Quality of Life in People with Leg Ulcer, Integrative Review

Directory of Open Access Journals (Sweden)

Daniela Alves

2016-04-01

Full Text Available Objective: To identify the main changes in the daily life of people with leg ulcer and how that affects the person’s quality of life. Methodology: We used the methodology PI [C] OD and selected four research articles, taken from EBSCO, PubMed, and EWMA. Results: The main changes identified in the people’s daily live with leg ulcers are physical (pain, decreased mobility, presence of exudate, bad smell from the wound and change in the style of clothing, psychological (sleep disorders, depression, anxiety, feelings of rejection and low self-steem, social (isolation, restriction in leisure activities, inability to perform household chores. Conclusions: The literature about the person’s quality of life with leg ulcer reported a significant impact in the daily life. The care provided by nurses should be centered on the person, integrating all the kind of needs and the leg ulcer must not be the sole focus of care

An exploration of current leg ulcer management practices in an Irish community setting.

Science.gov (United States)

Clarke-Moloney, M; Keane, N; Kavanagh, E

2006-10-01

To establish the prevalence of leg ulceration in the Irish Health Service Executive (HSE) mid-western region and to determine the level of assessment and treatment patients have been receiving in the local community. Before the introduction of a Doppler training programme, all public health and community health nurses working in the Irish HSE mid-western area were requested to complete an audit form on each patient being treated for leg ulceration during a predefined one-week period. This form recorded details on patient demographics, ulcer aetiology, assessment and treatment. Out of 97 nurses, 96 responded to this audit, giving a response rate of 98.9%. A total of 429 patients with 449 leg ulcers were identified. Mean age was 75.5 years (standard deviation 10.7). Overall prevalence was 0.12%, which increased to 1.2% in those aged 70 years and over. Women were almost twice as likely as men to be affected (ratio of 1.8:1). The main causes of ulceration were reported as venous incompetence accounting for 63.3% (284/449) and arterial insufficiency accounting for 8% (36/449) of all ulcers. Only 59.9% (269/449) of all ulcerated limbs had ABPI measurements performed. Of those reported as venous in origin, 71.8% (204/284) had ABPI measurements recorded. Evidence-based care was generally apparent in this group, with 47.5% (97/204) receiving high compression and 18.1% (37/204) receiving reduced compression. However, in venous leg ulcers where ABPIs were not recorded (n=80) care appeared haphazard and inappropriate. Our study has identified the benefit of ABPI Doppler assessment.This assessment could be done in local health centres by trained nurses who could provide more appropriate and timely care to patients, thereby improving outcomes and relieving pressure on acute hospital clinics.

Leg ulcer assessment techniques in a remote rural area.

Science.gov (United States)

Graham, Julia

Community-based leg ulcer clinics are a cost-effective and efficient way of managing patients with leg ulcers in the community (Blair et al, 1988; Moffatt and Oldroyd, 1994). According to the Scottish Clinical Standards for Vascular Services (NHS Quality Improvement Scotland, 2003): 'It is essential that all vascular patients are seen by a nurse with vascular expertise, who is able to provide information, support and health promotion advice'.

Management of venous leg ulcers in general practice - a practical guideline.

Science.gov (United States)

Sinha, Sankar; Sreedharan, Sadhishaan

2014-09-01

Chronic venous leg ulcers are the most common wounds seen in general practice. Their management can be both challenging and time-consuming. To produce a short practical guideline incorporating the TIME concept and A2BC2D approach to help general practitioners and their practice nurses in delivering evidence-based initial care to patients with chronic venous leg ulcers. Most chronic venous leg ulcers can be managed effectively in the general practice setting by following the simple, evidence-based approach described in this article. Figure 1 provides a flow chart to aid in this process. Figure 2 illustrates the principles of management in general practice. Effective management of chronic ulcers involves the assessment of both the ulcer and the patient. The essential requirements of management are to debride the ulcer with appropriate precautions, choose dressings that maintain adequate moisture balance, apply graduated compression bandage after evaluation of the arterial circulation and address the patient's concerns, such as pain and offensive wound discharge.

Successful use of vacuum-assisted closure therapy for leg ulcers caused by occluding vasculopathy and inflammatory vascular diseases--a case series.

Science.gov (United States)

Zutt, Markus; Haas, Ellen; Kruger, Ullrich; Distler, Meike; Neumann, Christine

2007-01-01

Leg ulcers caused by vasculitis, small vessel occlusion or other rare conditions often prove to be very difficult to treat. Despite polypragmatic, systemic and localized therapy, many of these wounds are progressive and characterized by severe pain. We here portray the cases of 5 patients with ulcers resistant to systemic therapy for the underlying disease, who were treated successfully using vacuum-assisted closure (VAC) for wound management. We present the advantages and disadvantages of this method, as well as illustrating the essential and known therapeutic principles. Our experience shows VAC to be an excellent and effective alternative in the treatment of therapy-resistant chronic wounds caused by vasculopathy (small vessel occlusion or vasculitis). We did not observe any pathergy or proinflammatory effects caused by VAC. 2007 S. Karger AG, Basel

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.

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

NARCIS (Netherlands)

Heinen, M.M.; Persoon, J.W.B.; Kerkhof, P.C.M. van de; Kooijmans-Otero, M.E.; 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

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

The bacterial microbiota plays an important role in the prolonged healing of chronic venous leg ulcers. The present study compared the bacterial diversity within ulcer material from 14 skin graft operations of chronic venous leg ulcers using culture-based methods and molecular biological methods...

[Nocardia brasiliensis leg ulcer and nodular lymphangitis in France].

Science.gov (United States)

Hamm, M; Friedel, J; Siré, C; Semon, J

2005-01-01

Nocardia brasiliensis is a very rarely reported cause of chronic phagedenic ulcerations. We report the case of an elderly woman who developed such an infection after falling on her right leg on the road in the Bresse country (an essentially agricultural and bovine-cattle breading region) and developed a chronic phagedenic ulcer secondarily complicated by nodular lymphangitis of the thigh. A 75 year-old woman fell on her right leg on the side of the main road outside her hamlet in the Bresse country and secondarily developed a chronique phagedenic ulceration. We first considered her as suffering from pyoderma gangrenosum. A complete scanning only revealed an autoimmune thyroiditis and a rapidly healing gastric ulceration, and none of the treatments, either local or systemic, helped the skin condition to heal. After 3 weeks of application of a local corticoid ointment, the patient developed fever, general malaise, an exacerbation of her wound and an infiltration of the skin round her knee, together with nodular lymphangitic dissemination. A supplementary bacterial swab disclosed massive proliferation of a slow-growing Gram-positive bacillus, which proved to be Nocardia brasiliensis, together with a methicillino-sensitive Staphylococcus aureus. The treatment with sulfamethoxazole-trimetoprim gave a rash after 12 hours and was changed to amoxicillin and clavulanic acid, which rapidly proved to be permanently effective. The revelation of this particular slow-growing bacteria is difficult and requires bacterial swabs. Nocardia brasiliensis is relatively rare in primary skin ulcerations and we discuss the reasons why an elderly women should find this bacteria on the road outside her hamlet in the French countryside. This particular infectious condition requires general scanning, to make sure that the primary skin condition does not extend to other organs. We review the therapeutical options for patients who exhibit allergic reactions to the classically effective

Leg ulcer in Werner syndrome (adult progeria): a case report.

Science.gov (United States)

Fumo, Giuseppe; Pau, Monica; Patta, Federico; Aste, Nicola; Atzori, Laura

2013-03-15

Werner syndrome (WS; MIM#277700) or adult progeria, is a rare disease, associated with mutations of a single gene (RECQL2 or WRN), located on chromosome 8 (8p12). It codes a DNA-helicase, whose defects cause genomic instability. The highest incidences are reported in Japan and Sardinia (Italy). On this major island of the Mediterranean Basin, the WS cases have been observed in the northern areas. The authors describe the apparently first case reported in southern Sardinia, a 51-year-old woman, who was born in and resides in the province of Cagliari. She presented with a 9-year history of an intractable leg ulcer and other characteristic symptoms, including "bird-like" face, high-pitched voice, premature greying, short stature, abdominal obesity in contrast with thin body type, scleroderma-like legs, decreased muscle mass, diabetes, atherosclerosis, and premature menopause. A specialized genetic Institute of Research (IRCCS-IDI, Rome) confirmed the clinical diagnosis. There is no cure or specific treatment and patients must be periodically screened for an increased risk of cardiovascular and cerebrovascular disease and malignancies. Among the many findings, leg ulcers significantly affect the patient's quality of life. This problem may send the patient to the dermatologist, who finally suspects the diagnosis. Poor response to medical treatment may require aggressive repeated surgery, with poor or temporary results.

Venous leg ulcer management: single use negative pressure wound therapy.

Science.gov (United States)

Dowsett, Caroline; Grothier, Lorraine; Henderson, Valerie; Leak, Kathy; Milne, Jeanette; Davis, Lynn; Bielby, Alistair; Timmons, John

2013-06-01

A number of leg ulcer specialist/tissue viability specialists from across the UK were invited to evaluate PICO (Smith and Nephew, Hull) as a treatment for venous leg ulcers also in conjunction with a variety of compression bandages and garments. Patients across 5 sites had PICO applied in conjunction with compression therapy. This group of treating clinicians were then asked to give feedback on the outcome of the patients on whom they had used the new device. All feedback was recorded at a meeting and this was used to create a guideline for use.

Delivery of compression therapy for venous leg ulcers.

Science.gov (United States)

Zarchi, Kian; Jemec, Gregor B E

2014-07-01

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. To assess whether home care nurses achieve adequate subbandage pressure when treating patients with venous leg ulcers and the factors that predict the ability to achieve optimal pressure. We performed a cross-sectional study from March 1, 2011, through March 31, 2012, in home care centers in 2 Danish municipalities. Sixty-eight home care nurses who managed wounds in their everyday practice were included. Participant-masked measurements of subbandage pressure achieved with an elastic, long-stretch, single-component bandage; an inelastic, short-stretch, single-component bandage; and a multilayer, 2-component bandage, as well as, association between achievement of optimal pressure and years in the profession, attendance at wound care educational programs, previous work experience, and confidence in bandaging ability. A substantial variation in the exerted pressure was found: subbandage pressures ranged from 11 mm Hg exerted by an inelastic bandage to 80 mm Hg exerted by a 2-component bandage. The optimal subbandage pressure range, defined as 30 to 50 mm Hg, was achieved by 39 of 62 nurses (63%) applying the 2-component bandage, 28 of 68 nurses (41%) applying the elastic bandage, and 27 of 68 nurses (40%) applying the inelastic bandage. More than half the nurses applying the inelastic (38 [56%]) and elastic (36 [53%]) bandages obtained pressures less than 30 mm Hg. At best, only 17 of 62 nurses (27%) using the 2-component bandage achieved subbandage pressure within the range they aimed for. In this study, none of the investigated factors was associated with the ability to apply a bandage with optimal pressure. This study demonstrates the difficulty of achieving the desired subbandage pressure and indicates that a substantial proportion of

[Necrotic leg ulcer revealing vasculitis induced by vitamin K antagonists].

Science.gov (United States)

Chabli, H; Hocar, O; Akhdari, N; Amal, S; Hakkou, M; Hamdaoui, A

2015-12-01

Vitamin K antagonists are widely used in thromboembolic diseases. Hemorrhagic complications related to drug overdose represent their main side effect. We report a rare side effect, a severe and unexpected type of skin vasculitis - necrotic leg ulcer - induced by vitamin K antagonist. A 63-year-old female with a history of diabetes developed hyperalgesic necrotic ulcerations on the lower limbs one month after starting an acenocoumarol-based treatment for ischemic heart disease. Histological examination revealed lymphocytic vasculitis with fibrinoid necrosis. Etiological explorations searching for vasculitis were negative. In the absence of a precise etiology, drug-induced ulcer was suspected. Low molecular weight heparin was prescribed to replace acenocoumarol. The lesions slowly resolved with topical treatment. The chronological criteria and the negativity of etiological explorations allowed the diagnosis of vitamin K antagonist-induced necrotic skin ulcer. Clinicians should be aware of this rare complication induced by oral anticoagulants because of its practical therapeutic implications. This is the first case of necrotic leg ulcer induced by acenocoumarol corresponding histologically to necrotising lymphocytic vasculitis. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

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

Directory of Open Access Journals (Sweden)

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.

Pinch grafting for chronic venous leg ulcers in general practice

OpenAIRE

Steele, Keith

1985-01-01

Twenty-five patients with chronic venous leg ulcers were treated in general practice by pinch grafting. Fifteen of the ulcers (60%) were completely healed one year after grafting. Prior to grafting 19 patients (76%) complained of daily pain in the ulcer. These patients experienced complete relief from pain after grafting. Pinch grafting is a simple, safe and effective therapy when applied in a domiciliary environment.

Comparative study of quality of life and psychosocial characteristics in patients with psoriasis and leg ulcers.

