.2 before treatment, healing ability could be evaluated after treatment on the basis of the appearance of significant increase in blood flow on stress in the ulcerated toes. 5) A stress index seemed to reflect the ischemic conditions in ulcerated toes in relation to stress. 6) U. I. and mU. I. measured using 201Tl-Cl were significantly correlated with the degree of inflammatory and reactive hyperemia in the floor of ulcers and in the ulcerated toes. (J.P.N.)

  13. Gastroprotective effects of thymol on acute and chronic ulcers in rats: The role of prostaglandins, ATP-sensitive K(+) channels, and gastric mucus secretion.

    Science.gov (United States)

    Ribeiro, Ana Roseli S; Diniz, Polyana B F; Pinheiro, Malone S; Albuquerque-Júnior, Ricardo L C; Thomazzi, Sara M

    2016-01-25

    Thymol, a monoterpene phenol derivative of cymene, is found in abundance in the essential oils of Thymus, Origanum, and Lippia species. The present study investigated the gastroprotective actions of thymol (10, 30, and 100 mg/kg, p.o.) in the acute (ethanol- and nonsteroidal anti-inflammatory drug-induced ulcers) and chronic (acetic acid-induced ulcers) ulcer models in rats. Some of the mechanisms underlying to the gastroprotective effect of thymol were investigated in the ethanol-induced ulcer model. Gastric secretion parameters (volume, pH, and total acidity) were also evaluated by the pylorus ligature model, and the mucus in the gastric content was determined. The anti-Helicobacter pylori activity of thymol was performed using the agar-well diffusion method. Thymol (10, 30, and 100 mg/kg) produced dose dependent reduction (P ulcer model. The gastroprotective response caused by thymol (30 mg/kg) was significantly attenuated (P ulcer index (P ulcer models, respectively. In the model pylorus ligature, the treatment with thymol failed to significantly change the gastric secretion parameters. However, after treatment with thymol (30 and 100 mg/kg), there was a significant increase (P ulcer models through mechanisms that involve increased in the amount of mucus, prostaglandins, and ATP-sensitive K(+) channels.

  14. Comparison of Helicobacter pylori infection and gastric mucosal histological features of gastric ulcer patients with chronic gastritis patients

    Institute of Scientific and Technical Information of China (English)

    Chuan Zhang; Nobutaka Yamada; Yun-Lin Wu; Min Wen; Takeshi Matsuhisa; Norio Matsukura

    2005-01-01

    AIM: To compare Helicobacter pyloriinfection and gastric mucosal histological features of gastric ulcer patients with chronic gastritis patients in different age groups and from different biopsy sites.METHODS: The biopsy specimens were taken from the antrum, corpus and upper angulus of gastric ulcer and chronic gastritis patients. Giemsa staining, improved Toluidine-blue staining and H pylori-specific antibody immune staining were performed as appropriate for the histological diagnosis of H pylori infection. Hematoxylineosin staining was used for the histological diagnosis of activity of H pylori infection, mucosal inflammation,glandular atrophy and intestinal metaplasia and scored into four grades according to the Updated Sydney System.RESULTS: Total rate of H pylori infection, mucosal inflammation, activity of H pylori infection, glandular atrophy and intestinal metaplasia in 3 839 gastric ulcer patients (78.5%, 97.4%, 82.1%, 61.1% and 64.2%,respectively) were significantly higher than those in 4 102chronic gastritis patients (55.0%, 90.3%, 56.2%, 36.8%,and 37.0%, respectively, P<0.05). The rate of H pylori colonization of chronic gastritis in <30 years, 31-40 years,41-50 years, 51-60 years, 61-70 years and >70 years age groups in antrum was 33.3%, 41.7%, 53.6%, 57.3%,50.7%, 43.5%, respectively; in corpus, it was 32.6%,41.9%, 53.8%, 60.2%, 58.0%, 54.8%, respectively; in angulus, it was 32.4%, 42.1%, 51.6%, 54.5%, 49.7%,43.5%, respectively. The rate of Hpyloricolonization of gastric ulcer in <30 years, 31-40 years, 41-50 years,51-60 years, 61-70 years and >70 years age groups in antrum was 60.5%, 79.9%, 80.9%, 66.8%, 59.6%, 45.6%,respectively; in corpus, it was 59.7%, 79.6%, 83.6%,80.1%, 70.6%, 59.1%, respectively; in angulus, it was61.3%, 77.8%, 75.3%, 68.8%, 59.7%, 45.8%,respectively. The rate of H pylori colonization at antrum was similar to corpus and angulus in patients, below50 years, with chronic gastritis and in patients, below40 years, with

  15. Defensin expression in chronic pouchitis in patients with ulcerative colitis or familial adenomatous polyposis coli

    Institute of Scientific and Technical Information of China (English)

    Karlheinz Kiehne; Gabriele Brunke; Franziska Wegner; Tomas Banasiewicz; Ulrich R F(o)lsch; Karl-Heinz Herzig

    2006-01-01

    AIM:Pouchitis develops in ileoanal pouches in up to 50% of patients with ulcerative colitis during the first 10years after pouch surgery while being rare in patients after proctocolectomy for familial adenomatous polyposis coii (FAP) syndrome. Defensins are major components of the innate immune system and play a significant role in gastrointestinal microbial homeostasis. Pouch defensin and cytokine expression were correlated with states of pouch inflammation to study their role in pouchitis.METHODS:Patients with ulcerative colitis and FAP syndrome were stratified into groups with pouches after surgery, pouches without or with pouchitis. Biopsies from terminal ileum from a healthy intestine or from normal terminal ileum of patients with ulcerative colitis served as controls, mRNA from pouches and controls was analysed for defensin and cytokine expression.RESULTS: Expression of defensins was increased in all pouches immediately after surgery, compared to ileum of controls. Initially, pouches in ulcerative colitis revealed higher defensin expression than FAP pouches. Defensin expression declined in both patient groups and increased again slightly in pouchitis in patients with ulcerative colitis. FAP pouches without pouchitis had strong expression of β-defensin hBD-1, while all other defensins remained at low levels. Cytokine expression in ulcerative colitis pouches was high, while FAP pouches showed moderately elevated cytokines only after surgery.CONCLUSION: Development of pouchitis correlates with decreased defensin expression in ulcerative colitis in addition to high expression of cytokines. The low incidence of pouchitis in FAP pouches correlates with increased expression of hBD-1 β- defensin in association with low cytokine levels.

  16. Clinical outcome of ileal pouch-anal anastomosis for chronic ulcerative colitis in China

    Institute of Scientific and Technical Information of China (English)

    Liu Gang; Han Hongqiu; Liu Tong; Fu Qiang; Lyu Yongcheng

    2014-01-01

    Background The incidence of chronic ulcerative colitis (CUC) in China is remarkably increasing,while little information on surgical treatment has been reported.This study aimed to completely describe and analyze the clinical outcome of restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) for CUC in China.Methods Ninety-five consecutive patients,who suffered CUC and had surgical indications,were carefully selected.All patients underwent IPAA.Data on patient characteristics,surgical indications,surgical details,postoperative complications,functional outcome,and quality of life were collected.Results The mean patient age at the time of the operation was 32 years.Twenty-nine (31%) patients underwent an emergency operation,and 66 (69%) underwent elective procedures.Four patients with severe dysplasia underwent operations,but no carcinoma was histologically confirmed.A two-stage operation was performed in 87 (92%) patients,and a hand-sewn technique was applied in 88 (93%) patients.Sixteen patients (17.0%) experienced early complications,and there was a significant difference between the emergency surgery group and the elective group (31.0% vs.10.6%,respectively; P <0.01).Five (5.3%) patients developed pouchitis as a late complication.The mean stool frequency after the operation was 4.6 (2-11) during the first 24 hours and 1.5 (0-4) overnight.According to the Kirwan grading scale,87 (91.8%) patients showed satisfactory anal continence function.The quality of life improved significantly from a preoperative mean value of 0.28-0.61 before ileostomy closure to 0.78 after ileostomy closure (P <0.01) according to the Cleveland Global Quality of Life index.Conclusions IPAA is an effective and safe surgical procedure for patients with CUC in China.However,some characteristics,such as the low incidence of pouchitis,require further study.

  17. A study to determine the knowledge and practice of foot care in patients with chronic diabetic ulcers

    Directory of Open Access Journals (Sweden)

    Chamil Vidusha Madushan Jinadasa

    2011-01-01

    Full Text Available Introduction: Diabetic foot ulcers accounts for many hospital admissions and it is also a major cause of amputations. More importantly it is preventable by effective identification, education and preventive foot care practice. Therefore, lifestyle modification remains a cornerstone of management.Objective: Determine the level of knowledge and practice of foot care among patients with chronic diabetic foot ulcers.Methodology: Individuals having diagnosed diabetic foot ulcers (n=110 were selected from National Hospital of Sri Lanka(NHSL for this descriptive cross sectional study. They were given an interviewer administered, pre tested questionnaire following informed consent. Patient perceptions of foot care were inquired. A scoring system ranging from 0-10 was employed to analyze the responses given for level of knowledge and practice of diabetic foot care. The study was approved by the Ethics Review Committees of Faculty of Medicine, Colombo.Results: Mean age was 58.4 years( SD ±8.6 and 57.3% were males. Non healing ulcers were present among 82.7% and amputations amounted to 38.2%. The control of diabetes was poor in 60%. Regarding foot care knowledge, the mean score was 8.37, 75.5% had scored above mean and 52.7% were aware of all principles of foot care. Regarding foot care practices, the mean score was 4.55, 47.3% participants had scored below mean and 22.7% did not practice any foot care principle and hence scored 0. A Statistically significant difference exists between the foot care knowledge and practice scores (p<0.001, z= -8.151. In the study sample 51% were not educated prior to occurrence of complications.Conclusion: Results demonstrate a satisfactory knowledge on diabetic foot disease, however their practices of preventive techniques were unsatisfactory. Implementation of a national policy on diabetic foot management and good patient follow-up to increase compliance would help to improve this situation.

  18. A Rare Cause of Chronic Life Threatening Bleeding in a Girl: The Ulcerated Blind Loops.

    Science.gov (United States)

    Sawant, Abhijeet D; Shah, Rasik; Shah, Nitin; Gupta, Tarun

    2016-01-01

    Ulceration in a blind loop can lead to massive gastrointestinal tract (GIT) bleeding. A 13-year old girl presented with symptomatic melena requiring repeated blood transfusion since childhood. She was an operated case of small bowel atresia in neonatal life. Her upper and lower gastrointestinal endoscopies were normal. Operation showed presence of multiple ulcers in two blind loops (parts of previous side to side anastomosis) and at the anastomotic site. She underwent resection and end-to-end anastomosis of the small bowel leading to complete resolution of melena and anemia. PMID:27170918

  19. A Rare Cause of Chronic Life Threatening Bleeding in a Girl: The Ulcerated Blind Loops

    Directory of Open Access Journals (Sweden)

    Abhijeet D Sawant

    2016-04-01

    Full Text Available Ulceration in a blind loop can lead to massive gastrointestinal tract (GIT bleeding. A 13-year old girl presented with symptomatic melena requiring repeated blood transfusion since childhood. She was an operated case of small bowel atresia in neonatal life. Her upper and lower gastrointestinal endoscopies were normal. Operation showed presence of multiple ulcers in two blind loops (parts of previous side to side anastomosis and at the anastomotic site. She underwent resection and end-to-end anastomosis of the small bowel leading to complete resolution of melena and anemia.

  20. 静脉溃疡病人愈合后皮肤结构变化的远期随访%Long-term mortality of ultrasound structure in patients with venous leg ulcers-healed from one week to twenty years

    Institute of Scientific and Technical Information of China (English)

    杨银辉; 贾赤字; 等

    2002-01-01

    目的观察静脉溃疡患者愈合后皮肤超声结构的变化,探讨创面愈合质量.方法应用皮肤超声仪检测静脉溃疡病人愈合后瘢痕表皮及真皮的厚度,分析真皮中低回声区像素(LEPs).结果与正常皮肤比较,静脉溃疡愈合后瘢痕的平均表皮厚度显著增加(P<0.01),平均真皮厚度显著降低(P<0.01),而真皮中LEPs的数量及分布均无明显变化.皮肤的回声参数与创面愈合时间、创面大小、创面存在时间及病人年龄均无显著相关性.结论静脉溃疡患者创面愈合后,真皮中液体的数量及分布无显著改变,表明愈合后水肿得到有效控制.%Objective To obtain information about the quality of scars of healed venous leg ulcers compared with intact skin on the opposite leg by using high-frequency ultrasound. Methods Twenty-eight patients (16 women, 12 men, aged 31-89 years) whose venous ulcers had healed and scars formed were included in this study. The echogenicities of scars were measured with a 20 MHz high-frequency ultrasound Dermascan. The thickness of epidermis and dermis was assessed and the number of low echogenic pixels (LEPs) in the papillary dermis and reticular dermis were counted using image analysis software.Results The average epidermal thickness of the scars after 1 week to 20 years of healing was significantly increased compared to those of the control (P<0.01), whereas the average dermal thickness of scars after healing was significantly decreased compared to the control (P<0.01). The numbers of LEPs and the distributions of LEPs between scars and controls had no statistically significant differences. There were no correlations among scar echogenicities, age of healed venous ulcers, initial ulcer areas, age of venous ulcers or age of patients. In the control skin samples, the young group aged 31-69 years had fewer LEPs than did the elderly group aged 70-89 years.Conclusion Our study demonstrates that after the healing of venous leg ulcers

  1. 大隐静脉电凝术结合高压氧治疗下肢静脉性溃疡%Clinical research on hyperbaric oxygen and electrocoagulation in the treatment of venous ulcers on legs

    Institute of Scientific and Technical Information of China (English)

    王宏业; 杨秀义; 杨秀峰

    2012-01-01

    Objective To observe the clinical effect of hyperbaric oxygen and electrocoagulation in the treatment of venous ulcers on legs.Methods 36 patients with venous ulcer on legs were divided into group A of 12 cases,group B of 12 cases and group C of 12 cases.Group A was treated by hyperbaric oxygen and electrocoagulation;group B was treated by hyperbaric oxygen;group C was treated by electrocoagulation.The operation method:every one had been performed electrocoagulation,and performed improved Linton operation if traffic vein valve had functional disorder,and performed wearing ring operation if vein reflux exceed Ⅲ °.Results The time of healing:group A was ( 18.00 ± 4.66) days,group B was (28.20 ± 6.42 ) days and group C was (31.32 ± 4.88 ) days.The time was significantly different between the two groups( A and B,P <0.01 ;A and C,P <0.01 ; B and C,P < 0.05).29 cases had been investigated by 6 to 40 months,the venous ulcers on legs had no recurrence.Conclusion The treatment for venous ulcer on legs by hyperbaric oxygen and electrocoagulation was a new therapy which had advantage of healing quickly and less recurrence,It ought to be popularized.%目的 观察大隐静脉电凝术结合高压氧治疗下肢静脉性溃疡的临床效果.方法 36例下肢静脉性溃疡,随机分为三组,A组(电凝术结合高压氧组)12例,B组(高压氧组)12例,C组(电凝术组)12例.手术方法:行大隐静脉电凝术,交通静脉瓣膜功能不全,采用改良的Linton手术,Ⅲ°以上反流者行戴戒术.结果 愈合时间:A组( 18.00±4.66)d,B组(28.20±6.42)d,C组(31.32±4.88)d.三组差异有统计学意义(F=8.93,P<0.05);A组与B组、C组差异均有统计学意义(q=4.62、7.81,均P<0.01);B组与C组差异有统计学意义(q =3.76,P<0.05).36例中29例获随访,随访时间6~40个月,下肢静脉曲张及溃疡均无复发.结论 大隐静脉电凝术结合高压氧治疗下肢静脉性溃疡,溃疡愈合快,不易复发,是一种新型治疗方法,疗效肯定,值得推广.

  2. Avaliação da circulação arterial pela medida do índice tornozelo/braço em doentes de úlcera venosa crônica Evaluation of arterial circulation using the ankle/brachial blood pressure index in patients with chronic venous ulcers

    Directory of Open Access Journals (Sweden)

    Fabiane Noronha Bergonse

    2006-03-01

    Full Text Available FUNDAMENTOS: As úlceras venosas dos membros inferiores são freqüentes e têm grande impacto na qualidade de vida e produtividade do indivíduo, além de alto custo para a saúde pública. OBJETIVOS: Detecção de alterações arteriais em pacientes de úlcera venosa crônica dos membros inferiores com emprego de método não invasivo, de modo a discriminar aqueles em que estaria contra-indicado o tratamento compressivo. MÉTODOS: Foram estudados 40 doentes portadores de úlcera venosa crônica, com o intuito de se avaliar a presença de doença arterial periférica pela medida do índice tornozelo/braço por doppler-ultra-som. RESULTADOS: O índice tornozelo/braço mostrou-se alterado (menor que 1 em 9/22 (40,9% doentes com úlcera venosa crônica e hipertensão arterial concomitante, e apenas em 1/13 (7,7% doentes de úlcera venosa crônica sem hipertensão arterial. CONCLUSÕES: Doentes de úlcera venosa crônica e hipertensão arterial concomitantes devem ser submetidos rotineiramente à medida do índice tornozelo/braço para detecção de possível insuficiência arterial periférica associada.BACKGROUND: Chronic venous ulcers are extremely frequent and have a significant impact on quality of life and work productivity of individuals, in addition to high costs to public health. OBJECTIVES: Detection of arterial circulation alterations in chronic venous ulcer legs using a non-invasive method to discriminate patients not indicated to have compressive treatment. METHODS: Forty patients with chronic venous ulcers were investigated for the presence of peripheral arterial disease with measurement of the ankle/brachial index by Doppler ultrasound. RESULTS: The resting ankle/brachial pressure index was abnormal (lower than 1 in 9/22 (40.9% patients with concomitant chronic venous ulcers and hypertension and only in one out of 13 (7.7% patients with chronic venous ulcers and no hypertension. CONCLUSIONS: Patients with concomitant chronic venous

  3. An integrated approach in the treatment of varicose ulcer

    Directory of Open Access Journals (Sweden)

    Deepa Patil

    2013-01-01

    Full Text Available Venous ulcers (stasis ulcers, varicose ulcers are the wounds occurring due to inappropriate functioning of venous valves, usually of the legs. It is one of the most serious chronic venous insufficiency complications. The overall incidence rate is 0.76% in men and 1.42% in women. When a venous valve gets damaged, it prevents the backflow of blood, which causes pressure in the veins that leads to hypertension and, in turn, venous ulcers. These are mostly along the medial distal leg, which is often very painful, can bleed, and get infected. Treating varicose ulcers is a difficult task to the physician and a nightmare to the suffering patients, though a good number of the treatment principles are mentioned and practiced in allied sciences. In Ayurveda, this condition is considered as dus.t.a vran.a. It can be managed with the specific s′odhana therapy. So, the same treatment protocol was used to treat the case discussed here, i.e. with Nitya virecana and by Basti karma. The wound was successfully treated and, therefore, is discussed in detail.

  4. Multiarticular chronic tophaceous gout with severe and multiple ulcerations: a case report

    Directory of Open Access Journals (Sweden)

    Pavlakis Emmanouil

    2011-08-01

    Full Text Available Abstract Introduction Gout is a common inflammatory arthritis caused by articular precipitation of monosodium urate crystals. It usually affects the first metatarsophalangeal joint of the foot and less commonly other joints, such as wrists, elbows, knees and ankles. Case presentation We report the case of a 75-year-old Caucasian man with tophaceous multiarticular gout, soft-tissue involvement and ulcerated tophi on the first metatarsophalangeal joint of the left foot, on the first interphalangeal joint of the right foot and on the left thumb. Conclusion Ulcers due to tophaceous gout are currently uncommon considering the positive effect of pharmaceutical treatment in controlling hyperuricemia. Surgical treatment is seldom required for gout and is usually reserved for cases of recurrent attacks with deformities, severe pain, infection and joint destruction.

  5. Development of Marjolin's ulcer following successful surgical treatment of chronic sacral pressure sore

    DEFF Research Database (Denmark)

    Knudsen, M.A.; Biering-Sørensen, Fin

    2008-01-01

    STUDY DESIGN: Case report. OBJECTIVE: Report of an unusual case, where a Marjolin's ulcer that developed 2.5 years after surgical excision and successful closure. SETTING: Department of Plastic and Reconstructive Surgery and Burn Unit and the Clinic for Spinal Cord Injuries, Copenhagen University...... tomography, and magnetic resonance imaging scans revealed a soft tissue process over the sacral and coccygeal bones and massive destruction of these bony structures. The patient died 11 months later, despite surgical and radiation treatment. CONCLUSION: The present case is unusual because, in spite...... of surgical excision and successful closure of the wound, the patient developed Marjolin's ulcer 2.5 years later. Yet it illustrates the primary importance of preventing the development pressure sores, of aggressive (surgical) therapy with healing when they do arise and of taking frequent biopsies...

  6. Risk of ulcerative colitis and Crohn's disease among offspring of patients with chronic inflammatory bowel disease

    DEFF Research Database (Denmark)

    Orholm, Marianne; Fonager, Kirsten; Sørensen, Henrik Toft

    1999-01-01

    OBJECTIVE: The incidence of inflammatory bowel disease (IBD) varies among and within countries, but several studies have indicated that genetic factors may play an important role in the etiology of IBD. A Danish regional study has observed an almost 10-fold increased risk for ulcerative colitis (UC...... significantly increased. CONCLUSION: The risk for UC and CD among offspring of patients with IBD is 2-13 times higher than the risk within the general population....

  7. Multidisciplinary and comprehensive approaches to optimal management of chronic pressure ulcers in the elderly

    OpenAIRE

    Jaul E

    2014-01-01

    Efraim Jaul Skilled Geriatric Nursing Department, Herzog Memorial Hospital, Affiliated to the Hebrew University Hadassah Medical School, Jerusalem, Israel Abstract: The occurrence of pressure ulcers (PUs) is common and poses serious problems for the frail elderly, with implications for functional disability and reduced quality of life. PUs are preventable in a majority of cases. The increase in PU occurrence, however, appears regardless of higher awareness in prevention and improvement throu...

  8. The Effect of Somatosensory and Cognitive-motor Tasks on the Paretic Leg of Chronic Stroke Patients in the Standing Posture

    OpenAIRE

    Ju, Sung-kwang; Yoo, Won-gyu

    2014-01-01

    [Purpose] The purpose of this study was to investigate how different standing surfaces alter somatosensory input and how postural control is affected by these changes during the performance of a dual task with a cognitive-motor aspect. [Subjects] The subjects were 20 chronic stroke patients: 18 males, 2 females. [Methods] COP total distance, sway velocity, and the weight load on the paretic leg were measured while subjects performed the following three tasks (somatosensory task, cognitive-mot...

  9. Anterior seromyotomy with posterior truncal vagotomy in uncomplicated chronic duodenal ulcer.

    Directory of Open Access Journals (Sweden)

    Supe A

    1995-07-01

    Full Text Available Thirty cases of uncomplicated duodenal ulcer treated by anterior superficial lesser curvature seromyotomy and posterior truncal vagotomy were studied to evaluate the efficacy of this procedure. There was completeness of vagotomy in all the cases as shown by endoscopic Congo Red test. Twenty-seven cases were asymptomatic at 1-48 months (Mean 22.3 follow up, while 3 patients had controllable side effects such as dumping and diarrhoea. There was no mortality. This procedure is safe, effective and is a favourable alternative to highly selective vagotomy.

  10. Helicobacter pylori lipopolysaccharide:Biological activities in vitro and in vivo, pathological correlation to human chronic gastritis and peptic ulcer

    Institute of Scientific and Technical Information of China (English)

    Yi-Hui Luo; Jie Yan; Ya-Fei Mao

    2004-01-01

    AIM: To determine the biological activity of Helicobacter pylori (Hpylori) lipopolysaccharide (H-LPS) and understand pathological correlation between H-LPS and human chronic gastritis and peptic ulcer.METHODS: H-LPS of a clinical Hpylori strain and LPS of Escherichia coli strain O55:B5 (E-LPS) were extracted by phenol-water method. Biological activities of H-LPS and E-LPS were detected by limulus lysate assay, pyrogen assay,blood pressure test and PBMC induction test in rabbits,cytotoxicity test in NIH 3T3 fibroblast cells and lethality test in NIH mice. By using self-prepared rabbit anti-H-LPS serum as the first antibody and commercial HRP-labeled sheep anti-rabbit sera as the second antibody, H-LPS in biopsy specimens from 126 patients with chronic gastritis (68 cases) or gastric ulcer (58 cases) were examined by immunohistochemistry.RESULTS: Fibroblast cytotoxicity and mouse lethality of H-LPS were weaker than those of E-LPS. But the ability of coagulating limulus lysate of the two LPSs was similar (+/0.5 ng/mL). At 0.5 h after H-LPS injection, the blood pressures of the 3 rabbits rapidly declined. At 1.0 h after H-LPS injection, the blood pressures in 2 of the 3 rabbits fell to zero causing death of the 2 animals. For the other one rabbit in the same group, its blood pressure gradually elevated. At 0.5 h after E-LPS injection, the blood pressures of the three rabbits also quickly declined and then maintained at low level for approximately 1.0 h. At 0.5 h after injection with H-LPS or E-LPS, PBMC numbers of the rabbits showed a remarkable increase. The total positivity rate of H-LPS from 126 biopsy specimens was 60.3%(76/126). H-LPS positivity rate in the biopsy specimens from chronic gastritis (50/68, 73.5%) was significantly higher than that from gastric ulcer (26/58, 44.8%) (X2=10.77,P<0.01). H-LPS positivity rates in biopsy specimens from chronic superficial gastritis (38/48, 79.2%) and chronic active gastritis (9/10, 90.0%) were significantly higher than

  11. Complex and dynamic times of being chronically ill: Beyond disease trajectories of patients with ulcerative colitis.

    Science.gov (United States)

    Shubin, Sergei; Rapport, Frances; Seagrove, Anne

    2015-12-01

    This article contributes to health research literature by problematizing the linear, sequential and intelligible understanding of time in the studies of illness. Drawing on the work of Martin Heidegger, it attempts to overcome the problem of considering the time of illness as either a framework controlling patients' experiences or a mind-dependent feature of their lives. The paper offers a conceptual analysis of the stories of ulcerative colitis patients from a recent clinical trial to present temporalities of illness as both objective and subjective, relational and dynamic. We attend to a combination of temporalities related to the ambiguous unfolding of illness and patients' relationships with such an unpredictable world of changing bodies, medical practices and temporal norms. Furthermore, our analysis reveals openness of times and considers ulcerative colitis patients as constantly evolving beings, with multiple possibilities brought about by illness. The paper highlights co-existence of times and considers patients' lives as incorporating a multiplicity of futures, presents and pasts. It concludes with conceptual observations about the consequences of developing complex approaches to illness in health research, which can better highlight the situatedness of patients and their multi-dimensional temporal foundations. PMID:26560409

  12. Determination of Oxidative Stress in Patients With Chronic Venous Ulcer%慢性静脉性溃疡组织中氧化应激产物的测定

    Institute of Scientific and Technical Information of China (English)

    杨帆; 邓璐

    2016-01-01

    ABSTRACT:ObjectiveTo clarify whether there is oxidative stress in chronic venous ulcer, and to lay a theoretical foundation for the further study of the pathogenesis of chronic venous ulcer. Methods 36 cases were diagnosed from January 2015 to October 2015 were treated for chronic venous insufficiency of lower extremity ulcers in patients with ulcer specimens, determination of malondialdehyde (MDA), reduced glutathione (GSH), superoxide dismutase (SOD) content and compared with the burn ulcer tissue and normal skin tissue.Results With the control group (normal skin, burn ulcer group),duration of ulcer2 weeks and> 1 month group, venous ulceration of the concentration of MDA significantly increased (P2weeks and >1 month group, the SOD、GSH of venous ulcer group significantly reduced (P2周和>1月组,静脉性溃疡MDA浓度显著增加(P2周和>1月组中,静脉性溃疡组SOD、GSH明显减少(P<0.05)。结论静脉性溃疡创面氧化应激反应增强,抗氧化能力减弱,并产生了大量的氧化应激产物。

  13. Venous ulcers of the lower limb: Where do we stand?

    Directory of Open Access Journals (Sweden)

    Chatterjee S Sasanka

    2012-01-01

    Full Text Available Venous ulcers are the most common ulcers of the lower limb. It has a high morbidity and results in economic strain both at a personal and at a state level. Chronic venous hypertension either due to primary or secondary venous disease with perforator paucity, destruction or incompetence resulting in reflux is the underlying pathology, but inflammatory reactions mediated through leucocytes, platelet adhesion, formation of pericapillary fibrin cuff, growth factors and macromolecules trapped in tissue result in tissue hypoxia, cell death and ulceration. Duplex scan with colour flow is the most useful investigation for venous disease supplying information about patency, reflux, effects of proximal and distal compression, Valsalva maneuver and effects of muscle contraction. Most venous disease can be managed conservatively by leg elevation and compression bandaging. Drugs of proven benefit in venous disease are pentoxifylline and aspirin, but they work best in conjunction with compression therapy. Once ulceration is chronic or the patient does not respond to or cannot maintain conservative regime, surgical intervention treating the underlying venous hypertension and cover for the ulcer is necessary. The different modalities like sclerotherapy, ligation and stripping of superficial varicose veins, endoscopic subfascial perforator ligation, endovenous laser or radiofrequency ablation have similar long-term results, although short-term recovery is best with radiofrequency and foam sclerotherapy. For deep venous reflux, surgical modalities include repair of incompetent venous valves or transplant or transposition of a competent vein segment with normal valves to replace a post-thrombotic destroyed portion of the deep vein.

  14. Venous ulcers of the lower limb: Where do we stand?

    Science.gov (United States)

    Chatterjee, Sasanka S

    2012-05-01

    Venous ulcers are the most common ulcers of the lower limb. It has a high morbidity and results in economic strain both at a personal and at a state level. Chronic venous hypertension either due to primary or secondary venous disease with perforator paucity, destruction or incompetence resulting in reflux is the underlying pathology, but inflammatory reactions mediated through leucocytes, platelet adhesion, formation of pericapillary fibrin cuff, growth factors and macromolecules trapped in tissue result in tissue hypoxia, cell death and ulceration. Duplex scan with colour flow is the most useful investigation for venous disease supplying information about patency, reflux, effects of proximal and distal compression, Valsalva maneuver and effects of muscle contraction. Most venous disease can be managed conservatively by leg elevation and compression bandaging. Drugs of proven benefit in venous disease are pentoxifylline and aspirin, but they work best in conjunction with compression therapy. Once ulceration is chronic or the patient does not respond to or cannot maintain conservative regime, surgical intervention treating the underlying venous hypertension and cover for the ulcer is necessary. The different modalities like sclerotherapy, ligation and stripping of superficial varicose veins, endoscopic subfascial perforator ligation, endovenous laser or radiofrequency ablation have similar long-term results, although short-term recovery is best with radiofrequency and foam sclerotherapy. For deep venous reflux, surgical modalities include repair of incompetent venous valves or transplant or transposition of a competent vein segment with normal valves to replace a post-thrombotic destroyed portion of the deep vein. PMID:23162226

  15. Reliability and validity of the Chinese version of the Venous Leg Ulcer Quality of Life Questionnaire%下肢静脉溃疡患者生命质量问卷的汉化及信效度检验

    Institute of Scientific and Technical Information of China (English)

    顾保娣; 刘谆谆; 夏玲

    2015-01-01

    目的 对英文版下肢静脉溃疡患者生命质量问卷(VLU-QoL)进行汉化,评价汉化后的中文版VLU-QoL的测量性能,探索其在国内下肢静脉溃疡(VLU)患者中的适用性.方法 征得原作者和版权作者的同意后,采用国际药物经济学会制定的翻译标准对英文版VLU-QoL进行汉化,将中文版VLU-QoL应用于182例VLU患者,并对施测结果进行项目分析和信效度检验.结果 中文版VLU-QoL共有34个条目,总的Cronbach a系数为0.940;评定者间信度为0.841;重测信度为0.825;问卷条目水平的内容效度指数的范围为0.83~1.00,量表水平的内容效度指数为0.955;因子分析共提取3个公因子,累积方差贡献率为54.367%;中文版VLU-QoL与简明健康测量量表生理健康、心理健康的相关系数即校标关联效度分别为0.714和0.541.结论 中文版VLU-QoL具有良好的信效度,可以用于评价VLU患者的生命质量.%Objective To translate the Venous Leg Ulcer Quality of life Questionnaire (VLU-QoL) into Chinese and evaluate the reliability and validity of Chinese version.Methods VLU-QoL was translated into Chinese according to the standards setted by ISPOR.Totally 232 patients with venous leg ulcer were recruited and investigated by the Chinese version of VLU-QoL.Results The Chinese version of VLU-QoL comprised 34 items,Cronbach α was 0.940,inter-rater reliability was 0.841;test-retest reliability was 0.825.I-CVI was 0.83-1.00,S-CVI/Ave was 0.955;Criterion-related validity were 0.714 and 0.541;factor analysis got 3 factors,which explained 54.367% of the total variance.Conclusions The Chinese version of VLU-QoL has been proved to be reliable and valid.It can be used as a valid tool for the measurement of quality of life for patients with venous leg ulcer.

  16. Avaliação da analgesia de opioide tópico em úlcera de perna de paciente falcêmico Evaluation of the topical application of opioid analgesia for a leg ulcer of a sickle cell disease patient

    Directory of Open Access Journals (Sweden)

    Alexandre F. Neves

    2010-01-01

    Full Text Available A doença falciforme é caracterizada por apresentar várias alterações clinicas e fisiopatológicas nos pacientes que por ela são acometidos. Uma dessas alterações é presença de úlceras de perna dolorosas e de difícil cicatrização, sendo necessário o apoio de equipe multiprofissional no seu manejo e tratamento. Com o objetivo de reduzir a dor associada a úlcera de perna, o paciente falcêmico faz uso de opioides parenterais e enterais que normalmente estão associados a efeitos colaterais indesejados. Com o objetivo de reduzir o uso desses opioides sistêmicos, avaliamos um gel de morfina, de fácil manipulação e baixo custo, que foi utilizado antes e após o processo de troca de curativo das úlceras de perna dos pacientes falcêmicos atendidos em nossa instituição. Baseados na escala analógica da dor foi avaliado o efeito analgésico do gel em 28 pacientes. Todos apresentavam dor grau 7 ou 8 antes da aplicação do gel. Vinte e quatro pacientes (85,7% apresentaram total ausência de dor por um período de 24 horas, não sendo necessário o uso de analgésicos sistêmicos. Em três pacientes (10,7% a ausência de dor durou um periodo de 12horas. Somente um paciente (3,6% não relatou analgesia apos o uso do gel. Os resultados demonstraram que o gel é altamente eficaz no controle da dor das úlceras de perna de pacientes falcêmicos.Sickle cell disease is characterized by several clinical and pathophysiological changes including painful leg ulcers. These are difficult to heal and require the support of a multidisciplinary team in their management. The treatment of pain in these patients usually involves the use of opioids. In order to reduce the use of systemic opioids, we evaluated an easy-to-use low-cost morphine gel (0.12% that was applied before and after changing leg ulcer dressings of sickle cell patients treated in Hemorio hospital. Based on the Analogue Pain Scale (APS we evaluated the analgesic effect of the gel with

  17. Low level laser therapy (GaAlInP 660 nm) in healing of a chronic venous ulcer: a case study

    Science.gov (United States)

    Botaro, C. A.; Faria, L. A.; Oliveira, R. G.; Bruno, R. X.; Rocha, C. A. Q. C.; Paiva-Oliveira, E. L.

    2015-07-01

    The venous ulcer represents approximately 70% to 90% of inferior member ulcers, and the most common etiological factor is venous insufficiency, triggered by venous hypertension. Currently in Brazil there are several types of lasers used in physiotherapy, which benefit biological potential, emitting low power radiation, with anti-inflammatory, analgesic, healing and circulatory effects. This study aimed at the analysis of low level laser therapy effects (LLLT) on the process of tissue repair in chronic venous ulcers. We conducted a case study of a patient with a venous ulcer in the lateral region of the right inferior member. The patient underwent LLLT, which used a GaAlInP diode laser, with a wavelength of 660 nm and energy density of 4 J cm-2 applied punctually at the edges of the wound, with an average distance of 1 cm between the points with a pen-laser perpendicular wrapped in paper and a plastic wrap, keeping contact with the tissue. After four months of therapy and a total of 21 sessions, an improvement was noticeable in the gross appearance of the wound, but after a month and a half without therapy, the dimensions of the wound increased in length and width. Analyzing the results of this case study allows us to conclude that the LLLT GaAlInP (660 nm) with an energy density of 4 J cm-2, was not successful in the healing of venous ulcers.

  18. Clinical unity and community empowerment: the use of smartphone technology to empower community management of chronic venous ulcers through the support of a tertiary unit.

    Directory of Open Access Journals (Sweden)

    Edel Marie Quinn

    Full Text Available BACKGROUND: Chronic ulcers affect roughly 60,000 Irish people, at a total cost of €600,000,000, or €10,000 per patient annually. By virtue of their chronicity, these ulcers also contribute a significant burden to tertiary outpatient vascular clinics. OBJECTIVE: We propose utilizing mobile phone technology to decentralise care from tertiary centres to the community, improving efficiency and patient satisfaction, while maintaining patient safety. METHODS: Bespoke mobile software was developed for Apples iPhone 4 platform. This allowed for the remote collection of patient images prospectively and their transmission with clinical queries, from the primary healthcare team to the tertiary centre. Training and iPhones were provided to five public health nurses in geographically remote areas of the region. Data were uploaded securely and user end software was developed allowing the review and manipulation of images, along with two way communication between the teams. Establishing reliability, patients were reviewed clinically as well as remotely, and concordance analysed. Qualitative data were collected through focus group discussion. RESULTS: From October to December 2011 eight patients (61-83 yrs, mean 75.3 yrs with chronic venous ulceration and their five public health nurses were recruited. Data were transmitted using 3 G, Edge, GPRS and WiFi, at a mean speed of 69.03 kps. Concordance was 100% for wound bed assessment, 80% for skin integrity/colour and 60% for exudate assessment. Focus group analysis explored the concept, practicalities and future applications of the system. CONCLUSIONS: With an evolving national data network, the secure transmission of clinical images is a safe alternative to regular clinic appointments for patients with chronic venous ulceration. With further development, and packaged as a freely downloadable application, this has the potential to support the community care of chronic wounds.

  19. Treatment of a Refractory Skin Ulcer Using Punch Graft and Autologous Platelet-Rich Plasma

    Directory of Open Access Journals (Sweden)

    Mauro Carducci

    2016-01-01

    Full Text Available Background. Chronic ulceration of the lower legs is a relatively common condition amongst adults: one that causes pain and social distress and results in considerable healthcare and personal costs. The technique of punch grafting offers an alternative approach to the treatment of ulcers of the lower limbs. Objective. Combining platelet-rich plasma and skin graft enhances the efficacy of treating chronic diabetic wounds by enhancing healing rate and decreasing recurrence rate. Platelet-rich plasma could, by stimulating dermal regeneration, increase the take rate after skin grafting or speed up reepithelialization. Methods and Materials. The ulcer was prepared by removing fibrin with a curette and the edges of the ulcer were freshened. The platelet-rich plasma has been infiltrated on the bottom and edges of the ulcer. The punch grafts were placed in 5 mm holes arranged. The ulcer was medicated with hydrogel and a pressure dressing was removed after 8 days. Results. After a few days the patient did not report more pain. Granulation tissue appeared quickly between implants. Most of the grafts were viable in 2-3 weeks. The grafts gradually came together to close the ulcer and were completed in four months.

  20. Effective use of negative pressure wound therapy provides quick wound-bed preparation and complete graft take in the management of chronic venous ulcers.

    Science.gov (United States)

    Egemen, Onur; Ozkaya, Ozay; Ozturk, Muhammed Besir; Aksan, Tolga; Orman, Çağdaş; Akan, Mithat

    2012-04-01

    Venous ulcers are characterised by longstanding and recurrent loss of skin integrity. Once occurred, healing is slow and recurrence is high because of inappropriate conditions of the wound bed. This study involves 20 patients with chronic venous ulcers at least 6 weeks of duration treated with negative pressure wound therapy (NPWT). Patients underwent a radical debridement of all devitalised tissues in the first operation. After adequate haemostasis, silver-impregnated polyurethane foam was applied. Once the wounds were determined to be clean and adequate granulation tissue formation was achieved, split-thickness skin grafts were applied. Black polyurethane foam was applied over them. All wounds completely healed without the need for further debridement or regrafting. The mean number of silver-impregnated foam dressing changes prior to grafting was 2·9 (one to eight changes). The mean number of NPWT foam changes was 2·6 after skin grafting (two to five changes). Two patients who did not use conservative treatments for chronic venous insufficiency (CVI) after discharge from the hospital had recurrence of venous ulcers in the follow-up period. Application of NPWT provides quick wound-bed preparation and complete graft take in venous ulcer treatment. PMID:21992173

  1. Reversal of Refractory Ulcerative Colitis and Severe Chronic Fatigue Syndrome Symptoms Arising from Immune Disturbance in an HLADR/DQ Genetically Susceptible Individual with Multiple Biotoxin Exposures

    Science.gov (United States)

    Gunn, Shelly R.; Gibson Gunn, G.; Mueller, Francis W.