Science.gov (United States)

Kouris, Anargyros; Christodoulou, Christos; Efstathiou, Vasiliki; Tsatovidou, Revekka; Torlidi-Kordera, Evangelia; Zouridaki, Eftychia; Kontochristopoulos, George

2016-03-01

Psoriasis and leg ulcers have a marked impact on the patient's quality of life and represent a life-long burden for affected patients. The aim of this study is to compare the quality of life, anxiety and depression, self-esteem, and loneliness in patients with psoriasis and leg-ulcer patients. Eighty patients with leg ulcers, eighty patients with psoriasis, and eighty healthy controls were included in this study. The quality of life, depression and anxiety, loneliness of the patient, and self-esteem were assessed using the Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS), the UCLA loneliness Scale (UCLA-Version 3), and the Rosenberg's Self-esteem Scale (RSES), respectively. The DLQI score among patients with psoriasis was 12.74 ± 4.89 and leg ulcer patients was 13.28 ± 2.57. The patients with psoriasis presented statistically significant higher anxiety (9.87 ± 4.56) than both leg ulcer patients (8.26 ± 2.82) and controls (6.45 ± 1.89), while leg ulcer patients also presented higher anxiety than controls. Regarding self-esteem, although there were no significant differences between the patients with psoriasis (15.25 ± 3.20) and the ones with leg ulcers (15.89 ± 2.93), they both presented statistically significant lower self-esteem scores than control group (18.53 ± 3.04). The patients with psoriasis presented statistically significant higher levels of loneliness and social isolation (46.18 ± 6.63) compared to leg ulcer patients (43.73 ± 5.68) than controls (42.49 ± 3.41). Psoriasis and leg ulcers are long-term skin diseases associated with significant impairment of the patient's quality of life, anxiety, and self-esteem, which are frequently under-recognized. © 2016 by the Wound Healing Society.

Compression stockings for treating venous leg ulcers: measurement of interface pressure under a new ulcer kit.

Science.gov (United States)

Partsch, B; Partsch, H

2008-01-01

The aim of this study was to measure the interface pressure of a newly designed two-layer compression stocking (Mediven ulcer kit Medi QMBH, Bayreuth, Germany) in different body positions and to compare the values with those obtained with another two-layer product. Interface pressure was measured on the distal medial leg in 16 legs of volunteers, with the basic layer alone and with the whole stocking kit in the supine, sitting and standing position for both stocking systems. The literature concerning ulcer-healing rates is reviewed. Mediven ulcerkit produced statistically significant higher pressure values than the ulcer stocking with a median resting value of 35.5 mmHg in the supine and 42.5 mmHg in the standing position. The pressure while standing comes close to values exerted by bandages. The basic layer alone applies a pressure of 20.5 mmHg. Especially designed compression stockings exerting sufficient interface pressure may be indicated in patients with small ulcers of short duration.

Epidemiology, etiology, and treatment of chronic leg ulcer ...

African Journals Online (AJOL)

Background: Chronic leg ulcer (CLU) is reported to have an impact on virtually all ... Conclusion: Most patients benefited from debridement with or without split thickness skin graft or flap. .... low incidence of arterial and venous diseases in.

Quality of life of elderly patients with leg ulcers

Directory of Open Access Journals (Sweden)

Ana Paula Cardoso Tavares

2017-10-01

Full Text Available Abstract Objectives: To identify compromised domains of the 36-Item Short Form Survey (SF-36 for elderly individuals with leg ulcers and correlate their clinical and sociodemographic variables with the SF-36's components. Method: Exploratory and cross-sectional study conducted with 50 elderly individuals with leg ulcers. The instruments were the sociodemographic and clinical form and the SF-36. The Statistical Package for the Social Sciences was used to analyze data. Results: Most were married, retired, and received one times the minimum wage, were Caucasians or of mixed race, and had hypertension. In regard to the SF-36, the most compromised domain was physical limitations, while social aspects and general health status were the less compromised domains. The SF-36 domains were not correlated with age, income, duration or size of the lesion or pain. Conclusion: The ulcer-related biopsychosocial aspects need to be considered in order to devise more effective nursing interventions.

[When to ask for a skin biopsy in a patient with leg ulcer? Retrospective study of 143 consecutive biopsies].

Science.gov (United States)

Stansal, A; Khayat, K; Duchatelle, V; Tella, E; Gautier, V; Sfeir, D; Attal, R; Lazareth, I; Priollet, P

2018-02-01

A vascular cause is found in around 85% of leg ulcer patients, but non-vascular causes are also observed. Their diagnosis is based on a set of clinical arguments and skin biopsy with histological analysis. The aim of this study was to analyze the results of these biopsies and to find common criteria for ulcers whose skin biopsies had led to the diagnosis of a non-vascular ulcer. A retrospective study was carried out on the analysis of 143 skin biopsies of leg ulcers. The reasons for the biopsy were mainly atypical clinical signs and/or the lack of improvement in care after 6 months, as advocated by the French health authorities. The skin biopsies led to a diagnosis of non-vascular ulcer in 4.9% of cases (7/143), including skin cancer (n=5, 3.5%), cutaneous leishmaniasis (n=1, 0.7%) and Pyoderma gangrenosum (n=1, 0.7%). The univariate statistical analysis revealed that an elevated rim and abnormal excessive granulation tissue were significantly more frequently found in these ulcers. All patients with a positive skin biopsy had associated vascular involvement. This study found a 5% rate of non-vascular causes of ulcers, mainly skin cancer. Elevated rims and abnormal excessive granulation tissue were the unusual features most commonly found in these ulcers. All patients whose skin biopsy revealed a non-vascular cause had associated vascular involvement. This information confirms the need to perform a skin biopsy, even in the presence of a vascular disease. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Changes in patient's quality of life comparing conservative and surgical treatment of venous leg ulcers.

Science.gov (United States)

Jankūnas, Vytautas; Rimdeika, Rytis; Jasenas, Marius; Samsanavicius, Donatas

2004-01-01

proves the decreased usage of painkillers in the group of the patients with the surgical treatment. All the patients (n=44) have had sleep disorders because of the ulcers. In the group of surgically treated patients, ulcers did not disturb the sleep after more than 3 months, and in the group, treated conservatively, the problem remained. We also found that after surgical treatment the patients were more optimistic and cried less. That shows the recovery of their emotional status. We have also found that the patients knew from the surgeon first than from the family doctor or other medical personnel about this disorder. We have made conclusions, that with the reduction of the ulcer area the pain is also reduced. Surgical treatment of ulcers (autodermoplasty) reveals a statistically reliable positive effect on patient life quality (sleep and emotions), but even 50% of patients are unaware of the real leg ulceration causes.

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

Several pathophysiologic mechanisms have been proposed to explain slow-healing leg ulcers, but little is known about the growth behavior of cells in these wounds. Platelet-derived growth factor-BB applied topically to chronic wounds has shown beneficial effects, although the effects have been less...... pronounced than would have been expected based on studies on acute wounds. The objective of this study was to compare fibroblasts in culture obtained from chronic wounds (non-healing chronic venous leg ulcers), acute wounds and normal dermis regarding growth, mitogenic response to platelet-derived growth...... chronic wounds have approached or even reached the end of their lifespan (phase III). This might provide one explanation for the non-healing state and therapy resistance to topical platelet-derived growth factor-BB of some venous leg ulcers....

Skin ulcers caused by Serratia marcescens: three cases and a review of the literature.

Science.gov (United States)

Veraldi, Stefano; Nazzaro, Gianluca

2016-08-01

Serratia marcescens is a Gram-negative, encapsulated, motile, anaerobic, non-sporulating bacillus that belongs to the Enterobacteriaceae family. It is found in water, soil, plants, food, and garbage. S. marcescens is an opportunistic pathogen. It usually causes nosocomial infections, such as lung and genitourinary infections, sinusitis, otitis, endocarditis, and sepsis. Skin infections caused by S. marcescens are rare. To describe three new cases of skin ulcers of the leg caused by S. marcescens and review the relevant literature. We investigated three patients admitted for ulcers on the leg. In two patients, post-traumatic aetiology was concluded. The modality of infection was not identified for the other patient. One patient was diabetic. All patients recovered with specific antibiotic therapy (ciprofloxacin, ceftriaxone and levofloxacin, respectively). Skin ulcers due to S. marcescens are very rare. The three cases presented here add to the limited literature of skin infections caused by S. marcescens.

Frozen allogeneic human epidermal cultured sheets for the cure of complicated leg ulcers.

Science.gov (United States)

Bolívar-Flores, Y J; Kuri-Harcuch, W

1999-08-01

Skin ulcers due to venous stasis or diabetes are common among the elderly and are difficult to treat. Repeated applications of cell-based products have been reported to result in cure or improvement of leg ulcers of small size in a fraction of patients. To examine the effects of frozen human allogeneic epidermal cultures for the treatment of acute and chronic ulcers. We treated a series of 10 consecutive patients with leg ulcers of different etiology and duration with frozen human allogeneic epidermal cultures stored frozen and thawed for 5-10 minutes at room temperature before application. Three patients had ulcers with exposed Achilles or extensor tendon. The ulcers treated were as large as 160 cm2 in area and of up to 20-years' duration. After preliminary preparation of the wounds by debridement to remove necrotic tissue and application of silver sulfadiazine to control infection, thawed cultures were applied biweekly from 2 to 15 times depending on the size and complexity of the ulcer. All ulcers healed, including those with tendon exposure. After the first few applications, granulation tissue formed in the ulcer bed and on exposed tendons, and epidermal healing took place through proliferation and migration of cells from the margins of the wound. The time required for complete healing ranged from 1 to 31 weeks after the first application. The use of frozen human allogeneic epidermal cultures is a safe and effective treatment for venous or diabetic ulcers, even those with tendon exposure. It seems possible that any leg ulcer will be amenable to successful treatment by this method.

Clinical and cost-effectiveness of compression hosiery versus compression bandages in treatment of venous leg ulcers (Venous leg Ulcer Study IV, VenUS IV): a randomised controlled trial.

Science.gov (United States)

Ashby, Rebecca L; Gabe, Rhian; Ali, Shehzad; Adderley, Una; Bland, J Martin; Cullum, Nicky A; Dumville, Jo C; Iglesias, Cynthia P; Kang'ombe, Arthur R; Soares, Marta O; Stubbs, Nikki C; Torgerson, David J

2014-03-08

Drawbacks exist with the standard treatment (four-layer compression bandages) for venous leg ulcers. We have therefore compared the clinical effectiveness and cost-effectiveness of two-layer compression hosiery with the four-layer bandage for the treatment of such ulcers. We undertook this pragmatic, open, randomised controlled trial with two parallel groups in 34 centres in England and Northern Ireland. The centres were community nurse teams or services, family doctor practices, leg ulcer clinics, tissue viability clinics or services, and wound clinics. Participants were aged 18 years or older with a venous leg ulcer and an ankle brachial pressure index of at least 0·8, and were tolerant of high compression. We randomly allocated participants (1:1) to receive two-layer compression hosiery or a four-layer bandage, using a remote randomisation service and prevalidated computer randomisation program. Participants were stratified by ulcer duration and ulcer area with permuted blocks (block sizes four and six). The primary endpoint was time to ulcer healing, with a maximum follow-up of 12 months. Although participants and health-care providers were not masked to treatment allocation, the primary endpoint was measured by masked assessment of photographs. Primary analysis was intention to treat with Cox regression, with adjustment for ulcer area, ulcer duration, physical mobility, and centre. This trial is registered with the ISRCTN register, number ISRCTN49373072. We randomly allocated 457 participants to the two treatment groups: 230 to two-layer hosiery and 227 to the four-layer bandage, of whom 453 (230 hosiery and 223 bandage) contributed data for analysis. Median time to ulcer healing was 99 days (95% CI 84-126) in the hosiery group and 98 days (85-112) in the bandage group, and the proportion of ulcers healing was much the same in the two groups (70·9% hosiery and 70·4% bandage). More hosiery participants changed their allocated treatment (38·3% hosiery vs 27�

Epidemiology, etiology, and treatment of chronic leg ulcer ...

African Journals Online (AJOL)

recovered accounting for 32.61% and 23.91%, respectively. Radiological investigation with plain. X-ray showed evidence of bony involvement in two patients. We managed our patients with wound dressing using. Table 1: Associated medical conditions seen in patients with chronic leg ulcer (n=60). Frequency Percent.

Delivery of Compression Therapy for Venous Leg Ulcers

DEFF Research Database (Denmark)

Zarchi, Kian; Jemec, Gregor B E

2014-01-01

adequate subbandage pressure when treating patients with venous leg ulcers and the factors that predict the ability to achieve optimal pressure. DESIGN, SETTING, AND PARTICIPANTS: We performed a cross-sectional study from March 1, 2011, through March 31, 2012, in home care centers in 2 Danish...

Pulmonary hypertension in patients with Martorell hypertensive leg ulcer: a case control study

Science.gov (United States)

2012-01-01

Background Martorell hypertensive ischemic leg ulcer (Martorell ulcer) is characterized by distinct alterations in the arteriolar wall of subcutaneous vessels, leading to progressive narrowing of the vascular lumen and increase of vascular resistance. These changes are similar to the alterations observed in pulmonary arterioles in patients with chronic pulmonary hypertension (PH). This study was aimed to assess an association between the two disorders. Methods In this case–control study, 14 patients with Martorell ulcer were clinically assessed for the presence of pulmonary hypertension using transthoracic Doppler echocardiography. Data from patients were compared to 28 matched hypertensive controls. Results Systolic pulmonary arterial pressure (sPAP) in patients with Martorell ulcer was significantly higher than in the control group (33.8 ± 16.9 vs 25.3 ± 6.5 mmHg, p = 0.023); the prevalence of pulmonary hypertension was 31% (5/14) in patients and 7% (2/28) in controls (p = 0.031). No differences were seen in left heart size and function between patients and controls. Conclusion This study provides first evidence that subcutaneous arteriolosclerosis, the hallmark of Martorell ulcer, is associated with PH. These findings suggest that patients with Martorell leg ulcer might be at significant risk to develop elevated pulmonary arterial pressure. Patients with leg ulcers who present with dyspnea should be evaluated by echocardiography for the presence of pulmonary hypertension. PMID:22686459

Does cryotherapy improve skin circulation compared with compression and elevation in preventing venous leg ulcers?

Science.gov (United States)

Kelechi, Teresa J; Mueller, Martina; Madisetti, Mohan; Prentice, Margie A; Dooley, Mary J

2017-08-01

This trial compared skin blood flow, temperature and incidence of venous leg ulcers in patients with chronic venous disease using compression wraps and elevation pillows. Patients with CEAP C4 skin damage and C5 history of ulcers were randomly assigned to a cryotherapy intervention (n = 138) or placebo cuff control (n = 138) applied to the lower legs over 9 months. The time the ulcers healed prior to enrollment in the study for the cryotherapy group ranged from 1 to 2218 days (n = 8, median = 32 days); for the control group, the range was 24 to 489 days (n = 6, median = 390 days). There were no statistically significant blood flow changes measured in perfusion units with a laser Doppler flowmetre within or between the groups; mean difference between the groups was 0·62, P = 0·619. No differences were noted in skin temperature measured with an infrared thermometer within and between the groups; mean difference between the groups was -0·17°C, P = 0·540. Cryotherapy did not improve skin blood flow or temperature and did not show efficacy in preventing ulcers. However, at least 30% of intervention and 50% of control participants were anticipated to develop an ulcer during the study; only ∼7% occurred. These findings suggest that strict adherence to standard of care decreases the incidence of leg ulcers and remains a best practice for leg ulcer prevention. © 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Dose-modifying factors for skin ulceration in mouse legs exposed to gamma rays

International Nuclear Information System (INIS)

Masuda, Kouji; Miyoshi, Makoto; Uehara, Satoru; Omagari, Junichi; Withers, H.R.

1996-01-01

To assess the dose-modifying factors for skin ulceration, the hind legs of mice were irradiated using gamma-rays of various doses in single exposures. The skin ulceration began to occur 2 months after irradiation, after early skin reactions such as wet desquamation, had healed completely. No new skin ulceration was observed more than 8 months after irradiation even though the observations were continued until 12 months post-irradiation. The ulceration dose 50 (UD50), a dose required to produce skin ulceration in from 2 to 8 months in 50% of the tested animals, was calculated for each treatment schedule. The preliminary shaving procedure reduced the UD50 dose to 0.85 that of the untreated controls. The ventral aspect of the hind leg was more radioresistant to single-dose irradiation than was to the dorsal aspect. The UD50 for the ventral aspect was 1.29 times that for the dorsal aspect when the skin had been previously shaved, and 1.46 times that for the unshaved control legs. The UD50 was 7 and 14% larger when mice were kept in the dorsal rather than the abdominal position during irradiation, for the preliminarily shaved and unshaved skin, respectively. (author)

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...

Leg ulcers in older people: a national study addressing variation in diagnosis, pain and sleep disturbance.

Science.gov (United States)

Hellström, Amanda; Nilsson, Camilla; Nilsson, Annina; Fagerström, Cecilia

2016-01-21

Leg ulcers commonly emerge as a symptom of other comorbidities, often in older people. As a consequence of the ulcer, pain and sleep disturbances might occur. Due to the complex illness, the responsibility of treatment is unclear between health caregivers. The interaction between ulcer type, sleep and pain has not previously been investigated. This study aimed to explore pain in older men and women (65 years and older) with different diagnoses of leg ulcers and to investigate the associations of sleep disturbances and pain in people with leg ulcer diagnosis. The study used a cross-sectional design and data from the Swedish Registry of Ulcer Treatment, collected between May 2009 and December 2013. One thousand and eight hundred and twenty four people were included, and 62.9% were women. The mean age was 83.4 years (SD 8.8). For the analyses, the chi-square test, Mann-Whitney U-test, t-test, one-way ANOVA and logistic regression was performed. Pain was measured by the Numeric Rating Scale (NRS), and sleep disturbances was assessed dichotomously. We found the prevalence of pain intensity ≥ 5 on the NRS to be 34.8% in those reporting pain. Additionally, the pain intensity was associated with the number of ulcers (p = 0.003). Sleep disturbances were associated with pain (p pain and scored higher on the NRS, no significant gender difference in sleep disturbances was found (p = 0.606). The mean NRS scores did not differ significantly between the ulcer types; however, arterial and venous-arterial ulcers increased the risk of sleep disturbances, as did higher pain scores. The majority of the participants were of advanced age (>80 years) and frequently suffered from pain and sleep disturbances. Further research is needed regarding pain, sleep and wound healing in the oldest old with leg ulcers. Ulcer pain sometimes appears to receive less attention in ulcer management, as do sleep disturbances, implying that individual needs might not be satisfactorily met

Low anti-streptokinase IgG concentrations following streptokinase-streptodornase treatment of leg ulcer patients

DEFF Research Database (Denmark)

Munkvad, S; Breuning, L; Tvedskov, Jesper

1994-01-01

We have evaluated whether neutralising anti-streptokinase IgG antibodies are produced following streptokinase-streptodornase therapy of leg ulcer patients. Serum anti-streptokinase IgG concentrations in 10 leg ulcer patients were determined before, and 1 week, 2 weeks, and 3 weeks following the t...... the treatment. We observed only a negligible increase in neutralizing anti-streptokinase IgG concentrations during the observation period, which was probably of no therapeutical significance....

Can Wound Exudate from Venous Leg Ulcers Measure Wound Pain Status?: A Pilot Study.

Directory of Open Access Journals (Sweden)

Taichi Goto

Full Text Available We investigated the associations between the self-evaluated pain status and two pain biomarker candidates, nerve growth factor and S100A8/A9, in exudate from venous leg ulcer to finally develop an objective pain evaluation method. Patients with venous leg ulcer participated in this cross-sectional observational study conducted between April and October 2014 at two medical facilities. During routine wound care, each participant self-evaluated their pain status at each examination using the 10-point numerical rating scale (present pain intensity and the short-form McGill Pain Questionnaire 2 (continuous pain, intermittent pain, neuropathic pain, affective descriptors, and total score. Venous leg ulcer exudate sample was collected after wound cleansing. The nerve growth factor and S100A8/A9 concentrations in the venous leg ulcer exudate were measured by enzyme-linked immunosorbent assay and standardized according to the wound area. The association between each pain status and the two standardized protein concentrations was evaluated using Spearman's correlation coefficient. In 30 sample collected from 13 participants, the standardized nerve growth factor concentration was negatively correlated with continuous pain (ρ = -0.47, P = 0.01, intermittent pain (ρ = -0.48, P = 0.01, neuropathic pain (ρ = -0.51, P = 0.01, and total score (ρ = -0.46, P = 0.01. The standardized S100A8/A9 concentration was positively correlated with present pain intensity (ρ = 0.46, P = 0.03 and continuous pain (ρ = 0.48, P = 0.03. Thus, these two proteins may be useful for objective evaluation of wound pain in venous leg ulcer patients.

Maggots as a wound debridement agent for chronic venous leg ulcers under graduated compression bandages: A randomised controlled trial.

Science.gov (United States)

Davies, C E; Woolfrey, G; Hogg, N; Dyer, J; Cooper, A; Waldron, J; Bulbulia, R; Whyman, M R; Poskitt, K R

2015-12-01

Slough in chronic venous leg ulcers may be associated with delayed healing. The purpose of this study was to assess larval debridement in chronic venous leg ulcers and to assess subsequent effect on healing. All patients with chronic leg ulcers presenting to the leg ulcer service were evaluated for the study. Exclusion criteria were: ankle brachial pressure indices 1.25, no venous reflux on duplex and ulcer surface covered with slough. Participants were randomly allocated to either 4-layer compression bandaging alone or 4-layer compression bandaging + larvae. Surface areas of ulcer and slough were assessed on day 4; 4-layer compression bandaging was then continued and ulcer size was measured every 2 weeks for up to 12 weeks. A total of 601 patients with chronic leg ulcers were screened between November 2008 and July 2012. Of these, 20 were randomised to 4-layer compression bandaging and 20 to 4-layer compression bandaging + larvae. Median (range) ulcer size was 10.8 (3-21.3) cm(2) and 8.1 (4.3-13.5) cm(2) in the 4-layer compression bandaging and 4-layer compression bandaging + larvae groups, respectively (Mann-Whitney U test, P = 0.184). On day 4, median reduction in slough area was 3.7 cm(2) in the 4-layer compression bandaging group (P bandaging + larvae group. Median percentage area reduction of slough was 50% in the 4-layer compression bandaging group and 84% in the 4-layer compression bandaging + larvae group (Mann-Whitney U test, P bandaging and 4-layer compression bandaging + larvae groups, respectively (Kaplan-Meier analysis, P = 0.664). Larval debridement therapy improves wound debridement in chronic venous leg ulcers treated with multilayer compression bandages. However, no subsequent improvement in ulcer healing was demonstrated. © The Author(s) 2014.

VenUS I: a randomised controlled trial of two types of bandage for treating venous leg ulcers.

Science.gov (United States)

Iglesias, C; Nelson, E A; Cullum, N A; Torgerson, D J

2004-07-01

To compare the clinical and cost-effectiveness of two different compression bandages for the healing of venous leg ulcers. A pragmatic, randomised controlled trial with an economic evaluation. Community, district nurse-led services; community leg ulcer clinics; hospital leg ulcer clinics with community outreach. A range of urban and rural settings in England and Scotland. Patients with a venous leg ulcer of at least 1-week's duration, at least 1 cm in length or width and an ankle:brachial pressure index of at least 0.8. The four-layer bandage (4LB) (which is multilayer elastic compression) compared with the short-stretch bandage (SSB) (multilayer, inelastic compression). The primary end-point was complete healing of all the ulcers on the trial leg. Secondary outcomes were the proportion of patients healed at 12 and 24 weeks, rate of recurrence, costs of leg ulcer treatment and quality of life. Between April 1999 and December 2000 the trial recruited 387 people aged from 23 to 97 years at trial entry. The majority of patients in this trial (82%; 316/387) had a reference ulcer of area bandage groups, the distribution of the cumulative times to healing of individuals in the two trial groups was compared using the log-rank test. The difference in the distribution of cumulative healing times between the individuals in the two groups was not statistically significant at the 5% level. Adjusting for the effects of variables which may influence healing (centre, baseline ulcer area, duration, episodes, ankle mobility, weight) in a Cox proportional hazards model, a statistically significant treatment effect in favour of the 4LB was identified. At any point in time, the probability of healing for individuals in the SSB treatment arm is significantly lower than that for people treated with the 4LB. Our base case economic analysis showed that the 4LB is the dominant strategy, that is, it is associated with a greater health benefit and lower costs than the SSB, although the

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.

Use of ultraportable vacuum therapy systems in the treatment of venous leg ulcer.

Science.gov (United States)

Cuomo, Roberto; Nisi, Giuseppe; Grimaldi, Luca; Brandi, Cesare; D'Aniello, Carlo

2017-10-23

The high incidence of venous leg ulcers and the difficult to give a complete healing involves in an increase of costs for National Health System. Main therapies to obtain a fast healing are compressive bandages, treatment of abnormal venous flow and in-situ-strategies of wound care. Negative pressure therapy does not conventionally used, because these systems not allow the use of compression bandages. Recently the development of ultraportable devices has improved the compliance and the results. Ten patients with venous chronic ulcer on the lower extremities were recruited for this study: all patients had venous leg ulcers from at least one year. We treated the patients with autologous partial thickness skin graft and subsequently we applied NANOVA device included in compressive bandage. We used NANOVA for fourteen days and after we made traditional medications. We submitted a questionnaire to evaluate the impact of dressing and NANOVA device in the quality of life of patients. The device contributed to the formation of granulation tissue and increased the success rate of autologous skin graft without limiting mobility of patient. In addition to this, we have been able to perform compression bandages thanks to small size of this device. Eight ulcers healed within 90 days of medication. We believe that ultraportable negative pressure systems are useful devices for treatment of venous leg ulcers because them allows to realize a compressive bandage without mobility limitations.

Saphenofemoral ligation as a safe and effective alternative for the treatment of chronic venous leg ulcer

International Nuclear Information System (INIS)

El-Hafez, Emad A.; Seleem, Mohamed I.

2004-01-01

To evaluate the effectiveness and safety of isolated saphenofemoral junction ligation for the treatment of chronic venous leg ulcer in comparison to traditional stripping procedure. 36 patients (28 men and 8 women) with mean age of 42.3+-8.7, presented with a venous leg ulcer. After taking the full history, they underwent examination for presence of edema, cellulitis or local ulcer infection. The site and size of ulceration were recorded and ankle-brachial pressure index (ABPI) was measured, Venous valvular incompetence was assessed using Valsalva testand calf compression. Patients were divided into 2 groups. Group I, (n=10) assigned for long saphenous stripping, while group II (n=26) assigned for saphenofemoral ligationan and divided combined with ligation of major tributaries under local infiltration anesthesia. Mean operative time, postoperative complications and hospital stay were recorded. The study was carried out in Benha University Hospital, Egypt and Armed Forces Hospital, Southern Region, Khamis Mushayt, Sadi Arabia between January 2000 and December 2001. The mean operative time and the hospital stay were significantly (p<0.05) reduced in group II compared to group I. The postoperative complications were signficantly (x=7.5, p<0.05) reduced in group II. Ulcer healing started after 3 months in group II and six months in group I, but by 12 month, group II had significant (x=6.7, p<0.05) number of healed ulcers (n=22, 84.6%), compared to group I (n=7, 70%). The isolated ligation of of saphenofemoral junction is a minimally invasive, safe and effective modality for treatment of chronic leg ulcer, and being easily performed under local anesthesia and considerd to be a satisfactory procedure for treatment of leg ulcer in patients who are unfit for general anesthesia. (author)

Chronic ulceration of the leg following extensive scarring due to a snake bite complicated by squamous cell carcinoma

International Nuclear Information System (INIS)

Mello, L.F.B.; Barcelos, M.G.; Nogueira Neto, N.C.; Meohas, W.; Pinto, L.W.; Melo, P.A.; Smith, J.