    2016-01-01

    Patient: Male, 25 Final Diagnosis: Ulcerative colitis and chronic fatigue syndrome Symptoms: Colitis • profound fatigue • multi-joint pain • cognitive impairment • corneal keratitis Medication: — Clinical Procedure: VIP replacement therapy Specialty: Family Medicine Objective: Unusual clinical course Background: Patients with multisymptom chronic conditions, such as refractory ulcerative colitis (RUC) and chronic fatigue syndrome (CFS), present diagnostic and management challenges for clinicians, as well as the opportunity to recognize and treat emerging disease entities. In the current case we report reversal of co-existing RUC and CFS symptoms arising from biotoxin exposures in a genetically susceptible individual. Case Report: A 25-year-old previously healthy male with new-onset refractory ulcerative colitis (RUC) and chronic fatigue syndrome (CFS) tested negative for autoimmune disease biomarkers. However, urine mycotoxin panel testing was positive for trichothecene group and air filter testing from the patient’s water-damaged rental house identified the toxic mold Stachybotrys chartarum. HLA-DR/DQ testing revealed a multisusceptible haplotype for development of chronic inflammation, and serum chronic inflammatory response syndrome (CIRS) biomarker testing was positive for highly elevated TGF-beta and a clinically undetectable level of vasoactive intestinal peptide (VIP). Following elimination of biotoxin exposures, VIP replacement therapy, dental extractions, and implementation of a mind body intervention-relaxation response (MBI-RR) program, the patient’s symptoms resolved. He is off medications, back to work, and resuming normal exercise. Conclusions: This constellation of RUC and CFS symptoms in an HLA-DR/DQ genetically susceptible individual with biotoxin exposures is consistent with the recently described CIRS disease pathophysiology. Chronic immune disturbance (turbatio immuno) can be identified with clinically available CIRS biomarkers and

  2. A new pathway for lower limb ulceration

    OpenAIRE

    Atkin, Leanne; Tickle, Joy

    2016-01-01

    Leg ulceration is a common cause of suffering for patients, additionally it places a significant burden on the NHS. As the NHS continues to face times of austerity, services need to find other ways of working to reduce cost and release nursing time whilst maintaining standards of care. The implementation of a pathway for the treatment of leg ulceration, which aids diagnosis and uses compression hosiery kits as a first-line management for venous leg ulceration, can form part of the solution by...

  3. A STUDY OF EFFICACY OF TOPICAL INSULIN THERAPY IN THE TREATMENT OF CHRONIC DIABETIC FOOT ULCERS

    OpenAIRE

    Mahidhar Reddy; Ashika Reddy; Rishita

    2015-01-01

    Chronic wounds are an economic burden to the patient as they put him out of work and consume quality working days. Local insulin therapy is an innovative method in wound care which accelerates wound healing by increasing angiogenesis and granulation tissue formation. This study aims to evaluate its efficacy. OBJECTIVES: To study the eff...

  4. Increased expression of heat shock protein 70 and heat shock factor 1 in chronic dermal ulcer tissues treated with laser-aided therapy

    Institute of Scientific and Technical Information of China (English)

    ZHOU Jian-da; LUO Cheng-qun; XIE Hui-qing; NIE Xin-min; ZHAO Yan-zhong; WANG Shao-hua; XU Yi; Pashupati Babu Pokharel; XU Dan

    2008-01-01

    Background Chronic dermal ulcers are also referred to as refractory ulcers, This study was conducted to elucidate the therapeutic effect of laser on chronic dermal ulcers and the induced expression of heat shock factor 1 (HSF1) and heat shock protein 70 (HSP70) in wound tissues.Methods Sixty patients with 84 chronic dermal ulcers were randomly divided into traditional therapy and laser therapy groups. Laser treatment was performed in addition to traditional therapy in the laser therapy group. The treatment efficacy was evaluated after three weeks. Five tissue sections of healing wounds were randomly collected along with five normal skin sections as controls. HSP70-positive cells from HSP70 immunohistochemical staining were counted and the gray scale of positive cells was measured for statistical analysis. Reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting were performed to determine the mRNA and protein expressions of HSF1 and HSP70.Results The cure rate of the wounds and the total efficacy in the laser therapy group were significantly higher than those in the traditional therapy group (P<0.05, P<0.01, respectively). Immunohistochemical staining revealed that the HSP70-positive cell count was significantly higher in laser therapy group than those in the traditional therapy group and controls (P<0.01), and the gray scale of the cell signal was obviously lower than traditional therapy group and controls (P <0.05). By contrast, the traditional therapy group and the control group were not significantly different. The RNA levels of HSF1 and HSP70 were higher in the laser therapy group by RT-PCR, but very low in normal skin and the traditional therapy group. The analysis on the gray scale of the Western blot bands indicated that the expression of HSF1 and HSP70 in the laser therapy group was significantly higher than in the traditional therapy group and the control group (P <0.01), and the expression in the traditional therapy group was also

  5. Etiological Analysis of 96 Cases of Patients with Chronic Pharyngeal Ulcer%96例慢性咽部溃疡患者的病因学分析

    Institute of Scientific and Technical Information of China (English)

    麦周生; 张佩玲

    2013-01-01

    Objective Analyze of the causes of 96 cases of patients with chronic pharyngeal ulcer. Methods We taked blood routine examination, laboratory test and immune function test to 96 cases of patients with chronic pharyngeal ulcer in our hospital and asked the patients with the habits and customs and history of inquiry, finally analyzed causes of chronic pharyngeal ulcer according to each patient's clinical symptoms and the inspection result. Results The results showed that benign ulcer of the patients is connected with work intensity, shift work,zinc and selenium in hair, the content of trace elements,but have no correlation with the sex of patient and if there is stomach trouble. Conclusion The causes of patients with chronic pharyngeal ulcer mainly are:work intensity, the nature of the work, if trace elements such as zinc, selenium in hair is lack.%  目的分析96例慢性咽部溃疡患者的病因。方法对来我院就诊的96例慢性咽部溃疡患者进行血常规检查、实验室检测及免疫功能检测,并对患者进行生活习惯与病史方面的询问,最后依据每位患者的临床症状及各项检查结果对其发生慢性咽部溃疡的病因进行分析。结果结果表明良性溃疡患者与其工作强度、工作是否倒班及头发中锌硒、微量元素的含量有相关性,而与患者的性别及是否有胃病无相关性。结论慢性咽部溃疡患者的病因主要有:工作强度、工作性质、头发中微量元素锌、硒是否缺乏。

  6. Reducing wound pain in venous leg ulcers with Biatain Ibu: A randomized, controlled double-blind clinical investigation on the performance and safety

    DEFF Research Database (Denmark)

    Gottrup, F.; Jorgensen, B.; Karlsmark, T.;

    2008-01-01

    Six out of 10 patients with chronic wounds suffer from persistent wound pain. A multinational and multicenter randomized double-blind clinical investigation of 122 patients compared two moist wound healing dressings: a nonadhesive foam dressing with ibuprofen (62 patients randomized to Biatain Ibu...... Nonadhesive Coloplast A/S) and a nonadhesive foam without ibuprofen (60 patients to Biatain Non-Adhesive-comparator). Patients were recruited from September 2005 to April 2006. The ibuprofen foam was considered successful if the pain relief on a five-point Verbal Rating Scale was higher than the comparator...... higher in the ibuprofen-foam group, as compared with the comparator on day 1-5, with a quick onset of action (p ibuprofen foam during day 1-5 with 40% from baseline, compared with 30% with the comparator (p

  7. Complex interventions for preventing diabetic foot ulceration

    NARCIS (Netherlands)

    Hoogeveen, Ruben C; Dorresteijn, Johannes A N; Kriegsman, Didi M W; Valk, Gerlof D.

    2015-01-01

    BACKGROUND: Ulceration of the feet, which can lead to the amputation of feet and legs, is a major problem for people with diabetes mellitus, and can cause substantial economic burden. Single preventive strategies have not been shown to reduce the incidence of foot ulceration to a significant extent.

  8. Reversal of Refractory Ulcerative Colitis and Severe Chronic Fatigue Syndrome Symptoms Arising from Immune Disturbance in an HLA-DR/DQ Genetically Susceptible Individual with Multiple Biotoxin Exposures.

    Science.gov (United States)

    Gunn, Shelly R; Gunn, G Gibson; Mueller, Francis W

    2016-01-01

    BACKGROUND Patients with multisymptom chronic conditions, such as refractory ulcerative colitis (RUC) and chronic fatigue syndrome (CFS), present diagnostic and management challenges for clinicians, as well as the opportunity to recognize and treat emerging disease entities. In the current case we report reversal of co-existing RUC and CFS symptoms arising from biotoxin exposures in a genetically susceptible individual. CASE REPORT A 25-year-old previously healthy male with new-onset refractory ulcerative colitis (RUC) and chronic fatigue syndrome (CFS) tested negative for autoimmune disease biomarkers. However, urine mycotoxin panel testing was positive for trichothecene group and air filter testing from the patient's water-damaged rental house identified the toxic mold Stachybotrys chartarum. HLA-DR/DQ testing revealed a multisusceptible haplotype for development of chronic inflammation, and serum chronic inflammatory response syndrome (CIRS) biomarker testing was positive for highly elevated TGF-beta and a clinically undetectable level of vasoactive intestinal peptide (VIP). Following elimination of biotoxin exposures, VIP replacement therapy, dental extractions, and implementation of a mind body intervention-relaxation response (MBI-RR) program, the patient's symptoms resolved. He is off medications, back to work, and resuming normal exercise. CONCLUSIONS This constellation of RUC and CFS symptoms in an HLA-DR/DQ genetically susceptible individual with biotoxin exposures is consistent with the recently described CIRS disease pathophysiology. Chronic immune disturbance (turbatio immuno) can be identified with clinically available CIRS biomarkers and may represent a treatable underlying disease etiology in a subset of genetically susceptible patients with RUC, CFS, and other immune disorders. PMID:27165859

  9. Hypertrophy and pseudohypertrophy of the lower leg following chronic radiculopathy and neuropathy: imaging findings in two patients

    Energy Technology Data Exchange (ETDEWEB)

    Beuckeleer, L. de; Schepper, A. de [Department of Radiology, University Hospital Antwerp, Edegem (Netherlands); Vanhoenacker, F. [Department of Radiology, University Hospital Antwerp, Edegem (Netherlands)]|[Department of Radiology, AZ St. Maarten, Campus Duffel, Duffel (Belgium); Schepper, A. Jr. de [Department of Radiology, University Hospital Antwerp, Edegem (Netherlands)]|[Department of Radiology, AZ Middelheim, Antwerpen (Belgium); Seynaeve, P. [Department of Radiology, AZ Middelheim, Antwerpen (Belgium)

    1999-04-01

    Enlargement of the ipsilateral muscle compartment is an exceptional finding in patients with chronic radiculopathy, peripheral nerve injury, anterior horn cell diseases, or acquired peripheral neuropathy. We report radiographic, ultrasonographic, CT and MRI findings in a patient with chronic S1 radiculopathy and another with chronic neuropathy of the common fibular nerve (L4-S2), both presenting with painless enlargement of the calf muscles. (orig.) With 2 figs., 7 refs.

  10. Managing painful chronic wounds: the Wound Pain Management Model

    DEFF Research Database (Denmark)

    Price, Patricia; Fogh, Karsten; Glynn, Chris;

    2007-01-01

    document persistent wound pain and not to develop a treatment and monitoring strategy to improve the lives of persons with chronic wounds. Unless wound pain is optimally managed, patient suffering and costs to health care systems will increase. Udgivelsesdato: 2007-Apr......Chronic wound pain is not well understood and the literature is limited. Six of 10 patients venous leg ulcer experience pain with their ulcer, and similar trends are observed for other chronic wounds. Chronic wound pain can lead to depression and the feeling of constant tiredness. Pain related...... to the wound should be handled as one of the main priorities in chronic wound management together with addressing the cause. Management of pain in chronic wounds depends on proper assessment, reporting and documenting patient experiences of pain. Assessment should be based on six critical dimensions...

  11. Evaluation of acute and sub-chronic toxicities of ulcer fast and reg;: a bi-herbal formula in male Wistar albino rats

    OpenAIRE

    Kingsley C. Patrick-Iwuanyanwu; Jane A. Emerue

    2014-01-01

    The acute and sub-chronic toxicities of ulcer fast and reg; (UF) - A commercial bi-herbal formula prepared with Alstonia boonei and Xylopia aethiopica in male Wistar albino rats was evaluated. There was no mortality in rats administered 2000 mg/kg body weight (BW) of UF in an acute toxicity study. A significant (p and #8804;0.05) increase in daily consumption of feed and fluid intake in experimental rats after 28 days was recorded followed by a progressive increase in BW of rats administered ...

  12. Transversal escharotomies: a new surgical technique adjuvant in the treatment of chronic ulcers with non-arterial etiology in the lower limbs Escarotomias transversais: uma nova opção cirúrgica adjuvante no tratamento de úlceras crônicas de etiologia não arterial em membros inferiores

    Directory of Open Access Journals (Sweden)

    Mário Augusto Silva Freitas

    2006-01-01

    Full Text Available PURPOSE: Propose a new and alternative surgical procedure in order to aid on treatments of chronic ulcers with non-arterial etiology in the lower limbs, especially those that reoccurs and accomplish of dermatosclerosis and skin contractures determining ankle and foot limits. METHODS: It describes a medical case regarding a female, 54 years old, with a pre-existing ulcer (sixteen years on her left leg. Despite of conventional treatments such as curatives, compressive therapy and surgeries, the ulcer on her leg was not cured for three years. The skin dermatosclerosis on her foot and ankle limited her mobility tremendously. The surgery involved the debridement of the ulcers, local phlebectomies and the correction of her scar contraction by a transversal escharotomies. Conventional procedures were applied in pre and post-surgery. RESULTS: After twelve weeks, the ulcer was completely healed by second intention. Despite the odds, she regained sustainable mobility in her foot and ankle, allowing this patient to wear medical elastic socks. Reoccurrences of the ulcer did not occur during the two years post-surgery. CONCLUSION: The transversal escharotomies may favor the healing of non-arterial chronic ulcers in the lower limbs, impeding perpetual mechanisms of this sort. For example, the ankle and foot limitation determinates in secondary scars, skin contractures, dermatosclerosis that produce the failure in the muscular calf-pump with deterioration in the ascending venous propulsion.OBJETIVO: Apresentar uma nova alternativa cirúrgica para auxiliar o tratamento de úlceras crônicas de etiologia não arterial em membros inferiores, especialmente aquelas com recidivas e complicadas por contraturas de pele, limitando movimentos do pé e tornozelo. MÉTODOS: Descrição de caso de uma paciente portadora de úlcera em perna esquerda com dezesseis anos de evolução, múltiplas recidivas, sem cicatrização há três anos apesar de curativos convencionais

  13. Modulation of gastrin and epidermal growth factor by pyrrolizidine alkaloids obtained from Senecio brasiliensis in acute and chronic induced gastric ulcers.

    Science.gov (United States)

    Toma, Walber; Trigo, José Roberto; Bensuaski de Paula, Ana Cláudia; Monteiro Souza Brito, Alba Regina

    2004-05-01

    We investigated the antiulcerogenic activity of pyrrolizidine alkaloids (PAs) integerrimine, retrorsine, senecionine, usaramine and seneciplhylline, an alkaloidal extract obtained from Senecio brasiliensis. The PA extract demonstrated significantly activity in both, acute and chronic gastric ulcers on rats. The effects of PA extract were dose dependent. The mechanisms implicated on this activity were evaluated by determination of gastrin plasma levels in rats subjected to the acute treatment with PA extract and by expression of mRNA of Epidermal Growth Factor (EGF) after chronic treatment with this extract. The results showed that the PA extract increased both the levels of gastrin and the expression of EGF on these animals. Moreover, the histological examinations showed a reduction of exfoliation of superficial cells, hemorrhages and blood cell infiltration. We concluded that the PAs showed an important and qualitative antiulcerogenic activity mediated by increase in gastrin secretion and mRNA expression of EGF. PMID:15213731

  14. Diabetic Ulcer (Neurogenic Ulcer)

    Science.gov (United States)

    ... commonly occur on the pressure points of the foot: the ball, heel, and side of the foot if a person's shoes are too tight. However, ... streaking up the leg, drainage of the area, pain, foul odor, rising blood glucose, ... of the top of the foot. Your doctor may have you wear a special ...

  15. Marjolin ulcer with multifocal origin

    Directory of Open Access Journals (Sweden)

    Das Sudip

    2009-01-01

    Full Text Available Marjolin ulcer developed from a twenty years old post burn scar. The patient presented with chronic ulceration followed by multifocal development of squamous cell carcinoma with different growth pattern. One nodular lesion grew rapidly to produce a large lesion with history of a little bleeding after trauma but without any pain. Excision followed by skin grafting resulted in good cosmetic scar.

  16. Closure of chronic non healing ankle ulcer with low level laser therapy in a patient presenting with thalassemia intermedia: Case report

    Directory of Open Access Journals (Sweden)

    Snehil Dixit

    2014-01-01

    Full Text Available In this single case study, the possible effect of low-level laser therapy (LLLT was explored in the form of light emitting diodes on a chronic non-healing wound of 6 months duration in an 18-year-old male patient suffering from thalassemia intermedia. After irradiation, with LLLT dosage of 17.3 J/cm 2 for 8 min for 2 weeks duration followed by proliferative dosage of 8.65-4.33 J/cm 2 for 4 min from 3 rd week to 6 th week for 2 min along with antibiotics vancomycin (15 mg/kg and a combination of amoxicillin and clavulanic acid (1 g. Proliferation of healthy granulation tissue was observed with decrease in score of pressure ulcer scale with complete re-epithelialization eventually LLLT irradiation could be a novel method of treatment for chronic non-healing wound in a thalassemia intermedia patient and an useful adjunct to standard care of treatment of pressure ulcers. It is postulated that LED irradiation augments wound healing with an early closure and no recurrence at the irradiated site even after follow up of 6 months.

  17. Pressure Ulcers Surveillance Report

    Directory of Open Access Journals (Sweden)

    Zehra Esin Gencer

    2015-04-01

    Full Text Available Objective: Pressure ulcer is a chronic wound. It reduces the quality of life of the elderly and individuals with restricted range of motion. It prolongs hospital stay and increases the risk of complications. The cost is quite high. Preventive actions for the prevention of pressure ulcers should be developed. Planning protocols and standards of care are among the main targets. Material and Method: Research was conducted in one-year period between 2012 May and 2013 May on patients who were followed up in Akdeniz University Hospital clinics and intensive care unit with pressure ulcers. The research population consisted of 569 patients. Patient data were recorded in SPSS 16 for Windows program. Statistical analyzes were performed with retrospective methods. The demographic characteristics of patients with pressure ulcers were analyzed as frequency and descriptive statistics. Prevalence and incidence of one year were calculated. Results: Of the patients, 58% were males, 42% were females. Of the patients, 36% were in the age range of 61-80 years, and their average length of stay was 42,9 days. Of the patients, 70% were at stage 2 and 3. In 15% of patients pressure ulcers occurred on the first day of hospitalization. Pressure ulcers were developed between days 2 and 10 in 59% of the patients. Prevalence rate was 2.5%, the incidence was 1.9%, the prevalence rate was 5.9% in the intensive care unit. Conclusion: It is easier to prevent pressure ulcers than treating.

  18. A prospective, descriptive study of hour-to-hour and day-to-day temperature variability of skin affected by chronic venous disorders.

    Science.gov (United States)

    Kelechi, Teresa J; McNeil, Rebecca B

    2008-04-01

    Evidence suggests that skin temperature is elevated in the lower legs of individuals with the most severe stages of chronic venous disorder-related skin inflammation. Fifteen (15) patients (average age 67.7 years) with several chronic health conditions, chronic venous disorders, and a history of leg ulcers volunteered to participate in a prospective, descriptive, two-part (hourly and daily) study to test two hypotheses: 1) that skin temperature variations of chronically inflamed skin of lower legs affected by chronic venous disorders exhibit no differences in hour-to-hour and day-to-day rhythmic patterns associated with sleep and activities such as walking, exercise, or compression stocking use among four selected skin sites (two per leg) or between the legs of individuals with chronic venous disorders; and 2) that the difference in temperature between sites is unequal between legs. All study participants were at high risk for developing venous ulcers (CEAP stage 4 and 5). Skin temperature was obtained at sites with highest temperatures and/or areas of healed ulcers and mapped hourly over a 2-day period with a data logger and daily for 30 days with an infrared thermometer. No consistent, visually detectable effects due to caffeine use, eating, activity, or other variables assessed were found; only sleeping resulted in a consistent increase in skin temperature. Difference in skin temperature between measurement sites was found to be dependent on the leg on which the sites were located (P=0.1127). Because skin temperature variability could not be explained by the variables assessed, a temperature change could suggest the presence of a pathological process such as an infection or increased inflammation. Future studies to determine whether variability of skin temperature over sites affected by chronic venous disorders heralds further skin impairment are warranted. PMID:18480503

  19. Healing of cysteamine-induced duodenal ulcers in the rat

    DEFF Research Database (Denmark)

    Poulsen, Steen Seier

    1985-01-01

    The mechanism and time for healing of cysteamine-induced duodenal ulcers in rats were investigated. Cysteamine induces a mixture of erosions, ulcers, and penetrating ulcers. These three stages of ulcerations healed in different ways and in different times. Erosions healed within three days...... layer of Brunner's glands in the submucosa. Healing was complete within 15 days. Penetrated ulcers healed very slowly by formation of new epithelium and Brunner's glands from the ulcer edges. The newly formed epithelium was desquamated unless protected by underlying Brunner's glands and the regeneration...... a model for a chronic duodenal ulcer which may be of value as a model for testing treatments of duodenal ulcers....

  20. The interest of the 13C urea breath test for the diagnostic and monitoring of chronic duodenal ulcer

    International Nuclear Information System (INIS)

    Duodenal ulcer is very frequently associated with Helicobacter pylori (Hp) present in the gastric mucous membrane. Breath tests with 13C-labelled urea have been carried out for the detection of Hp; these tests could be more sensitive than gastric biopsies, because of the heterogenous distribution of the bacteria in the mucous membrane. This breath test may be used repetitively and allows for a non-intrusive monitoring of the Hp eradication after treatment. 12 refs

  1. Wound care in venous ulcers.

    Science.gov (United States)

    Mosti, G

    2013-03-01

    -to-heal leg ulcers such as large, deep, infected and long-lasting venous ulcers, sharp debridement and skin grafting may favour and shorten ulcer healing. PMID:23482540

  2. Chronic ulcerative gastroduodenitis as a first gastrointestinal manifestation of Hermansky-Pudlak syndrome in a 1O-year-old child

    Institute of Scientific and Technical Information of China (English)

    Anselm Chi-Wai Lee; Kin-Hung Poon; Wing-Hong Lo; Lap-Gate Wong

    2008-01-01

    A 10-year-old Chinese boy who had a history of congenital thrombocytopathy presented with severe iron deficiency anemia secondary to chronic gastric inflammation and duodenal ulcerations. Subtle oculocutaneous albinism led to the finding of diminished dense bodies in the platelets under electron microscopy,hence the diagnosis of Hermansky-Pudlak syndrome (HPS). Biopsies from the stomach and duodenumrevealed a lymphocytic infiltration in the submucosa,but H pylori infection was absent. The gastroduodenitis responded to the treatment with omeprazole while iron deficiency anemia was corrected by oral iron therapy.HPS is a rare cause of congenital bleeding disorder with multisystemic manifestations. Upper gastrointestinal involvement is rare and should be distinguished from a mere manifestation of the bleeding diathesis.

  3. Sponge-Like Dressings Based on the Association of Chitosan and Sericin for the Treatment of Chronic Skin Ulcers. I. Design of Experiments-Assisted Development.

    Science.gov (United States)

    Mori, Michela; Rossi, Silvia; Ferrari, Franca; Bonferoni, Maria Cristina; Sandri, Giuseppina; Chlapanidas, Theodora; Torre, Maria Luisa; Caramella, Carla

    2016-03-01

    The aim of the present work was the development of sponge-like dressings based on chitosan glutamate (high molecular weight) and sericin for the treatment of chronic skin ulcers. Dressings were prepared by freeze-drying and glycine was added as cryoprotectant agent. Dressing development was assisted by design of experiments, using a simplex centroid design. Mechanical resistance, hydration propensity, viscous, and viscoelasticity properties of dressings were considered as response variables. The superimposition of the contour plots, calculated by the best fit model for each response variable, permitted to individuate a region of the factor space where the dressing of optimized quantitative composition was chosen. Such a dressing was able to absorb high amount of phosphate-buffered saline forming a gel characterized by rheological properties enabling both a lubricant and a protective effect. The optimized formulation was characterized by optimal mechanical properties and by cell proliferation and antioxidant activity on human fibroblast cell line. PMID:26886338

  4. Actovegin administration in patients with ulcerated gout tophuses

    Directory of Open Access Journals (Sweden)

    M S Eliseev

    2005-01-01

    Full Text Available Objective. To study actovegin efficacy in the treatment of chronic skin ulcers due to ulceration of tophuses in pts with chronic tophaceous gout. Materials and methods. 6 pts with chronic tophaceous gout aged 52 to 77 years with disease duration from 6 to 20 years with longstanding persisting skin ulcers due to tophuses ulceration were included. In addition to allopuri- nol, steroid and nonsteroidal anti-inflammatory drugs they were treated with actovegin 20% intravenously and local applications of 2% actovegin gel. Clinical examination was performed before and after the course of therapy- Results. Two from six pts showed healing of single chronic ulcers to the end of the treatment course. In the remaining pts ulcer count and size decrease was achieved. Conclusion. Actovegin administration in combined therapy of chronic skin ulcers in pts with chronic tophaceous gout promoted healing of the defects in all cases.

  5. 碘酊加高渗葡萄糖水外敷联合CO2激光照射治愈慢性溃疡3例%Three Cases of Chronic Ulcer Cured by the Application of Povidone Iodine in Addition to 25% Glucose Solution and the Irradiation with Carbon-dioxide Laser Rays

    Institute of Scientific and Technical Information of China (English)

    刘玉凤

    2003-01-01

    We report three cases ofchronic ulcer on the legs,cured by the application of povidone iodine in addition to25% glucose solution and the irradiation with carbon - dioxide laser rays.These three patients cured after the treatment of 2,3,6 months respectively. We think the method safe and effective as well as the cheap price.

  6. Lipschutz ulcer

    Directory of Open Access Journals (Sweden)

    Bhat Ramesh

    2007-01-01

    Full Text Available Lipschütz first identified an acute disease with ulceration of the external genital organs of young women. The syndrome has been termed acute vulvar ulcer or ulcus vulvae acutum. The following typical case history of a 19-year-old girl is a good illustration of this interesting clinical entity.

  7. Perinuclear anti-neutrophil cytoplasmic antibodies (p-anca) in chronic ulcerative colitis: Experience in a Mexican institution

    Institute of Scientific and Technical Information of China (English)

    Jesus K Yamamoto-Furusho; Takeshi Takahashi-Monroy; Omar Vergara-Fernandez; Edgardo Reyes; Luis Uscanga

    2006-01-01

    AIM: To assess the prevalence and clinical value of p-ANCA in a sample of Mexican ulcerative colitis (UC) patients.METHODS: In a prospective, IRB-approved protocol,p-ANCA was determined in 80 patients with UC (mean age, 32 ± 12.9 years). The severity and extension of disease were determined by clinical methods, searching a statistical association with p-ANCA status.RESULTS: p-ANCA were detected in 41 (51%) patients.Severity of disease was the only clinical variable statistically associated with their presence (P < 0.0001; OR = 9;CI 95% = 3.2-24.7).CONCLUSION: The prevalence of p-ANCA was similar to that reported in other countries. Their presence was associated to UC severity, but offered no more information than the obtained by clinical methods.

  8. The importance of growth factors for the treatment of chronic wounds in the case of diabetic foot ulcers

    Directory of Open Access Journals (Sweden)

    Ehm, Alexandra

    2010-01-01

    Full Text Available Introduction: Ulcers as a result of diabetes mellitus are a serious problem with an enormous impact on the overall global disease burden due to the increasing prevalence of diabetes. Because of long hospital stays, rehabilitation, often required home care and the use of social services diabetic foot complications are costly. Therapy with growth factors could be an effective and innovative add-on to standard wound care. Research questions: What is the benefit of therapies with growth factors alone or in combination with other technologies in the treatment of diabetic foot ulcer assessed regarding medical, economical, social, ethical and juridical aspects? Methods: We systematically searched relevant databases limited to English and German language and publications since 1990. Cost values were adjusted to the price level of 2008 and converted into Euro. A review and an assessment of the quality of publications were conducted following approved methodical standards conforming to evidence-based medicine and health economics. Results: We identified 25 studies (14 randomized controlled trials (RCT, nine cost-effectiveness analyses, two meta-analyses. The RCT compared an add-on therapy to standard wound care with standard wound care/placebo alone or extracellular wound matrix: in six studies becaplermin, in two rhEGF, in one bFGF, and in five studies the metabolically active skin grafts Dermagraft and Apligraf. The study duration ranged from twelve to 20 weeks and the study population included between 17 to 382 patients, average 130 patients. The treatment with becaplermin, rhEGF and skin implants Dermagraft and Apligraf showed in eight out of 13 studies an advantage concerning complete wound closure and the time to complete wound healing. Evidence for a benefit of treatment with bFGF could not be found. In four out of 14 studies the proportion of adverse events was 30% per study group with no difference between the treatment groups. The methodological

  9. Exertional Leg Pain.

    Science.gov (United States)

    Rajasekaran, Sathish; Finnoff, Jonathan T

    2016-02-01

    Exertional leg pain is a common condition seen in runners and the general population. Given the broad differential diagnosis of this complaint, this article focuses on the incidence, anatomy, pathophysiology, clinical presentation, diagnostic evaluation, and management of common causes that include medial tibial stress syndrome, tibial bone stress injury, chronic exertional compartment syndrome, arterial endofibrosis, popliteal artery entrapment syndrome, and entrapment of the common peroneal, superficial peroneal, and saphenous nerves. Successful diagnosis of these conditions hinges on performing a thorough history and physical examination followed by proper diagnostic testing and appropriate management. PMID:26616179

  10. Modelling of oedemous limbs and venous ulcers using partial differential equations

    Directory of Open Access Journals (Sweden)

    Wilson Michael J

    2005-08-01

    Full Text Available Abstract Background Oedema, commonly known as tissue swelling, occurs mainly on the leg and the arm. The condition may be associated with a range of causes such as venous diseases, trauma, infection, joint disease and orthopaedic surgery. Oedema is caused by both lymphatic and chronic venous insufficiency, which leads to pooling of blood and fluid in the extremities. This results in swelling, mild redness and scaling of the skin, all of which can culminate in ulceration. Methods We present a method to model a wide variety of geometries of limbs affected by oedema and venous ulcers. The shape modelling is based on the PDE method where a set of boundary curves are extracted from 3D scan data and are utilised as boundary conditions to solve a PDE, which provides the geometry of an affected limb. For this work we utilise a mixture of fourth order and sixth order PDEs, the solutions of which enable us to obtain a good representative shape of the limb and associated ulcers in question. Results A series of examples are discussed demonstrating the capability of the method to produce good representative shapes of limbs by utilising a series of curves extracted from the scan data. In particular we show how the method could be used to model the shape of an arm and a leg with an associated ulcer. Conclusion We show how PDE based shape modelling techniques can be utilised to generate a variety of limb shapes and associated ulcers by means of a series of curves extracted from scan data. We also discuss how the method could be used to manipulate a generic shape of a limb and an associated wound so that the model could be fine-tuned for a particular patient.

  11. Fighting Chronic Pain

    Science.gov (United States)

    ... leg pain from clogged arteries Stomach/Digestive: Gallstones, intestinal obstruction, diverticulitis, ulcers, severe indigestion, severe gas pain, inflammatory bowel disease, colitis Urinary/Reproductive: Kidney stones, pelvic pain, vulvodynia, ...

  12. 湿润烧伤膏在慢性糖尿病足溃疡愈合中的作用:随机对照试验%Role of Moist Exposed Burn Ointment ( MEBO) in Healing of Chronic Diabetic Foot Ulcers: A Controlled Randomized Trial

    Institute of Scientific and Technical Information of China (English)

    穆罕穆德·萨克; 哈斯玛 M·哈默德

    2012-01-01

      Objective To assess the efficacy and safety of Moist Environment Burn Ointment (MEBO) in promo-ting healing of chronic diabetic foot ulcers (DFUs). Methods Patients with chronic DFUs seen at the Ahmadi Hospital, Kuwait (2005 - 2010) were randomized to receive MEBO (n = 66 with 82 ulcers) or saline wet-to-moist dressing (n = 62 with 78 ulcers). Data collected prospectively included demographics, patient features and ulcer characteristics. Ulcer sur-face area (SA) and healing index (HI) were calculated at two-week intervals for 12 weeks. Secondary amputations and de-velopment of new ulcers were recorded at 24 weeks. Results Patients in both groups had similar demographic, clinical and ulcer characteristics. There was a significant increase in HI and reduction in SA starting on weeks two and four respectively, in patients treated with MEBO (P 0. 05). No adverse effects of MEBO were encountered. Conclusion (1) In ad-dition to its safety, MEBO significantly promotes the healing of chronic DFUs, with complete healing of > 50% of ulcers by 12 weeks, and (2) Significantly fewer secondary amputations were required by 24 weeks in patients treated with MEBO.

  13. Ulcerative colitis - discharge

    Science.gov (United States)

    Inflammatory bowel disease - ulcerative colitis - discharge; Ulcerative proctitis - discharge; Colitis - discharge ... were in the hospital because you have ulcerative colitis. This is a swelling of the inner lining ...

  14. Selective release of cytokines, chemokines, and growth factors by minced skin in vitro supports the effectiveness of autologous minced micrografts technique for chronic ulcer repair.

    Science.gov (United States)

    Pertusi, Ginevra; Tiberio, Rossana; Graziola, Francesca; Boggio, Paolo; Colombo, Enrico; Bozzo, Chiarella

    2012-01-01

    A new effective surgical procedure to repair chronic ulcers called minced micrografts technique has been recently reported. The technique consists in spreading a finely minced skin sample upon the wound bed. In this study, we investigate the in vitro release of cytokines (interleukin-6, tumor necrosis factor-α, interleukin-1α, and granulocyte-colony stimulating factor), chemokines (monocyte chemoattractant protein-1 and growth-related oncogene-α), and growth factors (platelet-derived growth factor, basic fibroblast growth factor, vascular endothelial growth factor, hepatocyte growth factor, and nerve growth factor) by minced (referred to as the minced sample) vs. not minced (referred to as the whole sample) human skin biopsy samples from the same donor. Factor release in the culture medium at different time points was detected using a multiplexed protein assay. The minced sample, which could behave like the skin fragments used in vivo in the autologous minced micrografts technique, expressed higher levels of tumor necrosis factor-α, interleukin-1α, platelet-derived growth factor, and basic fibroblast growth factor, and lower levels of interleukin-6, monocyte chemoattractant protein-1, growth related oncogene-α, and vascular endothelial growth factor compared with the whole sample. In conclusion, mincing of healthy skin may allow appropriate regulation of the inflammatory phase of wound healing and could induce overexpression of some growth factors, which facilitates the proliferative phase of healing. PMID:22304391

  15. Transcutaneous oximetry but not arterial toe blood pressure or ankle-brachial index is related to macular thickness in patients with chronic diabetic foot ulcers

    Directory of Open Access Journals (Sweden)

    Per Katzman

    2013-04-01

    Full Text Available Objectives: Diabetes related vascular complications of the lower extremity could be classified as micro- and macrovascular. Ankle-brachial index (ABI and toe blood pressure (TBP measurements evaluate macro-circulation, whereas transcutaneous oximetry (TcPO2 is considered to be a composite measure of vascular function, thereby also reflecting microcirculation. Microvascular disease in the eye involves abnormal capillary permeability and possibly thereby increased macular thickness. The aim of the present clinical study was to evaluate if microvascular disease in the eye was related to measures of foot ischemia in patients with diabetes mellitus. Methods: Twenty consecutive patients with diabetes and chronic full-thickness foot ulcers were included. Peripheral ischemia was diagnosed using TcPO2, TBP and ABI. Macular thickness was measured with optical coherence tomography technique. Results: Based on TcPO2, TBP and ABI measurements 14, 13 and 13 patients, respectively, were classified as ischemic. Patients with ischemic TcPO2 levels at the dorsum of the foot had significantly higher macular thicknesses. This was not the case in patients with ischemic TBP or ABI levels. Conclusion: TcPO2, unlike TBP and ABI, seems to be a clinically relevant measure of peripheral microvascular disease in patients with diabetes mellitus and may, if low, indicate an increased risk of macular edema. [J Exp Integr Med 2013; 3(2.000: 81-85

  16. Effect of mesenchymal stromal cells (MSC) on chronic visceral hypersensitivity in a radio-induced colonic ulceration model in the rat

    International Nuclear Information System (INIS)

    Patients who undergo pelvic radiotherapy may develop significant incidence of undesirable chronic gastrointestinal complications resulting from radiation-induced damages around the tumour. Chronic visceral pain is one of the radiation-induced side effects that greatly affects the quality of life of 'cancer survivors'. The lack of effective analgesic treatment highlights the importance of novel and effective therapeutic strategies. In our laboratory, mesenchymal stromal cell (MSC) based approach showed beneficial immunomodulatory and regenerative effects in a rat model of irreversible radiationinduced colonic ulcers. The goal of my work was to assess the relevance of this model to study radiation-induced visceral persistent hypersensitivity and its modulation by MSC treatment. We first demonstrated that this model is associated with long-lasting visceral hypersensitivity and central neuronal sensitization. In this context we showed then that mast cells (MC) are involved in the mechanism of peripheral sensitization. Moreover, we suggested the implication of the neuro-mediator NO. in the pathophysiology of persistent radiation-induced visceral hypersensitivity. We also suggested that MSC treatment reversed radiation-induced hypersensitivity by a mechanism that in part may involve the modulation of MC activation and/or the decrease in the number of MC and nerve fiber interactions. In addition, MSC treatment reduced the percentage of nitrinergic neurons, increased after irradiation, and restored colonic muscular contractibility. Such processes may promote the therapeutic benefit of MSC observed in our study. In conclusion, this work provided new insights on the therapeutic benefit of MSC in our study model and a new argument in favour of their use in a future clinical trial to cure abdomino-pelvic radiotherapy side effects. (author)

  17. Is oxycodone/naloxone effective and safe in managing chronic pain of a fragile elderly patient with multiple skin ulcers of the lower limbs? A case report 

    Directory of Open Access Journals (Sweden)

    Guerriero F

    2015-08-01

    Full Text Available Fabio Guerriero,1,2 Niccolo Maurizi,1 Matthew Francis,1 Carmelo Sgarlata,1 Giovanni Ricevuti,1,2 Mariangela Rondanelli,2,3 Simone Perna,2,3 Marco Rollone21Department of Internal Medicine and Medical Therapy, Section of Geriatrics, University of Pavia, 2Azienda di Servizi alla Persona, Istituto di Cura Santa Margherita of Pavia, 3Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, University of Pavia, Pavia, Italy Abstract: Skin ulcers are a common issue in the elderly, as physiological loss of skin elasticity, alterations in microcirculation, and concomitant chronic diseases typically occur in advanced age, thereby predisposing to these painful lesions. Wound-related pain is often associated with skin ulcers and negatively impacts both the patient’s quality of life and, indirectly, wound healing. Pain management is an ongoing issue in the elderly, and remains underestimated and undertreated in this fragile population. Recent guidelines suggest the use of opioids as the frontline treatment of moderate and severe pain in nononcological pain in the elderly. However, due to the concerns of adverse reactions, drug interactions, and addiction, clinicians frequently hesitate to prescribe opioids. This case report describes an elderly diabetic patient with multiple ulcers of the lower limbs suffering wound-related pain. In our report, oxycodone/naloxone has proved to be an effective and safe drug, providing pain relief as well as increased compliance when redressing wounds and faster healing compared to that in similar patients. Our case provides anecdotal evidence, supported by other studies, to justify future, larger studies on chronic pain using this therapy. Keywords: chronic pain, skin ulcers, elderly, opioids, oxycodone, naloxone

  18. Risk factors influencing the outcome of peptic ulcer bleeding in chronic kidney disease after initial endoscopic hemostasis: A nationwide cohort study.