2000-01-01

Chronic ulcers of the leg are common in Brazil, perhaps more common than in the developed world. We report a case of a chronic ulcer of the leg following extensive scarring due to a bite by a venomous snake, which eventually led to a squamous cell carcinoma. (orig.)

Decreased hematocrit-to-viscosity ratio and increased lactate dehydrogenase level in patients with sickle cell anemia and recurrent leg ulcers.

Directory of Open Access Journals (Sweden)

Philippe Connes

Full Text Available Leg ulcer is a disabling complication in patients with sickle cell anemia (SCA but the exact pathophysiological mechanisms are unknown. The aim of this study was to identify the hematological and hemorheological alterations associated with recurrent leg ulcers. Sixty-two SCA patients who never experienced leg ulcers (ULC- and 13 SCA patients with a positive history of recurrent leg ulcers (ULC+--with no leg ulcers at the time of the study--were recruited. All patients were in steady state condition. Blood was sampled to perform hematological, biochemical (hemolytic markers and hemorheological analyses (blood viscosity, red blood cell deformability and aggregation properties. The hematocrit-to-viscosity ratio (HVR, which reflects the red blood cell oxygen transport efficiency, was calculated for each subject. Patients from the ULC+ group were older than patients from the ULC- group. Anemia (red blood cell count, hematocrit and hemoglobin levels was more pronounced in the ULC+ group. Lactate dehydrogenase level was higher in the ULC+ group than in the ULC- group. Neither blood viscosity, nor RBC aggregation properties differed between the two groups. HVR was lower and RBC deformability tended to be reduced in the ULC+ group. Our study confirmed increased hemolytic rate and anemia in SCA patients with leg ulcers recurrence. Furthermore, our data suggest that although systemic blood viscosity is not a major factor involved in the pathophysiology of this complication, decreased red blood cell oxygen transport efficiency (i.e., low hematocrit/viscosity ratio may play a role.

Quality of life psychosocial characteristics in Greek patients with leg ulcers: a case control study.

Science.gov (United States)

Kouris, Anargyros; Armyra, Kalliopi; Christodoulou, Christos; Sgontzou, Themis; Karypidis, Dimitrios; Kontochristopoulos, George; Liordou, Fotini; Zakopoulou, Nikoletta; Zouridaki, Eftychia

2016-10-01

Chronic leg ulcers are a public health problem that can have a significant impact on the patient's physical, socioeconomic and psychological status. The aim of this study is to evaluate the quality of life, anxiety and depression, self-esteem and loneliness in patients suffering from leg ulcers. A total of 102 patients were enrolled in the study. The quality of life, anxiety and depression, self-esteem and loneliness of the patient were assessed using the Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS), Rosenberg's Self-esteem Scale (RSES) and the UCLA Loneliness Scale (UCLA-Version 3), respectively. The mean DLQI score was 13·38 ± 2·59, suggesting a serious effect on the quality of life of patients. Those with leg ulcers had statistically significant higher scores according to the HADS-total scale (P = 0·031) and HADS-anxiety subscale (P = 0·015) compared with healthy volunteers. Moreover, a statistically significant difference was found between the two groups concerning the UCLA-scale (P = 0·029). Female patients presented with a higher score of anxiety (P = 0·027) and social isolation (P = 0·048), and worse quality of life (P = 0·018) than male patients. A severe quality of life impairment was documented, reflecting a significant psychosocial impact on patients with leg ulcers. © 2014 The Authors. International Wound Journal © 2014 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

The psychosocial impact of leg ulcers in patients with sickle cell disease: I don't want them to know my little secret.

Directory of Open Access Journals (Sweden)

Nkeiruka I Umeh

Full Text Available Sickle cell disease (SCD impacts millions of individuals worldwide and more than 100,000 people in the United States. Leg ulcers are the most common cutaneous manifestation of SCD. The health status of individuals living with chronic leg ulcers is not only influenced by clinical manifestations such as pain duration and intensity, but also by psychosocial factors. Garnering insights into the psychosocial impact can provide a more holistic view of their influence on quality of life.Semi-structured interviews were conducted with participants living with active SCD-associated leg ulcers or with a history of ulcers. Subjects were recruited from an ongoing study (INSIGHTS, Clin Trial.Gov NCT02156102 and consented to this qualitative phase of the study. Five areas were explored: leg ulcer pain, physical function, social-isolation, social relationships and religious support. Data was collected from 20 individuals during these interviews and a thematic analysis was performed and reported.Twenty participants with a mean age of 42.4 (SD ± 11.1years were included in the study. Major themes identified included:1 pain (acute and chronic; 2 compromised physical function as demonstrated by decreased ability to walk, run, and play sports; 3 social isolation from activities either by others or self-induced as a means of avoiding certain emotions, such as embarrassment; 4 social relationships (family support and social network; 5 support and comfort through their religion or spirituality.SCD patients with leg ulcers expressed that they experience social isolation, intense and frequent ulcer pain, and difficulty in physical function. SCD-associated leg ulcers have been studied from a clinical approach, but the psychosocial factors investigated in this study informs how quality of life is impacted by the leg ulcers.

A review of a bi-layered living cell treatment (Apligraf® in the treatment of venous leg ulcers and diabetic foot ulcers

Directory of Open Access Journals (Sweden)

Larissa Zaulyanov

2007-04-01

Full Text Available Larissa Zaulyanov, Robert S Kirsner Department of Dermatology and Cutaneous Surgery; University of Miami Miller School of Medicine, Miami, Florida, USAAbstract: Apligraf® (Organogenesis, Canton, MA is a bi-layered bioengineered skin substitute and was the first engineered skin US Food and Drug Administration (FDA-approved to promote the healing of ulcers that have failed standard wound care. Constructed by culturing human foreskin-derived neonatal fibroblasts in a bovine type I collagen matrix over which human foreskin-derived neonatal epidermal keratinocytes are then cultured and allowed to stratify, Apligraf provides both cells and matrix for the nonhealing wound. Its exact mechanism of action is not known, but it is known to produce cytokines and growth factors similar to healthy human skin. Initially approved by the FDA in 1998 for the treatment of venous ulcers greater than one-month duration that have not adequately responded to conventional therapy, Apligraf later received approval in 2000 for treatment of diabetic foot ulcers of greater than three weeks duration. Herein, we review the use of Apligraf in the treatment of chronic venous leg ulcers and diabetic foot ulcers. Our goal is to provide a working understanding of appropriate patient selection and proper use of the product for any physician treating this segment of the aging population.Keywords: wound healing, Apligraf®, venous leg ulcer, diabetic foot ulcer

Physical therapy in the treatment of venous leg ulcers: biophysical mechanisms.

Science.gov (United States)

Taradaj, Jakub; Franek, Andrzej; Blaszczak, Edward; Polak, Anna; Chmielewska, Daria; Krol, Piotr; Dolibog, Patrycja

2012-05-01

 The present study sought to estimate the hemodynamic effects inside wounds after applying infrared thermography. Clinical results were analyzed to evaluate any correspondence with hemodynamic events occurring inside the wounds. Group 1 consisted of 20 patients with venous leg ulcers (12 women, 8 men). Patients from group 1 received 1 high-voltage stimulation (HVS) procedure. Group 2 consisted of 23 patients (16 women, 7 men). Patients from group 2 received 1 ultrasound (US) procedure. Group 3 consisted of 21 patients (13 women, 8 men). Patients from group 3 received 1 low-level laser therapy (LLLT) procedure. Group 4 consisted of 23 patients (15 women, 8 men). Patients from group 4 received 1 compression therapy (CT) procedure. Group 5 consisted of 19 patients (11 women, 8 men). Patients from group 5 received 1 quasi-CT procedure. Infrared thermography was used to monitor arterial hemodynamic effects for each ulcer. Infrared thermography, based on analysis of wound surface temperatures, was used to reflect normal or abnormal arterial circulation in capillaries. The average and maximal temperatures before and after each physical procedure were measured 5, 10, 15, and 30 minutes afterward. The application of HVS and LLLT did not change the temperature inside the wounds. A significant temperature increase was noted after application of US and CT. The quasi-CT induced a thermal effect (only for a few minutes), but was not as intense as the effect of the compression stockings. The measurements showed a prolonged and steady thermal effect. The hemodynamic effect (improvement of arterial microcirculation inside the venous leg ulcer) is one of the most significant biophysical mechanisms of healing after clinically efficient compression therapy. Hemodynamic reactions are not basic mechanisms of high voltage stimulation and ultrasound therapy during the healing of venous leg ulcers. Computed thermography is a simple and useful tool to measure hemodynamic

Management of leg and pressure ulcer in hospitalized patients: direct costs are lower than expected.

Science.gov (United States)

Assadian, Ojan; Oswald, Joseph S; Leisten, Rainer; Hinz, Peter; Daeschlein, Georg; Kramer, Axel

2011-01-01

In Germany, cost calculations on the financial burden of wound treatment are scarce. Studies for attributable costs in hospitalized patients estimate for pressure ulcer additional costs of € 6,135.50 per patient, a calculation based on the assumption that pressure ulcers will lead to prolonged hospitalization averaging 2 months. The scant data available in this field prompted us to conduct a prospective economical study assessing the direct costs of treatment of chronic ulcers in hospitalized patients. The study was designed and conducted as an observational, prospective, multi-centre economical study over a period of 8 months in three community hospitals in Germany. Direct treatment costs for leg ulcer (n=77) and pressure ulcer (n=35) were determined observing 67 patients (average age: 75±12 years). 109 treatments representing 111 in-ward admissions and 62 outpatient visits were observed. During a total of 3,331 hospitalized and 867 outpatient wound therapies, 4,198 wound dressing changes were documented. Costs of material were calculated on a per item base. Direct costs of care and treatment, including materials used, surgical interventions, and personnel costs were determined. An average of € 1,342 per patient (€ 48/d) was spent for treatment of leg ulcer (staff costs € 581, consumables € 458, surgical procedures € 189, and diagnostic procedures € 114). On average, each wound dressing change caused additional costs of € 15. For pressure ulcer, € 991 per patient (€ 52/d) was spent on average (staff costs € 313, consumables € 618, and for surgical procedures € 60). Each wound dressing change resulted in additional costs of € 20 on average. When direct costs of chronic wounds are calculated on a prospective case-by-case basis for a treatment period over 3 months, these costs are lower than estimated to date. While reduction in prevalence of chronic wounds along with optimised patient care will result in substantial cost saving, this

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

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

Science.gov (United States)

Heinen, Maud M; Bartholomew, L Kay; Wensing, Michel; van de Kerkhof, Peter; van Achterberg, Theo

2006-05-01

The objective of our project was to develop a lifestyle program for leg ulcer patients at outpatient clinics for dermatology. We used the intervention-mapping (IM) framework for systematically developing theory and evidence based health promotion programs. We started with a needs-assessment. A multidisciplinary project group of health care workers and patients was involved in all five IM steps; formulating proximal program objectives, selecting methods and strategies, producing program components, planning for adoption and implementation and planning for evaluation. Several systematic literature reviews and original studies were performed to support this process. Social Cognitive Theory was selected as the main theory behind the program 'Lively Legs' and was combined with elements of Goal-Setting Theory, the precaution adoption model and motivational interviewing. The program is conducted through health counseling by dermatology nurses and was successfully pre-tested. Also, an implementation and evaluation plan were made. Intervention mapping helped us to succeed in developing a lifestyle program with clear goals and methods, operational strategies and materials and clear procedures. Coaching leg ulcer patients towards adherence with compression therapy and healthy lifestyles should be taken on without delay. Systematic development of lifestyle programs for other patient groups should be encouraged.

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

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

OBJECTIVE: This study aimed to evaluate the safety and performance of a new sustained silver-releasing dressing, Contreet Foam (Coloplast A/S), in the treatment of moderately to highly exuding chronic venous leg ulcers in which healing is delayed due to the presence of bacteria. METHOD: The clini......OBJECTIVE: This study aimed to evaluate the safety and performance of a new sustained silver-releasing dressing, Contreet Foam (Coloplast A/S), in the treatment of moderately to highly exuding chronic venous leg ulcers in which healing is delayed due to the presence of bacteria. METHOD......'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...

Symptoms and Causes of Peptic Ulcer Disease

Science.gov (United States)

... ulcer. How do H. pylori cause a peptic ulcer and peptic ulcer disease? H. pylori are spiral-shaped bacteria that ... peptic ulcer. How do tumors from ZES cause peptic ulcers? Zollinger-Ellison syndrome is a rare disorder that ...

Waldenstrom's macroglobulinemia: An unusual cause of nonhealing leg ulcers

Directory of Open Access Journals (Sweden)

Navjyot Kaur

2017-01-01

Full Text Available Waldenstrom's macroglobulinemia (WM is one of the rare hematological malignancies and accounts for 1%–2% of all blood cancers. While fatigue is the most common presentation; hyperviscosity syndrome, symptomatic cryoglobulinemia, and cold agglutinin disease (CAD are the characteristic symptoms. However, they occur only in 5%–15% of all patients of WM. We discuss a 63-year-old patient who presented with nonhealing ulcers on both lower limbs and severe anemia. His blood clotted in ethylenediaminetetraacetic acid sample tubes, and there was difficulty in getting blood cross matched for transfusing him. During evaluation, he was found to have high erythrocyte sedimentation rate, albumin globulin reversal with serum protein electrophoresis, and immunofixation suggestive of immunoglobulin M monoclonal gammopathy. There was evidence of autoimmune hemolytic anemia and skin biopsy from ulcers revealed hyaline thrombosis and deposition of cryoglobulins. He was diagnosed to have WM with cryoglobulinemia and CAD.

Adjuvant Biological Therapies in Chronic Leg Ulcers

Directory of Open Access Journals (Sweden)

Natalia Burgos-Alonso

2017-11-01

Full Text Available Current biological treatments for non-healing wounds aim to address the common deviations in healing mechanisms, mainly inflammation, inadequate angiogenesis and reduced synthesis of extracellular matrix. In this context, regenerative medicine strategies, i.e., platelet rich plasmas and mesenchymal stromal cell products, may form part of adjuvant interventions in an integral patient management. We synthesized the clinical experience on ulcer management using these two categories of biological adjuvants. The results of ten controlled trials that are included in this systematic review favor the use of mesenchymal stromal cell based-adjuvants for impaired wound healing, but the number and quality of studies is moderate-low and are complicated by the diversity of biological products. Regarding platelet-derived products, 18 controlled studies investigated their efficacy in chronic wounds in the lower limb, but the heterogeneity of products and protocols hinders clinically meaningful quantitative synthesis. Most patients were diabetic, emphasizing an unmet medical need in this condition. Overall, there is not sufficient evidence to inform routine care, and further clinical research is necessary to realize the full potential of adjuvant regenerative medicine strategies in the management of chronic leg ulcers.

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.

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....... 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...

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-sectional s...

Value of combined exercise and ultrasound as an adjunct to compression therapy in chronic venous leg ulcers

Directory of Open Access Journals (Sweden)

Rehab A.E Sallam

2017-01-01

Conclusion Combined prescription of exercises and ultrasound as an adjunct to compression therapy would be a more effective means of promoting chronic venous ulcer healing, when standard compression therapy have failed. It is safe, easy and well tolerated and should be considered as adjunctive therapy in patients with venous leg ulcers.

[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. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Mesenchymal stem cell in venous leg ulcer: An intoxicating therapy.

Science.gov (United States)

Athanerey, Anjali; Patra, Pradeep Kumar; Kumar, Awanish

2017-08-01

Venous leg ulcers (VLU) are a prevalent and reoccurring type of complicated wound, turning as a considerable public healthcare issue, with critical social and economic concern. There are both medical and surgical therapies to treat venous leg ulcers; however, a cure does not yet exist. Mesenchymal stem cells (MSC) are capable and proved of accelerating wound healing in vivo and their study with human chronic wounds is currently awaited. MSCs are a promising source of adult progenitor cells for cellular therapy and have been demonstrated to differentiate into various mesenchymal cell lineages. They have a crucial and integral role in native wound healing by regulating immune response and inflammation. Improved understanding of the cellular and molecular mechanisms at work in delayed wound healing compels to the development of cellular therapy in VLU. This review focuses on the current treatment option of VLU and further emphasizing the role of MSCs in accelerating the healing process. With further understanding of the mechanism of action of these cells in wound improvement and, the involvement of cytokines can also be revealed that could be used for the therapeutic purpose for VLU healing. Clinical uses of MSCs have been started already, and induced MSCs are surely a promising tool or compelling therapy for VLU. Copyright © 2017 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

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

Atypical leg ulcers after sclerotherapy for treatment of varicose veins: Case reports and literature review

OpenAIRE

Mwipatayi, Bibombe P.; Western, Catherine E.; Wong, Jackie; Angel, Donna

2016-01-01

Introduction: Skin necrosis is a rare complication of foam sclerotherapy, a common form of treatment for varicose veins. Presentation of case: Both patients presented to the outpatient clinic within 2–14 days after foam sclerotherapy with Aethoxysklerol® 1%, with severe soft tissue and skin necrosis. Further aggressive treatment of the ulcer was required to resolve the necrosis, resulting in marked residual scar and well granulated leg ulcer respectively. Discussion: Foam sclerotherapy ...

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

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...... 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....

The use of a dermal substitute and thin skin grafts in the cure of "complex" leg ulcers.

Science.gov (United States)

Canonico, Silvestro; Campitiello, Ferdinando; Della Corte, Angela; Fattopace, Andrea

2009-02-01

In some chronic leg ulcers, a reconstructive operation using skin grafts may be extremely difficult or is quite likely to fail as a result of the position, the width, and the depth of the lesions. To evaluate the effectiveness of a dermal substitute and thin skin grafts in the treatment of patients suffering from deep and wide chronic leg ulcers. Twenty-six consecutive patients with leg ulcers at least 1 year old were admitted to the study. The ulcers were large (>100 cm2) and deep (>3 mm) over at least 50% of the surface area. After surgical debridement of the wounds, the dermal matrix was modeled and applied. After 21 days, the attachment of the artificial dermis was tested, and in positive cases, the patient was re-admitted for "thin" skin grafting. In all patients, at the first follow-up, a notable reduction in pain, exudate, and perilesional edema was ascertained. After 2 weeks, the progressive substitution of granulation tissue with new yellow or gold derma became evident in all patients. After 21 days, the dermal matrix was completely integrated with the guest tissue. In 23 patients (88.5%), attachment of the skin graft was complete, and in three patients (11.5%), it was partial but nevertheless larger than 70% of the surface. Even in these cases, complete healing of the lesions was achieved within 4 weeks at most. All patients were checked for a minimum of 3 months, and none suffered an ulcerous recurrence. In our series, the use of this dermal matrix allowed for the complete refilling of the loss of tissue, the rapid disappearance of pain, and the rapid regeneration of a permanent dermis.

The expression of inflammatory cytokines, TAM tyrosine kinase receptors and their ligands is upregulated in venous leg ulcer patients: a novel insight into chronic wound immunity.

Science.gov (United States)

Filkor, Kata; Németh, Tibor; Nagy, István; Kondorosi, Éva; Urbán, Edit; Kemény, Lajos; Szolnoky, Győző

2016-08-01

The systemic host defence mechanisms, especially innate immunity, in venous leg ulcer patients are poorly investigated. The aim of the current study was to measure Candida albicans killing activity and gene expressions of pro- and anti-inflammatory cytokines and innate immune response regulators, TAM receptors and ligands of peripheral blood mononuclear cells separated from 69 venous leg ulcer patients and 42 control probands. Leg ulcer patients were stratified into responder and non-responder groups on the basis of wound healing properties. No statistical differences were found in Candida killing among controls, responders and non-responders. Circulating blood mononuclear cells of patients overexpress pro-inflammatory (IL-1α, TNFα, CXCL-8) and anti-inflammatory (IL-10) cytokines as well as TAM receptors (Tyro, Axl, MerTK) and their ligands Gas6 and Protein S compared with those of control individuals. IL-1α is notably overexpressed in venous leg ulcer treatment non-responders; in contrast, Axl gene expression is robustly stronger among responders. These markers may be considered as candidates for the prediction of treatment response among venous leg ulcer patients. © 2015 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

A Bioengineered Living Cell Construct Activates an Acute Wound Healing Response in Venous Leg Ulcers

OpenAIRE

Stone, Rivka C.; Stojadinovic, Olivera; Rosa, Ashley M.; Ramirez, Horacio A.; Badiavas, Evangelos; Blumenberg, Miroslav; Tomic-Canic, Marjana

2017-01-01

Chronic non-healing venous leg ulcers (VLUs) are widespread and debilitating, with high morbidity and associated costs; approximately $15 billion is spent annually on the care of VLUs in the US. Despite this, there is a paucity of treatments for VLUs, due to the lack of pathophysiologic insight into ulcer development as well as the lack of knowledge regarding biologic actions of existing VLU-targeted therapies. The bioengineered bilayered living cellular construct (BLCC) skin substitute is an...

The Impact of Venous Leg Ulcers on Body Image and Self-esteem.

Science.gov (United States)

Salomé, Geraldo Magela; de Almeida, Sergio Aguinaldo; de Jesus Pereira, Maria Teresa; Massahud, Marcelo Renato; de Oliveira Moreira, Carmelita Naira; de Brito, Maria José Azevedo; Ferreira, Lydia Masako

2016-07-01

To evaluate self-esteem and body image in patients with venous leg ulcers (VLUs). A multicenter, prospective, descriptive, analytical, clinical study. A nursing care and education center of a university hospital, a health center, and an outpatient wound care clinic in Brazil. Fifty-nine consecutive adult patients with VLUs and Doppler ankle-brachial index ranging from 0.8 to 1.0 were recruited for the study. Exclusion criteria were mixed ulcers, arterial ulcers, and diabetic foot ulcers. A questionnaire assessing sociodemographic and clinical characteristics of patients, the Brazilian version of the Body Investment Scale, and the Rosenberg Self-esteem (RSE)/UNIFESP-EPM (São Paulo da Universidade Federal de São Paulo-Escola Paulista de Medicina) scale were administered to all patients. Most participants were women, aged between 60 and 70 years, and smokers; 33 (56%) were divorced, widowed, or single, and 26 (44%) were married. The patients had the ulcer for a mean of 5.42 years. Exudate and foul odor were present in most cases. Twenty-one ulcers (36%) measured 29 cm or less in surface area, and 17 (29%) ulcers measured between 30 and 49 cm (mean, 3.39 cm). The mean RSE score was 22.66, indicating low self-esteem. The mean Body Investment Scale total score was 27.49, and the scores on the body image and body touch subscales were also low, indicating negative feelings about the body. Patients with VLUs had low self-esteem and negative feelings about their bodies.

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...... dressing application, the mean concentration of ibuprofen in the wound exudate reached a constant level of 35 +/- 21 microg/ml.After 31 days, the relative wound area had reduced by 42%, with an associated decrease in fibrin and an increase in granulation tissue.The number of patients with wound malodour...

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

[Comparison of the effectiveness and cost of treatment with humid environment as compared to traditional cure. Clinical trial on primary care patients with venous leg ulcers and pressure ulcers].

Science.gov (United States)

Capillas Pérez, R; Cabré Aguilar, V; Gil Colomé, A M; Gaitano García, A; Torra i Bou, J E

2000-01-01

The discovery of moist environment dressings as alternatives to the traditional treatments based on exposing wounds to air, opened new expectations for the care and treatment of chronic wounds. Over the years, these expectations have led to the availability of new moist environment dressings which have made it possible to improve the care provided to patients suffering this kind of wounds, as well as providing important reasons to weigh in terms of cost-benefit-effectiveness at the time of selecting which type of treatment should be employed. The lack of comparative analysis among traditional treatments and moist environment treatments for chronic wounds among patients receiving primary health care led the authors to perform an analysis comparing these aforementioned options of treatment on patients suffering venous leg ulcers or pressure ulcers. The authors designed a Randomized Clinical Trial involving patients receiving ambulatory care in order to compare the effectiveness and cost-benefit of traditional versus moist environment dressing during the treatment of patients suffering stage II or III pressure ulcers or venous leg ulcers. In this trial, variables related to effectiveness of both treatments, as well as their costs were analyzed. 70 wounds were included in this Randomized Clinical Trial, 41 were venous leg ulcers of which 21 received a moist environment treatment while 20 received traditional cure, the other 29 wounds were pressure ulcers of which 15 received moist environment dressings treatment and 14 received traditional dressings. No statistically significant differences were found among the defining variables for these lesions in either group under treatment. In the venous leg ulcer study group, the authors conclusions were an average of 18.13 days, 16.33 treatment sessions and a cost of 10,616 pesetas to heal one square centimeter of the initial surface area of a wound on patients treated with traditional treatment compared to an average of 18

[Information needs of people suffering from venous leg ulcer. Expertise of people concerned as a basis of patient-centered information].

Science.gov (United States)

Schmitz, Astrid

2011-06-01

Patient-centred information is orientated on the needs. The main objective of such information is coping with every-day life and learning to live with the chronic disease. Regarding the current knowledge, such information does not exist in German speaking countries for people suffering from venous leg ulceration. In order to generate the subject matter of such information, a literature search and a secondary analysis of 27 transcripts of interviews, given by people living with chronic leg ulceration, were conducted. Both analyses show the complex impact of leg ulceration on every-day live. The dimensions competences in every-day live, knowledge, techniques and skills and the meaning of family were generated. The secondary analysis points out that family members are an important part of the supporting system and are concerned by effects of chronic disease as well. After long-lasting disease-experience people consider themselves as experts. They obtain special competences in dealing with their disease and judge their experience-based knowledge higher than the knowledge of healthcare professionals. The participants describe individual concepts about their disease. Medical knowledge constitutes just one source of knowledge among others. People know about alternative medicine and use it. They feel that the healthcare professionals do not take them seriously in most cases. Patient-centred information can be a guide to people suffering from venous leg ulceration and their family members, but also a support for healthcare professionals to reflect their professional behaviour and understanding.

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...... telluride (CdTe(Cl)) detectors. In both groups, the change from an upright to a supine position at the beginning of the night period elicited an instantaneous increment in the blood flow rate of 30-40% with a decrease in the central and local postural sympathetic vasoconstrictor activity. After...... approximately 1 h of sleep, a considerable increase in blood flow rate was seen in both patient and control groups which persisted for nearly 100 min. In the patient group, the mean increase was 137% compared to a mean increase of 68% in the control group (P less than 0.01). The blood flow then returned...

Do ready-made compression stockings fit the anatomy of the venous leg ulcer patient?