    Science.gov (United States)

    Liang, Chih-Ming; Hsu, Chien-Ning; Tai, Wei-Chen; Yang, Shih-Cheng; Wu, Cheng-Kun; Shih, Chih-Wei; Ku, Ming-Kun; Yuan, Lan-Ting; Wang, Jiunn-Wei; Tseng, Kuo-Lun; Sun, Wei-Chih; Hung, Tsung-Hsing; Nguang, Seng-Howe; Hsu, Pin-I; Wu, Deng-Chyang; Chuah, Seng-Kee

    2016-09-01

    Patients with chronic kidney disease (CKD) who had peptic ulcer bleeding (PUB) may have more adverse outcomes. This population-based cohort study aimed to identify risk factors that may influence the outcomes of patients with CKD and PUB after initial endoscopic hemostasis. Data from 1997 to 2008 were extracted from the National Health Insurance Research Database in Taiwan. We included a cohort dataset of 1 million randomly selected individuals and a dataset of patients with CKD who were alive in 2008. A total of 18,646 patients with PUB were screened, and 1229 patients admitted for PUB after endoscopic hemostasis were recruited. The subjects were divided into non-CKD (n = 1045) and CKD groups (n = 184). We analyzed the risks of peptic ulcer rebleeding, sepsis events, and mortality among in-hospital patients, and after discharge. Results showed that the rebleeding rates associated with repeat endoscopic therapy (11.96% vs 6.32%, P = 0.0062), death rates (8.7%, vs 2.3%, P < 0.0001), hospitalization cost (US$ 5595±7200 vs US$2408 ± 4703, P < 0.0001), and length of hospital stay (19.6 ± 18.3 vs 11.2 ± 13.1, P < 0.0001) in the CKD group were higher than those in the non-CKD group. The death rate in the CKD group was also higher than that in the non-CKD group after discharge. The independent risk factor for rebleeding during hospitalization was age (odds ratio [OR], 1.02; P = 0.0063), whereas risk factors for death were CKD (OR, 2.37; P = 0.0222), shock (OR, 2.99; P = 0.0098), and endotracheal intubation (OR, 5.31; P < 0.0001). The hazard ratio of rebleeding risk for aspirin users after discharge over a 10-year follow-up period was 0.68 (95% confidence interval [CI]: 0.45-0.95, P = 0.0223). On the other hand, old age (P < 0.0001), CKD (P = 0.0090), diabetes (P = 0.0470), and congestive heart failure (P = 0.0013) were the independent risk factors for death after discharge. In-hospital patients with CKD and PUB after endoscopic therapy

  19. Surgical treatment of severe chronic venous insufficiency caused by pulsatile varicose veins in a patient with tricuspid regurgitation.

    Science.gov (United States)

    Casian, D; Gutsu, E; Culiuc, V

    2009-04-01

    A case of severe chronic venous insufficiency caused by pulsatile varicose veins in a 46-year-old man with tricuspid regurgitation is presented. Active venous leg ulcer complicated with recurrent venous bleeding and inefficacy of conservative management serve as indications for surgical treatment. This case demonstrates the possibility of radical surgical correction of pathological venous reflux by means of saphenofemoral ligation, foam sclerotherapy and subfascial endoscopic perforator surgery.

  20. Ischemic Gastropathic Ulcer Mimics Gastric Cancer

    Directory of Open Access Journals (Sweden)

    Saleh Daher

    2016-01-01

    Full Text Available Gastric ulcer due to mesenteric ischemia is a rare clinical finding. As a result, few reports of ischemic gastric ulcers have been reported in the literature. The diagnosis of ischemic gastropathy is seldom considered in patients presenting with abdominal pain and gastric ulcers. In this case report, we describe a patient with increasing abdominal pain, weight loss, and gastric ulcers, who underwent extensive medical evaluation and whose symptoms were resistant to medical interventions. Finally he was diagnosed with chronic mesenteric ischemia, and his clinical and endoscopic abnormalities resolved after surgical revascularization of both the superior mesenteric artery and the celiac trunk.

  1. Pathogenesis of foot ulcers and the need for offloading.

    Science.gov (United States)

    Rathur, H M; Boulton, A J

    2005-04-01

    Diabetic foot ulceration represents a major medical, social and economic problem all over the world. While more than 5% of diabetic patients have a history of foot ulceration, the cumulative lifetime incidence may be as high as 15%. Ethnic differences exist in both ulcer and amputation incidences. Foot ulceration results from the interaction of several contributory factors, the most important of which is neuropathy. The use of the total-contact cast is demonstrated in the treatment of plantar neuropathic ulcers. Histological evidence suggests that pressure relief results in chronic foot ulcers changing their morphological appearance by displaying some features of an acute wound. Thus, repetitive stresses on the insensate foot appear to play a major role in maintaining ulcer chronicity. It is hoped that research activity in foot disease will ultimately result in fewer ulcers and less amputation in diabetes.

  2. Treatment of lingual traumatic ulcer accompanied with fungal infections

    OpenAIRE

    Sella Sella; Mochamad Fahlevi Rizal

    2011-01-01

    Background: Traumatic ulcer is a common form of ulceration occured in oral cavity caused by mechanical trauma, either acute or chronic, resulting in loss of the entire epithelium. Traumatic ulcer often occurs in children that are usually found on buccal mucosa, labial mucosa of upper and lower lip, lateral tongue, and a variety of areas that may be bitten. To properly diagnose the ulcer, dentists should evaluate the history and clinical description in detail. If the lesion is allegedly accomp...

  3. A large Italian observational multicentre study on vascular ulcers of the lower limbs (Studio Ulcere Vascolari).

    Science.gov (United States)

    Apollonio, Alessandro; Antignani, Pier L; Di Salvo, Michelangelo; Failla, Giacomo; Guarnera, Giorgio; Mosti, Giovanni; Ricci, Elia

    2016-02-01

    An observational study of 2 years was promoted by the Italian Association for Cutaneous Ulcers (AIUC) in order to monitor the epidemiology of leg ulcers, the trend of healing and the more frequent therapeutic approaches in lower limb ulcers. Fifty-nine sites in 14 different Italian regions involved in the study, with 1333 enrolled patients (1163 patients fully evaluated and followed up for 9 months). A prevalence of females (62%) was observed with a mean age of 70 years and a high rate of hypertension (62%), diabetes (38%) and obesity (29%). Venous ulcer was most frequent (55%), followed by mixed (25%) and diabetic (8·3%) ulcers. Basically, all patients received a local therapy (LT) (compression and advanced local therapies), while 63% of patients have an associated systemic pharmaceutical treatment. Ulcer healing rates progressively increased throughout the study and despite the type of observational study does not allow conclusions on the treatment, it was observed that the patients receiving additional systemic drugs were associated with a more rapid acceleration of healing rates of ulcers compared to LT alone (3 months: 39·7% versus 29·2%; 6 months: 62·0% versus 47·0%; 9 months: 74·7% versus 63·8%). In particular, the Studio Ulcere Vascolari (SUV) study showed that a combination treatment with sulodexide and compression therapy allows for a greater increase in the healing rates in venous ulcers.

  4. Combined NADPH oxidase 1 and interleukin 10 deficiency induces chronic endoplasmic reticulum stress and causes ulcerative colitis-like disease in mice.

    Science.gov (United States)

    Tréton, Xavier; Pedruzzi, Eric; Guichard, Cécile; Ladeiro, Yannick; Sedghi, Shirin; Vallée, Mélissa; Fernandez, Neike; Bruyère, Emilie; Woerther, Paul-Louis; Ducroc, Robert; Montcuquet, Nicolas; Freund, Jean-Noel; Van Seuningen, Isabelle; Barreau, Frédérick; Marah, Assiya; Hugot, Jean-Pierre; Cazals-Hatem, Dominique; Bouhnik, Yoram; Daniel, Fanny; Ogier-Denis, Eric

    2014-01-01

    Ulcerative colitis (UC) is a chronic inflammatory bowel disease affecting the rectum which progressively extents. Its etiology remains unknown and the number of treatments available is limited. Studies of UC patients have identified an unbalanced endoplasmic reticulum (ER) stress in the non-inflamed colonic mucosa. Animal models with impaired ER stress are sensitive to intestinal inflammation, suggesting that an unbalanced ER stress could cause inflammation. However, there are no ER stress-regulating strategies proposed in the management of UC partly because of the lack of relevant preclinical model mimicking the disease. Here we generated the IL10/Nox1dKO mouse model which combines immune dysfunction (IL-10 deficiency) and abnormal epithelium (NADPH oxidase 1 (Nox1) deficiency) and spontaneously develops a UC-like phenotype with similar complications (colorectal cancer) than UC. Our data identified an unanticipated combined role of IL10 and Nox1 in the fine-tuning of ER stress responses in goblet cells. As in humans, the ER stress was unbalanced in mice with decreased eIF2α phosphorylation preceding inflammation. In IL10/Nox1dKO mice, salubrinal preserved eIF2α phosphorylation through inhibition of the regulatory subunit of the protein phosphatase 1 PP1R15A/GADD34 and prevented colitis. Thus, this new experimental model highlighted the central role of epithelial ER stress abnormalities in the development of colitis and defined the defective eIF2α pathway as a key pathophysiological target for UC. Therefore, specific regulators able to restore the defective eIF2α pathway could lead to the molecular remission needed to treat UC. PMID:25014110

  5. Combined NADPH oxidase 1 and interleukin 10 deficiency induces chronic endoplasmic reticulum stress and causes ulcerative colitis-like disease in mice.

    Directory of Open Access Journals (Sweden)

    Xavier Tréton

    Full Text Available Ulcerative colitis (UC is a chronic inflammatory bowel disease affecting the rectum which progressively extents. Its etiology remains unknown and the number of treatments available is limited. Studies of UC patients have identified an unbalanced endoplasmic reticulum (ER stress in the non-inflamed colonic mucosa. Animal models with impaired ER stress are sensitive to intestinal inflammation, suggesting that an unbalanced ER stress could cause inflammation. However, there are no ER stress-regulating strategies proposed in the management of UC partly because of the lack of relevant preclinical model mimicking the disease. Here we generated the IL10/Nox1dKO mouse model which combines immune dysfunction (IL-10 deficiency and abnormal epithelium (NADPH oxidase 1 (Nox1 deficiency and spontaneously develops a UC-like phenotype with similar complications (colorectal cancer than UC. Our data identified an unanticipated combined role of IL10 and Nox1 in the fine-tuning of ER stress responses in goblet cells. As in humans, the ER stress was unbalanced in mice with decreased eIF2α phosphorylation preceding inflammation. In IL10/Nox1dKO mice, salubrinal preserved eIF2α phosphorylation through inhibition of the regulatory subunit of the protein phosphatase 1 PP1R15A/GADD34 and prevented colitis. Thus, this new experimental model highlighted the central role of epithelial ER stress abnormalities in the development of colitis and defined the defective eIF2α pathway as a key pathophysiological target for UC. Therefore, specific regulators able to restore the defective eIF2α pathway could lead to the molecular remission needed to treat UC.

  6. The relationship between helicobacter pylori infection with chronic gastritis and peptic ulcer%幽门螺杆菌感染与慢性胃炎和消化性溃疡的关系

    Institute of Scientific and Technical Information of China (English)

    赵荣章

    2015-01-01

    目的:探讨幽门螺杆菌(Hp)感染与慢性胃炎、消化性溃疡的关系。方法:收治胃镜检查确诊的慢性胃炎、消化性溃疡患者151例,包括慢性浅表性胃炎、慢性糜烂性胃炎、慢性萎缩性胃炎、胆汁反流性胃炎以及胃和十二指肠溃疡,分别给予胃黏膜组织活检及快速尿素酶试验检查Hp感染情况,分析炎性反应情况与Hp感染的关系。结果:慢性萎缩性胃炎37例,Hp感染阳性率86.48%;慢性糜烂性胃炎36例,Hp感染阳性率80.56%;慢性浅表性胃炎26例,Hp感染阳性率65.38%;胆汁反流性胃炎22例,Hp感染阳性率36.36%,消化性溃疡30例,Hp感染阳性率80.00%。慢性萎缩性胃炎阳性率最高,胆汁反流性胃炎阳性率最低,差异具有统计学意义(P<0.05)。结论:几种常见的慢性胃炎、消化性溃疡均伴有不同程度Hp的感染,不同胃炎、消化性溃疡中Hp感染率差异具有统计学意义。慢性糜烂性胃炎、慢性萎缩性胃炎以及消化性溃疡感染Hp明显高于正常人群,从而提出Hp感染是产生的重要致病因素。%Objective:To investigate the relationship between helicobacter pylori(Hp) infection with chronic gastritis and peptic ulcer.Methods:151 patients with chronic gastritis or peptic ulcer were selected,including chronic superficial gastritis,chronic erosive gastritis,chronic atrophic gastritis,bile reflux gastritis,gastric and duodenal ulcer.All of those patients were treated with gastric mucosal biopsy and rapid urease test to detected helicobacter pylori infection,then we analyzed the relationship between inflammatory response and Hp infection.Results:37 cases were with chronic atrophic gastritis,and the positive rate of Hp infection was 86.48%;36 cases were chronic erosive gastritis,and the positive rate was 80.56%;26 cases were chronic superficial gastritis, and the positive rate was 65.38%;22 cases were bile reflux gastritis,and the positive rate

  7. Excessive bleeding from genital ulcers of Behçet's disease.

    Science.gov (United States)

    Bostankolu, A; Aksungur, V L; Aksungur, E H; Ozpoyraz, M; Yücel, A; Memisoglu, H R

    1997-09-01

    Although genital ulcers are a common manifestation of Behçet's disease, bleeding from these lesions is unusual. In this report, a patient with excessive bleeding from genital ulcers is presented. A 22-year-old man with recurrent oral and genital ulcers, erythema nodosum, folliculitis, positive pathergic reaction, uveitis, superior vena cava syndrome, and generalized lymphadenopathy fulfilled the diagnostic criteria of Behçet's disease. Three years after presenting he was admitted to our clinic with excessive bleeding from large ulcers on the scrotum and upper thighs and with a leg ulcer. Bleeding was controlled with compresses. Examination of a biopsy specimen obtained from the leg ulcer showed findings consistent with Kaposi-like acroangiodermatitis. Results of various radiologic investigations showed thrombosis of the inferior vena cava, peritesticular varicosities, and venous insufficiency of the lower extremities. We suggest that the bleeding was secondary to the extension of genital ulcers to the varicose veins.

  8. The Effect of Licopid and Bifid and Lactic Acid Bacteria Complex on Lysozyme Activity as the Factor of Nonspecific Immune Protection in Chronic Gastric and Duodenal Ulcer

    OpenAIRE

    Dugina V.V.; Shirali Rashmi; Lebedeva N.V.; Babayan S.R.; Rudakova G.V.; Khrulyova N.S.

    2012-01-01

    The aim of the investigation is to study the effect of Licopid and bifid and lactic acid bacteria complex on Helicobacter pylori eradication and lysozyme activity as the factor of nonspecific immune protection in gastric and duodenal ulcer. Materials and Methods. There were studied 30 patients suffering from Helicobacter associated gastric and duodenal ulcer, lysozyme activity was determined in 8 conditionally healthy individuals. There were used endoscopic, cytomorphological, and imm...

  9. Evaluation of the efficacy of hyperbaric oxygen therapy in the management of chronic nonhealing ulcer and role of periwound transcutaneous oximetry as a predictor of wound healing response: A randomized prospective controlled trial

    Directory of Open Access Journals (Sweden)

    Sarbjot Kaur

    2012-01-01

    Full Text Available Background: Hyperbaric oxygen therapy (HBOT is a treatment option for chronic nonhealing wounds. Transcutaneous oximetry (TCOM is used for wound assessment. We undertook a randomized prospective controlled trial to evaluate the role of HBOT in healing of chronic nonhealing wounds and to determine whether TCOM predicts healing. Materials and Methods: This study was conducted in 30 consenting patients with nonhealing ulcer. The patients were randomized into group HT (receiving HBOT in addition to conventional treatment and group CT (receiving only conventional treatment. Duration of treatment in both the groups was 30 days. Wound ulcer was analyzed based on size of the wound, exudates, presence of granulation tissue, and wound tissue scoring. Tissue oxygenation (TcPO 2 was measured on 0, 10 th , 20 th , and 30 th day. Results: There was 59% reduction in wound area in group HT and 26% increase in wound area in group CT. Ten patients in group HT showed improvement in wound score as compared to five patients in group CT. Complete healing was seen in three patients in group HT as compared to none in group CT. Surgical debridement was required in 6 patients in group HT and 10 patients in group CT. One patient in group HT required amputation as compared to five patients in group CT. A positive correlation was found between TcPO 2 value and various markers of wound healing. Conclusion: HBOT has a definitive adjunctive role in the management of chronic nonhealing ulcers. It decreases the amputation rate and improves patient outcome. Periwound TcPO 2 may be used as a predictor of response to HBOT and has a positive correlation with wound healing.

  10. The stomach ulcer: character of morphogenesis.

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    Scherbinina M.B.

    2007-01-01

    Full Text Available Until now there were not completely known the causes of ulcerogenesis and chronisation of ulcerous gastric lesions as well as mechanisms of disorders of regeneration of gastroduodenal mucosa at all. The aim of this work was revealing the structural peculiarities of gastric mucosa that led to forming chronic ulcers. There was performed the histological examination of 24 biopsies in patients with mediogastral ulcer as well as the material of autopsies of 18 persons died due to the hemorrhage from gastric peptic ulcer. The biopsy material from curvature minor of gastric corpus in 12 persons without gastroduodenal diseases was control. There were determined the thickness of mucosa, thickness of submucosa, submucosal-mucosal index, height of superficial epitheliocytes and their nuclear diameter, nuclear-cytoplasmic interrelations, volume summary density of microcirculation in mucosa, mitotic index of growth zone of gastric glands using morphometry. Chronic gastric ulcers showed to form in the background of prolonged chronic gastritis associated with Helicobacter pylori. The structural peculiarities wall of a stomach which developed as result of progressing the chronic inflammation and led to forming the chronic ulcers were thickening submucosal layer as well as its sclerosis and hialinization, decrease of volumous summary density of microcircula-tion.

  11. Efectividad del tratamiento de las úlceras venosas con vendaje compresivo multicapa asociado a protección de la piel perilesional con Cavilon® (película barrera no irritante Effectiveness of the association of multilayer compression therapy and periwound protection with Cavilon® (no sting barrier film in the treatment of venous leg ulcers

    Directory of Open Access Journals (Sweden)

    N. Serra

    2010-09-01

    Full Text Available Introducción: el adecuado tratamiento de las úlceras de extremidad inferior de etiología venosa es fundamental para mejorar la calidad de vida de los pacientes. El uso de terapia compresiva con vendaje multicapa es el tratamiento que mejores resultados presenta. En la práctica, se utiliza en combinación con unos adecuados cuidados locales de la herida y de la piel perilesional. El objetivo del estudio fue evaluar la efectividad clínica de un vendaje multicapa de compresión y el impacto de la utilización de la película barrera Cavilon® en úlceras vasculares de origen venoso. Metodología: ensayo clínico controlado, aleatorizado, abierto, multicéntrico y pragmático en España. Todos los pacientes incluidos fueron tratados con terapia de compresión con el mismo vendaje multicapa y asignados aleatoriamente al grupo de intervención, tratados con la PBNI Cavilon®, o al grupo control. Se realizaron un máximo de 13 visitas de estudio separadas entre ellas por una semana. El estudio fue evaluado y aprobado por los comités éticos de investigación clínica (CEIC de los siete centros participantes. Resultados: participaron 98 pacientes en el estudio (49 en el grupo intervención y 49 como control. Tras cuatro semanas, el grupo intervención presentó una reducción media (DE del tamaño de úlcera superior al grupo control (56,7% (30,3 vs. 45,5% (47,4; p = 0,087. A las 12 semanas de tratamiento, las diferencias observadas fueron estadísticamente significativas (83,4% (31,1 vs. 71,6% (44,1; p = 0,046. El 69,4% de los pacientes del grupo intervención redujo el área de úlcera en > 50% en las cuatro primeras semanas de tratamiento, respecto al 46,9% de los pacientes del grupo control (p Aim: appropriate treatment of venous leg ulcers is essential to improve the quality of life of patients. Compression therapy using multilayer bandages show to the best clinical results. In practice, it is used in combination with a suitable local care of

  12. Restless Legs Syndrome Foundation

    Science.gov (United States)

    ... Into Relieved Are you experiencing symptoms linked to restless legs syndrome (RLS)? Find tools and support to help get ... I couldn’t sleep. Fortunately, I found the Restless Legs Syndrome Foundation and learned what type of doctor to ...

  13. Evaluation of acute and sub-chronic toxicities of ulcer fast and reg;: a bi-herbal formula in male Wistar albino rats

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    Kingsley C. Patrick-Iwuanyanwu

    2014-12-01

    Full Text Available The acute and sub-chronic toxicities of ulcer fast and reg; (UF - A commercial bi-herbal formula prepared with Alstonia boonei and Xylopia aethiopica in male Wistar albino rats was evaluated. There was no mortality in rats administered 2000 mg/kg body weight (BW of UF in an acute toxicity study. A significant (p and #8804;0.05 increase in daily consumption of feed and fluid intake in experimental rats after 28 days was recorded followed by a progressive increase in BW of rats administered 50, 100 and 200 mg/kg BW of UF in a dose-dependent manner. Alanine amino transferase, aspartate amino transferase, alkaline phosphatase, lactate dehydrogenase, triacylglycerides and creatinine increased significantly (p and #8804;0.05 in rats treated with UF, whereas urea and fasting blood sugar decreased significantly (p and #8804;0.05 in a dose-dependent manner when compared with control. There was a marginal decrease in serum calcium ion and phosphate ion following the administration of UF when compared with control. Packed cell volume and hemoglobin decreased significantly (p and #8804;0.05 in rats treated with UF, whereas white blood cell increased significantly (p and #8804;0.05 in a dose-dependent manner when compared with control. Histological examination of the liver, kidney, heart and lungs showed normal architecture in control group, whereas hepatocytes of rats treated with 50, 100 and 200 mg/kg BW of UF were characterized by slight periportal fatty change, marked change and ballooning degeneration. Heart muscle of rats treated with 200mg/kg BW of UF showed slight inflammation while histological examination of the lungs showed areas of interstitium damage and diffuse alveolar damage in rats treated with UF. In conclusion, indiscriminate administration of UF could be of public health concern and long-term exposure may cause a significant potential health risk. [Int J Basic Clin Pharmacol 2014; 3(6.000: 970-977

  14. Ulcerative Lichen Planus in Childhood

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    Chiyadu Padmini

    2013-01-01

    Full Text Available Lichen planus (LP is a chronic inflammatory mucocutaneous condition which is relatively common in adults but rarely affects children. The present study is a report on an unusual case of ulcerative oral LP involving the dorsum of tongue in a 12-year-old boy. Patient complained of painful oral lesion on the tongue which was burning in nature and obstructing talking and eating spicy foods. On intraoral examination, a white ulcerative lesion on the dorsum of tongue was observed. Diagnosis was made based on clinical examination and histopathological features. We instituted local treatment and patient responded well to the treatment. Although rarely reported in childhood, lichen planus should be considered in a differential diagnosis of hyperkeratotic, reticular, and ulcerative lesions of the oral mucosa in children.

  15. Preliminary Study Application of Placenta in Treatment of Patients with Refractory Chronic Ulcer%紫河车在慢性难愈性溃疡中的应用

    Institute of Scientific and Technical Information of China (English)

    朱朝军; 张朝晖; 李雅潇; 马静

    2012-01-01

    Objective; To review the application of placenta in the treatment of with chronic refractory ulcer and to investigate the form of placenta used as medicines. Method;The relevant articles were searched for in China Journal Full-text Database (CJFD) in China National Knowledge Infrastructure (CNKI) network with the key words ' placenta' , one hundred and thirty-eight articles were retrieved , with the key words ' placenta and ulcer' 1 article was retrieved. This paper describes the records of the ancient literature of the Placenta, explores the main components of placenta and the role of these components in treatment of chronic ulcers. Then, the clinical application of the placenta was studied. Finally, we investigate the form of placenta used as medicines. Result; Placenta plays an important role in the treatment of patients with refractory chronic ulcer. However, placenta used as medicines mostly was internal medicine, hardly used for external. Conclusion; Placenta used as internal medicine can supplement yin and yang, qi and blood. Placenta used for external can accelerate the healing of the wound.%目的:对紫河车在治疗慢性难愈性溃疡中应用的情况进行文献整理,并探讨紫河车治疗慢性难愈性溃疡的入药形式.方法:应用CNKI中国学术文献网络出版总库,检索近20年来紫河车治疗慢性难愈性溃疡的相关文献,以紫河车为题名,检索到文献138篇,以紫河车及溃疡为题名,检索到文献1篇.首先介绍古代文献对紫河车的记载,然后探讨了紫河车的主要成分以及这些成分在慢性溃疡治疗过程中的作用及紫河车的临床应用情况,初步论述了紫河车在治疗慢性难愈性溃疡中的应用形式.结果:在慢性难愈性溃疡的治疗中,紫河车发挥重要作用,其多以内服入药,作为外用入药甚少.结论:紫河车以其善五体之功,内服补阴阳气血,外用可以促进伤口愈合.

  16. Gastroprotective effect of Desmodium gangeticum roots on gastric ulcer mouse models

    OpenAIRE

    Ayyavu Mahesh; Robert Jeyachandran; Dowlathabad Muralidhara Rao; Devarajan Thangadurai

    2012-01-01

    In the present study, the ethanolic root extract of Desmodium gangeticum (L.) DC., Fabaceae, (EDG), have been studied in various acute and chronic ulcer mouse models. Oral administration of root extract, significantly decrease the ulcer index and lesion number in a dose dependent manner against ethanol induced acute gastric ulcer in mice. In gastric ulcerated animal that received high dose of 150 mg/kg EDG, the mucosa showed no ulceration with slight focal congestion and the glands appeared n...

  17. Duodenoscopic appraisal of duodenal ulcer in dogs

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    S Kavitha

    Full Text Available Aim: To assess the usefulness of duodenoscopy in the diagnosis of duodenal ulcers in dogs. Materials and Methods: Sick dogs with chronic gastrointestinal problems were physically examined and samples were collected for haematology, biochemistry and faecal examination. Duodenal biopsies, duodenal contents and brush cytology were obtained via duodenoscopy. Results: Seven duodenal ulcers cases were recorded, higher incidences was recorded in Labrador retriever, 2-4 years of aged male dogs. Significantly decreased Hb (9.10 ± 0.25 g/dl, RBCs (4.39 ± 0.19 mill/cu.mm and albumin (2.343b ± 0.13 g/dl level were noticed. Hyperaemia with ulceration of duodenal mucosa was observed. Conclusion: Duodenoscopy is very much useful for detection of duodenal ulceration and provided a sensitive technique for early diagnosis of mucosal lesions and ulceration. [Vet. World 2012; 5(7.000: 420-423

  18. Clinical challenges of chronic wounds: searching for an optimal animal model to recapitulate their complexity

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    Robert Nunan

    2014-11-01

    Full Text Available The efficient healing of a skin wound is something that most of us take for granted but is essential for surviving day-to-day knocks and cuts, and is absolutely relied on clinically whenever a patient receives surgical intervention. However, the management of a chronic wound – defined as a barrier defect that has not healed in 3 months – has become a major therapeutic challenge throughout the Western world, and it is a problem that will only escalate with the increasing incidence of conditions that impede wound healing, such as diabetes, obesity and vascular disorders. Despite being clinically and molecularly heterogeneous, all chronic wounds are generally assigned to one of three major clinical categories: leg ulcers, diabetic foot ulcers or pressure ulcers. Although we have gleaned much knowledge about the fundamental cellular and molecular mechanisms that underpin healthy, acute wound healing from various animal models, we have learned much less about chronic wound repair pathology from these models. This might largely be because the animal models being used in this field of research have failed to recapitulate the clinical features of chronic wounds. In this Clinical Puzzle article, we discuss the clinical complexity of chronic wounds and describe the best currently available models for investigating chronic wound pathology. We also assess how such models could be optimised to become more useful tools for uncovering pathological mechanisms and potential therapeutic treatments.

  19. The effects of sulodexide on both clinical and molecular parameters in patients with mixed arterial and venous ulcers of lower limbs

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    Serra R

    2014-05-01

    clinical and instrumental diagnosis of mixed ulcer. Results: Fifty-three patients of both sexes were enrolled and divided into two groups by means of randomization tables. Group A (treated group comprised 18 females and ten males (median age: 68.7 years treated with standard treatment (compression therapy and surgery + SDX (600 lipoprotein lipase-releasing units/day intramuscularly for 15 days followed by SDX 250 lipase-releasing units every 12 hours day orally for 6 months as adjunctive treatment. Group B (control group comprised 17 females and eight males (median age: 64.2 years treated with standard treatment only (compression therapy and surgery. The type of surgery was chosen according to anatomical level of vein incompetence: superficial venous open surgery and/or subfascial endoscopic perforating surgery. In all enrolled patients, blood samples were collected in order to evaluate the plasma levels of MMPs and NGAL through enzyme-linked immunosorbent assay. These results were compared to another control group (Group C of healthy individuals. Moreover, biopsies of ulcers were taken to evaluate the tissue expression of MMPs and NGAL through Western blot analysis. Our results revealed that SDX treatment is able to reduce both plasma levels and tissue expression of MMPs improving the clinical conditions in patients with mixed ulcers. Conclusion: Inhibition of MMPs could represent a possible therapeutic intervention to limit the progression of leg ulceration. In particular, our findings demonstrate the efficacy of SDX in patients with mixed arterial and venous chronic ulcers of the lower limbs. Keywords: mixed ulcer, arterial ulcer, metalloproteinases, neutrophil gelatinase-associated lipocalin

  20. Oral Ulcerations

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    Brandon Fetterolf

    2015-12-01

    Full Text Available A 35-year-old male presented with lower gum pain associated with fever, chills, and sore throat. His medical history included intravenous drug use, human immunodeficiency virus infection, and hepatitis C. Physical exam revealed tachycardia, a temperature of 38.9°C, anterior cervical lymphadenopathy, halitosis, an edematous lower lip, and purulent ulcers anterior and posterior to lower central incisors with marked tenderness and erythema (Figure. His laboratory work was notable for a low white blood cell count (2.6 thousand/µl, neutropenia (0.11 thousand/µl, a low absolute CD4 lymphocyte count (0.5 thousand/µl, and elevated C-reactive protein (129mg/L and sedimentation rate (23mm/hr. A computed tomography study showed a 0.5×1.3×0.3cm abscess anterior to the mandibular symphysis.

  1. 放射性皮肤溃疡中端粒酶逆转录晦表达与癌变及难愈合的机制%Differential expression of telomerase reverse transcriptase in chronic human skin ulcer induced by radiation and mechanism of cancer transformation and poor healing

    Institute of Scientific and Technical Information of China (English)

    赵坡; 刘武; 李志军; 吕亚莉; 钟梅; 谷庆阳; 王德文

    2003-01-01

    AIM: To study the expression of the catalytic subunit of telomerase, telomerase revere transcriptase(TRT) and explore the possible relationship between the TRT and cancer txanaformation or poor healing in radiation-induced chronic human skin ulcer. METHODS: Rabbit antibody to human TRT and SP immunohistochemical method were used to detect TRT expression in 24 cases of formalin-fixed, paraffin-embeded chronic human skin ulcer tissues induced by radiation, 5 cases of normal skin, 2 of burnt skin, and 8 of carcinoma. RESULTS: The TRT was detected positive in 14 of 24 (58.3%) chronic radiation ulcers, of which the stxongly positive was 10 of 24 (41.7%) and the weakly positive 4 of 24 (16. 7% ); in 0 of 5 normal and 0 of 2 burnt skins; and in 8 of 8 (100%) carcinomas. The expression of TRT was observed almost always strongly positive in the cytoplasm and nucleus of squamous epithelial cells of epidermis but negatively in the endoepithelial cells of capillaries and small blood vessels, or weakly in the cytoplasm of smooth myocytes of media and fibroblssts, of dermis. Chronic inflammtory cells, such an plasma cells and lymphocytes also showed weakly positive for TRT. CONCLUSION: The strong TRT expression in the epidermis could be involved in the cancer transformation from chronic radiation ulcer to scuamous carcinoma, whereas the negative or weak TRT expression in the capillaries, small blood vessels and fibroblasts of dermis might be responsible for the poor healing of chronic ulcers induced by radiation, caused by sclerosis of small blood vessels and lack of granulation tissue consisting of capillaries and fibroblasts.

  2. The Effect of Immunomodulating Therapy on a Lysozyme Activity and the Expression of Helicobacter Pylori Contamination in Chronic Gastric and Duodenal Peptic Ulcer

    OpenAIRE

    Dugina V.V.; Kuzin V.B.; Lebedeva N.V.

    2011-01-01

    There has been investigated a lysozyme activity level and the expression of Helicobacter pylori contamination in eradication therapy of gastric and duodenal peptic ulcer using immunomodulators of different pharmacological groups. The use of immunomodulators such as lycopid and immunal against a background of the anti-H.bacter “quadroscheme” has been stated to lead to the increase of eradication, with a lysozyme activity in saliva significantly increasing. The tendency to lysozyme normalizatio...

  3. Smart medical stocking using memory polymer for chronic venous disorders.

    Science.gov (United States)

    Kumar, Bipin; Hu, Jinlian; Pan, Ning

    2016-01-01

    Proper level of pressure or compression generated by medical stocking or hosiery is the key element for successful treatment or management of chronic venous disorders such as oedema, leg ulcers, etc. However achieving the recommended compression level and, more importantly, sustaining it using stockings has been a major challenge to the health practitioners supervising the treatment. This work aims to investigate and design a smart compression stocking using shape-memory polymer that allows externally controlling the pressure level in the wrapped position on the leg. Based on thermodynamical rubber theories, we first derived several criteria that have to be satisfied simultaneously in order to achieve the controlled pressure adjustment using external heat stimuli. We then presented a case where such a stocking is developed using a blend yarn consists of selected shape-memory polyurethane and nylon filaments. Extensive experimental work has also been conducted to demonstrate the feasibility and explore the influencing factors involved.

  4. The Effect of Licopid and Bifid and Lactic Acid Bacteria Complex on Lysozyme Activity as the Factor of Nonspecific Immune Protection in Chronic Gastric and Duodenal Ulcer

    Directory of Open Access Journals (Sweden)

    Dugina V.V.

    2012-06-01

    Full Text Available The aim of the investigation is to study the effect of Licopid and bifid and lactic acid bacteria complex on Helicobacter pylori eradication and lysozyme activity as the factor of nonspecific immune protection in gastric and duodenal ulcer. Materials and Methods. There were studied 30 patients suffering from Helicobacter associated gastric and duodenal ulcer, lysozyme activity was determined in 8 conditionally healthy individuals. There were used endoscopic, cytomorphological, and immunological (polymerase chain reaction, photonephelometric techniques. To study the effect of immunomodulator and probiotic on eradication and nonspecific immune protection, there were determined H. pylori contamination and lysozyme activity of oropharyngeal secretion and gastric juice before and after the treatment. Results. The analysis of biopsy specimens and lysozyme biological tests revealed the use of immunomodulator (Licopid and bifid and lactic acid bacteria complex combined with anti-Helicobacter pylori therapy increases H. pylori eradication and enhances lysozyme activity of saliva and gastric juice compared to data on quadroscheme. Conclusion. The administration of Licopid and bifid and lactic acid bacteria complex can be recommended in complex therapy of patients suffering from Helicobacter associated gastric and duodenal ulcers.

  5. Quality of life in patients with ulcerative colitis treated surgically

    OpenAIRE

    Kozłowska, Katarzyna A.; Bączyk, Grażyna; Krokowicz, Piotr

    2014-01-01

    Introduction Ulcerative colitis belongs to the group of inflammatory bowel diseases. The specific symptoms and chronic nature of the disease significantly affect the quality of patients’ lives. Quality-of-life assessment helps to define its determining factors as well as the efficiency of surgical procedures. Aim Quality-of-life evaluation of patients with ulcerative colitis treated surgically. Material and methods A retrospective review was carried out on 35 patients with ulcerative colitis,...

  6. Update in the treatment of paediatric ulcerative colitis.

    Science.gov (United States)

    Greifer, Melanie K; Markowitz, James F

    2006-10-01

    Ulcerative colitis is an important disease in the paediatric population. Ulcerative colitis is one of the chronic inflammatory bowel diseases, and is medically incurable. However, the arsenal of medications has grown as knowledge of the pathogenesis of this disease advances. This review looks at the classical treatments for children with ulcerative colitis, including the 5-aminosalicylates, corticosteroids and imunomodulators, as well as biological therapy and other, newer modalities. PMID:17020417

  7. Restless Legs Syndrome

    Science.gov (United States)

    ... Us FAQs Home » Health Information for the Public » Health Topics » Restless Legs Syndrome Explore Restless Legs Syndrome What Is... Causes Who Is at Risk Signs & Symptoms Diagnosis Treatments Living With Clinical Trials Links Related Topics Insomnia Sleep Deprivation and Deficiency Sleep Studies Send a ...

  8. Analysis of the chronic wound microbiota of 2,963 patients by 16S rDNA pyrosequencing.

    Science.gov (United States)

    Wolcott, Randall D; Hanson, John D; Rees, Eric J; Koenig, Lawrence D; Phillips, Caleb D; Wolcott, Richard A; Cox, Stephen B; White, Jennifer S

    2016-01-01

    The extent to which microorganisms impair wound healing is an ongoing controversy in the management of chronic wounds. Because the high diversity and extreme variability of the microbiota between individual chronic wounds lead to inconsistent findings in small cohort studies, evaluation of a large number of chronic wounds using identical sequencing and bioinformatics methods is necessary for clinicians to be able to select appropriate empiric therapies. In this study, we utilized 16S rDNA pyrosequencing to analyze the composition of the bacterial communities present in samples obtained from patients with chronic diabetic foot ulcers (N = 910), venous leg ulcers (N = 916), decubitus ulcers (N = 767), and nonhealing surgical wounds (N = 370). The wound samples contained a high proportion of Staphylococcus and Pseudomonas species in 63 and 25% of all wounds, respectively; however, a high prevalence of anaerobic bacteria and bacteria traditionally considered commensalistic was also observed. Our results suggest that neither patient demographics nor wound type influenced the bacterial composition of the chronic wound microbiome. Collectively, these findings indicate that empiric antibiotic selection need not be based on nor altered for wound type. Furthermore, the results provide a much clearer understanding of chronic wound microbiota in general; clinical application of this new knowledge over time may help in its translation to improved wound healing outcomes. PMID:26463872

  9. Noninfectious genital ulcers.

    Science.gov (United States)

    Kirshen, Carly; Edwards, Libby

    2015-12-01

    Noninfectious genital ulcers are much more common than ulcers arising from infections. Still, it is important to take a thorough history of sexual activity and a sexual abuse screen. A physical exam should include skin, oral mucosa, nails, hair, vulva, and vaginal mucosa if needed. The differential diagnosis of noninfectious genital ulcers includes: lipschütz ulcers, complex aphthosis, Behçet's syndrome, vulvar metastatic Crohn's disease, hidradenitis suppurativa, pyoderma gangrenosum, pressure ulcers, and malignancies. It is important to come to the correct diagnosis to avoid undue testing, stress, and anxiety in patients experiencing genital ulcerations.

  10. Foot, leg, and ankle swelling

    Science.gov (United States)

    Swelling of the ankles - feet - legs; Ankle swelling; Foot swelling; Leg swelling; Edema - peripheral; Peripheral edema ... Foot, leg, and ankle swelling is common when the person also: Is overweight Has a blood clot ...

  11. Diabetic foot disease: impact of ulcer location on ulcer healing

    DEFF Research Database (Denmark)

    Pickwell, KM; Siersma, Volkert Dirk; Kars, M;

    2013-01-01

    Healing of heel ulcers in patients with diabetes is considered to be poor, but there is relatively little information on the influence of ulcer location on ulcer healing.......Healing of heel ulcers in patients with diabetes is considered to be poor, but there is relatively little information on the influence of ulcer location on ulcer healing....

  12. Acupuncture Treatment for 76 Cases of Ulcerative Colitis

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    @@ Ulcerative colitis is also called nonspecific chronic ulcerative colitis. The author of this essay has treated 76 such cases with acupuncture and obtained satisfactory therapeutic effect. Meanwhile, the results were compared with 45 cases treated with azulfidine.A report follows.