DEFF Research Database (Denmark)

Nørregaard, S; Bermark, S; Gottrup, F

2014-01-01

. CONCLUSION: These results demonstrate that there is a need to standardise measuring methods in the selection of ready-made below-knee compression stockings and a need for an evaluation of the present stocking sizes in relation to the anatomy of the venous leg ulcer patient. This study has shown that ready...

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

OpenAIRE

Harrison, Margaret B; VanDenKerkhof, Elizabeth G; Hopman, Wilma M; Graham, Ian D; Carley, Meg E; Nelson, E Andrea

2011-01-01

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...

Impact of compression therapy using Unna's boot on the self-esteem of patients with venous leg ulcers.

Science.gov (United States)

Salome, G M; de Brito, M J A; Ferreira, L M

2014-09-01

To assess self-esteem in patients with venous leg ulcers treated with Unna's boot. • A descriptive, analytic, clinical study was conducted from June 2010 to May 2011 in an outpatient wound care clinic in São Paulo, Brazil. Patients of both sexes, aged ≥18 years, who had had a venous leg ulcer for more than one year and a Doppler ankle brachial index ranging from 0.8-1.0 were consecutively selected for inclusion. Patients were treated with wound dressings and Unna's boot. Self-esteem was assessed using the Brazilian version of the Rosenberg Self-Esteem Scale (RSE) at inclusion (baseline) and after 4, 8, and 12 months of compression therapy using Unna's boot. The scale is reverse-scored; thus lower scores indicate higher levels of self-esteem. • The patients showed a slight but significant improvement in self-esteem after 4 months of treatment (mean RSE score=17.12) compared with baseline (mean RSE score=24.90). However, a marked and significant improvement in self-esteem was observed after 8 months (mean RSE score=7.40) and 12 months (mean RSE score=2.10) of compression therapy using Unna's boot. • Patients with venous leg ulcers treated with Unna's boot for 12 months showed a significant improvement in self-esteem • All authors declare that no competing financial interests exist. There was no external funding for this study.

Shewanella alga bacteremia in two patients with lower leg ulcers

DEFF Research Database (Denmark)

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

1996-01-01

of infection. Both patients survived; however, one of them had extensive myonecrosis, while the other patient had an uncomplicated course. The strains were initially believed to be Shewanella putrefaciens on the basis of key characteristics and results of the API 20NE identification system (bioMerieux, Marcy l......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...

Leg ulcer treatment outcomes with new ovine collagen extracellular matrix dressing: a retrospective case series.

Science.gov (United States)

Bohn, Gregory A; Gass, Kimberly

2014-10-01

The purpose of this study was to describe the rate of closure observed in venous leg ulcers during treatment with ovine collagen extracellular matrix dressings and compression. Fourteen patients with 23 wounds were retrospectively evaluated with respect to healing rates, time to closure, and weekly facility charge fees.

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.

ImageJ: A Free, Easy, and Reliable Method to Measure Leg Ulcers Using Digital Pictures.

Science.gov (United States)

Aragón-Sánchez, Javier; Quintana-Marrero, Yurena; Aragón-Hernández, Cristina; Hernández-Herero, María José

2017-12-01

Wound measurement to document the healing course of chronic leg ulcers has an important role in the management of these patients. Digital cameras in smartphones are readily available and easy to use, and taking pictures of wounds is becoming a routine in specialized departments. Analyzing digital pictures with appropriate software provides clinicians a quick, clean, and easy-to-use tool for measuring wound area. A set of 25 digital pictures of plain foot and leg ulcers was the basis of this study. Photographs were taken placing a ruler next to the wound in parallel with the healthy skin with the iPhone 6S (Apple Inc, Cupertino, CA), which has a camera of 12 megapixels using the flash. The digital photographs were visualized with ImageJ 1.45s freeware (National Institutes of Health, Rockville, MD; http://imagej.net/ImageJ ). Wound area measurement was carried out by 4 raters: head of the department, wound care nurse, physician, and medical student. We assessed intra- and interrater reliability using the interclass correlation coefficient. To determine intraobserver reliability, 2 of the raters repeated the measurement of the set 1 week after the first reading. The interrater model displayed an interclass correlation coefficient of 0.99 with 95% confidence interval of 0.999 to 1.000, showing excellent reliability. The intrarater model of both examiners showed excellent reliability. In conclusion, analyzing digital images of leg ulcers with ImageJ estimates wound area with excellent reliability. This method provides a free, rapid, and accurate way to measure wounds and could routinely be used to document wound healing in daily clinical practice.

Low dose aspirin as adjuvant treatment for venous leg ulceration: pragmatic, randomised, double blind, placebo controlled trial (Aspirin4VLU).

Science.gov (United States)

Jull, Andrew; Wadham, Angela; Bullen, Chris; Parag, Varsha; Kerse, Ngaire; Waters, Jill

2017-11-24

Objective  To determine the effect of low dose aspirin on ulcer healing in patients with venous leg ulcers. Design  Pragmatic, community based, parallel group, double blind, randomised controlled trial. Setting  Five community nursing centres in New Zealand. Participants  251 adults with venous leg ulcers who could safely be treated with aspirin or placebo: 125 were randomised to aspirin and 126 to placebo. Interventions  150 mg oral aspirin daily or matching placebo for up to 24 weeks treatment, with compression therapy as standard background treatment. Main outcome measures  The primary outcome was time to complete healing of the reference ulcer (largest ulcer if more than one ulcer was present). Secondary outcomes included proportion of participants healed, change in ulcer area, change in health related quality of life, and adverse events. Analysis was by intention to treat. Results  The median number of days to healing of the reference ulcer was 77 in the aspirin group and 69 in the placebo group (hazard ratio 0.85, 95% confidence interval 0.64 to 1.13, P=0.25). The number of participants healed at the endpoint was 88 (70%) in the aspirin group and 101 (80%) in the placebo group (risk difference -9.8%, 95% confidence interval -20.4% to 0.9%, P=0.07). Estimated change in ulcer area was 4.1 cm 2 in the aspirin group and 4.8 cm 2 in the placebo group (mean difference -0.7 cm 2 , 95% confidence interval -1.9 to 0.5 cm 2 , P=0.25). 40 adverse events occurred among 29 participants in the aspirin group and 37 adverse events among 27 participants in the placebo group (incidence rate ratio 1.1, 95% confidence interval 0.7 to 1.7, P=0.71). Conclusion  Our findings do not support the use of low dose aspirin as adjuvant treatment for venous leg ulcers. Trial registration  ClinicalTrials.gov NCT02158806. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Effectiveness of an Internet-based learning program on venous leg ulcer nursing care in home health care--study protocol.

Science.gov (United States)

Ylönen, Minna; Viljamaa, Jaakko; Isoaho, Hannu; Junttila, Kristiina; Leino-Kilpi, Helena; Suhonen, Riitta

2015-10-01

To describe the study protocol for a study of the effectiveness of an internet-based learning program on venous leg ulcer nursing care (eVLU) in home health care. The prevalence of venous leg ulcers is increasing as population age. The majority of these patients are treated in a municipal home healthcare setting. However, studies show nurses' lack of knowledge of ulcer nursing care. Quasi-experimental study with pre- and postmeasurements and non-equivalent intervention and comparison groups. During the study, nurses taking care of patients with a chronic leg ulcer in home health care in one Finnish municipality will use the eVLU. Nurses working in home health care in another Finnish municipality will not use it providing standard care. Nurses will complete three questionnaires during the study and they will also be observed three times at patients' homes. Nurses' perceived and theoretical knowledge is the primary outcome of the study. Funding for this study was received from the Finnish Foundation for Nursing Education in 2014. Data from this study will provide information about the effectiveness of an internet-based educational program. After completing the program nurses will be accustomed to using internet-based resources that can aid them in the nursing care of patients with a VLU. Nurses will also have better knowledge of VLU nursing care. This study is registered with the International Clinical Trials Registry, identifier NCT02224300. © 2015 John Wiley & Sons Ltd.

Marjolin's Ulcers: A Review

African Journals Online (AJOL)

Alasia Datonye

remains a feature of this pathology even in recent times. Prognosis ... marjolin's ulcers such as chronic leg ulcers and poorly managed burns ... the distribution of the disease. ..... Squamous cell carcinoma complicating chronic venous leg.

Skin graft secured by VAC (vacuum-assisted closure) therapy in chronic leg ulcers: A controlled randomized study.

Science.gov (United States)

Leclercq, A; Labeille, B; Perrot, J-L; Vercherin, P; Cambazard, F

2016-01-01

Leg ulcers are a common condition. There have been very few studies of combined therapy involving VAC (vacuum-assisted closure) and skin graft. We performed a randomized controlled trial of VAC therapy vs. hydrocolloid dressings over 5 days following autologous grafting on chronic leg ulcers. The primary objective was to assess the difference in success (defined as a reduction in wound area of at least 50% at 1 month) between the two dressing methods. Forty-six patients with ulcers present for over one month were included. Following a 7-day hospitalization period, follow-up was performed for 3 months on an outpatient basis. Our study does not demonstrate a statistically significant difference, with a 45.8% success rate in the VAC group vs. 40.9% in the conventional dressing group (P=0.73). In the venous ulcer group, the success rate was 57.9% for VAC vs. 40% for conventional dressings (P=0.3). The difference in favor of VAC in this group was not statistically significant, most likely due to an insufficient number of patients studied. Our study does not demonstrate superiority of VAC associated with skin graft over conventional dressings. We observed more complications with VAC (40%) than with conventional dressings (23%) (P=0.06). Copyright © 2015 Elsevier Masson SAS. All rights reserved.

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

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...... 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....

A case of cutaneous large B-cell lymphoma of the legs appearing as chronic venous ulceration

Directory of Open Access Journals (Sweden)

Marta Carlesimo

2012-04-01

Full Text Available We report here a case of a woman with a cutaneous large B-cell lymphoma of the legs. She had a plaque lesion, superficially ulcerated and necrotized with tumorous borders situated on the posterior side of the right leg and two red or bluish-red nodular lesions. A skin biopsy from both nodular and plaque lesion showed a diffuse infiltrate of atypical large B cells CD20+ and CD79a+, spanning epidermis, dermis and subcutaneous tissue. A therapeutic approach containing anti-CD20 monoclonal antibody (rituximab was suggested.

[Modern approach to treatment of trophic ulcers of legs with perifocal varicose eczema, associated with mycotic infection].

Science.gov (United States)

Svetukhin, A M; Askerov, N G; Batkaev, E A; Makhulaeva, A M; Malinina, V N

2008-01-01

During 2005-2007 128 patients at the age from 21 to 80 years with extensive trophic ulcers of legs were treated in the contaminated surgery department of A.V. Vishnevsky Surgery Institute and Korolenko Hospital. In 87 patients (69.9%) varicosity was the cause of venous insufficiency, in 41 patients--post-thrombotic disease. 23 patients (17.97%) had double-sided throphic ulcers. In 50 patients (39.1%) ulcer area exceeded 40 cm2. In microscopical analysis fungi were discovered in 87 patients (89.06%). In the remaining 15 patients diagnosis was verified culturally. System etiotropic antimycotic antibacterial treatment including hyposensitizative, anti-inflammatory, antihistamine drugs was carried out. 34 patients (26.57%) received broad spectrum antibiotic from terbinafine group (Terbizil) in dosage 250 mg once a day during 3 moths with concurrent use of topical antimycotics. 34 patients (26.56%) recieved pulse therapy with broad spectrum antibiotic Rumicoz 400 mg a day during 7 days in combination with topical antimycotics. Nizoral 400 mg a day during 30 days was prescribed to 26 patients (20.3%). 34 patients (26.56%) were treated only with topical antimycotics. After preoperative preparation and reduction of inflammatory process 64 patients had underwent excision of trophic ulcers whereupon the therapy was continued. In these patients regress of varicose eczema manifestation was achieved on the 10th day. In patients who hadn't received surgical cure regress of varicose eczema was signed on the 23-25th day after onset of treatment. Question of plastic closing of throphic ulcers and wounds after their excision was solved particularly. 14 patients needed recurring surgical management becose inflammatory process was continued. Comprehensive approach to therapy taking into account mycotic semination appears to be appropriate and effective. Proactive surgical tactics (excision of throphic ulcer) allows to quicken preoperative preparation for correction of venous blood

Medical management of venous ulcers.

Science.gov (United States)

Pascarella, Luigi; Shortell, Cynthia K

2015-03-01

Venous disease is the most common cause of chronic leg ulceration and represents an advanced clinical manifestation of venous insufficiency. Due to their frequency and chronicity, venous ulcers have a high socioeconomic impact, with treatment costs accounting for 1% of the health care budget in Western countries. The evaluation of patients with venous ulcers should include a thorough medical history for prior deep venous thrombosis, assessment for an hypercoagulable state, and a physical examination. Use of the CEAP (clinical, etiology, anatomy, pathophysiology) Classification System and the revised Venous Clinical Severity Scoring System is strongly recommended to characterize disease severity and assess response to treatment. This venous condition requires lifestyle modification, with affected individuals performing daily intervals of leg elevation to control edema; use of elastic compression garments; and moderate physical activity, such as walking wearing below-knee elastic stockings. Meticulous skin care, treatment of dermatitis, and prompt treatment of cellulitis are important aspects of medical management. The pharmacology of chronic venous insufficiency and venous ulcers include essentially two medications: pentoxifylline and phlebotropic agents. The micronized purified flavonoid fraction is an effective adjunct to compression therapy in patients with large, chronic ulceration. Copyright © 2015 Elsevier Inc. All rights reserved.

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

[Personalized holistic approach to a patient with mixed leg ulcer].

Science.gov (United States)

Kovacević, Jadranka; Sinozić, Tamara

2014-10-01

Holistic approach as the philosophical orientation to care underpins the fundamental wholeness of human being and emphasizes the importance of balance within the person and between the person and his/her environment. It includes elements of the physiological, sociological, economic, psychological and spiritual dimensions, and thus providesan opportunity to assess the patient as a whole and in relation to his/ her living context. Such an integrated approach is part of the basic knowledge and skills of general practitioners/family doctors and makes them equal members of a multidisciplinary team in chronic wound patient care. In this case report on a patient with mixed leg ulcer, we will try to bring closer holistic approach in care for this kind of patients in daily practice of general practitioners/family doctors.

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

Chosen aspects of quality of life in patients with venous leg ulcers

Directory of Open Access Journals (Sweden)

Michaela Miertová

2016-12-01

Full Text Available Aim: The aim of the paper was to describe chosen aspects of quality of life in patients with venous leg ulcers treated at home in the Turiec region, and to find differences in assessing quality of life in relation to degree of adherence to external compression therapy. Design: A quantitative cross-sectional study. Methods: There were 61 patients with venous leg ulcers at 68.59 ± 9.49 years of age, with an average length of wound treatment of 6.34 ± 5.51 years. The adapted self-assessment questionnaire, the Freiburg Life Quality Assessment wound module (FLQA-w, was used to gain empirical data. Results: The findings revealed that the worst score was achieved in the category of everyday life (3.61 ± 0.93. Statistically significant differences were found between the group of respondents who apply bandages on a daily basis and those who did not use them at all. Regular bandage application is closely connected with positive assessment of wound therapy (p = 0.043, psychosocial life (p = 0.023, verbalisation of well-being in various categories (p = 0.001, assessment of state of the wound (p = 0.032, assessment of health condition (p = 0.019, and overall quality of life (p = 0.014. Length of wound treatment is related to assessments of quality of life. Conclusion: Non-healing wounds, the associated therapy and financial means required to treat them, and the pain resulting from them, are connected with physical difficulty, experience of negative emotions, and, thus, the worsening of patientsʼ quality of life. The results of the study could form the basis for further studies on similar issues.

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

Confidence and clinical judgement in community nurses managing venous leg ulceration - A judgement analysis.

Science.gov (United States)

Adderley, Una J; Thompson, Carl

2017-11-01

The variation in the management of venous leg ulceration in the UK is partly attributable to an uncertain clinical environment but the quality of judgements is influenced by the how well nurses' confidence and accuracy are aligned. To assess UK community nurses' confidence in the accuracy of their diagnostic judgements and treatment choices when managing venous leg ulceration. Judgement Analysis. UK community and primary care nursing services. 18 community non-specialist nurses working in district (home) nursing teams and general practitioner services and 18 community tissue viability specialist nurses. Using judgement analysis methods, 18 community non-specialist nurses and 18 community tissue viability specialist nurses made diagnoses and treatment judgements about compression therapy for 110 clinical scenarios and indicated their confidence for each judgement. An expert panel made consensus judgements for the same scenarios and these judgements were used as a standard against which to compare the participants. Confidence analysis was used to assess the nurses' confidence about their diagnostic judgements and treatment choices. Despite being very experienced, both non-specialist nurses' and specialist tissue viability nurses' levels of confidence were not well calibrated with their levels of accuracy. The results of this study are important as errors resulting from both over and under-confidence at the diagnostic phase of management may influence treatment choices, and thus increase the chances of treatment error. Copyright © 2017 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

Lymphogranuloma venereum causing a persistent genital ulcer.

Science.gov (United States)

Marcotte, Terrence; Lee, Yer; Pandori, Mark; Jain, Vivek; Cohen, Stephanie Elise

2014-04-01

Lymphogranuloma venereum (LGV) is a sexually transmitted cause of inguinal lymphadenopathy and proctocolitis. We report a patient with a persistent genital ulcer due to LGV (serovar L2b), an unusual presentation among US men who have sex with men. Lymphogranuloma venereum should be considered when evaluating persistent genital ulcers, and LGV-specific testing should be sought.

Complementary and alternative medicine for older adults with venous leg ulcer pain.

Science.gov (United States)

Tobón, Jeniffer

2010-11-01

Chronic pain management is an important, and often under-addressed, component in the care of older adults with venous leg ulcers (VLUs). Clinicians caring for older adults with VLUs must consider and address both the physiological and psychosocial aspects of chronic pain. Traditional pharmacological approaches to pain management are only part of the solution. One strategy is to adopt a more holistic approach to chronic pain management that includes complementary and alternative medicine (CAM) therapies. Unfortunately, there is a paucity of CAM research that focuses on the pain management of older adults with VLUs. Despite these limitations, pain management that includes discussion of relevant CAM modalities must be a priority for clinicians caring for older adults living with VLUs.

Lesões de pele causadas pelos espinhos de Mimosa pudica (Leg. Mimosoideae nos membros de bovinos e ovinos no estado do Pará Cutaneous lesions of the legs caused by the thorns of Mimosa pudica (Leg. Mimosoideae in cattle and sheep in the State of Pará

Directory of Open Access Journals (Sweden)

José Diomedes Barbosa

2009-05-01

Full Text Available Foi estudada uma doença em bovinos e ovinos caracterizada por lesões ulcerativas e granulomatosas da pele dos membros. Os estudos epidemiológicos e patológicos permitiram concluir que essas lesões são causadas pelos espinhos de Mimosa pudica (Leg. Mimosoideae. A doença foi observada somente em pastagens acentuadamente infestadas e os animais se recuperaram rapidamente após retirados destes pastos. Nos ovinos as lesões atingiam partes mais altas dos membros do que nos bovinos, devido ao seu menor porte.A condition of cattle and sheep characterized by ulcerous and granulomatous skin lesions of the legs was studied. Epidemiological data and the nature of the lesions indicate that they are caused by the thorns of Mimosa pudica (Leg. Mimosoideae. The disease was observed only in pastures largely infested by the plant, and animals recover quickly when moved from them.

Myonecrosis in the leg caused by Salmonella enteritidis

DEFF Research Database (Denmark)

Jørring, S; Kolmos, H J; Klareskov, B

1994-01-01

Five weeks after an episode of gastroenteritis, a 65-year-old diabetic male developed an extensive myonecrosis, with gas production in the left leg caused by Salmonella enteritidis. The patient was treated with surgical revision and antibiotics. To our knowledge, this is the first case of myonecr......Five weeks after an episode of gastroenteritis, a 65-year-old diabetic male developed an extensive myonecrosis, with gas production in the left leg caused by Salmonella enteritidis. The patient was treated with surgical revision and antibiotics. To our knowledge, this is the first case...

Venous ulcers -- self-care

Science.gov (United States)

... surgery to improve blood flow through your veins. Prevention If you are at risk for venous ulcers, take the steps listed above under Wound Care. ... weight if you are overweight. Manage your blood pressure and cholesterol levels. ... Venous leg ulcers - self-care; Venous insufficiency ulcers - self-care; Stasis ...

[Compression therapy: Choosing the right option for leg ulcers in 2016].

Science.gov (United States)

Senet, P; Monfort, J-B; Debure, C

2016-09-01

Compression therapy is a mandatory treatment of leg ulcers whether the goal is cure (stage C6 in the international classification for chronic venous disease) or prevention of recurrence (stage C5). Different indications for compression therapy were proposed by the French Superior Health Authority (HAS) in 2010, but new studies have modified attitudes since that time. Considering the very large number of options available, the many co-morbid conditions observed in these patients, as well as patient age and available assistance, it is important to adapt to the variable clinical and social situations encountered. One must keep in mind that a well-controlled treatment should improve trophic disorders and patient comfort. A poorly-adapted treatment with little or even deleterious effect will be abandoned by the patient. Copyright © 2016. Published by Elsevier Masson SAS.

Compression for the management of venous leg ulcers: which material do we have?

Science.gov (United States)

Partsch, Hugo

2014-05-01

Compression therapy is the most important basic treatment modality in venous leg ulcers. The review focusses on the materials which are used: 1. Compression bandages, 2. Compression stockings, 3. Self-adjustable Velcro-devices, 4. Compression pumps, 5. Hybrid devices. Compression bandages, usually applied by trained staff, provide a wide spectrum of materials with different elastic properties. To make bandaging easier, safer and more effective, most modern bandages combine different material components. Self-management of venous ulcers has become feasible by introducing double compression stockings ("ulcer kits") and self-adjustable Velcro devices. Compression pumps can be used as adjunctive measures, especially for patients with restricted mobility. The combination of sustained and intermittent compression ("hybrid device") is a promising new tool. The interface pressure corresponding to the dosage of compression therapy determines the hemodynamic efficacy of each device. In order to reduce ambulatory venous hypertension compression pressures of more than 50 mm Hg in the upright position are desirable. At the same time pressure should be lower in the resting position in order to be tolerated. This prerequisite may be fulfilled by using inelastic, short stretch material including multicomponent bandages and cohesive surfaces, all characterized by high stiffness. Such materials do not give way when calf muscles contract during walking which leads to high peaks of interface pressure ("massaging effect"). © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

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

Loss of membrane complement regulators accompanied by complement activation is suggested to be involved in the pathophysiological processes leading to tissue damage in myocardial ischaemia. In the present study we have investigated whether the same phenomenon may occur in ischaemic and/or venous...... results suggest that loss of CD59 may enhance deposition of TCC and that complement-dependent inflammation may be an important factor in the tissue-damaging processes seen in chronic leg ulcers....

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

Perforated peptic ulcer associated with abdominal compartment syndrome.

Science.gov (United States)

Lynn, Jiun-Jen; Weng, Yi-Ming; Weng, Chia-Sui

2008-11-01

Abdominal compartment syndrome (ACS) is defined as an increased intra-abdominal pressure with adverse physiologic consequences. Abdominal compartment syndrome caused by perforated peptic ulcer is rare owing to early diagnosis and management. Delayed recognition of perforated peptic ulcer with pneumoperitoneum, bowel distension, and decreased abdominal wall compliance can make up a vicious circle and lead to ACS. We report a case of perforated peptic ulcer associated with ACS. A 74-year-old man with old stroke and dementia history was found to have distended abdomen, edema of bilateral legs, and cyanosis. Laboratory tests revealed deterioration of liver and kidney function. Abdominal compartment syndrome was suspected, and image study was arranged to find the cause. The study showed pneumoperitoneum, contrast stasis in heart with decreased caliber of vessels below the abdominal aortic level, and diffuse lymphedema at the abdominal walls. Emergent laparotomy was performed. Perforated peptic ulcer was noted and the gastrorrhaphy was done. The symptoms, and liver and kidney function improved right after emergent operation.

Benign (solitary) ulcer of the rectum - another cause for rectal stricture

Energy Technology Data Exchange (ETDEWEB)

Chapa, H.J.; Smith, H.J.; Dickinson, T.A.

1981-01-15

Benign rectal ulcer syndrome is an uncommon cause of lower gastrointestinal bleeding. Patients may present with mild, often recurrent, rectal bleeding frequently ascribed to hemorrhoids. Barium enema may be normal during the early, nonulcerative phase of proctitis. Single (or multiple) ulcers with or without rectal stricture are the hallmarks of the radiographic diagnosis. Radiologic demonstration of the ulcer(s) is not required, however, for the diagnosis. Benign rectal ulcer should be included in the differential diagnosis of benign-appearing rectal strictures.

In search of optimal compression therapy for venous leg ulcers: a meta-analysis of studies comparing diverse [corrected] bandages with specifically designed stockings.

Science.gov (United States)

Amsler, Felix; Willenberg, Torsten; Blättler, Werner

2009-09-01

In search of an optimal compression therapy for venous leg ulcers, a systematic review and meta-analysis was performed of randomized controlled trials (RCT) comparing compression systems based on stockings (MCS) with divers bandages. RCT were retrieved from six sources and reviewed independently. The primary endpoint, completion of healing within a defined time frame, and the secondary endpoints, time to healing, and pain were entered into a meta-analysis using the tools of the Cochrane Collaboration. Additional subjective endpoints were summarized. Eight RCT (published 1985-2008) fulfilled the predefined criteria. Data presentation was adequate and showed moderate heterogeneity. The studies included 692 patients (21-178/study, mean age 61 years, 56% women). Analyzed were 688 ulcerated legs, present for 1 week to 9 years, sizing 1 to 210 cm(2). The observation period ranged from 12 to 78 weeks. Patient and ulcer characteristics were evenly distributed in three studies, favored the stocking groups in four, and the bandage group in one. Data on the pressure exerted by stockings and bandages were reported in seven and two studies, amounting to 31-56 and 27-49 mm Hg, respectively. The proportion of ulcers healed was greater with stockings than with bandages (62.7% vs 46.6%; P bandages better than MCS. Pain was assessed in three studies (219 patients) revealing an important advantage of stockings (P bandages, has a positive impact on pain, and is easier to use.

Comparison Between a New, Two-component Compression System With Zinc Paste Bandages for Leg Ulcer Healing: A Prospective, Multicenter, Randomized, Controlled Trial Monitoring Sub-bandage Pressures.