  13. Survey of bacterial diversity in chronic wounds using Pyrosequencing, DGGE, and full ribosome shotgun sequencing

    Directory of Open Access Journals (Sweden)

    Wolcott Benjamin M

    2008-03-01

    Full Text Available Abstract Background Chronic wound pathogenic biofilms are host-pathogen environments that colonize and exist as a cohabitation of many bacterial species. These bacterial populations cooperate to promote their own survival and the chronic nature of the infection. Few studies have performed extensive surveys of the bacterial populations that occur within different types of chronic wound biofilms. The use of 3 separate16S-based molecular amplifications followed by pyrosequencing, shotgun Sanger sequencing, and denaturing gradient gel electrophoresis were utilized to survey the major populations of bacteria that occur in the pathogenic biofilms of three types of chronic wound types: diabetic foot ulcers (D, venous leg ulcers (V, and pressure ulcers (P. Results There are specific major populations of bacteria that were evident in the biofilms of all chronic wound types, including Staphylococcus, Pseudomonas, Peptoniphilus, Enterobacter, Stenotrophomonas, Finegoldia, and Serratia spp. Each of the wound types reveals marked differences in bacterial populations, such as pressure ulcers in which 62% of the populations were identified as obligate anaerobes. There were also populations of bacteria that were identified but not recognized as wound pathogens, such as Abiotrophia para-adiacens and Rhodopseudomonas spp. Results of molecular analyses were also compared to those obtained using traditional culture-based diagnostics. Only in one wound type did culture methods correctly identify the primary bacterial population indicating the need for improved diagnostic methods. Conclusion If clinicians can gain a better understanding of the wound's microbiota, it will give them a greater understanding of the wound's ecology and will allow them to better manage healing of the wound improving the prognosis of patients. This research highlights the necessity to begin evaluating, studying, and treating chronic wound pathogenic biofilms as multi-species entities in

  14. Restless legs syndrome.

    Science.gov (United States)

    Miletić, Vladimir; Relja, Maja

    2011-12-01

    Being of the most frequent causes of insomnia, which in the end leads to chronic fatigue, inadequate performance of daily activities, and serious disruption of quality of living, restless legs syndrome (RLS) is nowadays not only a serious medical problem but a socio-economical one as well. Prevalence of the disorder in general population is estimated at 5 to 15%. Family history is positive in over 50% of idiopathic RLS patients which points to genetic basis of the disorder. The characteristics of the secondary or acquired form of RLS are symptoms that start later in life as well as a rapid progression of the disease. On the other hand, idiopathic RLS more often starts at a younger age and the prognoses are better. Over twenty disorders and conditions are brought in connection with secondary RLS. Although the cause of primary RLS is still unknown, there is a strong connection between central metabolism of iron as well as dopamine levels and RLS manifestation. A differential diagnosis of RLS includes a wide specter of motor and sensory disorders. Diagnosis is based on clinical features and the history of disease. To correctly diagnose idiopathic RLS one must first eliminate secondary causes of RLS and then also exclude any disorders with clinical features that mimic those of RLS. It has been estimated that some 20 to 25% of patients need pharmacological therapy. Best initial therapy is the application of nonergot dopamine agonists. Anticonvulsants, benzodiazepines and opioides can be given to patients who are refractory to dopaminergic therapy, those suffering from RLS with emphasized painful sensory component and those with RLS connected with insomnia.

  15. The Effect of Immunomodulating Therapy on a Lysozyme Activity and the Expression of Helicobacter Pylori Contamination in Chronic Gastric and Duodenal Peptic Ulcer

    Directory of Open Access Journals (Sweden)

    Dugina V.V.

    2011-03-01

    Full Text Available There has been investigated a lysozyme activity level and the expression of Helicobacter pylori contamination in eradication therapy of gastric and duodenal peptic ulcer using immunomodulators of different pharmacological groups. The use of immunomodulators such as lycopid and immunal against a background of the anti-H.bacter “quadroscheme” has been stated to lead to the increase of eradication, with a lysozyme activity in saliva significantly increasing. The tendency to lysozyme normalization in gastric juice has also been observed. A synthetic bacterial immunomodulator lycopid in a greater degree effects a lysozyme activity in comparison with the effect of immunal — an immunomodulator of plants.

  16. Glucagonoma, chronic recurrent peptic ulcer disease, and enhanced amylase-creatinine clearance ratio. Report of a case with review of the literature.

    Science.gov (United States)

    Pitchumoni, C S; Thelmo, W; Ahmed, K S; Kumar, A; Davidian, M; Einhorn, R; Adler, J; McCarthy, J

    1979-09-01

    A 53-year-old white woman developed diabetes mellitus, migratory erythema, and anemia, clinical features suggesting the presence of a "glucagonoma." Ten years earlier, after laparotomy and pancreatic biopsy, she had been told that she had an inoperable pancreatic carcinoma. Review of that biopsy together with current hormonal assay now confirms the diagnosis of glucagonoma. The recurrent peptic ulcer in this patient despite high levels of glucagon, a gastric inhibitory agent, is noted but not explained. An enhanced amylase-creatinine clearance ratio supports the notion that glucagon increases the clearances of amylase.

  17. Acute genital ulcers.

    Science.gov (United States)

    Delgado-García, Silvia; Palacios-Marqués, Ana; Martínez-Escoriza, Juan Carlos; Martín-Bayón, Tina-Aurora

    2014-01-28

    Acute genital ulcers, also known as acute vulvar ulcers, ulcus vulvae acutum or Lipschütz ulcers, refer to an ulceration of the vulva or lower vagina of non-venereal origin that usually presents in young women, predominantly virgins. Although its incidence is unknown, it seems a rare entity, with few cases reported in the literature. Their aetiology and pathogenesis are still unknown. The disease is characterised by an acute onset of flu-like symptoms with single or multiple painful ulcers on the vulva. Diagnosis is mainly clinical, after exclusion of other causes of vulvar ulcers. The treatment is mainly symptomatic, with spontaneous resolution in 2 weeks and without recurrences in most cases. We present a case report of a 13-year-old girl with two episodes of acute ulcers that fit the clinical criteria for Lipschütz ulcers.

  18. Living with diabetic foot ulcers: a life of fear, restrictions, and pain.

    Science.gov (United States)

    Ribu, Lis; Wahl, Astrid

    2004-02-01

    Lower extremity ulcers are a common and challenging problem for people with diabetes and clinicians who provide their care. A qualitative study of seven patients with type 1 or type 2 diabetes who had leg and/or foot ulcers was conducted to enhance understanding of the patient's perspective of living with lower extremity ulcers and diabetes. Data were collected through in-depth interviews guided by the patients' descriptive priorities. Results indicated that patients experienced changes in their feet, pain and insomnia, fatigue and limited mobility, social isolation and loneliness, a restricted life, loss of control, and fear for the future. When treating a patient's leg or foot ulcer, clinicians need to consider patients' subjective feelings toward the various aspects of their life situations and the impact of their situation on their quality of life. Understanding the ramifications of lower extremity ulcers and diabetes on patients is important to the health professional's ability to provide support during the illness process. PMID:15129612

  19. MEBO治愈1例下肢慢性溃疡恶变报告%MEBO Curing Malignant Transformation of Chronic Lower Limb Ulcer:A Case Report

    Institute of Scientific and Technical Information of China (English)

    陈方凯; 龚海粟

    2013-01-01

      目的 观察湿润烧伤膏( MEBO)在下肢慢性溃疡恶变中的治疗效果。方法 患者入院后,对创面予以病理活检、微生物培养、摄片等检查后,对创面局部纤维板给予划开清除,逐层削除老化、纤维化肉芽组织,使创面形成相对“新鲜”状态后,采用 MEBO换药治疗(每6 h换药1次),重新培育肉芽组织;全身给予抗感染、改善微循环等治疗。创面肉芽组织成熟后,再次多点活检病理检查,确认创面无明显癌组织后,行“邮票式”植皮手术、周围曲张静脉结扎及分段剥脱术,供皮区使用 MEBO油纱换药治疗;术后5 d,植皮区改用MEBO油纱包扎换药治疗,每日1次,直至创面完全愈合。结果 供皮区创面于术后14 d愈合,植皮区创面于术后30 d痊愈,愈后随访4年,创面轻度瘢痕增生,无新的溃疡创面形成及转移癌发生。结论 MEBO是肉芽组织生长的“培养基”,能促进慢性溃疡创面的愈合,是慢性溃疡创面修复的良好外用药。另外, MEBO可能影响体表肿瘤的生物特性,抑制肿瘤细胞生长。%Objective To observe the efficacy of MEBO in treating malignant transformation of chronic lower limb ulcer. Methods After admission, the wound was examined by pathological biopsy, microbial culture, and imaging. Per-form excision on the local wound fibreboard, excising degenerated and fibrotic granulation tissues layer by layer, exposing the“ fresh” wound surface. Then apply MEBO on the wound and change dressing once every 6 hours, cultivating new granu-lation tissue; systemic anti-infection and microcirculation improvement therapy were performed. When wound granulation tissue matured, multiple site pathological biopsy exam was taken to confirm there was no obvious wound tissue canceration. Then perform“ stamp” skin grafting and peripheral varicose ligation&segmented peeling surgery; the donor site wound was treated

  20. 三乙醇胺乳膏治疗皮肤慢性溃疡疗效观察%Efficacy of triethanolamine cream in the treatment of chronic skin ulcer: a clinical study

    Institute of Scientific and Technical Information of China (English)

    刘夕琳; 吴涛; 柳岚; 杨海平

    2014-01-01

    目的 探讨三乙醇胺乳膏治疗皮肤慢性溃疡的疗效和安全性.方法 38例皮肤慢性溃疡的患者分为两组,治疗组21例和对照组17例,治疗组在清创和换药的基础上待创面表面清洁后外敷厚层三乙醇胺乳膏,对照组仅用常规清创和换药.结果 治疗组21例中痊愈18例,占85.71%,显效2例,占9.52%,好转1例,占4.76%,总有效率为95.24%;对照组17例中痊愈8例,占47.06%,显效2例,占11.76%,好转5例,占29.41%,总有效率为58.82%,两组比较差异有统计学意义(P<0.05).治疗组者肉芽组织出现时间、皮肤溃疡愈合时间均优于对照组,两组比较差异有统计学意义(P<0.01).结论 三乙醇胺治疗皮肤慢性溃疡疗效确切,患者耐受性好.%Objective To assess the efficacy and safety of triethanolamine cream for the treament of chronic skin ulcer.Methods Thirty-eight patients with chronic skin ulcer were classified into the test group and control group.The control group was routinely treated with debridement and dressing,while the test group was topically treated with triethanolamine cream besides debredement and dressing.Results After 8 weeks of treatment,the lesions healed in 18 (85.71%) patients in the test group and 8 (47.06%) patients in the control group,markedly improved in 2 (9.52%) patients in the test group and 2 (11.76%) patients in the control group,improved in 1 (4.76%) patient in the test group and 5 (29.41%) patients in the control group.The total response rate was significantly different between the test group and control group (95.24% vs.58.82%,x2 =6.497,P < 0.05).Both the time required for granulation tissue to generate and that for skin ulcer to heal were shorter in the test group than in the control group (both P < 0.01).Conclusion Triethanolamine cream is a safe,effective,and well-tolerated treatment option for chronic skin ulcer.

  1. Intestinal microbiota and ulcerative colitis.

    Science.gov (United States)

    Ohkusa, Toshifumi; Koido, Shigeo

    2015-11-01

    There is a close relationship between the human host and the intestinal microbiota, which is an assortment of microorganisms, protecting the intestine against colonization by exogenous pathogens. Moreover, the intestinal microbiota play a critical role in providing nutrition and the modulation of host immune homeostasis. Recent reports indicate that some strains of intestinal bacteria are responsible for intestinal ulceration and chronic inflammation in inflammatory bowel diseases (IBD) such as ulcerative colitis (UC) and Crohn's disease (CD). Understanding the interaction of the intestinal microbiota with pathogens and the human host might provide new strategies treating patients with IBD. This review focuses on the important role that the intestinal microbiota plays in maintaining innate immunity in the pathogenesis and etiology of UC and discusses new antibiotic therapies targeting the intestinal microbiota.

  2. Novel topical formulation for ischemic chronic wounds. Technological design, quality control and safety evaluation.

    Science.gov (United States)

    Cabrera, Carla Agostina; Ramos, Alberto Nicolas; Loandos, María Del Huerto; Valdez, Juan Carlos; Sesto Cabral, Maria Eugenia

    2016-01-01

    Ulceration of the foot in diabetes is common and disabling, and frequently leads to amputation of the leg. The pathogenesis of foot ulceration is complex, clinical presentation variable and management requires early expert assessment. Despite treatment, ulcers readily become chronic wounds. Chronic wounds are those that remain in a chronic inflammatory state failing a normal healing process patterns. This is partially caused by inefficient eradication of opportunistic pathogens like Pseudomonas aeruginosa. We propose its control or eradication will promote wound healing. Lactobacillus plantarum cultures supernatants (LAPS) shows antipathogenic and pro-healing properties. The main objective was to design two pharmaceutical dosage forms by using LAPS as active pharmaceutical ingredient and to perform its quality control, in vitro activity conservation tests and human trials (safety evaluation). Both selected formulations reach the technological quality expected for 120 days, shows adequate occlusive characteristics and proper adhesion to human skin. From the in vitro release assays were found that LAPS shows adequate release from matrix and maintain its antimicrobial and anti-biofilm activity. First human trials were developed and neither edema nor erythema on healthy skin voluntaries was found. We conclude that C80 and C100 are adequate for their use in future clinical trials to demonstrate a comprehensive therapeutic effectiveness in ischemic chronic wounds.

  3. RESTLESS LEGS SYNDROME

    Directory of Open Access Journals (Sweden)

    Dmitriy Valer'evich Artem'ev

    2009-01-01

    Full Text Available The paper describes the epidemiology, etiology, pathogenesis, clinical picture, diagnosis, differential diagnosis, and treatment of restless legs syndrome. Recommendations are given how to choose therapeutic modalities and drugs in relation to different factors.

  4. SPONTANEOUS DUODENO-BILIARY FISTULA CAUSED BY DUODENAL PEPTIC ULCER

    Directory of Open Access Journals (Sweden)

    N. Danila

    2005-07-01

    Full Text Available Spontaneous duodeno-biliary fistula represents a rare complication of chronic duodenal peptic ulcer. The authors present two cases with this pathology and also the particularities of surgical approach. Spontaneous duodeno-biliary fistula caused by chronic peptic ulcer is often a surprising diagnostic in the era of H2 blockers. The difficulties and the complexity of the diagnosis associated with the particularities of surgical technique represent the key of this rare disease.

  5. Microarray Assisted Gene Discovery in Ulcerative Colitis

    DEFF Research Database (Denmark)

    Brusgaard, Klaus

    Inflammatory Bowel disease (IBD) is a condition characterised by chronic recidivous inflammation of the bowel and intestine. IBD includes chron´s disease (CD) and ulcerative colitis (UC). The combined prevalence of CD and UC are app. 1 in 500 in the general Caucasian population. In 25% of the cases...

  6. Diabetic foot ulcers: Part I. Pathophysiology and prevention.

    Science.gov (United States)

    Alavi, Afsaneh; Sibbald, R Gary; Mayer, Dieter; Goodman, Laurie; Botros, Mariam; Armstrong, David G; Woo, Kevin; Boeni, Thomas; Ayello, Elizabeth A; Kirsner, Robert S

    2014-01-01

    Diabetes mellitus is a serious, life-long condition that is the sixth leading cause of death in North America. Dermatologists frequently encounter patients with diabetes mellitus. Up to 25% of patients with diabetes mellitus will develop diabetic foot ulcers. Foot ulcer patients have an increased risk of amputation and increased mortality rate. The high-risk diabetic foot can be identified with a simplified screening, and subsequent foot ulcers can be prevented. Early recognition of the high-risk foot and timely treatment will save legs and improve patients' quality of life. Peripheral arterial disease, neuropathy, deformity, previous amputation, and infection are the main factors contributing to the development of diabetic foot ulcers. Early recognition of the high-risk foot is imperative to decrease the rates of mortality and morbidity. An interprofessional approach (ie, physicians, nurses, and foot care specialists) is often needed to support patients' needs.

  7. Vulvar ulcer as a presentation of systemic langerhans cell histiocytosis

    Directory of Open Access Journals (Sweden)

    Nina A Madnani

    2011-01-01

    Full Text Available We report a 38-year-old housewife with systemic Langerhans cell histiocytosis (LCH presenting as a chronic vulvar and peri-anal ulcer. She had systemic involvement in the form of diabetes insipidus and bone "hot-spots". She responded favorably to etoposide, 6-mercaptopurine, and systemic steroids, and has been in remission since 10 years. Chronic vulvar ulcers not responding to routine therapy should not be neglected and need to be biopsied repeatedly to come to a specific diagnosis. The vulvar ulcer in our case provided a vital clue to a systemic LCH, with a successful outcome.

  8. Genotypes of Helicobacter pylori in patients with peptic ulcer bleeding

    Institute of Scientific and Technical Information of China (English)

    Chin-Lin Perng; Hwai-Jeng Lin; Wen-Ching Lo; Guan-Ying Tseng; I-Chen Sun; Yueh-Hsing Ou

    2004-01-01

    AIM: Helicobacter pyloricauses chronic gastritis, peptic ulcer,gastric cancer and MALT-lymphoma. Different genotypes of Helicobacter pylori are confirmed from diverse geographic areas. Its association with bleeding peptic ulcer remains controversial. The aim of this study was to investigate the Helicobacter pylori vac4 alleles, cagA and iceA in patients with bleeding peptic ulcer.METHODS: We enrolled patients with bleeding, nonbleeding peptic ulcers and chronic gastritis. Biopsy specimens were obtained from the antrum of the stomach for rapid urease test, bacterial culture and PCR assay. DNA extraction and polymerase chain reaction were used to detect the presence or absence of cagA and to assess the polymorphism of vac4 and iceA.RESULTS: A total of 168 patients (60.4%) (25 patients with chronic gastritis, 26 patients with bleeding gastric ulcer,51 patients with non-bleeding gastric ulcer, 26 patients with bleeding duodenal ulcer, and 40 patients with non-bleeding duodenal ulcer) were found to have positive PCR results between January 2001 and December 2002. Concerning genotypes, we found cagA (139/278, 50%), vacA s1a (127/278, 45.7%), and iceA1 (125/278, 45%) predominated in all studied patients. In patients with bleeding peptic ulcers,vac4 s1a and m1T were fewer than those in patients with non-bleeding peptic ulcers (37/106 vs69/135, P=0.017, and 4/106 vs21/135, P=0.002).CONCLUSION: In patients with peptic ulcers, Hpylori vacA s1a and m1T prevent bleeding complication.

  9. Invasive mucormycosis in benign gastric ulcer.

    Science.gov (United States)

    Al-Rikabi, A C; Al-Dohayan, A D; Al-Boukai, A A

    2000-03-01

    Fungal elements are frequently noted overlying the base of chronic peptic ulcers of the stomach and it has been suggested that the fungi enhance the degree of necrosis and that these cases have protracted disease and deeper ulcers with more perforations. It has also been postulated that the number of fungal elements might be increased in the stomach of patients who are receiving potent medications such as H2-receptor antagonists to reduce gastric acidity, but there have not been adequate control studies, and the deleterious effects from the presence of the fungi in these cases have not been substantiated. We present a very rare case of invasive mucormycosis (phycomycosis) occurring in the base of a chronic gastric ulcer in a 55 years old diabetic male. This case was clinically and radiologically been mistaken for a gastric carcinoma. In addition, the ulcer was complicated by perforation and fungal septicemia with subsequent fatal outcome. The clinical, radiological and histopathological features are described together with a literature review of other reported fungal gastric ulcers.

  10. Observation of therapeutic effect of SilverCare nanometer silver antimicrobial gel on chronic ulcers%斯丽凯纳米银抗菌凝胶治疗慢性溃疡的临床观察

    Institute of Scientific and Technical Information of China (English)

    张龙; 崔正军; 韩兆峰; 周健; 张树堂

    2011-01-01

    Objective To observe the therapeutic effect of SilverCare nanometer silver antimicrobial gel on Chronic ulcers. Methods Trial group: To select 50 patients with chronic ulcer,and take silvercare nanometer silver gel to change dressings. Control group: Self-contral observation was used on the same patient with chronic ulcer,which scattered on adjacent or symmetrical parts of bodies,and taked sulfadiazine silver cream. Data was collected at different time points on wound pain,wound exudate,wound edema,wound effective rate,bacterial culture rate,and adverse drug reactions. Results Wound painand wound edema in trial group were significantly lower than those of control group at different time pionts (P<0.05); wound exudate in trial group was not significantly lower than those of control group at different time pionts (P>0.05); wound effective rate of trial group was obviously higher than those of control group (P< 0.05);and bacterial culture rate of trial group was evidently lower than those of control group (P<0.05);the obvious adverse reactions were not observed in trial group. Conclusions SilverCare nanometer silver antimicrobial gel has better antibacterial activity, promotes wound management,and decreases the healing time,comparing with sulfadiazine silver cream.%目的:观察斯丽凯纳米银抗菌凝胶治疗慢性溃疡的临床疗效.方法:试验组:选取慢性溃疡患者50例进行临床试验,应用斯丽凯纳米银抗菌凝胶进行创面换药.对照组:设自身同体对照,慢性溃疡面积相近、相邻或部位对称,应用磺胺嘧啶银乳膏换药.观测记录各组病例不同时相点的创面疼痛程度、创面渗出液、创面水肿程度、创面有效率、细菌培养率和药物不良反应.结果:试验组不同时相点的创面疼痛程度和创面渗出液明显小于对照组(P0.05);试验组不同时相点的创面有效率明显高于对照组(P<0.05);试验组不同时相点的细菌检出率明显低于对照组(P<0

  11. Spectrum of bacteria associated with diabetic foot ulcer and biofilm formation: A prospective study

    Directory of Open Access Journals (Sweden)

    Asima Banu

    2015-09-01

    The organisms causing chronic diabetic foot ulcers were commonly multidrug-resistant; this was also observed among biofilm formers. Therefore, screening for biofilm formation, along with the usual antibiogram, needs to be performed as a routine procedure in chronic diabetic ulcers to formulate effective treatment strategies for these patients.

  12. Current treatment of ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    JohannesMeier; AndreasSturm

    2011-01-01

    Ulcerative colitis (UC) is a chronic disease featuring re- current inflammation of the colonic mucosa. The goal of medical treatment is to rapidly induce a steroid-free remission while at the same time preventing complica- tions of the disease itself and its treatment. The choice of treatment depends on severity, localization and the course of the disease. For proctitis, topical therapy with 5-aminosalicylic acid (5-ASA) compounds is used. More extensive or severe disease should be treated with oral and local 5-ASA compounds and corticosteroids to induce remission. Patients who do not respond to this treatment require hospitalization. Intravenous steroids or, when refractory, calcineurin inhibitors (cyclosporine, tacrolimus), tumor necrosis factor-α antibodies (infliximab) or immunomodulators (azathioprine, 6-mercaptopurine) are then called for. Indications for emergency surgery include refractory toxic megacolon, perforation, and continuous severe colorectal bleeding. Close collaboration between gastroenterologist and surgeon is mandatory in order not to delay surgical therapy when needed. This article is intended to give a general, practice-orientated overview of the key issues in ulcerative colitis treatment. Recommendations are based on published consensus guidelines derived from national and international guidelines on the treatment of ulcerative colitis.

  13. Current treatment of ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    Johannes Meier; Andreas Sturm

    2011-01-01

    Ulcerative colitis (UC) is a chronic disease featuring recurrent inflammation of the colonic mucosa. The goal of medical treatment is to rapidly induce a steroid-free remission while at the same time preventing complications of the disease itself and its treatment. The choice of treatment depends on severity, localization and the course of the disease. For proctitis, topical therapy with 5-aminosalicylic acid (5-ASA) compounds is used. More extensive or severe disease should be treated with oral and local 5-ASA compounds and corticosteroids to induce remission. Patients who do not respond to this treatment require hospitalization. Intravenous steroids or, when refractory, calcineurin inhibitors (cyclosporine, tacrolimus), tumor necrosis factor-α antibodies (infliximab) or immunomodulators (azathioprine, 6-mercaptopurine) are then called for. Indications for emergency surgery include refractory toxic megacolon, perforation, and continuous severe colorectal bleeding. Close collaboration between gastroenterologist and surgeon is mandatory in order not to delay surgical therapy when needed. This article is intended to give a general, practice- orientated overview of the key issues in ulcerative colitis treatment. Recommendations are based on published consensus guidelines derived from national and international guidelines on the treatment of ulcerative colitis.

  14. Choledochoduodenal fistula of ulcer etiology

    Directory of Open Access Journals (Sweden)

    Čolović Radoje

    2010-01-01

    Full Text Available Introduction Choledochoduodenal fistulas are very rare and in most cases are caused by a long-lasting and poorly treated chronic duodenal ulcer. They may be asymptomatic or followed by symptoms of ulcer disease, by attacks of cholangitis or bleeding or vomiting in cases of ductoduodenal stenosis. The diagnosis is simple and safe, however treatment is still controversial. If surgery is the choice of treatment, local findings should be taken into consideration. As a rule, intervention involving closure of fistula is not recommended. Case Outline The authors present a 60-year-old woman with a long history of ulcer disease who developed attacks of cholangitis over the last three years. Ultrasonography and CT showed masive pneumobilia due to a choledochoduodenal fistula. . As there was no duodenal stenosis or bleeding, at operation the common bile duct was transected and end-to-side choledochojejunostomy was performed using a Roux-en Y jejunal limb. From the common bile duct, multiple foreign bodies of herbal origin causing biliary obstruction and cholangitis were removed. After uneventful recovery the patient stayed symptom free for four years now. Conclusion The performed operation was a simple and good surgical solution which resulted in complication-free and rapid recovery with a long-term good outcome. .

  15. New trends in healing chronic wounds

    OpenAIRE

    KREJSKOVÁ, Kamila

    2013-01-01

    Basic theoretical bases As a chronic wound is called a secondarily healing wound which despite adequate therapy does not tend to heal for a period of 6-9 weeks. The cause of the chronic wound occurrence and its transformation into an acute wound can be infection, influence of associated diseases, skin top layer microtraumatization or skin necrosis cavity. Among the most frequent types of chronic wounds there are aligned venous ulcerations, arterial rodent ulcers, decubitus ulcers and neuropat...

  16. Aphthous ulcers (recurrent)

    OpenAIRE

    Porter, Stephen R; Scully CBE, Crispian

    2007-01-01

    Most people with recurrent aphthous ulcers develop a few ulcers less than 1 cm in diameter, that heal after 5 to 14 days without scarring. The causes are unknown, but risks of recurrence may decrease if the person gives up smoking.Local physical trauma may trigger ulcers in susceptible people.In 10% of sufferers, lesions are more than 1 cm in diameter and can cause scarring.

  17. Helicobacter pylori infection analysis in chronic hepatitis B and hepatitis B cirrhosis complicated with peptic ulcer patients%慢性乙型肝炎及乙肝肝硬化合并消化性溃疡患者幽门螺杆菌感染分析

    Institute of Scientific and Technical Information of China (English)

    张武汉; 罗雪兵; 马爱霞

    2015-01-01

    目的:分析慢性乙型肝炎及乙肝肝硬化合并消化性溃疡患者幽门螺杆菌(Hp)感染情况。方法对67例慢性乙型肝炎合并消化性溃疡患者(设为观察组)与48例乙肝肝硬化合并消化性溃疡患者(设为对照组)分别实施胃镜检查、快速尿素酶测定和14C呼气试验,比较两组的Hp感染情况。结果观察组的Hp阳性率为70.15%(47/67),胃溃疡21例,其中Hp感染4例, Hp阳性率占19.05%,十二指肠溃疡46例, Hp感染43例, Hp阳性率占93.48%。对照组患者中,胃溃疡18例,其中Hp感染3例, Hp阳性率占16.67%,十二指肠溃疡30例, Hp感染13例, Hp阳性率占43.33%。结论慢性乙型肝炎十二指肠溃疡与Hp感染有显著的相关性,慢性乙型肝炎胃溃疡、乙肝肝硬化胃溃疡与Hp感染相关性则不明显。%ObjectiveTo analyze helicobacter pylori (Hp) infection in chronic hepatitis B and hepatitis B cirrhosis complicated with peptic ulcer patients.MethodsGastroscopy, rapid urease test assay, and14C breath test were applied in 67 chronic hepatitis B complicated with peptic ulcer patients (as observation group) and 48 hepatitis B cirrhosis complicated with peptic ulcer patients (as control group) for comparison of their Hp infection condition.ResultsThe observation group had Hp positive rate as 70.15% (47/67). Among 21 cases with gastric ulcer, there were 4 cases of them with Hp infection, with the Hp positive rate as 19.05%. Among 46 cases with duodenal ulcer, there were 43 cases with Hp infection, with the Hp positive rate as 93.48%. In the control group, there were 18 cases with gastric ulcer, and 3 cases among them had Hp infection, with the Hp positive rate as 16.67%. Among 30 cases with duodenal ulcer, there were 13 cases with Hp infection, with the Hp positive rate as 43.33%.ConclusionChronic hepatitis B duodenal ulcer has significant correlation with Hp infection, while chronic hepatitis B gastric ulcer and hepatitis B cirrhosis

  18. The mangled lower leg

    NARCIS (Netherlands)

    Hoogendoorn, Jochem Maarten

    2002-01-01

    A surgeon faced with a patient presenting with an open tibial/fibular fracture in combination with severe damage of the surrounding soft tissues, has to make the difficult decision whether to attempt salvage or to perform an immediate amputation of the leg. Until late in the nineteenth century the

  19. Quantitative analysis of the cellular inflammatory response against biofilm bacteria in chronic wounds

    DEFF Research Database (Denmark)

    Fazli, Mustafa; Bjarnsholt, Thomas; Kirketerp-Møller, Klaus;

    2011-01-01

    counting on the tissue sections from wounds containing either Pseudomonas aeruginosa or Staphylococcus aureus. The P. aeruginosa-containing wounds had significantly higher numbers of neutrophils accumulated compared with the S. aureus-containing wounds. These results are discussed in relation...... to the wound. One such stimulus might be the presence of bacterial biofilms in chronic wounds. In the present study, biopsy specimens from chronic venous leg ulcers were investigated for the detection of bacteria using peptide nucleic acid-based fluorescence in situ hybridization (PNA-FISH) and confocal laser...... to the hypothesis that the presence of P. aeruginosa biofilms in chronic wounds may be one of the main factors leading to a persistent inflammatory response and impaired wound healing....

  20. Other Causes of Leg Pain

    Science.gov (United States)

    ... Past Issues Special Section Other Causes of Leg Pain Past Issues / Summer 2008 Table of Contents For ... a crowd of people walking. Photo: iStock Leg pain can come from a variety of causes. Your ...

  1. Mucosal polymerase chain reaction for diagnosing Helicobacter pylori infection in patients with bleeding peptic ulcers

    Institute of Scientific and Technical Information of China (English)

    Hwai-Jeng Lin; Wen-Ching Lo; Chin-Lin Perng; Guan-Ying Tseng; Anna Fen-Yau Li; Yueh-Hsing Ou

    2005-01-01

    AIM: Helicobacter pylori(Hpylori) has been linked to chronic gastritis, peptic ulcers, gastric cancer and MALT-lymphoma.Conventional invasive tests are less sensitive than noninvasive tests in diagnosing H pylori infection in patients with bleeding peptic ulcers. Polymerase chain reaction is a sensitive and accurate method for diagnosing H pylori infection. The aim of this study was to evaluate the diagnostic role of mucosal polymerase chain reaction for H pylori infection in patients with bleeding peptic ulcers.METHODS: In patients with bleeding, non-bleeding peptic ulcers and chronic gastritis, we checked rapid urease test,histology, bacterial culture and mucosal polymerase chain reaction for detecting H pylori infection. Positive H pylori infection was defined as positive culture or both a positive histology and a positive rapid urease test. For mucosal polymerase chain reaction of Hpylori, we checked vacA (s1a, s1b, s1c, s2, m1, m1T, m2),iceA1,iceA2 and cag A.RESULTS: Between October 2000 and April 2002, 88 patients with bleeding peptic ulcers (males/females: 60/28, gastric ulcers/duodenal ulcers: 55/33), 81 patients with non-bleeding peptic ulcers (males/females: 54/27, gastric ulcers/duodenal ulcers: 45/36) and 37 patients with chronic gastritis (males/females: 24/13) were enrolled in this study. In patients with bleeding peptic ulcers, non-bleeding peptic ulcers and chronic gastritis, 45 patients (51%), 71 patients (88%)and 20 patients (54%) respectively were found to have positive H pylori infection (P<0.001). In patients with bleeding peptic ulcers, non-bleeding peptic ulcers and chronic gastritis, polymerase chain reaction for H pylori infection was positive in 54 patients (61%), 70 patients (86%) and 20 patients (54%) respectively (P<0.001). The sensitivity,positive predictive value and diagnostic accuracy of mucosal polymerase reaction for Hpylori infection were significantly lower in patients with bleeding peptic ulcers (84%, 79%and 81%) than in

  2. The stress ulcer syndrome

    NARCIS (Netherlands)

    H.A. van Essen

    1986-01-01

    textabstractThe stress ulcer syndrome is described in this thesis. This syndrome is seen in patients admitted to intensive care departments or being treated in field hospitals, in disaster areas, or battle fields. Acute mucosal lesions associated with burns (Curling's ulcers) and central nervous sys

  3. Neonatal Pressure Ulcer Prevention.

    Science.gov (United States)

    Scheans, Patricia

    2015-01-01

    The incidence of pressure ulcers in acutely ill infants and children ranges up to 27 percent in intensive care units, with a range of 16-19 percent in NICUs. Anatomic, physiologic, and developmental factors place ill and preterm newborns at risk for skin breakdown. Two case studies illustrate these factors, and best practices for pressure ulcer prevention are described. PMID:26803094

  4. Restless Legs Syndrome and Leg Motor Restlessness in Parkinson’s Disease

    Directory of Open Access Journals (Sweden)

    Keisuke Suzuki

    2015-01-01

    Full Text Available Sleep disturbances are important nonmotor symptoms in Parkinson’s disease (PD that are associated with a negative impact on quality of life. Restless legs syndrome (RLS, which is characterized by an urge to move the legs accompanied by abnormal leg sensations, can coexist with PD, although the pathophysiology of these disorders appears to be different. RLS and PD both respond favorably to dopaminergic treatment, and several investigators have reported a significant relationship between RLS and PD. Sensory symptoms, pain, motor restlessness, akathisia, and the wearing-off phenomenon observed in PD should be differentiated from RLS. RLS in PD may be confounded by chronic dopaminergic treatment; thus, more studies are needed to investigate RLS in drug-naïve patients with PD. Recently, leg motor restlessness (LMR, which is characterized by an urge to move the legs that does not fulfill the diagnostic criteria for RLS, has been reported to be observed more frequently in de novo patients with PD than in age-matched healthy controls, suggesting that LMR may be a part of sensorimotor symptoms intrinsic to PD. In this paper, we provide an overview of RLS, LMR, and PD and of the relationships among these disorders.

  5. Diabetes Foot Ulcers: A novel Treatment Strategy

    Directory of Open Access Journals (Sweden)

    Golnaz Namazi

    2008-05-01

    Full Text Available Foot ulcers are common in 12-25 percent of diabetic patients. Preventing, controlling and treating of these kind chronic wounds are of the major clinical challenges.Evidence based documents revealed that DFU (Diabetic Foot ulcer is a chronic wound type originating from disturbed cellular and molecular mechanisms that have to be in its functional form to overcome its problem. In diabetes and some other chronic based diseases, harmonized acting machine causes chronic phases that result in conditions as foot ulceration and related complications seen commonly in diabetes.DFU needs to be transformed into acute phase in order to be healed in a physiological manner. Disturbed mechanisms have to be corrected reversely and to achieve such a goal it is essential to better understanding of disturbing factors responsible for biological abnormalities. Factors associated with DFU are as cellular and molecular recruitment and function impairments and there is need to repair these mechanisms. For this, we believe that the activated Th-1 cells (T helper-1 Cells might have a critical role in regulation of the several effector functions of the cellular and molecular mechanisms essential to the body to act the best. Evidences and our successful results urge us to suggest this regulatory role for effector cells and molecules generated through activation of Th-1 cells as a treatment strategy.

  6. Endoscopic Evaluation of Peptic Ulcer Disease During Ramadan Fasting

    Directory of Open Access Journals (Sweden)

    G. M. Malik

    1996-01-01

    Full Text Available The effects of fasting on peptic ulcer disease were evaluated in a prospective study, involving 23 fasting patients who underwent endoscopy before and after Ramadan. Eighteen patients took an H2-blocker (ranitidine, 150 mg twice daily regularly at “Suhur” and “Iftar” as prescribed, while 5 were drug defaulters. On the first endoscopy the diagnosis in 4 patients was active acute duodenal ulcer (AADU, in 8 patients was active chronic duodenal ulcer (ACDU in 8 patients was healed duodenal ulcer (HDU, in 2 patients was erosive duodenitis (ED, and in 1 patient was chronic gastric ulcer (CGU. All of the patients with AADU showed signs of healing on repeat endoscopy. None of the ACDU patients showed signs of healing on repeat endoscopy. Instead, 7 patients in this group bled during fasting. All of the 5 drug defaulters belonged to the ACDU group. One patient in the HDU group had developed an active ulcer near the previous scar, as which was seen on repeat endoscopy. The 2 patients with ED showed signs of healing, while the only patient with CGU had bled from the same ulcer as seen on repeat endoscopy. The results were compared with those of 15 nonfasting control subjects (6 patients with ACDU, 3 with HDU, and 6 with ED as diagnosed on the first endoscopy, who took an H2-blocker regularly. The repeat endoscopy did not show any change in these patients. In conclusion, we inferred that Ramadan fasting may prove hazardous in patients with peptic ulcer disease in general and with active chronic ulcers in particular, although the fact that only 23 patients volunteered for this study, of whom 5 were drug defaulters, is a limitation.

  7. SOLAR THERAPY: A BOON FOR NON-HEALING ULCERS

    Directory of Open Access Journals (Sweden)

    Varunjikar

    2014-04-01

    Full Text Available : Compound fractures are common following road traffic accidents. It leads to open wound which needs treatment by plastic repairs such as rotation flaps, cross leg flaps, and skin grafting. Similarly, raw wounds and non-healing ulcers especially in osteomyelitis is a challenge to Orthopaedicians. Wounds with infection heal slowly and this often results in prolonged hospitalization. Standard treatment includes dressing and use of antibiotics which leads to financial burden on poor patients. Irrational use of antibiotics has lead to increasing resistance of bacteria to antibiotics. So far, sunlight has been utilized in treatment of rickets and osteomalacia. We have tried to utilize this mode of ecological treatment in an alternate way. Infected, non-healing wounds and ulcers were treated with exposure to sunlight which lead to scab formation and epithelisation leading to healing of wound due to UV rays. The purpose of this study was to determine the effects of ultraviolet radiation (UVR on the healing of ulcers. METHODS: Our patients having non healing ulcers were subjected to this type of treatment. RESULTS: In selected patients having non- healing ulcers on extremities of various sizes were treated previously with routine line of treatment such as dressing and oral or parenteral antibiotics. Patients were explained mode of treatment and underwent solar therapy after receiving informed consent. Epithelisation on ulcer took place following UV therapy within average duration of 23 days. CONCLUSION: It was concluded that ultraviolet radiation had significant effects in destroying bacteria and also promoting wound healing

  8. Activated protein C to heal pressure ulcers.

    Science.gov (United States)

    Wijewardena, Aruna; Lajevardi, Sepehr S; Vandervord, Elle; Vandervord, John; Lang, Thomas C; Fulcher, Gregory; Jackson, Christopher J

    2016-10-01

    Pressure ulcers present a major clinical challenge, are physically debilitating and place the patient at risk of serious comorbidities such as septic shock. Recombinant human activated protein C (APC) is an anticoagulant with anti-inflammatory, cytoprotective and angiogenic effects that promote rapid wound healing. Topical negative pressure wound therapy (TNP) has become widely used as a treatment modality in wounds although its efficacy has not been proven through randomised controlled trials. The aim of this study was to determine the preliminary efficacy and safety of treatment with APC for severe chronic pressure sores with and without TNP. This case presentation describes the history, management and outcome of two patients each with a severe chronic non-healing pressure ulcer that had failed to respond to conventional therapy. TNP was added to conservative management of both ulcers with no improvement seen. Then local application of small doses of APC was added to TNP and with conservative management, resulted in significant clinical improvement and rapid healing of both ulcers, displaying rapid growth of vascular granulation tissue with subsequent epithelialisation. Patients tolerated the treatment well and improvements suggested by long-term follow-up were provided. Randomised placebo-controlled double blind trials are needed to quantify the efficacy, safety, cost-effectiveness, optimal dose and quality of life changes seen from treatment with APC.

  9. have a hollow leg

    Institute of Scientific and Technical Information of China (English)

    周立

    2003-01-01

    英语对话 A:We must prevent our family members from getting involved with drugs, really. B:That’s a sure thing.We must make sure that they never involve them- selves with that. A:By the way,does your husband drink a lot? B:Yeah.That’s the only thing that keeps worrying me.And he often boasts that he has a hollow leg and nobody can drink him under the ta- ble.

  10. Stable walking with asymmetric legs

    International Nuclear Information System (INIS)

    Asymmetric leg function is often an undesired side-effect in artificial legged systems and may reflect functional deficits or variations in the mechanical construction. It can also be found in legged locomotion in humans and animals such as after an accident or in specific gait patterns. So far, it is not clear to what extent differences in the leg function of contralateral limbs can be tolerated during walking or running. Here, we address this issue using a bipedal spring-mass model for simulating walking with compliant legs. With the help of the model, we show that considerable differences between contralateral legs can be tolerated and may even provide advantages to the robustness of the system dynamics. A better understanding of the mechanisms and potential benefits of asymmetric leg operation may help to guide the development of artificial limbs or the design novel therapeutic concepts and rehabilitation strategies.

  11. CASE STUDY OF LEECH APPLICATION IN DIABETIC FOOT ULCER

    OpenAIRE

    Dwivedi, Amarprakash P.

    2012-01-01

    In diabetes, slight injury to the glucose laden tissue may cause chronic infection and ulcer formation. About 15% of all diabetic patients develops foot ulcer in their life time. The etiological factors include increased sugar level, diabetic micro angiopathy and peripheral neuropathy.Mainstay of treatment includes antibiotics, debridement, and local wound care and footwear improvisation. In spite of all advances in health sciences, statistics reveals that about 3% patients yet have to underg...

  12. Diagnostics of pressure ulcer risk and pressure ulcers

    OpenAIRE

    Kottner, Jan

    2011-01-01

    Pressure ulcers are serious health problems and they develop in every healthcare setting. Pressure ulcer risk scales aim to support practitioners in determining individual pressure ulcer risk and in starting preventive activities. Study results indicate validity problems inherent in pressure ulcer risk scale scores. Since risk scores are too imprecise for individual clinical decision making, it is questionable whether the standardized pressure ulcer risk assessments improve resident and patie...

  13. Connective tissue ulcers.

    Science.gov (United States)

    Dabiri, Ganary; Falanga, Vincent

    2013-11-01

    Connective tissue disorders (CTD), which are often also termed collagen vascular diseases, include a number of related inflammatory conditions. Some of these diseases include rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis (scleroderma), localized scleroderma (morphea variants localized to the skin), Sjogren's syndrome, dermatomyositis, polymyositis, and mixed connective tissue disease. In addition to the systemic manifestations of these diseases, there are a number of cutaneous features that make these conditions recognizable on physical exam. Lower extremity ulcers and digital ulcers are an infrequent but disabling complication of long-standing connective tissue disease. The exact frequency with which these ulcers occur is not known, and the cause of the ulcerations is often multifactorial. Moreover, a challenging component of CTD ulcerations is that there are still no established guidelines for their diagnosis and treatment. The morbidity associated with these ulcerations and their underlying conditions is very substantial. Indeed, these less common but intractable ulcers represent a major medical and economic problem for patients, physicians and nurses, and even well organized multidisciplinary wound healing centers.

  14. Assessment of chronic wounds by three-dimensional optical imaging based on integrating geometrical, chromatic, and thermal data.

    Science.gov (United States)

    Barone, S; Paoli, A; Razionale, A V

    2011-02-01

    Chronic wounds represent a particular debilitating health care problem, mainly affecting elderly people. A full and correct diagnosis of tissue damage should be carried out considering both dimensional, chromatic, and thermal parameters. A great variety of methods have been proposed with the aim of producing objective assessment of skin lesions, but none of the existing technologies seem to be robust enough to work for all ulcer typologies. This paper describes an innovative and non-invasive system that allows the automatic measurement of non-healing chronic wounds. The methodology involves the integration of a three-dimensional (3D) optical scanner, based on a structured light approach, with a thermal imager. The system enables the acquisition of geometrical data, which are directly related to chromatic and temperature patterns through a mapping procedure. Damaged skin areas are detected by combining visible and thermal imaging. This approach allows for the automatic measurement of extension and depth of ulcers, even in the absence of significant and well-defined chromatic patterns. The proposed technology has been tested in the measurement of ulcers on human legs. Clinical tests have demonstrated the effectiveness of this methodology in supporting medical experts for the assessment of chronic wounds. PMID:21428152

  15. Muscle hernias of the leg: A case report and comprehensive review of the literature

    OpenAIRE

    Nguyen, Jesse T.; Nguyen, Jenny L; Wheatley, Michael J; Nguyen, Tuan A.

    2013-01-01

    A case involving a retired, elderly male war veteran with a symptomatic peroneus brevis muscle hernia causing superficial peroneal nerve compression with chosen surgical management is presented. Symptomatic muscle hernias of the extremities occur most commonly in the leg and are a rare cause of chronic leg pain. Historically, treating military surgeons pioneered the early documentation of leg hernias observed in active military recruits. A focal fascial defect can cause a muscle to herniate, ...

  16. Restless Legs Syndrome Presenting as an Acute Exacerbation of Multiple Sclerosis

    OpenAIRE

    Bernheimer, James H.

    2011-01-01

    Restless legs syndrome is common in patients with multiple sclerosis but has not been reported as occurring due to an acute, inflammatory, demyelinating attack. Restless legs syndrome is known to be related to low brain iron levels. Multiple sclerosis has been associated with the abnormal accumulation of iron in the chronic, progressive phase of axonal degeneration. Iron deficiency may play a role in demyelination. This suggests that restless legs syndrome may be caused by the inflammator...

  17. Nonspecific genital ulcers.

    Science.gov (United States)

    Sehgal, Virendra N; Pandhi, Deepika; Khurana, Ananta

    2014-01-01

    Recent intervention of nonspecific genital ulcers has added refreshing dimensions to genital ulcer disease. It was considered pertinent to dwell on diverse clinical presentation and diagnostic strategies. It seems to possess spectrum. It includes infective causes, Epstein Bar Virus, tuberculosis, Leishmaniasis, HIV/AIDS related ulcers and amoebiasis. Noninfective causes are immunobullous disorders, aphthosis, Behcet's disease (BD), inflammatory bowel disease, lichen planus and lichen sclerosis et atrophicus, drug reactions, premalignant and malignant conditions, pyoderma gangrenosum, and hidradenitis suppurativa. The diagnostic features and treatment option of each disorder are succinctly outlined for ready reference.

  18. Leg size and muscle functions associated with leg compliance

    Science.gov (United States)

    Convertino, Victor A.; Doerr, Donald F.; Flores, Jose F.; Hoffler, G. Wyckliffe; Buchanan, Paul

    1988-01-01

    The relationship between the leg compliance and factors related to the size of leg muscle and to physical fitness was investigated in ten healthy subjects. Vascular compliance of the leg, as determined by a mercury strain gauge, was found to be not significantly correlated with any variables associated with physical fitness per se (e.g., peak O2 uptake, calf strength, age, body weight, or body composition. On the other hand, leg compliance correlated with the calf cross-sectional area (CSA) and the calculated calf volume, with the CSA of calf muscle being the most dominant contributing factor (while fat and bone were poor predicators). It is suggested that leg compliance can be lowered by increasing calf muscle mass, thus providing structural support to limit the expansion of leg veins.

  19. Diabetes - foot ulcers

    Science.gov (United States)

    ... of the ulcer area. This will help speed healing. Be sure to wear shoes that do not ... American Diabetes Association. Standards of medical care in diabetes -- 2014. Diabetes Care. 2014;37:S14-S80. PMID: 24357209 www. ...

  20. Stasis dermatitis and ulcers

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/000834.htm Stasis dermatitis and ulcers To use the sharing features on this page, please enable JavaScript. Stasis dermatitis is a change in the skin that occurs ...

  1. Giant duodenal ulcers

    Institute of Scientific and Technical Information of China (English)

    Eric Benjamin Newton; Mark R Versland; Thomas E Sepe

    2008-01-01

    Giant duodenal ulcers (GDUs) are a subset of duodenal ulcers that have historically resulted in greater morbidity than usual duodenal ulcers. Until recently,few cases had been successfully treated with medical therapy. However, the widespread use of endoscopy,the introduction of H-2 receptor blockers and proton pump inhibitors, and the improvement in surgical techniques all have revolutionized the diagnosis,treatment and outcome of this condition. Nevertheless,GDUs are still associated with high rates of morbidity,mortality and complications. Thus, surgical evaluation of a patient with a GDU should remain an integral part of patient care. These giant variants, while usually benign, can frequently harbor malignancy. A careful review of the literature highlights the important differences when comparing GDUs to classical peptic ulcers and why they must be thought of differently than their more common counterpart.

  2. Leg 179 summary

    Digital Repository Service at National Institute of Oceanography (India)

    Pettigrew, T.J.; Casey, J.F.; Miller, D.J.; Araki, E.; Boissonnas, R.; Busby, R.; Einaudi, F.; Gerdom, M.; Guo, Z.P.; Hopkins, H.; Myers, G.; Rao, D.G.; Shibata, T.; Thy, P.

    of an extended delay in port because of ship repairs and loss of equipment in shipment, 17 of the 26 operational days scheduled for primary and ancillary objectives were lost. Although 2 additional days were added early in the leg to ensure completion of as many... on the results of these tests we remain confident in the viability of the sys- tem. In contrast, despite the abbreviated operations schedule, our sec- ond primary objective, establishing a borehole for the ION program, was wholly a success. One consequence...

  3. Trigeminal Neurotrophic Ulceration

    OpenAIRE

    El-Daly, Ahmed; Snyderman, Carl H.

    1997-01-01

    A 74 year-old female developed a trigeminal neurotrophic ulcer (TNU) 20 years following surgical ablation of the trigeminal nerve. The diagnosis of this unusual disorder is suggested when an ulcerative lesion develops. In the ala nasi in a patient with trigeminal sensory loss. A history of self-induced trauma to that area and some form of mental impairment further support the diagnosis.

  4. Biomechanics of Counterweighted One-Legged Cycling.

    Science.gov (United States)

    Elmer, Steven J; McDaniel, John; Martin, James C

    2016-02-01

    One-legged cycling has served as a valuable research tool and as a training and rehabilitation modality. Biomechanics of one-legged cycling are unnatural because the individual must actively lift the leg during flexion, which can be difficult to coordinate and cause premature fatigue. We compared ankle, knee, and hip biomechanics between two-legged, one-legged, and counterweighted (11.64 kg) one-legged cycling. Ten cyclists performed two-legged (240 W), one-legged (120 W), and counterweighted one-legged (120 W) cycling (80 rpm). Pedal forces and limb kinematics were recorded to determine work during extension and flexion. During counterweighted one-legged cycling relative ankle dorsiflexion, knee flexion, and hip flexion work were less than one-legged but greater than two-legged cycling (all P one-legged cycling were greater than one-legged but less than two-legged cycling (all P one-legged cycling reduced but did not eliminate differences in joint flexion and extension actions between one- and two-legged cycling. Even with these differences, counterweighted one-legged cycling seemed to have advantages over one-legged cycling. These results, along with previous work highlighting physiological characteristics and training adaptations to counterweighted one-legged cycling, demonstrate that this exercise is a viable alternative to one-legged cycling.

  5. Treatment of venous ulcers with fibrin sealant derived from snake venom

    Directory of Open Access Journals (Sweden)

    MAN Gatti

    2011-01-01

    Full Text Available Venous ulcers of the lower limbs complicated by infection or chronicity represent a serious public health problem. The elevated number of those afflicted burdens the health services, interferes in quality of life and causes absenteeism. Although there are 2,500 items on the market, ranging from the simplest dressing up to the most complex types of dressing, treatment remains a challenge. Among the substances used, fibrin sealant is the one that promotes diminution of bacterial colonization and of edema, controls hemorrhaging, alters the pain threshold by protecting the nerve endings, hydrates the wound bed and forms granulation tissue that favors healing. Its disadvantages include higher cost and utilization of human fibrinogen that can transmit infectious diseases. The Center for the Study of Venoms and Venomous Animals (CEVAP at São Paulo State University (UNESP developed a new sealant made up of fibrinogen extracted from large animals and from an enzyme obtained from snake venom. The present study, developed in the Health Education Clinic (CEPS of Sacred Heart University (USC aimed to evaluate the effect of the new sealant on the healing process of venous ulcers in 24 adult patients, seven of whom were male and 17 female. Two study groups were formed as follows: Group 1 (G1 - control group of 11 patients treated with essential fatty acid (EFA and Unna's boot, and Group 2 (G2 - 13 patients treated with essential fatty acid (EFA, fibrin sealant and Unna's boot. The follow-up lasted eight weeks and the sealant was applied at only the first and fourth weeks. The results showed that Group 2 presented worse lesion conditions as to healing, but, when comparing the two groups, it was noteworthy that the the sealant was effective in healing venous ulcers. There is evidence that the new sealant is recommended for leg ulcers with the following advantages: ease of application, preparation of the wound bed, diminution of pain and a higher number of

  6. Desulfovibrio bacterial species are increased in ulcerative colitis.

    LENUS (Irish Health Repository)

    Rowan, Fiachra

    2012-02-01

    BACKGROUND: Debate persists regarding the role of Desulfovibrio subspecies in ulcerative colitis. Combined microscopic and molecular techniques enable this issue to be investigated by allowing precise enumeration of specific bacterial species within the colonic mucous gel. The aim of this study was to combine laser capture microdissection and quantitative polymerase chain reaction to determine Desulfovibrio copy number in crypt-associated mucous gel in health and in acute and chronic ulcerative colitis. METHODS: Colonic mucosal biopsies were harvested from healthy controls (n = 19) and patients with acute (n = 10) or chronic (n = 10) ulcerative colitis. Crypt-associated mucous gel was obtained by laser capture microdissection throughout the colon. Pan-bacterial 16S rRNA and Desulfovibrio copy number\\/mm were obtained by polymerase chain reaction at each locus. Bacterial copy numbers were interrogated for correlation with location and disease activity. Data were evaluated using a combination of ordinary linear methods and linear mixed-effects models to cater for multiple interactions. RESULTS: Desulfovibrio positivity was significantly increased in acute and chronic ulcerative colitis at multiple levels within the colon, and after normalization with total bacterial signal, the relative Desulfovibrio load was increased in acute colitis compared with controls. Desulfovibrio counts did not significantly correlate with age, disease duration, or disease activity but interlevel correlations were found in adjacent colonic segments in the healthy control and chronic ulcerative colitis groups. CONCLUSION: The presence of Desulfovibrio subspecies is increased in ulcerative colitis and the data presented suggest that these bacteria represent an increased percentage of the colonic microbiome in acute ulcerative colitis.

  7. 自体富血小板凝胶治疗糖尿病足和糖尿病皮肤慢性溃疡的疗效分析%Curative effect analysis on autologous plate-rich gel in the treatment of diabetic foot and diabetic chronic ulcer.

    Institute of Scientific and Technical Information of China (English)

    郎红梅; 肖洁; 金小岚; 艾智华; 游志清; 程莹; 万勇; 刘君静; 邢军; 张杨

    2013-01-01

    Objective To evaluate the clinical effectiveness and security of autologous platelet-rich gel ( APG) in the treatment of diabetic foot and diabetic chronic ulcer. Methods 15 patients with diabetic foot and diabetic chronic ulcer were received routine debridement to remove necrotic tissue completely , and then received combined therapy with negative pressure aspirator drainage and APG . Results The wound healing rate of 12 patients was obviously improved after treatment with APG. 3 patients were better than before. The wound healing time of all 15 patients was shortened obviously. Conclusion Topical therapy with APG may be considered as an effective and safe adjuvant method to treat diabetic foot and diabetic chronic ulcer, with significantly shortened wound healing time and without obvious adverse reaction.%目的 观察自体富血小板凝胶治疗糖尿病足和糖尿病皮肤慢性溃疡的临床疗效.方法 15例患者伤口局部经彻底清创清除坏死组织后,使用负压吸引器引流,再配合自体富血小板凝胶联合治疗.结果 15例患者经自体富血小板治疗后,12例痊愈,3例好转,创面愈合时间明显缩短.结论 采用自体富血小板凝胶治疗糖尿病足和糖尿病皮肤慢性溃疡,伤口愈合时间明显缩短,无不良反应,是一种简单易行、安全有效的方法.

  8. [Local treatment of chronic skin wounds in a Swiss out-patient wound centre 2010].

    Science.gov (United States)

    Baumgartner, Marc; Tanner, Daniel; Hunziker, Thomas

    2011-03-01

    In Switzerland around 30,000 patients suffer from chronic skin wounds. Appropriate topical wound care along with treatment of the causes of the wounds enables to heal a lot of these patients and to avoid secondary disease such as infections. Thereby, the final goal of wound care is stable reepithelisation. Based on experience with chronic leg ulcers mainly in our out-patient wound centre, we give a survey of the wound dressings we actually use and discuss their wound-phase adapted application. Furthermore, we address the two tissue engineering products reimbursed in Switzerland, Apligraf and EpiDex, as well as the biological matrix product Oasis. The crucial question, which treatment options will be offered in future to the wound patients by our health regulatory and insurance systems, is open to debate.

  9. Extraintestinal manifestations in Crohn's disease and ulcerative colitis

    DEFF Research Database (Denmark)

    Isene, Rune; Bernklev, Tomm; Høie, Ole;

    2015-01-01

    BACKGROUND: In chronic inflammatory bowel disease (IBD) (Crohn's disease [CD] and ulcerative colitis [UC]), symptoms from outside the gastrointestinal tract are frequently seen, and the joints, skin, eyes, and hepatobiliary area are the most usually affected sites (called extraintestinal manifest......BACKGROUND: In chronic inflammatory bowel disease (IBD) (Crohn's disease [CD] and ulcerative colitis [UC]), symptoms from outside the gastrointestinal tract are frequently seen, and the joints, skin, eyes, and hepatobiliary area are the most usually affected sites (called extraintestinal......, skin, and liver) manifestations: 20.1% versus 10.4% (p colitis compared to proctitis in UC increased the risk of EIM. CONCLUSION: In a European inception cohort, EIMs in IBD...

  10. Faecal Bacterial Communities in Healthy Controls and Ulcerative Colitis Patients

    DEFF Research Database (Denmark)

    Vigsnæs, Louise Kristine; Wilcks, Andrea; Brynskov, Jørn;

    Ulcerative colitis (UC) is an idiopathic inflammatory bowel disease (IBD) that is characterized by chronic inflammation of the colonic mucosa. The aetiology of IBD is not well understood, however the commensal intestinal microbiota is thought to play an important pathogenetic role. Hence, a detai......Ulcerative colitis (UC) is an idiopathic inflammatory bowel disease (IBD) that is characterized by chronic inflammation of the colonic mucosa. The aetiology of IBD is not well understood, however the commensal intestinal microbiota is thought to play an important pathogenetic role. Hence...

  11. Differentiating nocturnal leg cramps and restless legs syndrome.

    Science.gov (United States)

    Rana, Abdul Qayyum; Khan, Fatima; Mosabbir, Abdullah; Ondo, William

    2014-07-01

    Leg pain and discomfort are common complaints in any primary physician's clinic. Two common causes of pain or discomfort in legs are nocturnal leg cramps (NLC) and restless leg syndrome (RLS). NLC present as painful and sudden contractions mostly in part of the calf. Diagnosis of NLC is mainly clinical and sometimes involves investigations to rule out other mimics. RLS is a condition characterized by the discomfort or urge to move the lower limbs, which occurs at rest or in the evening/night. The similarity of RLS and leg cramps poses the issue of errors in diagnosing and differentiating the two. In this paper we review the pathopysiology of each entity and their diagnosis as well as treatment. The two conditions are then compared to appreciate the differences and similarities. Finally, suggestions are recommended for complete assessment.

  12. Surgery for Crohn's Disease and Ulcerative Colitis

    Science.gov (United States)

    ... Crohn's Disease & Ulcerative Colitis Go Back Surgery for Crohn's Disease & Ulcerative Colitis Email Print + Share ( Disclaimer: Surgery information ... helps you to learn what to expect. About Crohn’s disease and ulcerative colitis Crohn’s disease and ulcerative colitis ...

  13. Maneuvers during legged locomotion

    Science.gov (United States)

    Jindrich, Devin L.; Qiao, Mu

    2009-06-01

    Maneuverability is essential for locomotion. For animals in the environment, maneuverability is directly related to survival. For humans, maneuvers such as turning are associated with increased risk for injury, either directly through tissue loading or indirectly through destabilization. Consequently, understanding the mechanics and motor control of maneuverability is a critical part of locomotion research. We briefly review the literature on maneuvering during locomotion with a focus on turning in bipeds. Walking turns can use one of several different strategies. Anticipation can be important to adjust kinematics and dynamics for smooth and stable maneuvers. During running, turns may be substantially constrained by the requirement for body orientation to match movement direction at the end of a turn. A simple mathematical model based on the requirement for rotation to match direction can describe leg forces used by bipeds (humans and ostriches). During running turns, both humans and ostriches control body rotation by generating fore-aft forces. However, whereas humans must generate large braking forces to prevent body over-rotation, ostriches do not. For ostriches, generating the lateral forces necessary to change movement direction results in appropriate body rotation. Although ostriches required smaller braking forces due in part to increased rotational inertia relative to body mass, other movement parameters also played a role. Turning performance resulted from the coordinated behavior of an integrated biomechanical system. Results from preliminary experiments on horizontal-plane stabilization support the hypothesis that controlling body rotation is an important aspect of stable maneuvers. In humans, body orientation relative to movement direction is rapidly stabilized during running turns within the minimum of two steps theoretically required to complete analogous maneuvers. During straight running and cutting turns, humans exhibit spring-mass behavior in the

  14. Do We Eradicate Helicobacter pylori in Hospitalized Patients with Peptic Ulcer Disease?

    Directory of Open Access Journals (Sweden)

    Frank Wong

    2013-01-01

    Full Text Available BACKGROUND: Helicobacter pylori infection is the most common chronic infection in humans. It is a major contributor to the cause of duodenal and gastric ulcers worldwide. Its eradication has been shown to reduce rates of H pylori-related ulcers as well as other complications such as gastric cancer.

  15. Topical application of amelogenin extracellular matrix protein in non-healing venous ulcers

    Directory of Open Access Journals (Sweden)

    Burçin Abud

    2014-12-01

    Full Text Available Background and Design: Treatment of chronic venous ulcers of the lower extremity is still an important difficulty. The principal treatment of these ulcers includes compression therapy, local wound care and surgery. Unresponsiveness to these standard treatments is a frequent situation with negative effects on life quality and reductions in personal productivity. Therefore, there is a need for new applications to increase the effectiveness of treatment in treatment-resistant cases. In the present study, we retrospectively evaluated the results of topical application of amelogenin extracellular matrix protein in resistant venous ulcers. Materials and Methods: We analyzed the records of patients with treatment-resistant venous ulceration who were treated with amelogenin extracellular matrix protein between June 2011 and December 2012.. Results: 26 patients (21 male and 5 female with a total number of 28 ulcers (24 patients with 1 ulcer, 2 patients with two ulcers were evaluated. The patients were treated with topically applied amelogenin extracellular matrix protein and regional four bandage compression. Bandages were changed weekly. Each cure continued for six weeks. In fourteen patients (15 ulcers, we observed a complete healing by the end of the first cure. In another twelve cases (13 ulcers, the same period resulted with a reduction in wound diameter. We continued to the second cure for these patients. By the end of the second cure, complete healing was achieved in five cases (6 ulcers. Conclusion: Topical application of amelogenin extracellular matrix protein may be considered as an effective therapeutic choice for refractory venous ulcers.

  16. Quality of healing of gastric ulcers: Natural products beyond acid suppression.

    Science.gov (United States)

    Kangwan, Napapan; Park, Jong-Min; Kim, Eun-Hee; Hahm, Ki Baik

    2014-02-15

    Gastric ulcer is a chronic disease featured with unexpected complications, including bleeding, stenosis and perforation, as well as a high incidence of recurrence. Clinical treatments for gastric ulcer have allowed the rapid development of potent anti-ulcer drugs during the last several decades. Gastric ulcer healing is successful with conventional treatments including H2-receptor antagonists, and proton pump inhibitors (PPIs) have been essential for ulcer healing and prevention of complications. Additionally, Helicobacter pylori eradication therapy is effective in reducing ulcer recurrence and leads to physiological changes in the gastric mucosa which affect the ulcer healing process. However, in spite of these advancements, some patients have suffered from recurrence or intractability in spite of continuous anti-ulcer therapy. A new concept of the quality of ulcer healing (QOUH) was initiated that considers the reconstruction of the mucosal structure and its function for preventing ulcer recurrence. Although several gastroprotection provided these achievements of the QOUH, which PPI or other acid suppressants did not accomplish, we found that gastroprotection that originated from natural products, such as a newer formulation from either Artemisia or S-allyl cysteine from garlic, were very effective in the QOUH, as well as improving clinical symptoms with fewer side effects. In this review, we will introduce the importance of the QOUH in ulcer healing and the achievements from natural products.

  17. Secondary restless legs syndrome

    Directory of Open Access Journals (Sweden)

    SHEN Yun

    2013-05-01

    Full Text Available This paper reviewed the latest findings related to secondary restless legs syndrome (RLS systematically. There were a variety of causes. Renal failure, injury of spinal cord and peripheral nerve were related risk factors. During pregnancy, the levels of folic acid and iron diminished and many hormone levels underwent significant changes, which might also be predisposing factors for RLS. The underlying dopamine dysfunction might affect Pakinson's disease (PD patients with RLS symptoms. In addition, there were some evidences which would illustrate some drugs (mainly antidepressants, antipsychotics, histamine receptor antagonist, smoking, caffeine, alcohol and migraine might be associated with the prevalence of RLS, or even the severity of the disease. Clinicians should pay more attention to early diagnosis and treatment plan to improve the quality of life of these patients.

  18. Management of parastomal ulcers

    Institute of Scientific and Technical Information of China (English)

    Heather Yeo; Farshad Abir; Walter E Longo

    2006-01-01

    Management of surgically placed ostomies is an important aspect of any general surgical or colon and rectal surgery practice. Complications with surgically placed ostomies are common and their causes are multifactorial. Parastomal ulceration, although rare, is a particularly difficult management problem. We conducted a literature search using MD Consult, Science Direct,OVID, Medline, and Cochrane Databases to review the causes and management options of parastomal ulceration. Both the etiology and treatments are varied.Different physicians and ostomy specialists have used a large array of methods to manage parastomal ulcers;these including local wound care; steroid creams;systemic steroids; and, when conservative measures fail, surgery. Most patients with parastomal ulcers who do not have associated IBD or peristomal pyoderma gangrenosum (PPG) often respond quickly to local wound care and conservative management. Patients with PPG,IBD,or other systemic causes of their ulceration need both systemic and local care and are more likely to need long term treatment and possibly surgical revision of the ostomy. The treatment is complicated, but improved with the help of ostomy specialists.

  19. RECURRENT MARJOLIN’S ULCER WITH REGIONAL LYMPH NODE METASTASIS

    Directory of Open Access Journals (Sweden)

    Anjali

    2012-11-01

    Full Text Available ABSTRACT: Marjolin’s ulcer is a malignant tumour developing in a chronic skin lesion (burn scar, vaccination scar, non-healing wound etc.. Th e majority of cases reported are squamous cell carcinoma. Surgery remains the first treatment of choice (resection with 2cms. safety margin of healthy skin for primary squamous cell car cinoma Marjolin ulcers and 2.5cms. safety margin for recurrent cases. Recurrence after surge ry and regional lymph node metastasis are not uncommon (17% & 30% respectively.We presents a c ase report and literature review of Recurrent Marjolin’s Ulcer with regional Lymph Node Metastasis. Marjolin's ulcer should be considered as a significant post-burn complication; i t should be treated with full emphasis on adequate local clearance and regular follow up for m any years; if not treated adequately, it may lead to complicated recurrence.

  20. [Peripheral ulcerative keratitis].

    Science.gov (United States)

    Stamate, Alina-cristina; Avram, Corina Ioana; Malciolu, R; Oprea, S; Zemba, M

    2014-01-01

    Ulcerative keratitis is frequently associated with collagen vascular diseases and presents a predilection for peripheral corneal localization, due to the distinct morphologic and immunologic features of the limbal conjunctiva, which provides access for the circulating immune complexes to the peripheral cornea via the capillary network. Deposition of immune complexes in the terminal ends of limbal vessels initiates an immune-mediated vasculitis process, with inflammatory cells and mediators involvement by alteration of the vascular permeability. Peripheral ulcerative keratitis generally correlates with exacerbations of the background autoimmune systemic disease. Associated sceritis, specially the necrotizing form, is usually observed in severe cases, which may evolve in corneal perforation and loss of vision. Although the first-line of treatment in acute phases is represented by systemic administration of corticosteroids, immunosuppressive and cytotoxic agents are necessary for the treatment of peripheral ulcerative keratitis associated with systemic diseases.

  1. Pycnogenol® in chronic venous insufficiency and related venous disorders.

    Science.gov (United States)

    Gulati, Om P

    2014-03-01

    The present review provides an update of the biological profile of Pycnogenol in the light of its use in the treatment of chronic venous insufficiency (CVI) and related venous disorders such as deep vein thrombosis (DVT), post-thrombotic syndrome, long haul air-travel-related leg oedema, venous ulcers and acute haemorrhoids. Pycnogenol is a French maritime pine bark extract produced from the outer bark of Pinus pinaster Ait. subsp. atlantica. Its strong antioxidant, anti-inflammatory and vasodilator activities, antithrombotic effects and collagen stabilizing properties make it uniquely able to target the multi facet pathophysiology of CVI and related venous disorders. Clinical studies have shown that it can reduce oedema of the legs in CVI, reduce the incidence of deep venous thrombosis during long haul flights and enhance the healing of venous ulcers and haemorrhoidal episodes by topical application and/or oral administration. This review highlights clinical research findings on the safety, compliance and efficacy of Pycnogenol, including its use in combination products. PMID:23775628

  2. Restless leg syndrome: pathogenesis, diagnosis and treatment. Literature review

    Directory of Open Access Journals (Sweden)

    M. O. Kovalchuk

    2012-01-01

    Full Text Available Restless leg syndrome (RLS is a chronic sensory‑motor disorder characterized by sensory discomfort in legs, appearing or worsening during rest in the evening or night time, evoking the urge to move. Despite its wide prevalence (around 5−10% in the population and essential influence on the quality of life, not all the physicians, specialists of the primary care and even neurologists are common with this disorder. Because of that RLS stays commonly unrecognized.

  3. Giant Ulcerative Dermatofibroma

    Directory of Open Access Journals (Sweden)

    Turgut Karlidag

    2013-01-01

    Full Text Available Dermatofibroma is a slowly growing common benign cutaneous tumor characterized by hard papules and nodules. The rarely seen erosions and ulcerations may cause difficulties in the diagnosis. Dermatofibrosarcoma protuberans, which is clinically and histopathologically of malignant character, displays difficulties in the diagnosis since it has similarities with basal cell carcinoma, epidermoid carcinoma, and sarcomas. Head and neck involvement is very rare. In this study, a giant dermatofibroma case, which is histopathologically, ulcerative dermatofibroma, the biggest lesion of the head and neck region and seen rarely in the literature that has characteristics similar to dermatofibrosarcoma protuberans, has been presented.

  4. Intestinal Behcet's disease with esophageal ulcers and colonic longitudinal ulcers

    Institute of Scientific and Technical Information of China (English)

    Soichiro Fujiwara; Ichiro Shimizu; Momoko Ishikawa; Kohzo Uehara; Hirofumi Yamamoto; Michiyo Okazaki; Takahiro Horie; Arata Iuchi; Susumu Ito

    2006-01-01

    Intestinal Behcet's disease in a 38-year-old woman was diagnosed because of the history of recurrent oral aphthous ulcers, erythema nodosum-like eruptions,genital ulcer, and endoscopic findings of esophageal and ileocolonic punched-out ulcers with colonic longitudinal ulcers. Esophageal lesions and colonic longitudinalulcers are rarely seen in intestinal Behcet's disease. The ulcers of esophagus and ileocolon healed with 3 wk of treatment with prednisolone and mesalazine without any adverse effect. Mesalazine may decrease the total dose of prednisolone required to treat the disease.

  5. Ulcerative Colitis: Update on Medical Management.

    Science.gov (United States)

    Iskandar, Heba N; Dhere, Tanvi; Farraye, Francis A

    2015-11-01

    Ulcerative colitis (UC) is a chronic inflammatory bowel disease whose pathogenesis is multifactorial and includes influences from genes, the environment, and the gut microbiome. Recent advances in diagnosis and treatment have led to significant improvement in managing the disease. Disease monitoring with the use of therapeutic drug monitoring, stool markers, and assessment of mucosal healing have garnered much attention. The recent approval of vedolizumab for treatment of moderate to severe UC has been a welcome addition. Newer biologics, including those targeting the Janus tyrosine kinase (JAK) pathway, are on the horizon to add to the current armamentarium of anti-TNF alpha and anti-integrin therapies. The recent publication of the SCENIC consensus statement on surveillance and management of dysplasia in UC patients supports the use of chromoendoscopy over random biopsies in detecting dysplasia. This review highlights these recent advances along with others that have been made with ulcerative colitis.

  6. Ileal pouch surgery for ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    Simon P Bach; Neil J Mortensen

    2007-01-01

    Ulcerative colitis (UC) is a relapsing and remitting disease characterised by chronic mucosal and submucosal inflammation of the colon and rectum.Treatment may vary depending upon the extent and severity of inflammation. Broadly speaking medical treatments aim to induce and then maintain remission.Surgery is indicated for inflammatory disease that is refractory to medical treatment or in cases of neoplastic transformation. Approximately 25% of patients with UC ultimately require colectomy. Ileal pouch-anal anastomosis (IPAA) has become the standard of care for patients with ulcerative colitis who ultimately require colectomy. This review will examine indications for IPAA, patient selection, technical aspects of surgery,management of complications and long term outcome following this procedure.

  7. A chronic ulcerative colitis model in rats

    Institute of Scientific and Technical Information of China (English)

    Li Zheng; Zhen Qiang Gao; Shu Xian Wang

    2000-01-01

    @@ INTRODUCTION In recent years, there have been many reports about animal model to investigate drugs for inflammatory bowel diseases (IBD). The experimental animal model often used is acetic acid-induced damage of colonic muscosa. In the present study, this animal model was investigated by administering various concentrations of TNBS.

  8. Measurement of body fat using leg to leg bioimpedance

    OpenAIRE

    Sung, R; Lau, P; Yu, C.; Lam, P.; Nelson, E

    2001-01-01

    AIMS—(1) To validate a leg to leg bioimpedance analysis (BIA) device in the measurement of body composition in children by assessment of its agreement with dual energy x ray absorptiometry (DXA) and its repeatability. (2) To establish a reference range of percentage body fat in Hong Kong Chinese children.
METHODS—Sequential BIA and DXA methods were used to determine body composition in 49 children aged 7-18 years; agreement between the two methods was calculated. Repea...

  9. Restless legs syndrome

    Directory of Open Access Journals (Sweden)

    Ovallath S

    2012-10-01

    Full Text Available Sujith Ovallath, P DeepaJames Parkinson's Movement Disorder Research Centre, Kannur Medical College, Kerala, IndiaBackground: Restless legs syndrome (RLS is a common sleep-related disorder characterized by abnormal sensation and an urge to move the lower limbs. Symptoms occur at rest in the evening or at night, and they are alleviated by moving the affected extremity or by walking. Although the exact etiopathogenesis of RLS remains elusive, the rapid improvement of symptoms with dopaminergic agents suggests that dopaminergic system dysfunction may be a basic mechanism. Dopaminergic agents are the best-studied agents, and are considered first-line treatment of RLS.Objective: To review the diagnostic criteria, clinical features, etiopathogenesis, and the treatment options of RLS.Methods: The suggestions are based on evidence from studies published in peer-reviewed journals, or upon a comprehensive review of the medical literature.Results/conclusion: Extensive data are available for proving the link between the dopaminergic system and RLS. A possible genetic link also has been studied extensively. Dopamine agonists, especially pramipexole and ropinirole, are particularly useful in the treatment of RLS. Pharmacological treatment should however be limited to those patients who suffer from clinically relevant RLS with impaired sleep quality or quality of life.Keywords: dopamine, levodopa, pramipexole

  10. Exercise training using arms and legs versus legs along.

    Science.gov (United States)

    Mostardi, R A; Gandee, R N; Norris, W A

    1981-07-01

    This study was undertaken to determine whether levels of conditioning associated with conventional leg work are comparable to those associated with both arm and leg work. Six healthy men conditioned for 6 weeks using both arms and legs while a similar group of 5 men conditioned using legs alone. The subjects trained 3 times per week on a bicycle ergometer, and covered a distance of 3 miles (4.83 km) per session using interval training techniques. Oxygen consumption (VO2) and heart rate (HR) were the primary comparative measures. There were no differences in improvement of maximal aerobic power between the 2 groups. However, the arm and leg subjects were able to do more work at a lower HR during the conditioning program. This implies considerably less physical stress on the heart and skeletal muscle, and indicates that the feeling of stress is related to metabolic rate per square area of working muscle rather than to total metabolism. Since this type of conditioning provides high levels of improvement in aerobic power wit less demands on the myocardium, it is suggested that arm and leg exercise be incorporated in the rehabilitation of cardiac patients. PMID:7247660

  11. Recent advances on the association of apoptosis in chronic non healing diabetic wound

    OpenAIRE

    Arya, Awadhesh K; Tripathi, Richik; Kumar, Santosh; Tripathi, Kamlakar

    2014-01-01

    Generally, wounds are of two categories, such as chronic and acute. Chronic wounds takes time to heal when compared to the acute wounds. Chronic wounds include vasculitis, non healing ulcer, pyoderma gangrenosum, and diseases that cause ischemia. Chronic wounds are rapidly increasing among the elderly population with dysfunctional valves in their lower extremity deep veins, ulcer, neuropathic foot and pressure ulcers. The process of the healing of wounds has several steps with the involvement...

  12. 星状神经节阻滞对慢性溃疡性结肠炎患者细胞因子(白细胞介素-8、TNF-α)的影响%The Influence of Stellate Ganglion Block Chronic Ulcerative Colitis Patients Cytokines(Interleukin -8, TNF-α)

    Institute of Scientific and Technical Information of China (English)

    丁玉莲; 潘道波; 喻晚利

    2012-01-01

      Objective Observed stellate ganglion block to treat the clinical symptoms of patients with chronic ulcerative colitis and cytokines (interleukin-8, TNF-α) the analysis of the impact of the change. Methods RandomLy selected from February 2010 to February 2012, 60 patients with chronic ulcerative colitis, were randomLy divided into two groups, namely the control group and the observation group, each have their own 30 cases of chronic ulcerative colitis patients. The patients in the control group oral sulfasalazine treatment, while patients in the observation group to take the stellate ganglion block treatment. A comparative analysis of the clinical outcomes of the two groups of chronic ulcerative colitis patients .Results From abdominal pain, tenesmus, blood and pus, and it plays a few terms, the observation group patients planets like ganglion block comparison of the data before and after treatment was significantly different (P<0.05), the data to be statistically significant; above indicators from the control groupcompared with the observation group, the data still exists a significant difference (P<0.05), the data have significant changes in cytokine levels; observation group after treatment was significantly (P<0.05), with statistical significance. Conclusion Take stellate ganglion block for treatment in the treatment of patients with chronic ulcerative colitis, can effectively improve the patient's disease treatment efficiency, ease the patient's pain, and have a positive impact.%  目的观察星状神经节阻滞治疗对慢性溃疡性结肠炎患者的临床症状及细胞因子(白细胞介素-8、TNF-α)变化的影响进行分析.方法随机抽取2010年2月至2012年2月期间患慢性溃疡性结肠炎的患者60例,随机分为两组,即对照组和观察组,每组各有30例慢性溃疡性结肠炎患者.对照组中的患者进行口服柳氮磺吡啶片治疗,而观察组中的患者采取星状神经节阻滞治疗.对

  13. Critical leg ischaemia with tissue loss : a challenge for the vascular surgeon

    OpenAIRE

    Söderström, Maria

    2011-01-01

    There is a widespread reporting habit of combining the outcomes for patients with rest pain (Fontaine III) and tissue loss (Fontaine IV) under the single category of critical leg ischaemia (CLI). This study focused on patients with ischaemic tissue loss treated with infrainguinal bypass surgery (IBS). All patients included in the study were treated at Helsinki University Central Hospital in 2000-2007. First, ulcer healing time after IBS and factors influencing healing time were prospecti...

  14. INTENSIVE TREATMENT OF LEG LYMPHEDEMA

    OpenAIRE

    Pereira de Godoy Jose; Azoubel Lina; Guerreiro de Godoy Maria de Fatima

    2010-01-01

    Background: Despite of all the problems caused by lymphedema, this disease continues to affect millions of people worldwide. Thus, the identification of the most efficacious forms of treatment is necessary. Aim: The aim of this study was to evaluate a novel intensive outpatient treatment for leg lymphedema. Methods: Twenty-three legs of 19 patients were evaluated in a prospective randomized study. The inclusion criteria were patients with Grade II and III lymphedema, where the difference...

  15. Marjolin's ulcers: theories, prognostic factors and their peculiarities in spina bifida patients

    Directory of Open Access Journals (Sweden)

    Nthumba Peter M

    2010-12-01

    Full Text Available Abstract Background Due to improved care, more and more children born with spina bifida in rural Kenya are surviving into adulthood. This improved survival has led to significant challenges in their lifestyles, especially the need to ensure pressure ulcer prevention and treatment. Malignant degeneration of pressure ulcers in spina bifida patients is very rare. The author describes the clinical presentation of two pressure ulcer carcinomas that are at variance from classical descriptions. Materials and methods An internet/Medline/PubMed search of English literature for theories on Marjolin's ulcer evolution and prognostic features of Marjolin's ulcers was performed. A chart review of two young adults with spina bifida who had presented to the author's hospital between 2004 and August 2010 with chronic pressure ulcers found to be Marjolin's ulcers on histo-pathological examination was performed, and the clinical features are reported. Results The two ulcers appeared clinically benign: one was a deep ulcer, while the other was shallow; both had normal, benign-appearing edges, and a foul smelling discharge. The two ulcers were surrounded by induration and multiple communicating sinuses, with no evidence of chronic osteomyelitis. The internet search revealed a total of nine theories on Marjolin's ulcer development, as well as seven clinical and four histological prognostic features. Discussion The multifactorial theory, a coalescence of a number of proposed theories, best explains the evolution of Marjolin's ulcers. Poor prognostic features include pressure ulcer carcinomas, lesions and location in the lower limbs/trunks, all present in the two patients making their prognosis dim: this is despite the surgical margins being clear of tumor. Benign appearance, induration and presence of multiple communicating sinuses are features that have not been previously described as presenting features of pressure ulcers carcinomas. Conclusion There is need for

  16. Anti-ulcer effects of Lycium barbarum polysaccharide in rats

    Institute of Scientific and Technical Information of China (English)

    YE Rui-dong; YANG Qian-zi; XIAO Wei; LIU Fang-e; CHEN Jian-kang

    2005-01-01

    Objective: To investigate the effects of Lycium barbarum polysaccharide (LBP) on experimental gastric ulcers in rats. Methods: The ulcers were induced by water-immersion restraint stress, acetic acid and pylorus-ligation in rats. In each model, animals were divided randomly into 4 groups and administrated with LBP of 100 mg/kg and 300 mg/kg, ranitidine 100 mg/kg (as a reference standard) and saline respectively. Mucosal lesions were scored as ulcer index. In the pylorus-ligation model, we also compared the gastric juice volume, total acidity, acid output and pepsin activity among groups. Results: Oral administration of LBP inhibited the formation of the acute gastric lesions induced by physical stress such as water-immersion restraint (P<0.05), and accelerated the healing of chronic gastric ulcer model induced by acetic acid (P<0.05 to P<0.01). In the pylorus-ligated rats, significant decrease was also seen in ulcer index (P<0.05 to P<0.01), total acidity (P<0.05), acid output (P<0.05 to P<0.01). LBP 300 mg/kg even showed marked reduction of the volume (P<0.05) and pepsin activity (P<0.05) in the gastric juice. These effects were in a dose-dependent manner. Conclusion: LBP has protective effects on treating gastric ulcer and this action may relate to the reduction of acid output and pepsin activity in the gastric juice.

  17. 法莫替丁与扑尔敏联合应用治疗乙酸致胃溃疡的协同作用%Synergistic Action of Famotidine and Chlorpheniramine of Acetic Acid-induced Chronic Gastric Ulcer in Rats

    Institute of Scientific and Technical Information of China (English)

    陈超; 覃珍

    2005-01-01

    Objective: Previous work demonstrates that H2 receptors antagonist shows gastroprotective effect in the ethanol, aspirin and pilorous ligature-induced gastric ulcer in rats as well as in the ethanol/hydrochloric acid-induced ulcer in rats ,and H1-receptor antagonists have been reported to be potent anti-inflammatory compounds. The aim of the present study was designed to assess the synergistic action of famotidine and chlorpheniramine in the acetic acid-induced chronic gastric ulcer model in rats. Methods:Chronic gastric lesions were induced in male Sprague-Dawley rats with serosal application of acetic acid. 40 SD rats were randomly divided into 5 groups:blank group,control group, famotidine (FMD) group, chlorpheniramine (CPA) group and FMD+CPA group; Every group was given intraperitoneally(i.p.) distilled water 0.5 ml/100 g、the same volume of 0.9% saline、FMD4 mg/kg、CPA10mg/kg、FMD+CPA (the same dose) respectivedly daily for 10 days. On days 10,the ulcer area was determined by planimetry, The levels of MPO in the liver homogenation was measured by bio-chemical methods and the plasma levels of 6-keto-PGF1a and IL-8 by radio-immune assay methods.Results:although FMD or CPA alone possess a potent antiulcer or anti-inflammatory activity. The synergistic effects of FMD+CPA were confirmed in the lesion area, IL-8,6-keto-PGF1a and MPO. The effect of FMD+CPA was significantly different as compared to the control and FMD reducing the lesion area (mm2) from 40.18+/-2.6 in controls to 6.83+/-2.97,P0.05),FMD+ CPA联合组与CPA组、FMD组有显著差异性(P<0.05).但是FMD+ CPA联合组与FMD组的大鼠血浆IL-8及肝组织MPO相比要明显低IL-8,P<0.05;MPO,P<0.01,提示扑尔敏有抗炎作用. 结论:联合应用H1、H2受体阻滞剂治疗胃溃疡能取得良好的疗效,尤其抗炎作用显著差异性.其机制与减少炎症因子的产生,减少对胃黏膜的损伤,改善胃黏膜血流有关.

  18. Pneumorrhachis Secondary to a Sacral Decubitus Ulcer.

    Science.gov (United States)

    Moayedi, Siamak; Babin, Lisa

    2016-07-01

    An elderly woman with a chronic decubitus sacral ulcer presented to the emergency department with sepsis. A computed tomography of her abdomen showed diffuse gas extending throughout the thoracolumbar spinal canal. Pneumorrhachis is a rare radiographic finding defined as gas within the spinal canal. There are many causes of pneumorrhachis ranging from trauma to infection. In this case the pneumorrhachis was caused by direct spread of gas-forming organisms from vertebral osteomyelitis. Emergency physicians should know about the implication of gas in the spinal canal in the setting of sepsis. PMID:27429699

  19. Dominant cagA/vacA genotypes and coinfection frequency of H. Pylori in peptic ulcer or chronic gastritis patients in Zhejiang Province and correlations among different genotypes, coinfection and severity of the diseases

    Institute of Scientific and Technical Information of China (English)

    CHEN Xue-jun; YAN Jie; SHEN Yue-fang

    2005-01-01

    Background Almost half of the world's population suffer from the Helicobacter pylori (H. Pylori) infection, but only some individuals develop gastric diseases with clinical symptoms. One reason for the phenomenon may be the different pathogenicity of infected H. Pylori strains. The presence of cytotoxin-associated gene A (cagA) and expression of vacuolating cytotoxin activity encoded by vacuolating cytotoxin gene A (vacA) are considered the two major virulent markers of H. Pylori. The aim of this study was to detect dominant cagA/vacA genotypes and coinfection frequency of H. Pylori in patients with peptic ulceration (PU) or chronic gastritis (CG), and to determine correlations among different cagA/vacA genotypes, coinfection and severity of the diseases. Methods For each of 139 patients in Zhejiang Province who had been diagnosed as PU or CG based on clinical symptoms and gastroscopy, two gastric biopsy specimens (one from antrum and the other from corpus) for H. Pylori isolation were taken by two different disinfected biopsy forceps. One hundred and fifty-six H. Pylori strains were isolated from both the antrum and corpus biopsy specimens of 78 patients (36 PU and 42 CG). PCRs were performed to detect cagA genes, and signal (s) and middle (m) regions of vacA genes in the H. Pylori isolates. The amplified fragments of dominant vacA gene s and m subtypes from representative H. Pylori isolates were sequenced after TA cloning. Dominant cagA/vacA genotypes of the H. Pylori isolates, coinfection frequency and correlations among the different genotypes, coinfection and severity of the diseases were determined.Results Of the H. Pylori strains isolated from the antrum specimens, 96.2% were cagA gene positive, as were 97.4% of the H. Pylori strains isolated from the corpus specimens. Only one s region subtype (s1a) and four m region subtypes m1, m2, m1b and m1b-m2 of vacA gene were found. The proportions of vacA gene subtypes s1a/m1, s1a/m2, s1a/m1b and s1a/m1b-m2 in the

  20. Comparison of Behçet's Disease and Recurrent Aphthous Ulcer According to Characteristics of Gastrointestinal Symptoms

    OpenAIRE

    Rhee, Seung-Ho; Kim, Young-Bae; Lee, Eun-So

    2005-01-01

    Behçet's disease (BD) is a multisystemic chronic inflammatory disease. It is characterized by recurrent oral and genital ulcers, uveitis, skin lesions and other manifestations, including neurologic, vascular, joint, and gastrointestinal ulcers of variable severity. Recurrent aphthous ulcer (RAU) represents a very common, but poorly understood, mucosal disorder. If a patient of RAU without any other typical symptoms of BD has gastrointestinal symptoms, it is difficult to distinguish this RAU f...

  1. The interest of the {sup 13}C urea breath test for the diagnostic and monitoring of chronic duodenal ulcer; Interet du test respiratoire a l`uree {sup 13}C dans le diagnostic et le suivi de l`ulcere duodenal chronique

    Energy Technology Data Exchange (ETDEWEB)

    Rousseau-Tsangaris, M. [INBIOMED, 69 - Lyon (France); Centarti, M.; Mion, F.; Minaire, Y. [Hopital Edouard-Herriot, 69 - Lyon (France); Brazier, J.L. [Faculte de Pharmacie, 69 - Lyon (France)

    1994-12-31

    Duodenal ulcer is very frequently associated with Helicobacter pylori (Hp) present in the gastric mucous membrane. Breath tests with {sup 13}C-labelled urea have been carried out for the detection of Hp; these tests could be more sensitive than gastric biopsies, because of the heterogenous distribution of the bacteria in the mucous membrane. This breath test may be used repetitively and allows for a non-intrusive monitoring of the Hp eradication after treatment. 12 refs.

  2. Tratamiento de las úlceras crónicas en los miembros inferiores con un equivalente cutáneo autólogo y desbridación con larvas de Lucilia sp. (Diptera: Calliphoridae. Reporte de un caso. Chronic lower limb ulcers treatment with autologous skin equivalent and larvae debriding (diptera calliphoridae

    Directory of Open Access Journals (Sweden)

    Sergio Estrada Mira

    2007-12-01

    larvae were applied directly onto the ulcer and then covered with a sterile tulle, that allowed tissue oxygenation and necrotic material elimination. They were left on the ulcer during 48 hours, after which they were discarded in alcohol 70%; debridement was then evaluated. This procedure was carried out at the Entomology Laboratory (GIEM, University of Antioquia, Medellín,Colombia. Keratinocytes and fibroblasts were obtained from a skin specimen taken according to the established protocol. For keratinocytes primary culture, 90% of the cells obtained from the biopsy were seeded in 75 cm2 culture plates, over a feeding monolayer of 7 x 106 3T3-Swiss cells treated with mitomycin C. For fibroblasts primary culture, 10% of the cells were seeded in 75 cm2 culture plates, containing DMEM supplemented medium. For the production of the skin equivalent, AB human plasma from a blood bank, 6-7,5 x 104 fibroblasts, CaCl2 and tranexamic acid were used in order to obtain a gel; keratinocytes obtained in the primary culture were placed on this gel and the culture was followed-up under an inverted microscope. When cell confluence was near 100%, the skin equivalent was covered with a sterile tulle, and detached for its immediate application on the ulcer. We report the case of a 66 year old woman treated for a leg ulcer with larvae debridement and autologous skin equivalent. After being followed up for 15 months the ulcer continues closed, no pain has been reported and the leg function is normal.

  3. ULCERATED ACROCHORDON IN VULVA

    Directory of Open Access Journals (Sweden)

    Borré-Arrieta Orlando

    2015-01-01

    Full Text Available Introduction: the acrochordon, also known as soft fibromas, is a dermatological disease of common location in the cutaneous folds. Its appearance in external genitalia is weird, but it generates negative consequences regarding the quality of life of the patients. Due to the typical characteristics of the genital area in women, it increases the risk of ulceration and superinfection. Case record: patient in the third decade of life with lesion of slow growth in the vulvar area, who attended late to the emergency service because of the presence of laceration and infection signs in the genital lesion. Conclusions: the acrochordon in vulva or vulvar fibroma is a vulvar benign and uncommon disease, however it always merits opportune treatment by esthetic reason as for the ulceration risk. Revista ciencias biomédicas. 2015;6(1:138-141 KEYWORDS Vulva; Vulvar diseases; Vulvar neoplasms.

  4. Perforated peptic ulcer

    DEFF Research Database (Denmark)

    Søreide, Kjetil; Thorsen, Kenneth; Harrison, Ewen M;

    2015-01-01

    Perforated peptic ulcer is a common emergency condition worldwide, with associated mortality rates of up to 30%. A scarcity of high-quality studies about the condition limits the knowledge base for clinical decision making, but a few published randomised trials are available. Although Helicobacter...... pylori and use of non-steroidal anti-inflammatory drugs are common causes, demographic differences in age, sex, perforation location, and underlying causes exist between countries, and mortality rates also vary. Clinical prediction rules are used, but accuracy varies with study population. Early surgery...... need further assessment. Adequate trials with low risk of bias are urgently needed to provide better evidence. We summarise the evidence for perforated peptic ulcer management and identify directions for future clinical research....

  5. ULCERATED ACROCHORDON IN VULVA

    OpenAIRE

    Borré-Arrieta Orlando; Monsalve-Montoya Rosa

    2015-01-01

    Introduction: the acrochordon, also known as soft fibromas, is a dermatological disease of common location in the cutaneous folds. Its appearance in external genitalia is weird, but it generates negative consequences regarding the quality of life of the patients. Due to the typical characteristics of the genital area in women, it increases the risk of ulceration and superinfection. Case record: patient in the third decade of life with lesion of slow growth in the vulvar area...

  6. Genetic correlations between claw health and feet and leg conformation in Norwegian Red cows.

    Science.gov (United States)

    Ødegård, C; Svendsen, M; Heringstad, B

    2014-07-01

    The aim of this study was to estimate genetic correlations between claw disorders and feet and leg conformation traits in Norwegian Red cows. A total of 188,928 cows with claw health status recorded at claw trimming from 2004 to September 2013 and 210,789 first-lactation cows with feet and leg conformation scores from 2001 to September 2013 were included in the analyses. Traits describing claw health were corkscrew claw, infectious claw disorders (dermatitis, heel horn erosion, and interdigital phlegmon), and laminitis-related claw disorders (sole ulcer, white line disorder, and hemorrhage of sole and white line). The feet and leg conformation traits were rear leg rear view (new and old definition), rear leg side view, foot angle, and hoof quality. Feet and leg conformation traits were scored linearly from 1 to 9, with optimum scores depending on the trait. Claw disorders were defined as binary (0/1) traits for each lactation. Threshold sire models were used to model claw disorders, whereas the feet and leg conformation traits were described by linear sire models. Three multivariate analyses were performed, each including the 5 feet and leg conformation traits and 1 of the 3 claw disorders at a time. Posterior means of heritability of liability of claw disorders ranged from 0.10 to 0.20 and heritabilities of feet and leg conformation traits ranged from 0.04 to 0.11. Posterior standard deviation of heritability was ≤0.01 for all traits. Genetic correlations between claw disorders and feet and leg conformation traits were all low or moderate, except between corkscrew claw and hoof quality (-0.86), which are supposed to measure the same trait. The genetic correlations between rear leg rear view (new) and infectious claw disorders (-0.20) and laminitis-related claw disorders (0.26), and between hoof quality and laminitis-related claw disorders (-0.33) were moderate. Eight of the 15 genetic correlations between claw disorders and feet and leg conformation traits had 0

  7. Microcirculatory remodeling in marginal zone of duodenal ulcer after bleeding

    Directory of Open Access Journals (Sweden)

    Sulayeva О.N.

    2009-01-01

    Full Text Available To estimate objectively vessels network remodeling in duodenal mucosa after ulcer bleeding the morphometric analysis of marginal ulcer zone biopsies was performed in 32 patients. It was shown that reparation is accompanied with chronic inflammation and acute alteration of microcirculation. Injection hemostasis led to enhancement of microcirculation, development of edema and ischemic alteration of mucosal tissues. Acute neutrophilic infiltration during 1 day was changed on 3 day with granular tissue development and angiogenesis stimulation. Intensification and prolongation of angiogenesis paral-leled with lymphocytes infiltration after 7 days resulted to villi dysmorphogenesis and changes in cellular content of intestinal epithelium.

  8. 远程伤口治疗平台在偏远地区下肢慢性溃疡患者中的应用%Application of tele-wound treatment platform to patients with chronic lower limb ulcers in remote areas

    Institute of Scientific and Technical Information of China (English)

    楚婷; 陈正英; 吴冬琼; 刘细寒

    2012-01-01

    目的 探讨以手机彩信为平台的远程伤口治疗模式对偏远地区下肢慢性溃疡的治疗作用.方法 采取整群抽样方法收集湘西地区综合性医院就诊的37例农村下肢慢性溃疡患者,随机分为干预组25例和对照组12例,干预组进行彩信平台的远程伤口治疗,对照组按常规处理伤口,6个月后通过自制问卷调查评估.结果 干预6个月后,干预组伤口治疗评分、疼痛及症状管理评分显著高于对照组(均P<0.05).结论 基于彩信平台的远程伤口治疗有助于改善偏远地区下肢慢性溃疡患者的伤口治疗效果.%Objective To investigate the effect of a multimedia-message-based tele-wound treatment platform on chronic lower limb ulcers for patients living in remote areas. Methods Thirty seven cases with chronic lower limb ulcers from backwoods of west Hunan Province, and seeking medical service in a comprehensive hospital, were collected by cluster sampling. They were randomly divided into 2 groups: the intervention group (n = 25) were managed with a remote wound treatment platform via which medical staff sent multimedia messages to inctruct patients to care for the wounds, while the control group (n=12) were given routine intervention. Six months later, a self-designed questionaire was used to assess the effect of the interventions. Results Six months later, the wound treatment score, pain management score, symptom management score of the intervention group were significantly higher than those of the controls (P<0. 05 for all). Conclusion The multimedia-message-based tele-wound treatment platform helps improve therapeutic effect of wound care of backwoods residents with chronic lower limb ulcers.

  9. Contact Lens Related Corneal Ulcer

    OpenAIRE

    Loh, KY; P Agarwal

    2010-01-01

    A corneal ulcer caused by infection is one of the major causes of blindness worldwide. One of the recent health concerns is the increasing incidence of corneal ulcers associated with contact lens user especially if the users fail to follow specific instruction in using their contact lenses. Risk factors associated with increased risk of contact lens related corneal ulcers are: overnight wear, long duration of continuous wear, lower socio-economic classes, smoking, dry eye and poor hygiene. Th...

  10. Use of a hydrocapillary dressing in the management of highly exuding ulcers: a comparative study

    DEFF Research Database (Denmark)

    Norkus, A; Dargis, V; Thomsen, J K;

    2005-01-01

    was conducted on 97 patients with an ankle brachial pressure index > or = 0.8 and a highly exuding leg ulcer. Ulcer duration was at least four weeks.Treatment continued until healing or for a maximum of 12 months. RESULTS: There was no statistically significant difference in healing time or wound area reduction...... between the two treatment protocols. The test dressing (Alione Hydrocapillary) had better absorption capacity and was more comfortable for the patients than the comparator dressings (Tielle/Tielle Plus) and adhered less to the wound bed.Also, more patients preferred the test dressing to their previous...

  11. Golimumab in unresponsive ulcerative colitis

    Directory of Open Access Journals (Sweden)

    Lippert E

    2014-05-01

    Full Text Available Elisabeth Lippert, Martina Müller, Claudia Ott University Hospital Regensburg, Department of Internal Medicine I, Regensburg, Germany Abstract: Ulcerative colitis (UC is a chronic inflammation mainly affecting the colon mucosa. It predominantly occurs in younger patients. Until recently, the main goals in the treatment of UC were to temper the symptoms, such as diarrhea, pain, and weight loss, by using mesalazine and steroids. With newer medications, such as immunomodulators (thiopurines and the biologics providing blockade of tumor necrosis factor (TNF, the goals of the therapy in UC have changed to long-term remission and mucosal healing. The first available anti-TNF therapy in UC included infusion therapy with infliximab every few weeks. In 2012, subcutaneously administered adalimumab gained approval for the treatment of UC in Germany. In patients with a mild disease, therapy with mesalazine, orally or topically, can be sufficient. In patients with moderate to severe disease, therapy with azathioprine or anti-TNF is often required to reach disease control; however, this is only efficient in about two-thirds of patients. Some patients either show no response or a lost response while on treatment. So, further medical options are warranted in the treatment of UC. With golimumab, a new approach in the treatment of mild to moderate UC recently became available in Germany and is a promising new option in the therapy regimen for patients with UC. Keywords: anti-TNF, biological therapy, inflammatory bowel disease

  12. [Peptic ulcer disease and stress].

    Science.gov (United States)

    Herszényi, László; Juhász, Márk; Mihály, Emese; Tulassay, Zsolt

    2015-08-30

    The discovery that Helicobacter pylori infection is the major cause of peptic ulcer disease revolutionised our views on the etiology and treatment of the disease. This discovery has tempted many experts to conclude that psychological factors and, specifically, stress are unimportant. However, Helicobacter pylori infection alone does not explain fully the incidence and prevalence of peptic ulcer disease. It has been demonstrated that stress can cause peptic ulcer disease even in the absence of Helicobacter pylori infection, supporting a multicausal model of peptic ulcer etiology. Psychological stress among other risk factors can function as a cofactor with Helicobacter pylori infection.

  13. Fecal calprotectin and ulcerative colitis endoscopic activity index as indicators of mucosal healing in ulcerative colitis.

    Science.gov (United States)

    Taghvaei, Tarang; Maleki, Iradj; Nagshvar, Farshad; Fakheri, Hafez; Hosseini, Vahid; Valizadeh, Seyed Mohammad; Neishaboori, Hassan

    2015-04-01

    Ulcerative colitis (UC) is a chronic, idiopathic, inflammatory large bowel disease with recurrent variable periods of exacerbation. The aim of the current study is to evaluate the correlation of UCEIS with fecal calprotectin (FC) level to assess disease activity in UC patients in order to determine whether FC can prognosticate clinical outcome and disease activity of UC instead of colonoscopic evaluation. Our endoscopic investigations revealed the extension of UC as the following: proctitis (11.6%), procto-sigmoiditis (18.5%), left-sided colitis (15.8%), extensive colitis (11.7%), and normal endoscopy (42.4%). Conclusively, we suggest that FC can be used as a reliable tool to evaluate disease activity in ulcerative colitis patients. Moreover, our findings indicate a significant correlation between FC level and mucosal healing. PMID:25366383

  14. Crohn's Disease and Ulcerative Colitis: Emotional Factors

    Science.gov (United States)

    ... Ulcerative Colitis: Emotional Factors Q & A Go Back Crohn’s Disease and Ulcerative Colitis: Emotional Factors Q & A Email ... WHAT IS THE CAUSE OF ULCERATIVE COLITIS AND CROHN’S DISEASE? The origin of IBD is still unknown. It ...

  15. Prometheus Hot Leg Piping Concept

    Science.gov (United States)

    Gribik, Anastasia M.; DiLorenzo, Peter A.

    2007-01-01

    The Naval Reactors Prime Contractor Team (NRPCT) recommended the development of a gas cooled reactor directly coupled to a Brayton energy conversion system as the Space Nuclear Power Plant (SNPP) for NASA's Project Prometheus. The section of piping between the reactor outlet and turbine inlet, designated as the hot leg piping, required unique design features to allow the use of a nickel superalloy rather than a refractory metal as the pressure boundary. The NRPCT evaluated a variety of hot leg piping concepts for performance relative to SNPP system parameters, manufacturability, material considerations, and comparison to past high temperature gas reactor (HTGR) practice. Manufacturability challenges and the impact of pressure drop and turbine entrance temperature reduction on cycle efficiency were discriminators between the piping concepts. This paper summarizes the NRPCT hot leg piping evaluation, presents the concept recommended, and summarizes developmental issues for the recommended concept.

  16. Promethus Hot Leg Piping Concept

    International Nuclear Information System (INIS)

    The Naval Reactors Prime Contractor Team (NRPCT) recommended the development of a gas cooled reactor directly coupled to a Brayton energy conversion system as the Space Nuclear Power Plant (SNPP) for NASA's Project Prometheus. The section of piping between the reactor outlet and turbine inlet, designated as the hot leg piping, required unique design features to allow the use of a nickel superalloy rather than a refractory metal as the pressure boundary. The NRPCT evaluated a variety of hot leg piping concepts for performance relative to SNPP system parameters, manufacturability, material considerations, and comparison to past high temperature gas reactor (HTGR) practice. Manufacturability challenges and the impact of pressure drop and turbine entrance temperature reduction on cycle efficiency were discriminators between the piping concepts. This paper summarizes the NRPCT hot leg piping evaluation, presents the concept recommended, and summarizes developmental issues for the recommended concept

  17. Promethus Hot Leg Piping Concept

    Energy Technology Data Exchange (ETDEWEB)

    AM Girbik; PA Dilorenzo

    2006-01-24

    The Naval Reactors Prime Contractor Team (NRPCT) recommended the development of a gas cooled reactor directly coupled to a Brayton energy conversion system as the Space Nuclear Power Plant (SNPP) for NASA's Project Prometheus. The section of piping between the reactor outlet and turbine inlet, designated as the hot leg piping, required unique design features to allow the use of a nickel superalloy rather than a refractory metal as the pressure boundary. The NRPCT evaluated a variety of hot leg piping concepts for performance relative to SNPP system parameters, manufacturability, material considerations, and comparison to past high temperature gas reactor (HTGR) practice. Manufacturability challenges and the impact of pressure drop and turbine entrance temperature reduction on cycle efficiency were discriminators between the piping concepts. This paper summarizes the NRPCT hot leg piping evaluation, presents the concept recommended, and summarizes developmental issues for the recommended concept.

  18. Tension leg platform project execution

    Institute of Scientific and Technical Information of China (English)

    Zhang Dagang; Wang Chunsheng; Zhang Tianyu

    2013-01-01

    The first floating platform concept design work for South China Sea is undergoing in DMAR' s office now.This tension leg platform has potential to become the first advanced floating production platform project.Project execution is always a challenge for floating system.This paper focuses on the critical elements of project execution for tension leg platform,and studies potential implications to future oil and gas exploration in South China Sea.There are many factors affecting successful execution of floating system project,including technical issues,engineering management,interface management,etc.There are also failure examples of project execution in the industry.The author has participated 28 large detailed projects and has gained extensive experience on floating projects,with ample hands-on project experiences.A detailed tension leg platform project study example and discussions in depth are presented for future project execution in China deepwater development.

  19. Association of incident restless legs syndrome with outcomes in a large cohort of US veterans.

    Science.gov (United States)

    Molnar, Miklos Z; Lu, Jun L; Kalantar-Zadeh, Kamyar; Kovesdy, Csaba P

    2016-02-01

    Restless legs syndrome is a common sleep disorder, but there is a paucity of large cohort studies examining the association of restless legs syndrome with clinical outcomes, including all-cause mortality, incident coronary heart disease, stroke and chronic kidney disease. From a nationally representative prospective cohort of over 3 million US veterans [93% male, median follow-up time of 8.1 years (interquartile range: 7.0-8.5 years)] with baseline estimated glomerular filtration rate ≥ 60 mL min(-1) 1.73 m(-2), a propensity-matched cohort of 7392 patients was created, and the association between incident restless legs syndrome and the following was examined: (1) all-cause mortality; (2) incident coronary heart disease; (3) incident strokes; and (4) incident chronic kidney disease defined as estimated glomerular filtration rate restless legs syndrome-negative patients, incident restless legs syndrome was associated with 88% higher mortality risk [hazard ratio and 95% confidence interval: 1.88 (1.70-2.08)], and almost four times higher risk of coronary heart disease and stroke [hazard ratio: 3.97 (3.26-4.84) and 3.89 (3.07-4.94), respectively]. The risk of incident chronic kidney disease was also significantly higher in incident restless legs syndrome patients [hazard ratio: 3.17 (2.74-3.66)] compared with restless legs syndrome-negative counterparts. In this large and contemporary cohort of US veterans, incident restless legs syndrome was associated with higher risk of mortality, incident coronary heart disease, stroke and chronic kidney disease.

  20. Diagnosis and management of long-standing benign oral ulceration.

    Science.gov (United States)

    Birt, D; From, L; Main, J

    1980-05-01

    The authors formed a Mouth Clinic at Sunnybrook Hospital in 1973 since when there have been 3025 patient visits. Those patients with chronic ulceration present a challenge, the diagnosis sometimes being difficult and therapy not rapidly effective. The differential diagnosis includes lichen planus, pemphigus vulgaris, benign mucous membrane pemphigoid, discoid lupus erythematosus, erythema multiforme, aphthous ulcers, Behcets disease, periadenitis mucosa necrotica recurrens, specific infections and iatrogenic causes. It is possible to reach a definite diagnosis in virtually every case by means of a good history and careful clinical examination supplemented by biopsies and in some cases direct and indirect immunofluorescent studies. Treatment emphasizes scrupulous attention to oral hygiene with baking soda mouthwashes and careful teeth cleaning to minimize the accumulation of dental plaque. Specific therapy includes topical steroids in lichen planus, intra muscular gold in benign mucous membrane pemphigoid, a previously unreported treatment which considerably improved seven out of ten patients, and tetracycline mouthwashes in aphthous ulcers. PMID:6990140

  1. Management of the diabetic foot ulcer: exercising control.

    Science.gov (United States)

    Bentley, Jenny; Foster, Ali

    2008-03-01

    The incidence of diabetes is increasing and therefore patients with diabetic foot ulcers will become increasingly common in the community. The NHS model of Health and Social Care (Department of Health (DH), 2005) places a high emphasis on self care and disease management, and, as a long-term condition, diabetes mellitus requires efficient and effective management. The supervision and organization of the care of diabetic patients is multi-factorial and for this reason, a multi-disciplinary approach is essential for effective care, without which patients with diabetic foot ulcers are at high risk of complications. Diabetic wounds present differently to other chronic wounds; unless these are adequately assessed and treated, there may be devastating consequences for the patient--the most serious being major amputation and/or death. In the first article, accurate assessment was discussed; in this second article, the management of diabetic foot ulcers is explored.

  2. Photoletter to the editor: Oral ulceration in pyoderma gangrenosum.

    LENUS (Irish Health Repository)

    Verma, Saroj

    2012-02-01

    A 65-year-old woman presented with widespread necrotising cutaneous ulceration and oral involvement. Past history included rheumatoid arthritis, and a left nephrectomy.Examination revealed multiple violaceous undermined ulcers. Blood investigations showed an acute inflammatory response. Skin histopathology showed epidermal ulceration with acute and chronic inflammation. Direct immunofluorescence was negative. A diagnosis of pyoderma gangrenosum with oral involvement was made. Mycophenolate mofetil therapy resulted in complete resolution of her pyoderma gangrenosum. Her treatment was complicated by a left proteus mirabilis psoas abscess. This resolved following four weeks of antibiotics.Pyoderma gangrenosum with oral involvement is rare but has been linked with inflammatory bowel disease and hematological disorders. Oral pyoderma gangrenosum has not previously been described in rheumatoid arthritis. Primary psoas abscess is rare but can develop in immunocompromised patients. Proteus mirabilis has been reported in patients years after nephrectomy. This is a rare case of pyoderma gangrenosum with oral involvement.

  3. Cryptogenic Multifocal Ulcerous Stenosing Enteritis: An Exceptionally Rare Disease

    Directory of Open Access Journals (Sweden)

    Amandeep Kaur

    2016-01-01

    Full Text Available Cryptogenic Multifocal Ulcerous Stenosing Enteritis (CMUSE is a rare idiopathic disease of the small bowel. Its origin and pathophysiology has not been well described. Clinicopathologic features include unexplained ileal strictures with supercial ulceration. We present a case of a 31-year-old HIV positive lady who was admitted with complaints of recurrent abdominal pain and constipation. Laboratory investigations revealed iron deciency anemia. Ultrasonography of the abdomen showed dilated bowel loops and a subsequent barium follow through showed ve strictures in the ileum. Segmental small bowel resection with end-to-end anastomosis was performed. Grossly ileum showed ve ileal strictures. The diagnosis of CMUSE was made on histopathology after ruling out other causes of strictures. The present case highlights the importance of considering CMUSE in patients with chronic or recurrent episodes of intestinal obstruction with multiple small intestinal ulcers and strictures after other common causes have been ruled out.

  4. c-fos与c-jun癌蛋白在溃疡与增生性瘢痕创面联合表达的特征与意义%Expression of oncoproteins c-fos and c-jun in hypertrophic scars and chronic dermal ulcers and their regulation of basic fibroblast growth factor

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    目的探讨c-fos与c-jun两种原癌基因产物在溃疡与增生性瘢痕创面表达的特征与规律以及与不同组织修复结局发生的关系。 方法 16例标本均取自于外科手术患者,其中增生性瘢痕8例,溃疡创面8例,另有正常对照皮肤5例取自增生性瘢痕患者作为对照。用免疫组化法(ABC法)检测c-fos与c-jun两种癌蛋白以及bFGF在三种组织切片的分布特征。 结果在正常皮肤c-fos与c-jun的阳性表达主要见于表皮基底细胞和少量皮下成纤维细胞,但在相应部位c-jun的表达较c-fos为弱。在增生性瘢痕,c-fos与c-jun均出现强阳性表达,主要见于成纤维细胞。在溃疡组织,c-fos与c-jun的联合表达多见于毛细血管内皮细胞、部分炎症细胞以及成纤维细胞胞浆。 结论增生性瘢痕与溃疡创面c-fos与c-jun表达量与部位同正常皮肤存在显著差异,提示这两种原癌基因产物在影响和调控组织修复中有重要作用。%Objective To explore the characteristics of oncoprotein expression of c-fos and c-jun in hypertrophic scars and chronic dermal ulcers and their regulation of basic fibroblast growth factor (bFGF). Methods Tissues of hypertrophic scars (n=8), chronic dermal ulcers (n=8) and normal skin (n=5) were taken from 21 patients with burns and chronic dermal ulcers in operation. The ABC immunohistochemical method was used to characterize the gene product expression of c-fos, c-jun and bFGF in the above tissues. Results In normal skin, both c-fos and c-jun protein expression and bFGF protein expression were observed. The signals of both oncoproteins were localized mainly in subcutaneous fibroblasts, but, positive expression of the bFGF protein was mainly in keratinocytes. In hypertrophic scars, positive expression of both oncoproteins could be found mainly in fibroblasts, but bFGF was mainly in fibroblasts and endothelial cells. In chronic dermal ulcers, endothelial cells, some

  5. Analysis of treatment of 126 cases of chronic gastritis and peptic ulcer with positive helicobacter pylori%慢性胃炎、消化性溃疡、幽门螺杆菌阳性治疗分析126例

    Institute of Scientific and Technical Information of China (English)

    孟定德

    2014-01-01

    Chronic gastritis and peptic ulcer are common digestive system diseases in clinic.The treatment of the disease is mainly the eradication of helicobacter pylori infection.The treatment options are diverse.In this paper,2 kinds of treatment regimen for helicobacter pylori are compared to guide the clinical work.%慢性胃炎以及消化性溃疡在临床上是较为常见的消化系统疾病,在针对该病的治疗上主要是根除幽门螺杆菌感染,其治疗方案多种多样。本文就两种治疗幽门螺杆菌方案进行比较,以期望对临床工作有所指导。

  6. Our Experience in treating Ischemic Ulcer of a Lower Limb in 4 diabetic patients with Autologous Bone Marrow Stem Cells

    Directory of Open Access Journals (Sweden)

    Subrammaniyan SR

    2007-01-01

    Full Text Available Chronic limb ischemia is an outcome of peripheral arterial occlusive disease. When conventional medical and surgical treatments are not feasible, amputation is the only option left. Recent studies report that the injection of bone marrow mononuclear cells and Peripheral blood mononuclear cells rich in CD34+ cells have resulted in symptomatic recovery, improved functional activity of the ischemic limb as well as healing of the ulcers. Here we report our experience with 4 patients of such case where autologous bone marrow mononuclear cells were injected and the patient followed up for 6 months. Materials and Methods: Four patients with critical limb ischemia with ulcers were referred for amputation of their limb. A 68-year-old female with critical limb ischemia with an ulcer in the left leg measuring 30X12 cm over the posterior portion of the leg and extending to the medial aspect of the foot measuring 14X10 cm, a 65-year-old male with necrotic wound in his lower foot, a 69-year-old male with a deep wound in his lower foot and a 61-year-old male with ulcer in his toe amputated with all the toe fingers. The first two patients were given injections for more than one sitting at appropriate intervals specified by the clinician. Under short general anesthesia, 110 ml of Bone marrow was aspirated each time, transported in Acid Citrate Dextrose and was processed for mononuclear cells (MNC by Ficoll density gradient centrifugation, following the cGMP protocols. The MNC concentrate was injected at various sites in the Gastrocnemius muscle and the surrounding area after necessary debridement. Skin grafting was performed in the first two patients and followed up for a period of at regular intervals of 6 to 9 months. The patients have been followed up at regular intervals for six months after the treatment with investigations such as Ankle-Brachial Index, Doppler and Angiogram.Results: All the patients showed improvements with healthy granulation gradually

  7. Importance of luminal and mucosal zinc in the mechanism of experimental gastric ulcer healing.

    Science.gov (United States)

    Opoka, W; Adamek, D; Plonka, M; Reczynski, W; Bas, B; Drozdowicz, D; Jagielski, P; Sliwowski, Z; Adamski, P; Brzozowski, T

    2010-10-01

    Zinc has been reported to exert a gastroprotective action against various experimental gastric lesions suggesting that this trace element is involved in the integrity of the gastric mucosa. Compounds containing zinc, such as polaprezinc, were developed in Japan and used as an antiulcer drugs in the treatment of human peptic ulcer disease. However, the precise mechanism of Zn(2+) containing compounds and their effects on mucosal integrity, gastroprotection and ulcer healing remain unclear. We have determined the efficacy of zinc hydroaspartate, a compound containing Zn(2+), in the mechanism of gastric secretion and ulcer healing in rats with chronic gastric ulcers induced by acetic acid (initial ulcer area = 28 mm(2)). Rats with gastric ulcers were randomized into two groups: A) with gastric fistulas (GF) and B) without gastric fistulas and received a daily treatment with zinc hydroaspartate (32-130 mg/kg-d i.g.) for 3, 7 and 14 days. At the termination of each treatment, the area of gastric ulcers were examined by planimetry, the gastric blood flow (GBF) at ulcer margin was assessed by laser Doppler flowmetry and H(2)-gas clearance methods. The venous blood was withdrawn for a measurement of plasma gastrin levels by radioimmunoassay (RIA). The concentration of Zn(2+) in the gastric juice and mucosa at the ulcer margin were determined by differential pulse anodic stripping voltammetry (DPASV) and flame atomic absorption spectrometry (FAAS) methods and the gastric biopsy samples were taken for histopathological assessment of the quality of ulcer healing. The ulcers healed gradually, with the ulcer area in the vehicle control rats being diminished by 15%, 48% and 78% upon ulcer induction at 3, 7 and 14 days, respectively. Zinc hydroaspartate dose-dependently inhibited the area of gastric ulcer, the dose reducing this area by 50% (ID(50)) being about 60 mg/kg-d. The mucosal concentration of Zn(2+) significantly was unchanged from the baseline immediately after ulcer

  8. Tofacitinib in ulcerative colitis.

    Science.gov (United States)

    Archer, Thomas P; Moran, Gordon W; Ghosh, Subrata

    2016-05-01

    Cytokines orchestrate immune and inflammatory responses involved in the pathogenesis of ulcerative colitis (UC). Protein kinases are essential for signal transduction in eukaryotic cells. Janus kinases (JAKs) are a family of protein tyrosine kinases that play a pivotal role in cytokine receptor signaling. Indeed, a major subgroup of cytokines use Type I and II cytokine receptors which signal via the activation of JAKs. Tofacitinib is an oral JAK inhibitor that has been studied in autoimmune pathologies, including UC and rheumatoid arthritis with good overall efficacy and acceptable safety profile. This literature review was performed with the goal of summarizing the knowledge on JAK inhibitors in UC treatment. PMID:27140405

  9. Helicobacter pylori and Peptic Ulcers

    Centers for Disease Control (CDC) Podcasts

    2010-08-17

    In this podcast, CDC's Dr. David Swerdlow discusses the relationship between Helicobacter pylori and peptic ulcer disease and trends in hospitalization rates for peptic ulcer disease in the United States between 1998 and 2005.  Created: 8/17/2010 by National Center for Emerging and Zoonotic Infectious Diseases.   Date Released: 8/17/2010.

  10. Prognostic stratification of ulcerated melanoma

    DEFF Research Database (Denmark)

    Bønnelykke-Behrndtz, Marie L; Schmidt, Henrik; Christensen, Ib J;

    2014-01-01

    OBJECTIVES: For patients with melanoma, ulceration is an important prognostic marker and interestingly also a predictive marker for the response of adjuvant interferon. A consensual definition and accurate assessment of ulceration are therefore crucial for proper staging and clinical management. We...

  11. [Non-Helicobacter pylori, Non-nonsteroidal Anti-inflammatory Drug Peptic Ulcer Disease].

    Science.gov (United States)

    Chang, Young Woon

    2016-06-25

    Non-Helicobacter pylori, non-NSAID peptic ulcer disease (PUD), termed idiopathic PUD, is increasing in Korea. Diagnosis is based on exclusion of common causes such as H. pylori infection, infection with other pathogens, surreptitious ulcerogenic drugs, malignancy, and uncommon systemic diseases with upper gastrointestinal manifestations. The clinical course of idiopathic PUD is delayed ulcer healing, higher recurrence, higher re-bleeding after initial ulcer healing, and higher mortality than the other types of PUD. Genetic predisposition, older age, chronic mesenteric ischemia, cigarette smoking, concomitant systemic diseases, and psychological stress are considered risk factors for idiopathic PUD. Diagnosis of idiopathic PUD should systematically explore all possible causes. Management of this disease is to treat underlying disease followed by regular endoscopic surveillance to confirm ulcer healing. Continuous proton pump inhibitor therapy is an option for patients who respond poorly to the standard ulcer regimen. PMID:27312831

  12. [Non-Helicobacter pylori, Non-nonsteroidal Anti-inflammatory Drug Peptic Ulcer Disease].

    Science.gov (United States)

    Chang, Young Woon

    2016-06-25

    Non-Helicobacter pylori, non-NSAID peptic ulcer disease (PUD), termed idiopathic PUD, is increasing in Korea. Diagnosis is based on exclusion of common causes such as H. pylori infection, infection with other pathogens, surreptitious ulcerogenic drugs, malignancy, and uncommon systemic diseases with upper gastrointestinal manifestations. The clinical course of idiopathic PUD is delayed ulcer healing, higher recurrence, higher re-bleeding after initial ulcer healing, and higher mortality than the other types of PUD. Genetic predisposition, older age, chronic mesenteric ischemia, cigarette smoking, concomitant systemic diseases, and psychological stress are considered risk factors for idiopathic PUD. Diagnosis of idiopathic PUD should systematically explore all possible causes. Management of this disease is to treat underlying disease followed by regular endoscopic surveillance to confirm ulcer healing. Continuous proton pump inhibitor therapy is an option for patients who respond poorly to the standard ulcer regimen.

  13. Cutaneous ulcers in a returning traveller: a rare case of imported diphtheria in the UK.

    Science.gov (United States)

    Nelson, T G; Mitchell, C D; Sega-Hall, G M; Porter, R J

    2016-01-01

    We describe a case of cutaneous diphtheria in the UK, presenting as lower leg ulcers in a returning traveller, and discuss the epidemiology, significance and public health implications of this disease and the therapeutic options available. A 65-year-old woman presented with a 6-week history of multiple ulcers appearing on her legs following a holiday in Kenya. Culture of biopsy tissue grew Corynebacterium diphtheriae. A cascade of therapeutic and public health interventions followed, many of which were terminated once the isolate was confirmed as nontoxigenic. Cutaneous diphtheria is a rare, notifiable disease in the UK, but is common in tropical countries, and is most often seen in the West as a traveller's disease. Corynebacteria are common skin commensals, and without appropriate clinical details, laboratories may not recognize C. diphtheriae/Corynebacterium ulcerans. This is likely to have led to under-reporting and under-recognition of the condition. PMID:26455435

  14. Seronegative Herpes simplex Associated Esophagogastric Ulcer after Liver Transplantation

    Directory of Open Access Journals (Sweden)

    Edouard Matevossian

    2008-03-01

    Full Text Available Herpes simplex infection is characterized by acute or subacute infection, often followed by a chronic carrier state. Consecutive recurrences may flare up if immunocompromise occurs. Herpes simplex associated esophagitis or duodenal ulcer have been reported in immunocompromised patients due to neoplasm, HIV/AIDS or therapeutically induced immune deficiency. Here we report the case of an HSV-DNA seronegative patient who developed grade III dysphagia 13 days after allogeneic liver transplantation. Endoscopy revealed an esophageal-gastric ulcer, and biopsy histopathology showed a distinct fibroplastic and capillary ulcer pattern highly suspicious for viral infection. Immunohistochemistry staining revealed a distinct nuclear positive anti-HSV reaction. Antiviral therapy with acyclovir and high-dose PPI led to a complete revision of clinical symptoms within 48 h. Repeat control endoscopy after 7 days showed complete healing of the former ulcer site at the gastroesophageal junction. Although the incidence of post-transplantation Herpes simplex induced gastroesophageal disease is low, the viral HSV ulcer may be included into a differential diagnosis if dysphagia occurs after transplantation even if HSV-DNA PCR is negative.

  15. The treatment of skin ulcers in patients with systemic sclerosis

    Directory of Open Access Journals (Sweden)

    M. Matucci- Cerinic

    2011-09-01

    Full Text Available Systemic Sclerosis (Ssc is a complex disease of the connective tissue, characterized by progressive thickening and fibrosis of the skin and the internal organs and by diffused damage of the microvascular system. The fibrosis ones of the skin associated to the characteristic vascular alterations lead to the genesis of ulcers, more or less extended, often multiple, peripheral localization, chronic course, painful, able to influence patient’s quality of life. Indeed, immunity reactivity, the thinning and the loss of elasticity of the skin, the peripheral neurological damage and the eventual drug assumption that can reduce regenerative/reparative abilities, can easy chronicizzate an ulcer and become infected complicating still more the patient disease, rendering more difficult the cure often, ulcer evolves to gangrene, and in some cases, in amputation too. For all these reasons, we have begun to study ulcers therapy (local and systemic, considering this activity it leave integrating of the charitable distance of the sclerodermico patient, putting to point on strategy both diagnostic and therapeutic, but above all with the primary scope, if possible, is to prevent ulcers, in contrary case, to alleviate the pain and to render the quality of the life of the patient better.

  16. Psychiatric Comorbidities in Restless Legs Syndrome.

    Science.gov (United States)

    Kallweit, Ulf; Werth, Esther; Seiz, Angela; Sefidan, Sandra; Dahmen, Norbert; Manconi, Mauro; Ehlert, Ulrike; Bassetti, Claudio L A

    2016-01-01

    Restless legs syndrome (RLS) is a neurological sleep disorder with frequent (39%) coexisting psychiatric comorbidities. Patients with any psychiatric comorbidity had fewer periodic leg movements in sleep. Psychiatric disorders should be taken into account in patients with RLS. PMID:27019065

  17. Nursing care of chronic renal failure patients undergoing hemodialysis complicated with restless legs syndrome%慢性肾衰竭血液透析病人不宁腿综合征的护理

    Institute of Scientific and Technical Information of China (English)

    杨素云; 宋保利; 贾燕

    2008-01-01

    @@ 不宁腿综合征(restless legs syndrome,RLS)是一种常见的神经病变,发病率为5%~10%,且随着年龄的增加有明显的上升趋势[1].病人主要表现为小腿难以形容的不适感、蚁走感、酸胀感、夜晚或休息时加重,运动后可短暂缓解,严重者可侵及上肢并引发夜间睡眠障碍,白天疲乏倦怠,昏昏欲睡,更严重者可以出现焦虑、抑郁等精神症状[2].经过严格的体格检查、化验检查病因不明的RLS称为特发性RLS,具有明显的家族聚集倾向,占50% ~92%[3].继发性RLS多见于慢性肾衰竭、妊娠、缺铁性贫血、糖尿病、周围神经病变等[4].RLS是困扰众多慢性肾衰竭血液透析病人的一个重要问题,病人RLS发生率较高,但易被忽略.笔者采用回顾性分析方法对血液透析病人RLS的护理进行研究.

  18. Characterization of Helicobacter Pylori Infection in Patients with Gastric Ulcer

    Directory of Open Access Journals (Sweden)

    Marcos Félix Osorio Pagola

    2009-12-01

    Full Text Available Background: Nowadays, infection due to Helicobacter Pylori is recognized as a medical problem worldwide. It causes chronic gastritis, peptic ulcer disease, lymphatic proliferative disorders and it is a risk factor for gastric cancer. Objective: To characterize Helicobacter Pylori infection in patients with gastric ulcer and to relate this infection to gastric histological diagnoses. Methods: An observational, descriptive, correlational retrospective study in patients with gastric ulcers at the Dr.Gustavo Aldereguía Lima Hospital was carried out from January 2005 to December 2007. Endoscopy and mucous gastric biopsy were performed for the histological and diagnostic study of the infection due to Helicobacter Pylori by means of the hematoxiline-eosine and giemsa stain respectively. The sample was composed by 137 patients. Results: the frequency of infection due to Helicobacter pylori was 59,1 % prevailing in the age groups 51-60 years old (34,6 % and 61-70 yearsold. (30,8 %. The highest frequency of malignant ulcers were located at the antral region (85,7 % with predominance of Helicobacter Pylori (80 %. There was a 95 % reliability between the relationship of Helicobacter Pylori and the histological diagnoses. The patients under the diagnosis of Helicobacter Pylori showed a greater probability to present cancer (OR 4,32 IC: 0,58-39,44 and worsened chronic gastritis (OR 2,59 IC: 0,61-11,30. Chronic gastritis did not constitute a risk factor for acute gastritis(OR 0,86 IC: 0,09-7,08. Conclusions: The probability of suffering from gastric cancer, chronic gastritis and worsened chronic gastritis was greater in all those patients who presented with Helicobacter pylori infection but in this study Helicobacter pylori did not constitute a risk factor for acute gastritis

  19. Restless legs syndrome in patients on dialysis

    Directory of Open Access Journals (Sweden)

    Al-Jahdali Hamdan

    2009-01-01

    Full Text Available Restless legs syndrome (RLS is an extremely distressing problem experienced by patients on dialysis; the prevalence appears to be greater than in the general population, with a wide variation from 6.6% to 80%. The diagnosis of RLS is a clinical one, and its definition has been clarified and standardized by internationally recognized diagnostic criteria, published in 1995 by the International Restless Legs Syndrome Study Group (IRLSSG. This study was designed to find out the prevalence of RLS in Saudi patients with end-stage renal disease (ESRD on maintenance dialysis. This is a cross sectional study carried out between May and Sept 2007 at two centers, King Abdulaziz Medical City-King Fahad National Guard Hospital (KAMC-KFNGH, Riyadh and King Faisal Specialist Hospital and Research Centre (KFHRC, Jeddah, Saudi Arabia. Data were gathered on 227 Saudi patients on chronic maintenance hemodialysis or chronic peritoneal dialysis. The prevalence of RLS was measured using IRLSSG′s RLS Questionnaire (RLSQ. Potential risk factors for RLS including other sleep disorders, underlying cause of chronic renal failure, duration on dialysis, dialysis shift, biochemical tests and demographic data were also evaluated. The overall prevalence of RLS was 50.22% including 53.7% males and 46.3% females. Their mean age was 55.7 ± 17.2 years and mean duration on dialysis 40.4 ± 37.8 months. Significant predictors of RLS were history of diabetes mellitus (DM, coffee intake, afternoon dialysis, gender and type of dialysis (P= 0.03, 0.01, < 0.001, 0.05 and 0.009 respectively. Patients with RLS were found to be at increased risk of having insomnia and excessive daytime sleepiness (EDS (P= < 0.001 and 0.001, respectively. Our study suggests that RLS is a very common problem in dialysis population and was significantly associated with other sleep disorders, particularly insomnia, and EDS. Optimal care of dialysis patient should include particular attention to the diagnosis

  20. Healing effect of aloe vera gel,in non-healed ulcers

    Institute of Scientific and Technical Information of China (English)

    Majid Avijgan; Victoria Beigi Broujeni; Ali Akbar Beigi; Hojatollah Rohi Borojeni; Seyyed Ka-myar Mostafavizadeh; Iraj Karimi; Abbas Ali Javadi

    2009-01-01

    Objective:Aloe Vera gel (AVG)has a prominent role as a contemporary folk remedy.The Non-healed chron-ic ulcers of 16 non-responders to conventional treatment were treated with AVG for which the clinical efficacy was studied.Methods:This study included 16 patients having chronic ulcer (9 males and 7 females)with mean age of 41.8 ±14.6 who following failure treatment to conventional therapy,were dispensed AVG to ap-ply.AVG is consisted from gel part of Aloe Vera plant plus one preservative material,in this study ECG jelly. The patients were assessed as responder whenever intensity of inflammation,the number and /or the size of ul-cers have been reduced.Results:The period of time till healing (complete or reduction in size of ulcer), were from 5 to 160 days with mean of 31.2 ±36.4 days.The mean time of decreasing for secreting,swelling and redness was from 5-11 days.Spearman coefficient of correlation,showed no significant correlation between first size and depth of ulcer and timing till 50% reduction in size of ulcer.Conclusion:All patients had been treated with conventional treatment all to no avail.There were some full thickness ulcer which at the end of treatment we observed an improvement and normal skin for those ulcers.There was a minor complication like itching in one patient but no leading to stop treatment.These findings suggest that AVG is an excellent and sa-fer choice than current conventional therapeutic management of chronic ulcers.

  1. Sobel Edge Detection Method to Identify and Quantify the Risk Factors for Diabetic Foot Ulcers

    Directory of Open Access Journals (Sweden)

    Allam Appa Rao

    2013-03-01

    Full Text Available Thepurpose of this studyis toidentify andquantify theneurovascular riskfactors for foot problems inpatients with diabetes mellitus, which is amajor public health concern these days.Themost feared factoramong the diabeticpatients is lower extremityamputation.Thesequence of events leading to amputation isinitiatedby ulcerationcombined with sensation loss.To prevent complications and amputations it isnecessaryto detect the foot at risk of plantar ulceration atan early stage of sensation loss.Doctors useimaging test to determine whether the plantar ulceration has spread to upper areas in the leg, andtoevaluate the size and location of the ulcer.To locate the ulceration area and assess the severity,doctor’susesanimaging technology, such as ultrasound, fluoroscopy, a computed tomography (CT or CAT scan,x-ray, or a magnetic resonance imaging (MRI test, this procedure is called asan image-guided biopsy.Toaccess the severity of foot ulcer,a new method isintroduced,whichisa popular edge detectionmethod.This method is known asSobel method, whichuses edge detection function for derivativeapproximation tofind edges. TheSobel edge methodreturns edges at those points where the gradient ofthe consideredimage is maximum,so the recognition of risk factors will be analyzed in efficient manner. Based on theseverity of foot ulcer, preventivefoot maintenance and regular foot examinations will take place in diabetespatients

  2. Clinical relevance of radioimmunologic gastrin determination for peptic ulcer

    International Nuclear Information System (INIS)

    The clinical validity of the specific and sensitive radioimmunoassay was proved by the verification of the gastrin concentrations (given in the special literature) in the fasting serum of healthy control persons and of defined patient groups: duodenal ulcer, gastric ulcer, peptico-jejunal ulcer, chronically atrophic gastritis with and without pernicious anaemia, pyloric stenosis, gastric carcinoma and renal insufficiency. The result of the examinations carried out with a standardised beverage test was that the serum gastric release, which was basally and postprandially increased with respect to healthy control persons, is significantly increased by selective and proximal vagotomy in patients with chronically recurrent duodenal ulcer. Pyloroplasty has no significant influence on the serum gastrin reaction after selective proximal vagotomy. Contrary to that the reduced basal serum gastrin values of patients with Billroth II gastrectomy could not be stimulated by the beverage test. The basal and postprandial hypergastrinaemia existing after selective proximal vagotomy does not change significantly during the first postoperative year. In order to statistically compare such studies the authos suggests the 'integrated overall gastrin release'. Synchronous measurements of insulin and blood-sugar reactions do not give any indication that hypergastrinaemia, induced by selective proximal vagotomy, causes any change of the endocrine pancreatic function. Several own examples illustrate the higher diagnostic value of the secretin provocative and calcium infusion test in cases of the Zollinger-Ellison syndrome and that of the standardised beverage test in antral G-cell hyperplasia. In most cases the glucagon test is not required. (orig./MG)

  3. Genetics Home Reference: restless legs syndrome

    Science.gov (United States)

    ... Me Understand Genetics Home Health Conditions restless legs syndrome restless legs syndrome Enable Javascript to view the expand/collapse boxes. ... Other Names for This Condition Ekbom syndrome Ekbom's syndrome restless leg syndrome RLS WED Willis-Ekbom disease Related Information ...

  4. Generalized Pyoderma Gangrenosum Associated with Ulcerative Colitis: Successful Treatment with Infliximab and Azathioprine.

    Science.gov (United States)

    Chatzinasiou, Foteini; Polymeros, Dimitrios; Panagiotou, Maro; Theodoropoulos, Konstadinos; Rigopoulos, Dimitrios

    2016-04-01

    cytoplasmic antibodies (cANCA), perinuclear neutrophil antibodies (p-ANCA), antiphospholipid antibodies, and tumor markers were within normal limits. The patient was negative for cryoglobulins, viral hepatitis (B, C) and human immunodeficiency virus (HIV). Blood cultures were negative. Microscopy and cultures for mycobacteria and fungi gave negative results. Stool samples tested negative for infections agents. The Mantoux skin test was negative. Colonoscopy showed severe pancolitis, and biopsies from the rectum and sigmoid colon were consistent with chronic ulcerative colitis. Abdominal ultrasound and chest and abdominal X-rays did not result in significant findings. Because of severe anemia, the patient received 2 blood transfusions. The histopathologic examination carried out on the erythematous border of a lesion on the lower leg showed a neutrophilic infiltrate, confined to the dermis. On the basis of clinical findings, the diagnosis of PG was established. Topical wound care consisted of local wound care and a topical corticosteroid. Systemic therapy was initiated with 40 mg/day methylprednisolone for 7 days, 30 mg/day for 7 days, then 25 mg/day, and then tapered down further. The patient received an infusion of infliximab 7.5 mg/kg at weeks 0, 2, and 6 and every 8 weeks thereafter. After week 2, oral azathioprine 2.5 mg/kg daily was added to the treatment. The patient also received mesalazine tablets (2 g ×2/day) and mesalazine enema (1-2/day). The patient showed good response to treatment, with clinical remission of skin lesions. Lesions healed with characteristic thin, atrophic scars (Figure 2, a-d). At 7-month follow-up the patient was continuing with infusions of infliximab 7.5 mg/kg and azathioprine 2.5 mg/kg and was still in remission. We reported our experience with a case of generalized bullous pyoderma gangrenosum associated with ulcerative colitis. Generalized pyoderma gangrenosum is very rare. Bullous or atypical PG was first described by Perry and Winklemann

  5. The expression of matrix metalloproteinase-9 in the chronic venous ulcer tissues and significance%基质金属蛋白酶-9在静脉性溃疡组织中的表达及意义

    Institute of Scientific and Technical Information of China (English)

    杨帆; 李金朋; 王勇

    2016-01-01

    Objective To observe the expression of matrix metalloproteinase-9 (MMP-9) in the tissues of venous ulcer,and to explore the pathological mechanism of angiogenesis dysfunction.Methods Sixty-four ulcer samples were obtained from the patients [(56.27 ± 5.12) years old] including 52 males and 12 females with lower extremity venous ulcer treated in our hospital.The ulcer samples were divided into 2-,3-,4-,and 5-week groups based on the course of the disease,and 50 cases of traumatic ulcer [(54.42 ±6.87) years old] served as the contol group.The expression of MMP-9,and vascular endothelial growth factor receptor 2 (VEGFR2) was analyzed by Western blotting and grey ratio detection.The immunofluorescence double staining was used to observe the correlation of MMP-9/CD31 expression.Results There was significant difference in the grey ratio detection of MMP-9 between 4-,and 5-week groups with 2-,3-week groups (0.181 ± 0.031,0.007 ± 0.014 vs.0.512 ± 0.113,0.685 ± 0.174);VEGFR2 between 4-,and 5-week groups and 3-week group (0.614 ± 0.143,0.497 ± 0.262 vs.1.465 ± 0.074,P < 0.05).Immunofluorescence double staining revealed that the levels of MMP-9/CD31 was also markedly decreased in the venous ulcer group as compared with those in traumatic ulcer group,and the correlation was observed.Conclusion The low expression of VEGFR2 that is regulated by MMP-9 possibly is associated with angiogenesis dysfunction in the tissues of venous ulcer.%目的 观察静脉性溃疡组织中的基质金属蛋白酶-9(MMP-9)表达,探讨静脉性溃疡血管再生障碍机制.方法 采集我院64例静脉性溃疡患者溃疡创面标本,其中男52例,女12例,平均年龄(56.27±5.12)岁,按病程分为2周组、3周组、4周组、5周组,以创伤性溃疡50例作为对照组,平均年龄(54.42±6.87)岁,Western blot检测各组溃疡创面MMP-9、血管内皮生长因子受体2(VEGFR2)表达趋势;用免疫荧光双染色检测MMP-9/CD31在溃疡组

  6. Effectiveness of papain gel in venous ulcer treatment: randomized clinical trial1

    OpenAIRE

    Ana Luiza Soares Rodrigues; Beatriz Guitton Renaud Baptista de Oliveira; Débora Omena Futuro; Silvia Regina Secoli

    2015-01-01

    OBJECTIVE: to assess the effectiveness of 2% papain gel compared to 2% carboxymethyl cellulose in the treatment of chronic venous ulcer patients. METHOD: randomized controlled clinical trial with 12-week follow-up. The sample consisted of 18 volunteers and 28 venous ulcers. In the trial group, 2% papain gel was used and, in the control group, 2% carboxymethyl cellulose gel. RESULTS: the trial group showed a significant reduction in the lesion area, especially between the fifth and twelfth wee...

  7. Fecal calprotectin is a useful marker to diagnose ulcerative colitis from irritable bowel syndrome

    OpenAIRE

    Hamid Kalantari; Akhtar Taheri; Majid Yaran

    2015-01-01

    Background: This study was aimed to evaluate the predictive value of fecal calprotectin in patients with ulcerative colitis from patients with irritable bowel syndrome (IBS). Materials and Methods: Between May and October 2013, 88 adult patients, between the age 18 and 65 years with a history of chronic diarrhea of unknown origin were assessed. Standard colonoscopies were performed in all patients to assess ulcerative colitis. Before colonoscopies, they were asked to supply a stool speci...

  8. Topical application of amelogenin extracellular matrix protein in non-healing venous ulcers

    OpenAIRE

    Burçin Abud; Kemal Karaarslan; Işıl Kılınç Karaarslan; Süreyya Talay; Soysal Turhan

    2014-01-01

    Background and Design: Treatment of chronic venous ulcers of the lower extremity is still an important difficulty. The principal treatment of these ulcers includes compression therapy, local wound care and surgery. Unresponsiveness to these standard treatments is a frequent situation with negative effects on life quality and reductions in personal productivity. Therefore, there is a need for new applications to increase the effectiveness of treatment in treatment-resistant cases. In the prese...

  9. Low-Level Laser Therapy Along With Intravascular Laser in Deep Pressure Ulcer Resistant to Conventional Therapies

    Directory of Open Access Journals (Sweden)

    Kazemikhoo

    2015-12-01

    Full Text Available Introduction Pressure ulcer is a common and troublesome complication in patients with spinal cord injury (SPI. The purpose of this case report was to describe the treatment of chronic pressure ulcer in a patient with SPI using low-level laser therapy (LLLT. Case Presentation The patient was a 45-year-old male with T8 complete paraplegia; he had developed severe pressure ulcer. The authors used LLLT as a complementary treatment. They used 980 nm, continuous 6 J/cm2 for margins and 655 nm, continuous 1.8 J/cm2 for bed of the ulcer, along with intravascular laser therapy. After 24 sessions of LLLT and z-plasty surgery, the ulcer healed completely. Conclusions LLLT is effective in tissue regeneration and increasing blood flow; this gives faster healing process of the wounds and faster cell proliferation. This treatment may be effective even in deep pressure ulcers.

  10. Protective effects of pentadecapeptide BPC 157 on gastric ulcer in rats

    Institute of Scientific and Technical Information of China (English)

    Xiao-Chang Xue; Yong-Jie Wu; Ming-Tang Gao; Wen-Guang Li; Ning Zhao; Zeng-Lu Wang; Chun-Jie Bao; Zhen Yan; Ying-Qi Zhang

    2004-01-01

    AIM: To investigate the protective effects of gastric pentadecapeptide BPC 157 on acute and chronic gastric ulcers in rats and to compare the results in therapy of human gastric ulcers by different administration methods.METHODS: Gastric pentadecapeptide BPC 157 was administered (initial single or continuous administration) into rats either intragastrically or intramuscularly before (induced acute gastric ulcer) or after (induced chronic gastric ulcer) the applications of inducing agents, and each animal was sacrificed to observe the protective effects of BPC 157 on gastric ulcers.RESULTS: Both intramuscular (im) and intragastric (ig) administration of BPC 157 could apparently reduce the ulcer area and accelerate the healing of induced ulcer in different models and the effect of im administered BPC 157 was better than that of ig. The rats treated with higher dosages (400 ng/kg, 800 ng/kg) of BPC 157 (im and ig) showed significantly less lesion (P<0.01 vs excipient or saline control), the inhibition ratio of ulcer formation varied between 45.7% and 65.6%, from all measurements except 400 ng/kg BPC 157 in pylorus ligation induced model (P<0.05),in which the inhibition rate was 54.2%. When im administered (800 ng/kg BPC 157) in three models, the inhibition ratio of ulcer formation was 65.5%, 65.6% and 59.9%, respectively, which was better than that of famotidine (its inhibition rate was 60.8%, 57.2% and 34.3%,respectively). Continuous application of BPC 157 (in chronic acetate induced gastric ulcer) could accelerate rebuilding of glandular epithelium and formation of granulation tissue (P<0.05 at 200 ng/kg and P<0.01 at 400 ng/kg and 800 ng/kg vs excipient or saline control).CONCLUSION: Both im and ig administered gastric pentadecapeptide BPC 157 can apparently ameliorate acute gastric ulcer in rats and antagonize the protracted effect of acetate challenge on chronic ulcer. The effect of im administration of BPC 157 is better than that of ig, and the effective

  11. [Drug Treatment of Chronic Venous Diesease].

    Science.gov (United States)

    Pavlović, Miloš D

    2016-06-01

    Chronic venous disease (CVD) affects at least 15-25 % of the general population incurring not only high morbidity but also considerable economical burden. The mainstay of modern treatment of CVD are endovenous therapeutic procedures and compression therapy. As far as the pathogenesis of CVD is being gradually unraveled the interest in drugs able to impact the process is growing. Here we have presented an overview of a majority of oral preparations used so far to treat CVD including venous leg ulcers. After several decades of clinical use a few flavonoid preparations, in the first place micronized purified flavonoid fraction, collected enough evidence to recommend them as a short-term adjunct treatment of CVD. However, other compounds are also promising in this regards. Yet, we need more larger and longer-term clinical trials to more precisely define effects, cost-effectiveness and, above all, capacity for prophylactic application of the drugs. Learning more about basis of CVD will help design new drugs directed at specific aspects of the disease process. PMID:27379855

  12. Is There an Association between Restless Legs Syndrome and Urticaria?

    Science.gov (United States)

    Tuna, Serpil; Alan, Sevil; Samancı, Nehir; Karakaş, Ayşe Akman

    2016-05-01

    Restless legs syndrome (RLS) is a disease characterized by the urge to move the legs and sleep disturbances. Similarly, chronic spontaneous urticaria (CSU) is a dermatological disease characterized by pruritus and sleep disorders. In this study, we aimed to determine the prevalence and severity of RLS in patients with chronic spontaneous urticaria (CSU) and to compare the quality of sleep of patients with and without RLS in the CSU group using the Pittsburgh Sleep Quality Index. A total of 130 patients with CSU and 100 healthy controls were included in this study. The frequency of RLS, frequency of sleep disturbances, and average score of RLS in patients with CSU were statistically significantly higher than control groups (respectively P = 0.008, P = 0.009, P = 0.004). Subjective sleep quality, sleep latency and habitual sleep efficiency scores in patients with RLS were statistically significantly higher than patients without RLS (respectively P = 0.016, P = 0.007, P = 0.035). We claimed that pruritus of urticaria may decrease the quality of sleep in patients with RLS and it may trigger and worsen the restless legs syndrome. Furthermore, RLS and CSU may share a common etiology.

  13. Is There an Association between Restless Legs Syndrome and Urticaria?

    Science.gov (United States)

    Tuna, Serpil; Alan, Sevil; Samancı, Nehir; Karakaş, Ayşe Akman

    2016-05-01

    Restless legs syndrome (RLS) is a disease characterized by the urge to move the legs and sleep disturbances. Similarly, chronic spontaneous urticaria (CSU) is a dermatological disease characterized by pruritus and sleep disorders. In this study, we aimed to determine the prevalence and severity of RLS in patients with chronic spontaneous urticaria (CSU) and to compare the quality of sleep of patients with and without RLS in the CSU group using the Pittsburgh Sleep Quality Index. A total of 130 patients with CSU and 100 healthy controls were included in this study. The frequency of RLS, frequency of sleep disturbances, and average score of RLS in patients with CSU were statistically significantly higher than control groups (respectively P = 0.008, P = 0.009, P = 0.004). Subjective sleep quality, sleep latency and habitual sleep efficiency scores in patients with RLS were statistically significantly higher than patients without RLS (respectively P = 0.016, P = 0.007, P = 0.035). We claimed that pruritus of urticaria may decrease the quality of sleep in patients with RLS and it may trigger and worsen the restless legs syndrome. Furthermore, RLS and CSU may share a common etiology. PMID:27134503

  14. Hot topics in venous ulcer treatment: an international survey

    Directory of Open Access Journals (Sweden)

    Stefano Ricci

    2013-01-01

    Full Text Available Compression is the most effective treatment to promote skin ulcer healing, although there are as many different methods of performing a leg compression as the number of phlebologists, each one having personal tricks, solutions, habits. Conversely, though dressings may be done in different ways, none is considered the standard solution. We asked few (18 questions to physicians involved in this field, in Italy and abroad, looking for some common feature. The analysis of 100 replies indicated the average treatment: compression made by multilayer bandage when edema is present, knee long stocking when edema is removed, mostly based on patient’s agreement. Escharectomy should be done when ulcer bed is covered by necrotic tissue. Advanced wound care is used, with dressing changed several times a week. For highly exuding ulcers, a specific dressing is used or frequent changing is performed. The treatment in early stage of disease is done by the physician while subsequently the dressings may be performed by the patient himself, nurses or doctors. Usually no medical treatments are associated. The cost of a single dressing is often lower than 10 Euro, without any reimbursement. The compression devices aren’t reimbursed as well. The expected compression pressure is 30/40 mm Hg. Daytime compression is not reduced at night-time. The patient is always invited to walk. The same compression is used if the ABPI is <1. However the survey shows that several variations in the cookbook may occur, sometimes even contradictory.

  15. Effect of centrally administered oxytocin on gastric and duodenal ulcers in rats%脑室注射催产素对大鼠胃和十二指肠溃疡的作用

    Institute of Scientific and Technical Information of China (English)

    Mohammed ASAD; Deepak Gopal; Kallasam KOUMARAVELOU; Benny K ABRAHAM; Sadashivam VASU; Subramanian RAMASWAMY

    2001-01-01

    AIM: To investigate the effect of centrally administered oxytocin and its receptor antagonist, atosiban, on gasuic acid secretion and on experimentally induced gastric and duodenal ulcers. METHODS: The acute gastric ulcer models, such as pylorus ligation, indomethacin-induced and ethanol-induced gastric ulcers were used. Chronic gastric ulcers were induced by acetic acid and duodenal ulcers by cysteamine HC1. RESULTS: In pylorus ligated rats, oxytocin ( 10 μg/kg, icv) showed signifi cant antisecretory and antiulcer activity (P<0.01 ). However, it aggravated the ethanol-induced gastric ulcers and did not show any effect on indomethacin-induced gas tric ulcers. Oxytocin increased gastric ulcer healing in acetic acid-induced chronic gastric ulcers. The effect of oxytocin was reversed by atosiban (10 μg/kg, icy), a selective oxytocin receptor antagonist. Atosiban when given alone increased gastric acid secretion and ulcer index in pylorus-ligated rats and also aggravated acetic acid-induced chronic gastric ulcers. It seems the antiul cer activity of oxytocin was due to its anti-secretory ef fect. CONCLUSION: Centrally administered oxytocin possesses gastric anti-secretory and anti-ulcer activity and oxytocin antagonist, atosiban, is pro-ulcerogenic in rats.

  16. Restless legs syndrome in multiple system atrophy.

    Science.gov (United States)

    Ghorayeb, Imad; Dupouy, Sandrine; Tison, François; Meissner, Wassilios G

    2014-12-01

    The purpose of the study was to evaluate the frequency of restless legs syndrome in 30 patients with multiple system atrophy. Eight patients complained from restless legs syndrome, their severity score was 19.4 ± 4.1. Pittsburgh Sleep Quality Index scores were significantly higher in patients with restless legs syndrome than those without (9.3 ± 3.7 vs. 4.8 ± 2.9, p = 0.00165). Periodic limb movements were found in 75% of patients with restless legs syndrome. Restless legs syndrome is more prevalent in multiple system atrophy as compared to the acknowledged prevalence in the general population.

  17. Restless legs syndrome in the elderly.

    OpenAIRE

    O'Keeffe, S. T.; Noel, J; Lavan, J. N.

    1993-01-01

    The prevalence and significance of restless legs syndrome was assessed in 307 patients presenting to an acute-care geriatric medical service. Fifteen patients (5%) had restless legs syndrome; 13 (87%) of these patients had insomnia and 10 (67%) reported troublesome or frequent leg symptoms. Of 147 patients with current insomnia, iron deficiency (serum ferritin < 18 ng/ml) was present in 4/13 (31%) patients with restless legs and 8/134 (6%) patients without restless legs (P < 0.025). Improveme...

  18. Treatment of restless legs syndrome.

    Science.gov (United States)

    Ferini-Strambi, Luigi; Manconi, Mauro

    2009-12-01

    Restless legs syndrome (RLS) is a common condition characterized by an urge to move the legs, accompanied by uncomfortable or unpleasant sensations. Symptoms predominantly occur at rest in the evening or at night, and they are alleviated by moving the affected extremity or by walking. Recent European epidemiological studies reported an overall prevalence of RLS up to 10%, with a female preponderance. The prevalence rates reported in south-eastern Europe are lower, as are those in Asiatic populations. Although the aetiopathogenesis of RLS is still unknown, the rapid and dramatic improvement of RLS with dopaminergic compounds suggests a dopaminergic system dysfunction as the basic mechanism. Extensive data are available for l-dopa and dopamine receptor agonists, especially for pramipexole and ropinirole. Pharmacological treatment should be limited to those patients who suffer from clinically relevant RLS with impaired sleep quality or quality of life. Treatment on demand is a clinical need in RLS cases that present intermittent symptoms. PMID:20123560

  19. Targinact for restless legs syndrome.

    Science.gov (United States)

    2016-04-01

    Idiopathic restless legs syndrome (RLS)--also known as Willis-Ekbom disease--is a neurological condition characterised by an overwhelming urge to move the legs, occurring during rest or inactivity, especially at night. Symptoms are highly variable in frequency and severity, and can affect sleep and quality of life. First-line management includes addressing precipitating or aggravating factors and providing explanation, reassurance and advice on self-help strategies. Drug therapy (e.g. a dopamine agonist) is used for patients with more severe symptoms. In December 2014, the marketing authorisation for a modified-release preparation containing oxycodone and naloxone (Targinact-Napp Pharmaceuticals) was expanded to include use in the treatment of severe to very severe RLS after failure of dopaminergic therapy.(10)Here we review the management of adults with RLS, including the place of oxycodone/naloxone. PMID:27079737

  20. An unusual case of spontaneous Mycobacterium chelonae corneal ulcer in a healthy middle-aged adult

    Directory of Open Access Journals (Sweden)

    Bhandari V

    2016-05-01

    Full Text Available Vipul Bhandari, R Sriganesh, Kirti RelekarDepartment of Cornea, Nethradhama Eye Hospital, Bengaluru, IndiaBackground: To report a rare presentation of culture-positive Mycobacterium chelonae corneal ulcer and its management.Findings: We report a rare case of a patient with a history of chronic pain and blurriness of vision. Examination revealed a chronic nonhealing paracentral corneal ulcer inferiorly at the 5–7 o'clock meridian with anterior chamber reaction unresponsive to routine antibiotic and antifungal medications with Mantoux test positivity in a middle-aged nondiabetic patient with no prior history of trauma, ocular surgery, and contact lens usage. Ziehl–Neelsen staining of the nonhealing ulcer revealed acid-fast bacilli typical of M. chelonae, with subsequent culture positivity in Löwenstein–Jensen medium. Subsequent treatment with topical fortified amikacin and tobramycin resulted in rapid healing of the corneal ulcer.Conclusion: M. chelonae presenting as a chronic nonhealing corneal ulcer spontaneously occurring in a healthy adult with no predisposing factor draws attention towards the need to have a good index of suspicion by performing a Ziehl–Neelsen stain and culture, and subsequent successful management with topical fortified amikacin and tobramycin.Keywords: spontaneous, M. chelonae, nonhealing corneal ulcer, healthy

  1. Immunomodulators and Immunosuppressants for Japanese Patients with Ulcerative Colitis

    OpenAIRE

    Shigeki Bamba; Tomoyuki Tsujikawa; Masaya Sasaki; Yoshihide Fujiyama; Akira Andoh

    2011-01-01

    Ulcerative colitis (UC) is characterized by a long-standing chronic course with remissions and exacerbations. Previously, patients do not respond to 5-aminosalicylic acid compounds and corticosteroids are considered for colectomies, however, in recent years, alternative treatments emerged for steroid-refractory or steroid-dependent UC. In this review article, we focus on immunomodulators (such as azathioprine [AZA] and 6-mercaptopurine [6-MP]) and immunosuppressants (such as cyclosporine A [C...

  2. Helicobacter pylori and peptic ulcer disease.

    OpenAIRE

    Feldman, M; Peterson, W. L.

    1993-01-01

    Medical therapy for duodenal or gastric ulcer disease has traditionally involved gastric acid antisecretory therapy for 4 to 8 weeks to promote initial healing and indefinitely to prevent recurrences of ulcer. The discovery of Helicobacter pylori in most patients with peptic ulcer disease has led to a change in this approach. Therapy designed to eradicate H pylori may facilitate ulcer healing with acid antisecretory agents and, more important, may greatly reduce the incidence of ulcer recurre...

  3. Effects of"Bazhen Decoction"on Proliferating Cell Nuclear Antigen and Cell Apoptosis in Granulation Tissue of Rats with Chronic Skin Ulcers%八珍汤对大鼠慢性难愈性创面肉芽组织增殖细胞核抗原与细胞凋亡的影响

    Institute of Scientific and Technical Information of China (English)

    邢捷; 阙华发

    2011-01-01

    Objective: To explore the effects of “Bazhen Decoction” on proliferating cell nuclear antigen (PCNA) and cell apoptosis in granulation tissue of rats with chronic skin ulcers. Methods: A total of 54 male SD rats with back full-thickness skin lesion were chosen in this study. Except for the normal control group, the rats were injected with hydrocortisono for establishing chronic skin ulcer model, and were randomly divided into model group and “Bashen Decoction” group. The time of wound healing was observed; immunohistochemical method combined with image analytical technology were used to test the expression of PCNA in granulation tissue of dermal chronic ulcers in rats; flow cytometer was used to detect the index of cell apoptosis in granulation tissue of dermal chronic ulcers in rats. Results: The time of wound healing in model group was significantly longer than that in normal control group (P <0.01 ), and the time of wound healing in “Bazhen Decoction” group was shorter than that in model group (P<0. 01 ); the expression of PCNA in model group was lower than that in normal control group (P <0.05), and the expression of PCNA in “Bazhen Decoction” group was higher than that in model group ( P < 0. 01 ) and lower than that in normal control group ( P <0.01 ); the index of cell apoptosis in model group was higher than that in normal control group ( P <0.01 ), and the index of cell apoptosis in “Bazhen Decoction” group was lower than that in model group (P<0.01) and higher than that in normal control group (P < 0. 01 ). Conclusion: “Bazhen Decoction” cen promote wound healing of rots with chronic skin ulcers and its mechanisms may have relation with promoting cell proliferation and inhibiting cell apoptosis in granulation tissue.%目的:探讨八珍汤对慢性难愈性创面大鼠创面肉芽组织增殖细胞核抗原(PCNA)与细胞凋亡的影响.方法:选择雄性SD大鼠,于背部制造全层皮肤缺损开放性创面.

  4. Psychological nursing influence on anxiety,depression and life quality of patients with chronic ulcerative colitis%心理护理对慢性溃疡性结肠炎患者焦虑、抑郁状况及生活质量的影响

    Institute of Scientific and Technical Information of China (English)

    吴志娟; 吉雅玲; 孙春霞

    2016-01-01

    目的:探讨心理护理对慢性溃疡性结肠炎患者焦虑、抑郁状况与生活质量的影响。方法选取2013年6月—2015年6月收治的100例慢性溃疡性结肠炎患者,按随机数字法随机分为对照组(50例)和研究组(50例),对照组采用常规慢性溃疡性结肠炎治疗和护理,研究组在对照组的基础上进行针对性的心理疏导、音乐放松等心理护理。比较两组治疗效果、护理前后的汉密尔顿抑郁评分(HAMD)、汉密尔顿焦虑评分(HAMA)及生活质量。结果对照组治疗有效率84.00%,研究组治疗有效率96.00%,差异有统计学意义(P <0.05);干预后对照组 HAMD 得分、HAMA 得分分别为(16.76±3.69)分、(14.46±1.68)分,研究组 HAMD 得分、HAMA 得分分别为(10.28±2.41)分、(9.44±1.53)分,差异有统计学意义(P <0.05)。研究组护理后生理机能、生理职能、躯体疼痛、总体健康、活力、社会功能、情感职能和精神健康8个维度的生存质量得分均高于对照组,差异有统计学意义(P <0.05)。结论在常规慢性溃疡性结肠炎治疗和护理的基础上进行心理疏导、音乐放松等心理护理有利于慢性溃疡性结肠炎疗效的提高、抑郁和焦虑等不良心理状态的缓解以及生存质量的提高。%Objective To investigate the influence of psychological nursing on anxiety,depression and quality of life of the patients with chronic ulcerative colitis.Methods One hundred patients with chronic ulcerative colitis in our hospital from June 201 3 to June 2015 were selected and randomly divided into control group (n =50)and study group (n =50)according to number random table.The patients in control group accepted the conventional chronic ulcerative colitis treatment and care,while the patients in study group accepted the psychological nursing including targeted psychological counseling and music

  5. Nutritional prediction of pressure ulcers.

    Science.gov (United States)

    Breslow, R A; Bergstrom, N

    1994-11-01

    This article focuses on nutritional risk factors that predict the development of pressure ulcers in hospital and nursing home patients. Cross-sectional studies associate inadequate energy and protein intake; underweight; low triceps skinfold measurement; and low serum albumin, low serum cholesterol, and low hemoglobin levels with pressure ulcers. Prospective studies identify inadequate energy and protein intake, a poor score on the Braden scale (a risk assessment instrument that includes a nutrition component), and possibly low serum albumin level as risk factors for developing a pressure ulcer. Nutritionists should provide a high-energy, high-protein diet for patients at risk of development of pressure ulcers to improve their dietary intake and nutritional status.

  6. Management of bleeding gastroduodenal ulcers

    DEFF Research Database (Denmark)

    Laursen, Stig Borbjerg; Jørgensen, Henrik Stig; Schaffalitzky de Muckadell, Ove B

    2012-01-01

    Description: A multidisciplinary group of Danish experts developed this guideline on management of bleeding gastroduodenal ulcers. Sources of data included published studies up to March 2011. Quality of evidence and strength of recommendations have been graded. The guideline was approved...

  7. Genetics Home Reference: ulcerative colitis

    Science.gov (United States)

    ... my area? Other Names for This Condition colitis gravis idiopathic proctocolitis inflammatory bowel disease, ulcerative colitis type ... for professional medical care or advice. Users with questions about a personal health condition should consult with ...

  8. Management and treatment of distal ulcerative colitis

    Directory of Open Access Journals (Sweden)

    Andrea Calafiore

    2013-12-01

    Full Text Available Ulcerative colitis (UC is a chronic inflammatory condition that is confined to the colonic mucosa. Its main symptoms include diarrhea, rectal bleeding and abdominal pain. Approximately two-thirds of UC patients have disease confined distal to the splenic flexure, which can be treated effectively with topical therapy. This means the active drug can be delivered directly to the site of inflammation, limiting the systemic absorption and potential side effects. Topical treatment with aminosalicylates is the most effective approach in the treatment of these forms, provided that the formulation reaches the upper margin of the disease. Given this, the suppository formulation is the treatment of choice for proctitis and distal sigmoiditis. Thanks to their proximal spread, enemas, foams and gels represent the treatment of choice for proctosigmoiditis and for distal ulcerative colitis. Oral aminosalicylates are less effective than topical therapies in patients with active disease, while the combination of topical and oral treatment is more effective in patients refractory to topical or oral mono-therapy. Topically administered aminosalicylates play an important role in the maintenance of remission, but the long-term adhesion to therapy is poor. For this reason, the oral formulation is the first-line therapy in the maintenance of remission. Refractory patients can be treated with topical steroids or systemic steroids and TNF-alpha inhibitors in severe forms.

  9. Diagnosis and classification of ulcerative colitis.

    Science.gov (United States)

    Conrad, Karsten; Roggenbuck, Dirk; Laass, Martin W

    2014-01-01

    Ulcerative colitis (UC) is a chronic relapsing inflammatory bowel disease (IBD) characterised by superficial mucosal ulceration, rectal bleeding, diarrhoea, and abdominal pain. In contrast to Crohn's disease (CrD), UC is restricted to the colon and the inflammation is limited to the mucosal layer. Classic UC affects the colon in a retrograde and continuous fashion starting from the rectum and extending proximally. Dependent on the anatomic extent of involvement, UC can be classified as proctitis, left-sided colitis, or pancolitis. Inflammatory arthropathies and primary sclerosing cholangitis (PSC) are the most common and clinically most important extraintestinal manifestations of UC. The aetiopathogenesis of UC is incompletely understood, but immune-mediated mechanisms are responsible for dysregulated immune responses against intraluminal antigens in genetically predisposed individuals. The diagnosis is based on the history, as well as clinical, radiological, endoscopic and histological features. Autoantibodies, mainly antineutrophil cytoplasmic antibodies (ANCA) and anti-goblet cell antibodies (GAB) may be helpful in the early diagnosis of UC and in differentiating it from CrD.

  10. 设计师访谈:Three Legged Legs

    Institute of Scientific and Technical Information of China (English)

    JOE; RUSS

    2007-01-01

    Greg Gunn、Casey Hunt和Reza Rasoli,又称Three Legged Legs。于2006年获得了全球学生动画奖(Global Student Animation Award)。现在他们又带回了一个精彩的新短片《Samurai》。我们自然也不会放过这次机会,看看能不能了解到更多内幕信息。

  11. A CROSS SECTIONAL STUDY OF PREVALENCE AND TYPE OF DIABETIC FOOT ULCERS IN TYPE 2 DIABETIC MELLITUS PATIENTS

    Directory of Open Access Journals (Sweden)

    Yadavendra Reddy

    2015-06-01

    Full Text Available BACK GROUND : Diabetic foot ulcers are common and estimated to affect 15% of all diabetics. In India it is estimated that approximately 40 , 000 legs are being amputated every year of which 75% are potentially preventable. METHODOLOGY : To determine the prevalence of diabetic foot ulcers and the type of ulcers amongst the diagnosed diabetes mellitus patients a prospective study was carried out d uring the period January 2013 to December 2014 in the department of General medicine , Rajiv Gandhi Institute of Medical Sciences and Medical college , Kadapa , A.P. RESULTS : Diabetic foot ulcers were found in 14% diabetes mellitus patients. Neuropathic type of foot ulcer was present in 48.62% of patients (60.5% in male and 18.5% in female. Ischemic type of foot ulcer was present in 18.26% of patients (39.5% in male and in 14.06% females. Neuro - ischemic type of foot ulcer was present in 33.12% of patients (2 1% in males and 46.44% in females. CONCLUSION : Neuropathy occurred most frequently either singly or with peripheral vascular disease. General awareness about the disease , early diagnosis and proper management will prevent this dreaded complication.

  12. Effect observation of hydrotalcite combined with amoxicillin clavulanic acid and berberine in the treatment of chronic stubborn gastritis and gastric ulcer in 60 cases%铝碳酸镁联用阿莫西林克拉维酸钾及黄连素治疗慢性顽固性胃炎、胃溃疡60例效果观察

    Institute of Scientific and Technical Information of China (English)

    邱桂扣

    2015-01-01

    Objective:To explore the effect of hydrotalcite combined with amoxicillin clavulanic acid and berberine in the treatment of chronic stubborn gastritis,gastric ulcer.Methods:60 patients with chronic stubborn gastritis,gastric ulcer were selected. They were randomly divided into the study group and the control group with 30 cases in each.The control group were given hydrotalcite combined with amoxicillin clavulanic acid treatment.The study group were given hydrotalcite combined with amoxicillin clavulanic acid and berberine treatment.We compared the treatment efficiency,helicobacter pylori clearance rate, recurrence rate and the rate of adverse reactions of the two groups.Results:In the study group,the effective rate was 86.67% ;helicobacter pylori eradication rate was 73.33%;the recurrence rate was 10.00%.They were all significantly better than the control group(P0.05).Conclusion:Hydrotalcite combined with amoxicillin clavulanic acid and berberine in the treatment of chronic stubborn gastritis,gastric ulcer can significantly improve the clinical efficacy,and reduce the recurrence rate.%目的:探讨铝碳酸镁联用阿莫西林克拉维酸钾及黄连素治疗慢性顽固性胃炎、胃溃疡的疗效。方法:收治慢性顽固性胃炎、胃溃疡患者60例,随机平均分成研究组和对照组,对照组给予铝碳酸镁联合阿莫西林克拉维酸钾治疗,研究组应用铝碳酸镁联用阿莫西林克拉维酸钾及黄连素治疗,比较两组患者治疗有效率、幽门螺杆菌清除率、复发率及不良反应率。结果:研究组治疗有效率86.67%,幽门螺杆菌清除率73.33%,复发率10.00%,均显著优于对照组(P<0.05),不良反应率组间比较,差异无统计学意义(P>0.05)。结论:铝碳酸镁联用阿莫西林克拉维酸钾及黄连素治疗慢性顽固性胃炎、胃溃疡能显著提高临床疗效、降低复发率。

  13. 综合护理干预对慢性胃炎及消化性溃疡患者生活质量的影响分析%Effect of comprehensive nursing intervention on quality of life of patients with chronic gastritis and peptic ulcer

    Institute of Scientific and Technical Information of China (English)

    陈敏

    2016-01-01

    目的:针对慢性胃炎及消化性溃疡患者,讨论临床实施综合护理干预,观察对患者生活质量的影响,为日后的临床护理提供参考及指导。方法选择我院于2013年3月—2015年5月收治的慢性胃炎及消化性溃疡患者160例为研究对象,临床应用抽签的方法,将160例患者随机划分为两组,分别定义为观察组及对照组,每组患者80例。对照组患者给予常规护理,观察组患者给予综合护理干预,对比两组患者的临床护理效果。结果经过临床护理干预,两组患者在护理满意度方面,观察组患者为98.75%,对照组患者为81.25%,临床比较差异显著,P﹤0.05,观察组优于对照组。在NHP评分方面,两组患者比较差异显著,临床有统计学意义,P﹤0.05,观察组优于对照组。结论针对慢性胃炎及消化性溃疡患者,临床实施综合护理干预后,患者临床表现缓解明显,身体素质提升,生活质量较高,对患者积极作用较大。建议在今后的临床护理中,将综合护理推广应用。%Objective:to discuss the clinical effect of comprehensive nursing intervention on patients with chronic gas-tritis and peptic ulcer,to provide reference and guidance for clinical nursing in the future. Methods:in our hospital in March 2013 —2015 years 5 months from chronic gastritis and digestive ulcer patients 160 cases as the object of study, clinical application of the draw method,160 cases were randomly divided into two groups were defined as the observation group and the control group. Each group of 80 cases of patients. Patients in the control group were given routine nursing, the observation group were given comprehensive nursing intervention,the clinical nursing effect of the two groups were com-pared. Results:after clinical nursing intervention,the two groups of patients in nursing satisfaction,the observation group was 98. 75%,the control group was 81. 25%,the

  14. Assessment of external methods of traditional Chinese medicine in patients with chronic ulcer of the lower extremities: study protocol of a multicenter, randomized, parallel-group, prospective trial%“祛腐化瘀补虚生肌外治法治疗慢性下肢溃疡的临床示范性研究”的研究方案

    Institute of Scientific and Technical Information of China (English)

    王云飞; 单玮; 刘安民; 仇莲胤; 邓大一; 高丹; 阙华发; 徐杰男; 唐汉钧; 向寰宇; 刘晓鸫; 张臻; 邢捷; 沈亮

    2012-01-01

    BACKGROUND: Chronic ulcer of the lower extremities amounts for a grave and serious problem for public health. Western medicine focuses on controlling infection, improving blood circulation, surgical debridement, skin grafting, etc, but there are bottlenecks in the treatment. Traditional Chinese medicine (TCM) has a long history and a legacy of sound clinical efficacy in this area. TCM has developed a unique, effective external theory, and a large number of topical prescriptions and external technology. Through this research, a safe and effective treatment protocol of TCM for chronic ulcer of the lower extremities can be formed. During China's "Eleventh Five-Year" Plan, special research committees and projects on TCM external treatments and external technologies were established. This study on ulcer of the lower extremities constitutes one of the major research topics.METHODS AND DESIGN: Clinical information of patients with chronic ulcer of the lower extremities will be first collected in a large, multicenter, epidemiological survey. Concurrently, a large multicenter, randomized, parallel-group, prospective study will be launched based on evidence-based medical principles to evaluate the efficacy and safety of external methods for removing carrion, dissolving stasis, reinforcing deficiency and promoting tissue regeneration. The evaluated indexes will include the wound healing percentage for primary outcome, wound healing time, wound healing rate, time and rate of removal of necrotic tissue, and TCM syndromes for secondary outcomes and routine blood test, routine urine test, liver and kidney function, blood mercury content and finally urine mercury content for adverse events.DISCUSSION: In this trial, the authors will evaluate the efficacy and safety of external methods for removing carrion, dissolving stasis, reinforcing deficiency and promoting tissue regeneration in cases of chronic ulcer of the lower extremities for standardizing external therapy of TCM for

  15. Avaliação da eficácia da pomada de própolis em portadores de feridas crônicas Evaluación de la eficacia de la pomada de própolis en portadores de heridas crónicas The effect of propolis cream in healing chronic ulcers

    Directory of Open Access Journals (Sweden)

    Marinaldo José dos Santos

    2007-06-01

    ón de todas las lesiones fue de 13,1 semanas. Considerando un seguimiento de 20 semanas el 74,1% de las úlceras lograron la cicatrización antes de ese período. En cuanto a la etiología, las úlceras venosas cicatrizaron en 35% (7 de los pacientes, contraponiéndose a las úlceras de presión cuya cicatrización sucedió en apenas el 10,0% (2 de los pacientes. CONCLUSIÓN: Se concluye, que la utilización de pomada de própolis, de fácil acceso y bajo costo, fue sido eficiente en la cicatrización de heridas.OBJECTIVE: To evaluate the effect of propolis cream in healing chronic. METHODS: This descriptive study used a sample of 20 subjects from a Basic Unit of Health of Maringá City, Paraná, Brazil, who had chronic wounds. Wound healing was measured through progress notes of wound length, width, and depth. Data were analyzed with Pearson's correlation to determine the degree and strength of the relationship between propolis cream treatment and wound healing. RESULTS: The progress notes of 22 chronic ulcers showed that the probability of wound healing was 18.7 weeks. Regarding the study period of 13,1 weeks, the majority of ulcers (74.1% of ulcers healed completely. Regarding wound etiology, vascular ulcers (35% healed in 7 patients. And, pressure ulcers (10% healed in patients. CONCLUSION: The use of propolis cream, which is widely accessible and inexpensive, was effective in healing chronic wounds.

  16. Neuroimaging in Restless Legs Syndrome.

    Science.gov (United States)

    Provini, Federica; Chiaro, Giacomo

    2015-09-01

    Neuroimaging studies are of crucial relevance in defining the pathophysiology of restless legs syndrome (RLS). MRI studies showed no structural brain lesions and confirmed a central iron deficiency. Structural and functional studies showed an involvement of the thalamus, sensorimotor cortical areas, and cerebellum in RLS and assessed neurotransmission abnormalities in the dopaminergic and opiate systems. Finally, glutamatergic hyperactivity has been proposed as a cause of disrupted and shortened sleep in RLS. Differences among the results of the studies make it difficult to draw any definitive conclusions, thus, suggesting the need for future research.

  17. A disseminated case of Buruli ulcer at Macenta in the forest region of Guinea in West Africa

    Institute of Scientific and Technical Information of China (English)

    Bafende Aombe Eric; Strahm Stefan; Loua Richard.; Beavogui Galada Daniel; Kolie Valentin; Guilavogui Raphael; Keita Samba

    2012-01-01

    The author report a confirmed case of Buruli ulcer at Macenta in the forest region of Guinea in West Africa. An 8 years old girl came to the general hospital of Macenta located in the forest region of Guinea at 800km south-west of Conakry. Her story reveals that she used to swim in the local river of Man region in Ivory Coast. There is no notion of trauma or insect bite .The disease started 2 years ago by a nodule of the skin in her right leg which had ulcerated; she received various traditional treatments.

  18. Leg Spasticity and Ambulation in Multiple Sclerosis

    OpenAIRE

    Swathi Balantrapu; Sosnoff, Jacob J.; Pula, John H.; Brian M. Sandroff; Motl, Robert W.

    2014-01-01

    Background. Spasticity of the legs is common in multiple sclerosis (MS), but there has been limited research examining its association with ambulatory outcomes. Objective. This study examined spasticity of the legs and its association with multiple measures of ambulation in persons with MS. Methods. The sample included 84 patients with MS. Spasticity of the legs was measured using a 5-point rating scale ranging between 0 (normal) and 4 (contracted). Patients completed the 6-minute walk (6 MW)...

  19. The Legs Problem--For All Ages

    Science.gov (United States)

    Way, Jenni

    2005-01-01

    This article presents an example of a versatile multi-solution problem that can be used right across the primary years. The basic problem is: "Noah saw 16 legs go past him into the Ark. How many creatures did he see?" Any even number can be used, although, 2 legs allows only one answer and with 16 legs there are already 14 different solutions, so…

  20. Histopathological Analysis of High {sup 18}F-FDG Uptake in Meniscoid Ulcer of Colon Carcinoma: Report of A Case

    Energy Technology Data Exchange (ETDEWEB)

    Bahk, Yong Whee [Sung Ae Hospital, Seoul (Korea, Republic of); Jang, Ja June [Seoul National University School of Medicine, Seoul (Korea, Republic of)

    2008-04-15

    Prominent 18F-fluorodeoxyglucose (18F-FDG) accumulation has been reported to occur in meniscoid ulcer of gastric carcinoma. A mouse-model study carried out by Kubota et al. revealed that inflammatory cells, particularly macrophages, in necrotic tumor accumulates 18F-FDG more avidly than viable tumor cells. A search of literature failed to disclose earlier publication reporting histological study on such high 18F-FDG metabolism in patient with ulcerating colon cancer. This communication presents prominent 18FDG uptake observed in relation with chronic inflammation in meniscoid ulcer of sigmoid colon carcinoma. Cross correlation of PET findings with those of CT scan and colonoscopy showed that the high 18F-FDG uptake was localized to ulcerated part of tumor and not in heaved-up border that was not ulcerated. Histopathology of removed tumor revealed that the denuded bottom of ulcer consisted of a thick layer of submucosal tissue diffusely infiltrated with inflammatory cells. The meniscoid malignant ulcer, originally described in 1921 by Carman and re-studied in detail by Kirklin, is created by barium filling of crescent defect of ulcerating gastric carcinoma. Since then the sign has long been appreciated as a clue of ulcerating gastric carcinoma. In the meantime, the sign has also been reported to occur in the carcinomas of the esophagus by Gloyna et al. and the colon by Siskind and Burrell.

  1. Histopathological evaluation of gastric mucosal environments in peptic ulcer using the endoscopic 5-point gastric biopsy method.

    Directory of Open Access Journals (Sweden)

    Kobayashi,Hisataka

    1995-08-01

    Full Text Available Although a strong association has been established between chronic Helicobacter pylori infection and peptic ulcers, the role of H. pylori is not necessarily causative because there are many patients infected with H. pylori who do not develop peptic ulcer. Therefore, we studied the relationship between the gastric mucosal environment and the development of peptic ulcers. We examined 165 endoscopic biopsy specimens from the gastric mucosa of 33 patients with peptic ulcers using the 5-point gastric biopsy method. The follow-up biopsies done within 3 weeks were well correlated with the first biopsy samples. We also reviewed the clinicohistopathological findings of 2250 endoscopic biopsy specimens from 450 patients with active gastric and/or duodenal ulcers. Over 90% of the patients with duodenal ulcer, with or without gastric ulcer, had no fundic gland atrophy, and a high incidence of intestinal metaplasia and pyloric mucosal atrophy was found in the patients with gastric ulcer. These findings suggest that patients with concomitant active gastric and duodenal ulcers exhibit severe atrophic changes in the antral mucosa but not in the fundic mucosa.

  2. Gastroprotective effect of Desmodium gangeticum roots on gastric ulcer mouse models

    Directory of Open Access Journals (Sweden)

    Ayyavu Mahesh

    2012-10-01

    Full Text Available In the present study, the ethanolic root extract of Desmodium gangeticum (L. DC., Fabaceae, (EDG, have been studied in various acute and chronic ulcer mouse models. Oral administration of root extract, significantly decrease the ulcer index and lesion number in a dose dependent manner against ethanol induced acute gastric ulcer in mice. In gastric ulcerated animal that received high dose of 150 mg/kg EDG, the mucosa showed no ulceration with slight focal congestion and the glands appeared normal. Pylorus ligated mice, pretreated with EDG showed significant decrease in ulcerous activity under chronic condition. The highest dose (150 mg/kg of the extract provoked a marked increase in protein and glutathione levels, when compare to control. Furthermore, gastric juice, free acidity and total acid output were inhibited in a dose-dependent manner at p<0.05 level. Our results indicate that the EDG possess gastroprotective activity and increasing regeneration of damaged gastric mucosa and thus safe for human use.

  3. SCREENING FOR ANTI ULCER ACTIVITY OF CONVOLVULUS PLURICAULIS USING PYLORIC LIGATION METHOD IN WISTER RATS.

    Directory of Open Access Journals (Sweden)

    Sharath S S

    2015-01-01

    Full Text Available Peptic ulcer disease is a chronic problem of the gastrointestinal tract characterized by mucosal damage secondary to pepsin and gastric acid secretion. Herbal medicines are generally used in cases when drugs are to be used for chronic periods. The study was conducted to evaluate antiulcerogenic activity of convolvulus pluricaulis in wistar rats. The antiulcer activity was carried out employing - Pyloric ligation method. The rats were randomly divided into 4 groups of 6 animals each. First group was given 1ml of 0.1% of vehicle (Tween 80; the second group was treated with ranitidine 50 mg/kg in 1 ml Tween 80. The remaining groups receive 200 mg/kg and 400 mg/kg of Convolvulus pluricaulis alcoholic extract (CPAE in 1 ml Tween 80 respectively. All the drugs were administered orally for five days duration daily in two divided doses. Evaluation of antiulcer activity was done by Ulcer score/ulcer index. Volume of gastric juice secreted, gastric free acidity, total acidity, total protein, pepsin mucin and pH were also estimated. CPAE at a dose of 200 mg/kg inhibited ulcer index by 40.87% and at a dose of 400 mg/kg inhibited ulcer index by 26.64 %. Alcoholic extracts of Convolvulus pluricaulis have shown a significant protection against gastric ulcers in pyloric ligation model.

  4. Stewart-Treves syndrome following idiopathic leg lymphoedema: remember sarcoma.

    Science.gov (United States)

    Harrison, W D; Chandrasekar, C R

    2015-06-01

    Patients with skin complaints secondary to oedema are commonly encountered and can be a diagnostic challenge. Here, we present the case of a 78-year-old lady with Stewart-Treves syndrome, a rare cutaneous angiosarcoma. The histology showed angiocutaneous sarcoma with poorly defined margins. The prognosis remains extremely poor. A successful transfemoral amputation reduced the massive tumour burden and cleared a source of sepsis from this fungating tumour. Our aim is to highlight this rare but high-grade sarcoma which results from chronic lymphoedema. The red flag signs of sarcoma are masses greater than 5 cm, tumours which are rapidly growing, deep to fascia or painful, and tumours that recur after previous surgery. Non-healing or progressive ulceration in the background of chronic lymphoedema should raise the possibility of underlying malignancy. We need a low threshold for biopsy and early referral to an appropriate multidisciplinary team for the optimum management of the patient. PMID:26075513

  5. Intra-arterial intervention chemotherapy for sarcoma and cancerous ulcer via an implanted pump.

    Science.gov (United States)

    Liu, Cheng; Cui, Qiu; Guo, Jun; Li, Dingfeng; Zeng, Yanjun

    2014-04-01

    To observe the efficacy of intra-arterial chemotherapy with subcutaneously implanted pump for soft tissue sarcoma in extremities and cancerous ulcer. 31 patients with ulcerative skin squamous cell carcinoma or sarcoma in extremities who received treatment during the period from July 2003 to November 2011 at our hospital were recruited, including 15 male and 16 female patients, aging between 14 and 83 with average age of 49 years old. 10 patients had tumor in upper extremities and 21 patients in lower extremities. The pathological types of studied cases include 9 cases with skin squamous cell carcinoma, 6 cases with synovial sarcoma, 5 cases with malignant fibrous histiocytoma, 3 cases with liposarcoma, 3 cases with osteosarcoma, 2 cases with malignant melanoma, 2 cases with epidermoid sarcoma, and 1 case with protuberans. The main symptoms of cancerous ulcer were pain, infection and hemorrhage; All the studied patients were administrated with cisplatin and doxorubicin by intra-arterial chemotherapy pump, and the patients with squamous cell carcinoma were additionally applied with bleomycin and patients with malignant melanoma were additionally applied with dacarbazine. The chemotherapy efficiency was observed after at 3 cycles of intra-arterial chemotherapy. The total remission rate of pain (RR) was 87 %, and total remission rate of ulcer cicatrization (RR) was 71 %, with ulcer cicatrizing spontaneously in 9 cases and obvious homeostasis in 5 cases with bleeding ulcers. 19 patients underwent surgery after chemotherapy, in which 16 cases had limb-salvage surgery and 3 cases underwent lower leg amputation after chemotherapy, and 3 patients out of 16 cases had local recurrence (19 %). The subcutaneous intra-arterial targeting chemotherapy could be applied to treat refractory sarcoma and cancerous ulcer in extremities to significantly increase the chemotherapeutic concentration at tumor area so as to effectively constrain the tumor rupture induced main symptoms

  6. Potassium Channelopathies and Gastrointestinal Ulceration

    Science.gov (United States)

    Han, Jaeyong; Lee, Seung Hun; Giebisch, Gerhard; Wang, Tong

    2016-01-01

    Potassium channels and transporters maintain potassium homeostasis and play significant roles in several different biological actions via potassium ion regulation. In previous decades, the key revelations that potassium channels and transporters are involved in the production of gastric acid and the regulation of secretion in the stomach have been recognized. Drugs used to treat peptic ulceration are often potassium transporter inhibitors. It has also been reported that potassium channels are involved in ulcerative colitis. Direct toxicity to the intestines from nonsteroidal anti-inflammatory drugs has been associated with altered potassium channel activities. Several reports have indicated that the long-term use of the antianginal drug Nicorandil, an adenosine triphosphate-sensitive potassium channel opener, increases the chances of ulceration and perforation from the oral to anal regions throughout the gastrointestinal (GI) tract. Several of these drug features provide further insights into the role of potassium channels in the occurrence of ulceration in the GI tract. The purpose of this review is to investigate whether potassium channelopathies are involved in the mechanisms responsible for ulceration that occurs throughout the GI tract. PMID:27784845

  7. Topical honey for the treatment of diabetic foot ulcer: A systematic review.

    Science.gov (United States)

    Kateel, Ramya; Adhikari, Prabha; Augustine, Alfred J; Ullal, Sheetal

    2016-08-01

    Topical honey has been used for the treatment of wound since ancient time. But the medical evidence proving it is limited. Hence a systematic review was planned. An exhaustive literature search was done in PUBMED, COCHRANE, GOOGLE using 'topical honey', 'diabetic foot ulcer', 'chronic wounds' as key words. Literature search showed total of five clinical trials and about ten observational studies in various part of world. Out of five clinical trials three concluded that honey dressing is better than conventional dressing, all the clinical trials proved safety of honey for the treatment of diabetic foot ulcer. Observational studies included total of 320 patients which also showed safety of honey but efficacy cannot be considered from observational studies. This review showed that honey dressing is safer for treatment of diabetic foot ulcer but there is insufficient good quality data to realistically conclude on the efficacy of honey on diabetic foot ulcers. PMID:27502813

  8. Hypertrophic osteoarthropathy of chronic inflammatory bowel disease

    Energy Technology Data Exchange (ETDEWEB)

    Oppenheimer, D.A.; Jones, H.H.

    1982-12-01

    The case of a 14-year old girl with painful periostitis and ulcerative colitis is reported. The association of chronic inflammatory bowel disease with osteoarthropathy is rare and has previously been reported in eight patients. The periosteal reaction found in association with inflammatory bowel disease is apparently related to a chronic disease course and may cause extreme localized pain.

  9. The effects of antidepressants on gastric ulcer

    Directory of Open Access Journals (Sweden)

    Mehmet Latif Güneş

    2013-12-01

    Full Text Available In their daily practice, psychiatrists often experience gastriccomplaints in patients beside psychiatric disorders.Peptic ulcer is one of the diseases, which accompanyto psychiatric disorders including mainly depression. Itis shown that antidepressants can inflame the bleedingsincluding gastrointestinal (GI bleedings, while they havepositive effect on ulcer healing. In this review, studies,which conducted about the positive or negative effects ofantidepressant drugs on ulcer treatment were examined.Accordingly; it was found that opipramol, amitriptyline,imipramine that of tricyclic antidepressants was found tobe helpful in healing of the ulcer. It was stated that SelectiveSerotonin Reuptake Inhibitors generally inflamedulcers, exceptionally fluvoxamine and fluoxetine reducedulcer; moclobemide that of monoamine-oxidase inhibitorand tianeptine and mirtazapine that of atypical antidepressantshad positive effect in ulcer healing. To be carefulin choosing the appropriate antidepressant in psychiatricpatients with gastric ulcer is important in the prognosisof both ulcer and depression.Key words: peptic ulcer; depression; antidepressant drugs

  10. Diagnostic Features of Common Oral Ulcerative Lesions: An Updated Decision Tree

    Science.gov (United States)

    Safi, Yaser

    2016-01-01

    Diagnosis of oral ulcerative lesions might be quite challenging. This narrative review article aims to introduce an updated decision tree for diagnosing oral ulcerative lesions on the basis of their diagnostic features. Various general search engines and specialized databases including PubMed, PubMed Central, Medline Plus, EBSCO, Science Direct, Scopus, Embase, and authenticated textbooks were used to find relevant topics by means of MeSH keywords such as “oral ulcer,” “stomatitis,” and “mouth diseases.” Thereafter, English-language articles published since 1983 to 2015 in both medical and dental journals including reviews, meta-analyses, original papers, and case reports were appraised. Upon compilation of the relevant data, oral ulcerative lesions were categorized into three major groups: acute, chronic, and recurrent ulcers and into five subgroups: solitary acute, multiple acute, solitary chronic, multiple chronic, and solitary/multiple recurrent, based on the number and duration of lesions. In total, 29 entities were organized in the form of a decision tree in order to help clinicians establish a logical diagnosis by stepwise progression. PMID:27781066

  11. Sulphomucin expression in ileal pouches: emerging differences between ulcerative colitis and familial adenomatous polyposis pouches.

    LENUS (Irish Health Repository)

    Bambury, Niamh

    2012-02-03

    PURPOSE: We characterized the expression of sialomucin and sulphomucin in pouches fashioned for familial adenomatous polyposis and ulcerative colitis. We correlated sulphomucin expression with bacterial colonization and mucosal inflammation. METHODS: Ethical approval and informed consent were obtained. Mucosal biopsies from 9 patients with familial adenomatous polyposis and 12 with ulcerative colitis were obtained. Sulphomucin levels were assessed by using the high iron-diamine stain. Mucous gel layer composition was correlated with villous height, crypt depth, and total mucosal thickness. Mucous gel layer composition was correlated with acute and chronic inflammatory infiltrates. Colonization by a panel of seven bacterial species (including sulphate reducing bacteria) was established and correlated with sulphomucin levels. RESULTS: High-iron-diamine positivity (i.e., sulphomucin expression) was greater in ulcerative colitis pouch mucous gel (2.083 +\\/- 0.5 vs. 0.556 +\\/- 0.4, P = 0.003). Sulphomucin expression correlated with reduced crypt depth, villous height, and total mucosal thickness. In the ulcerative colitis group, chronic inflammatory infiltrate scores were significantly greater for high-iron-diamine-positive patients. Colonization by sulphate reducing bacteria was increased in high-iron-diamine-positive patients. CONCLUSIONS: Sulphomucin expression is increased in the mucous gel layer of the ulcerative colitis pouch compared with that of the familial adenomatous polyposis pouch. Sulphomucin expression is associated with colonization by sulphate-reducing bacteria and increased chronic inflammation.

  12. S100A8/A9 is an important host defence mediator in neuropathic foot ulcers in patients with type 2 diabetes mellitus.

    Science.gov (United States)

    Trøstrup, Hannah; Holstein, Per; Christophersen, Lars; Jørgensen, Bo; Karlsmark, Tonny; Høiby, Niels; Moser, Claus; Ågren, Magnus S

    2016-07-01

    Chronic wounds and in particular diabetic foot ulcers (DFUs) are a growing clinical challenge, but the underlying molecular pathophysiological mechanisms are unclear. Recently, we reported reduced levels of the immunomodulating and antimicrobial S100A8/A9 in non-healing venous leg ulcers (VLUs), while another study found increased S100A8/A9 in DFUs. To clarify these apparently contradictory findings, we compared S100A8/A9 as well as an inducer, lipopolysaccharide (LPS) and selected innate immune response mediators in wound fluids from non-healing DFUs and VLUs with healing wounds. Wound fluids were collected from neuropathic DFUs (n = 6) and VLUs (n = 9) of median 2-year duration, and split-thickness skin graft donor site wounds (n = 10) by standardized method. None of the patients had ischaemic extremities or clinically infected wounds. LPS was determined by limulus amoebocyte lysate test, and S100A8/A9, granulocyte colony-stimulating factor (G-CSF), interleukin (IL)-10 and vascular endothelial growth factor (VEGF) by immunospecific quantitative assays. LPS levels were median 8.7 (interquartile range 5.4-21.2) ng/ml in DFUs compared with 121 (22-2000) ng/ml in VLUs. S100A8/A9 was higher (p = 0.020) in DFUs [718 (634-811) µg/ml] than in VLUs [303 (252-533) µg/ml]. Neither G-CSF nor IL-10 wound fluid levels differed significantly between the chronic wound groups. VEGF levels correlated with LPS (r = 0.758, p = 0.011, n = 10) and were higher (p = 0.024) in VLU wound fluids. LPS (p < 0.0001), S100A8/A9 (p = 0.005), G-CSF (p = 0.003), IL-10 (p = 0.003) and VEGF (p = 0.005) were increased in chronic wound fluids combined compared with the sterile donor site wound fluids. The protein alterations in the wounds were not reflected in the patients' sera. Low S100A8/A9 levels may contribute to poor wound healing in colonized chronic wounds with striking difference between DFUs and VLUs. PMID:27084691

  13. [Combined therapy for a vascular ulcer. 2008 Biatain First Prize. A clinical case of a patient with an infected vascular ulcer].

    Science.gov (United States)

    Romo Sanz, María Isabel; Juárez Vela, Raul

    2009-03-01

    The use of a combined therapy which includes hydropolymeric dressings with ionic silver and dressings which release of ibuprofen together with a constant reevaluation made it possible to heal an ulcer which had afflicted a patient for 10 years. In order to succeed in doing so, medical professionals started off with the evidence that, in the complicated process which the cicatrization of long-lasting wounds difficult to cure constitutes, a series of factors involved in tissue regeneration appear which, at the same time, are not expected and which delay and slow down this process (critical colonization and infection, nutritional and metabolic state, repetitive infections, vascular state or hormonal alterations). This case story won the 2008 Biatain First Prize in the category "Clinical Case Study of a patient with an infected leg ulcer".

  14. Nonhealing Ulcer: Acroangiodermatitis of Mali

    Directory of Open Access Journals (Sweden)

    Neeraj Varyani

    2011-01-01

    Full Text Available An 18-year-old male presented with a nonhealing wound on left lower limb, pain and swelling over multiple joints, weight loss, and yellowish discoloration of eyes and urine for the past 4 years. On examination, the patient had pallor, icterus, and generalized lymphadenopathy with a nonhealing unhealthy ulcer over left medial malleolus. He had deformed joints with hepatomegaly and splenomegaly. His laboratory investigations were positive for antinuclear antibody (ANA and anticardiolipin antibody (ACLA. Synovial fluid analysis showed inflammatory findings. Biopsy of margin of the ulcer showed findings consistent with Acroangiodermatitis of Mali. The patient was treated with disease-modifying antirheumatic drugs (DMARDs and aspirin for juvenile idiopathic arthritis and secondary antiphospholipid antibody syndrome (APS, respectively. The ulcer was managed conservatively with systemic antibiotics and topical steroids along with limb elevation and compression elastic stockings. The patient's symptoms improved significantly, and he is in our followup.

  15. Management of bleeding gastroduodenal ulcers

    DEFF Research Database (Denmark)

    Laursen, Stig Borbjerg; Jørgensen, Henrik Stig; Schaffalitzky de Muckadell, Ove B.

    2012-01-01

    serious ulcer bleeding is suspected and blood found in gastric aspirate, endoscopy within 12 hours will result in faster discharge and reduced need for transfusions. Endoscopic hemostasis remains indicated for high-risk lesions. Clips, thermocoagulation, and epinephrine injection are effective......Description: A multidisciplinary group of Danish experts developed this guideline on management of bleeding gastroduodenal ulcers. Sources of data included published studies up to March 2011. Quality of evidence and strength of recommendations have been graded. The guideline was approved......-risk stigmata. Although selected patients can be discharged promptly after endoscopy, high-risk patients should be hospitalized for at least 3 days after endoscopic hemostasis. Patients with peptic ulcer bleeding who require secondary cardiovascular prophylaxis should start receiving acetylsalicylic acid (ASA...

  16. [Genital ulcers--what's new?].

    Science.gov (United States)

    Abu Raya, Bahaa; Bamberger, Ellen; Srugo, Isaac

    2013-08-01

    The most common infectious causes of genital ulcers are herpes simplex virus and syphilis. However, mixed infections can occur and genital ulcer may increase the risk of acquiring human immunodeficiency virus. Although the history and physical examination can narrow the differential diagnosis, there is a need for initial routine laboratory testing for the most common pathogens that includes: for syphilis: serologic screening and dark field examination of the lesion; for herpes simplex virus: serology, vial culture and/or polymerase chain reaction. Human immunodeficiency testing is mandatory. Recently, some clinical laboratories adapted the reverse screening algorithm for syphilis (initial treponemal test, and, if positive, followed by non-treponemal test) that may potentially lead to overtreatment. Early and prompt therapy may decrease the risk of transmission of the infectious agent to others. This article reviews the infectious pathogens causing genital ulcers, their unique clinical manifestation, diagnosis and treatment.

  17. Steroid ulcers:Any news?

    Institute of Scientific and Technical Information of China (English)

    Mario; Guslandi

    2013-01-01

    Steroid ulcers,although a common feature in experimental studies,seldom develop in clinical practice,as observed by the meta-analyses carried out in the 90s.Corticosteroids alone become ulcerogenic only if treatment lasts longer than one month and the total administered dose exceeds 1000 mg.On the other hand concomitant intake of non-steroidal anti-inflammatory drugs results in a synergistic,highly damaging effect on the gastroduodenal mucosa.Thus,despite the survival of the steroid ulcer myth in the medical culture,pharmacological protection against steroid-induced peptic ulcers is a rare necessity while the best prophylactic strategy still remains to be determined.

  18. Management of patients with pressure ulcers

    OpenAIRE

    Bora Ozel

    2014-01-01

    A pressure ulcer is an area of localized damage to the skin and underlying tissue caused by pressure or shear. Although these ulcers can occur anywhere on the body, they are often located in the ischial, trochanteric, sacral areas and. heel. These ulcers are primarily the products of a combination of pressure and decreased angiogenic response. Early intervention and comprehensive treatment should result in complete healing of ulcers. In this review, we tried to create a general perspective ab...

  19. Diabetic foot ulcers. Pathophysiology, assessment, and therapy.

    OpenAIRE

    Bowering, C. K.

    2001-01-01

    OBJECTIVE: To review underlying causes of diabetic foot ulceration, provide a practical assessment of patients at risk, and outline an evidence-based approach to therapy for diabetic patients with foot ulcers. QUALITY OF EVIDENCE: A MEDLINE search was conducted for the period from 1979 to 1999 for articles relating to diabetic foot ulcers. Most studies found were case series or small controlled trials. MAIN MESSAGE: Foot ulcers in diabetic patients are common and frequently lead to lower limb...

  20. Diagnosis and treatment of restless legs syndrome.

    Science.gov (United States)

    Sales, Samantha; Sanghera, Manjit K; Klocko, David J; Stewart, R Malcolm

    2016-07-01

    Restless legs syndrome (RLS) is a disorder characterized by an irresistible urge to move the legs during rest, usually accompanied by uncomfortable sensations in the affected extremity or extremities. RLS can manifest at any age but prevalence increases with advancing age. This article describes the symptoms of RLS, associated comorbidities, and how to diagnose and manage RLS. PMID:27306327