Science.gov (United States)

Mosti, Giovanni; Crespi, Aldo; Mattaliano, Vincenzo

2011-05-01

Compression therapy is standard treatment for venous leg ulcers. The authors prefer multi-layer, multi-component, stiff, high-pressure bandages to treat venous leg ulcers. The Unna boot (UB) is an example of this type of bandage. The aim of this study was to compare the effectiveness and tolerability of UB to a new, two-component bandage. One hundred (100) patients with venous ulcers were randomized into two groups: group A (n = 50) received UB and group B (n = 50) 3M™ Coban™ 2 Layer Compression System (C2L). All patients were followed weekly for 3 months and then monthly until complete healing was achieved. The primary outcomes were: ulcer healing or surface reduction; pain; and exudate control. The secondary outcomes were: ease of application and removal of the bandage, pressure exerted in the supine and standing position after application and before removal, and bandage comfort. C2L was associated with 100% ulcer healing; 47 out of 50 cases healed within the first 3 months after application of the bandage. Compared with the UB, there was no statistically significant difference. In both groups the effect of compression on pain and overall well being was excellent; pain decreased by 50% within 1-2 weeks and remained low throughout the duration of treatment and overall well being improved significantly. There was no significant difference between the two systems concerning level of comfort. C2L proved to be effective in treating venous ulcers due to its stiffness and pressure. Its effectiveness was similar to UB, which is often considered the gold-standard compression device for venous ulcers. This fact, in combination with high tolerability and ease of application and removal, make this new bandage particularly suitable for the treatment of venous leg ulcers. .

Pyoderma Gangrenosum–Like Ulcer in a Patient With X-Linked Agammaglobulinemia

Science.gov (United States)

Murray, Patrick R.; Jain, Ashish; Uzel, Gulbu; Ranken, Raymond; Ivy, Cristina; Blyn, Lawrence B.; Ecker, David J.; Sampath, Rangarajan; Lee, Chyi-Chia Richard; Turner, Maria L.

2011-01-01

Background Pyoderma gangrenosum–like ulcers and cellulitis of the lower extremities associated with recurrent fevers in patients with X-linked (Bruton) agammaglobulinemia have been reported to be caused by Helicobacter bilis (formerly classified as Flexispira rappini and then Helicobacter strain flexispira taxon 8). Consistent themes in these reports are the difficulty in recovering this organism in blood and wound cultures and in maintaining isolates in vitro. We confirmed the presence of this organism in a patient’s culture by using a novel application of gene amplification polymerase chain reaction and electrospray ionization time-of-flight mass spectrometry. Observation An adolescent boy with X-linked agammaglobulinemia presented with indurated plaques and a chronic leg ulcer whose origin was strongly suspected to be an H bilis organism. Histologic analysis demonstrated positive Warthin-Starry staining of curvilinear rods, which grew in culture but failed to grow when sub-cultured. They could not be identified by conventional techniques. A combination of gene amplification by polymerase chain reaction and electrospray ionization time-of-flight mass spectrometry confirmed the identity of this organism. Conclusions This novel technology was useful in the identification of a difficult-to-grow Helicobacter organism, the cause of pyoderma gangrenosum–like leg ulcers in patients with X-linked agammaglobulinemia. Correct identification of this organism as the cause of pyoderma gangrenosum–like ulcers in patients with X-linked agammaglobulinemia is of great importance for the early initiation of appropriate and curative antibiotic therapy. PMID:20479300

The effects of intermittent negative pressure on the lower extremities' peripheral circulation and wound healing in four patients with lower limb ischemia and hard-to-heal leg ulcers: a case report.

Science.gov (United States)

Sundby, Øyvind H; Høiseth, Lars Ø; Mathiesen, Iacob; Jørgensen, Jørgen J; Sundhagen, Jon O; Hisdal, Jonny

2016-10-01

Peripheral circulation is severely compromised in the advanced stages of peripheral arterial disease. Recently, it was shown that the application of -40 mmHg intermittent negative pressure (INP) to the lower leg and foot enhances macro- and microcirculation in healthy volunteers. In this case report, we describe the effects of INP treatment on four patients with lower limb ischemia and hard-to-heal leg and foot ulcers. We hypothesized that INP therapy may have beneficial hemodynamic and clinical effects in the patients. Four patients (age range: 61-79 years) with hard-to-heal leg and foot ulcers (6-24 months) and ankle-brachial pressure indices of ≤0.60 on the affected side were included. They were treated with an 8-week intervention period of -40 mmHg INP (10 sec negative pressure and 7 sec atmospheric pressure) on the lower limbs. A custom-made vacuum chamber was used to apply INP to the affected lower leg and foot for 2 h per day. After 8 weeks of INP therapy, one ulcer healed completely, while the other three ulcers were almost completely healed. These cases suggest that INP may facilitate wound healing. The theoretical foundation is that INP assists wound healing by improving blood flow to the small blood vessels in the affected limb, increasing the flow of oxygen and nutrients to the cells. © 2016 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society.

The influence of different sub-bandage pressure values on venous leg ulcers healing when treated with compression therapy.

Science.gov (United States)

Milic, Dragan J; Zivic, Sasa S; Bogdanovic, Dragan C; Jovanovic, Milan M; Jankovic, Radmilo J; Milosevic, Zoran D; Stamenkovic, Dragan M; Trenkic, Marija S

2010-03-01

Venous leg ulcers (VLU) have a huge social and economic impact. An estimated 1.5% of European adults will suffer a venous ulcer at some point in their lives. Despite the widespread use of bandaging with high pressure in the treatment of this condition, recurrence rates range between 25% to 70%. Numerous studies have suggested that the compression system should provide sub-bandage pressure values in the range from 35 mm Hg to 45 mm Hg in order to achieve the best possible healing results. An open, randomized, prospective, single-center study was performed in order to determine the healing rates of VLU when treated with different compression systems and different sub-bandage pressure values. One hundred thirty-one patients (72 women, 59 men; mean age, 59-years-old) with VLU (ulcer surface >3 cm(2); duration >3 months) were randomized into three groups: group A - 42 patients who were treated using an open-toed, elastic, class III compression device knitted in tubular form (Tubulcus, Laboratoires Innothera, Arcueil, France); group B - 46 patients treated with the multi-component bandaging system comprised of Tubulcus and one elastic bandage (15 cm wide and 5 cm long with 200% stretch, Niva, Novi Sad, Serbia); and group C - forty-three patients treated with the multi-component bandaging system comprised of Tubulcus and two elastic bandages. Pressure measurements were taken with the Kikuhime device (TT MediTrade, Soro, Denmark) at the B1 measuring point in the supine, sitting, and standing positions under the three different compression systems. The median resting values in the supine and standing positions in examined study groups were as follows: group A - 36.2 mm Hg and 43.9 mm Hg; group B - 53.9 mm Hg and 68.2 mm Hg; group C - 74.0 mm Hg and 87.4 mm Hg. The healing rate during the 26-week treatment period was 25% (13/42) in group A, 67.4% (31/46) in group B, and 74.4% (32/43) in group C. The success of compression treatment in group A was strongly associated with the

Case report 379: 'Ulcer osteoma' associated with sickle cell disease

International Nuclear Information System (INIS)

Wiggins, T.; Bohrer, S.P.

1986-01-01

In summary, a 32-year-old black man with homozygous sickle cell anemia has been presented. The patient developed bilateral ulcers of the leg which never completely healed. In one leg he demonstrated a focal, fusiform, periosteal reaction which probably in time would become incorporated into the cortex, resulting in the formation of an ulcer osteoma of the tibia associated with sickle cell disease. The ulcer osteoma has the same radiological appearance as the ulcer osteoma in individuals in Africa without sickle cell disease. (orig./SHA)

Extracorporal Shock Waves Activate Migration, Proliferation and Inflammatory Pathways in Fibroblasts and Keratinocytes, and Improve Wound Healing in an Open-Label, Single-Arm Study in Patients with Therapy-Refractory Chronic Leg Ulcers.

Science.gov (United States)

Aschermann, Ilknur; Noor, Seema; Venturelli, Sascha; Sinnberg, Tobias; Mnich, Christian D; Busch, Christian

2017-01-01

Chronic leg ulcers (CLUs) are globally a major cause of morbidity and mortality with increasing prevalence. Their treatment is highly challenging, and many conservative, surgical or advanced therapies have been suggested, but with little overall efficacy. Since the 1980s extracorporal shock wave therapy (ESWT) has gained interest as treatment for specific indications. Here, we report that patients with CLU showed wound healing after ESWT and investigated the underlying molecular mechanisms. We performed cell proliferation and migration assays, FACS- and Western blot analyses, RT-PCR, and Affymetrix gene expression analyses on human keratinocytes and fibroblasts, and a tube formation assay on human microvascular endothelial cells to assess the impact of shock waves in vitro. In vivo, chronic therapy-refractory leg ulcers were treated with ESWT, and wound healing was assessed. Upon ESWT, we observed morphological changes and increased cell migration of keratinocytes. Cell-cycle regulatory genes were upregulated, and proliferation induced in fibroblasts. This was accompanied by secretion of pro-inflammatory cytokines from keratinocytes, which are known to drive wound healing, and a pro-angiogenic activity of endothelial cells. These observations were transferred "from bench to bedside", and 60 consecutive patients with 75 CLUs with different pathophysiologies (e.g. venous, mixed arterial-venous, arterial) were treated with ESWT. In this setting, 41% of ESWT-treated CLUs showed complete healing, 16% significant improvement, 35% improvement, and 8% of the ulcers did not respond to ESWT. The induction of healing was independent of patient age, duration or size of the ulcer, and the underlying pathophysiology. The efficacy of ESWT needs to be confirmed in controlled trials to implement ESWT as an adjunct to standard therapy or as a stand-alone treatment. Our results suggest that EWST may advance the treatment of chronic, therapy-refractory ulcers. © 2017 The Author

Extracorporal Shock Waves Activate Migration, Proliferation and Inflammatory Pathways in Fibroblasts and Keratinocytes, and Improve Wound Healing in an Open-Label, Single-Arm Study in Patients with Therapy-Refractory Chronic Leg Ulcers

Directory of Open Access Journals (Sweden)

Ilknur Aschermann

2017-02-01

Full Text Available Background/Aims: Chronic leg ulcers (CLUs are globally a major cause of morbidity and mortality with increasing prevalence. Their treatment is highly challenging, and many conservative, surgical or advanced therapies have been suggested, but with little overall efficacy. Since the 1980s extracorporal shock wave therapy (ESWT has gained interest as treatment for specific indications. Here, we report that patients with CLU showed wound healing after ESWT and investigated the underlying molecular mechanisms. Methods: We performed cell proliferation and migration assays, FACS- and Western blot analyses, RT-PCR, and Affymetrix gene expression analyses on human keratinocytes and fibroblasts, and a tube formation assay on human microvascular endothelial cells to assess the impact of shock waves in vitro. In vivo, chronic therapy-refractory leg ulcers were treated with ESWT, and wound healing was assessed. Results: Upon ESWT, we observed morphological changes and increased cell migration of keratinocytes. Cell-cycle regulatory genes were upregulated, and proliferation induced in fibroblasts. This was accompanied by secretion of pro-inflammatory cytokines from keratinocytes, which are known to drive wound healing, and a pro-angiogenic activity of endothelial cells. These observations were transferred “from bench to bedside”, and 60 consecutive patients with 75 CLUs with different pathophysiologies (e.g. venous, mixed arterial-venous, arterial were treated with ESWT. In this setting, 41% of ESWT-treated CLUs showed complete healing, 16% significant improvement, 35% improvement, and 8% of the ulcers did not respond to ESWT. The induction of healing was independent of patient age, duration or size of the ulcer, and the underlying pathophysiology. Conclusions: The efficacy of ESWT needs to be confirmed in controlled trials to implement ESWT as an adjunct to standard therapy or as a stand-alone treatment. Our results suggest that EWST may advance the

Venous Ulcers

Science.gov (United States)

Caprini, J.A.; Partsch, H.; Simman, R.

2013-01-01

Venous leg ulcers are the most frequent form of wounds seen in patients. This article presents an overview on some practical aspects concerning diagnosis, differential diagnosis and treatment. Duplex ultrasound investigations are essential to ascertain the diagnosis of the underlying venous pathology and to treat venous refluxes. Differential diagnosis includes mainly other vascular lesions (arterial, microcirculatory causes), hematologic and metabolic diseases, trauma, infection, malignancies. Patients with superficial venous incompetence may benefit from endovenous or surgical reflux abolition diagnosed by Duplex ultrasound. The most important basic component of the management is compression therapy, for which we prefer materials with low elasticity applied with high initial pressure (short-stretch bandages and Velcro-strap devices). Local treatment should be simple, absorbing and not sticky dressings keeping adequate moisture balance after debridement of necrotic tissue and biofilms are preferred. After the ulcer is healed compression therapy should be continued in order to prevent recurrence. PMID:26236636

BURULI ULCER THE (1)

African Journals Online (AJOL)

We report a 22 years old female patient from Southern Ethiopia with ulcerative form of Buruli ulcer on the left leg. The case suffered for more ... general, there is no difference in the infection rate among males and ... 'Department of Pediatrics and Child Health, College of Public Health and Medical Sciences, Jimma University.

Benign (solitary) ulcer of the rectum - another cause for rectal stricture

International Nuclear Information System (INIS)

Chapa, H.J.; Smith, H.J.; Dickinson, T.A.; Veterans Administration Hospital, Dallas, TX; Texas Univ., Dallas

1981-01-01

Benign rectal ulcer syndrome is an uncommon cause of lower gastrointestinal bleeding. Patients may present with mild, often recurrent, rectal bleeding frequently ascribed to hemorrhoids. Barium enema may be normal during the early, nonulcerative phase of proctitis. Single (or multiple) uclers with or without rectal stricture are the hallmarks of the radiographic diagnosis. Radiologic demonstration of the ulcer(s) is not required, however, for the diagnosis. Benign rectal ulcer should be included in the differential diagnosis of benign-appearing rectal strictures. (orig.) [de

History of venous leg ulcers.

Science.gov (United States)

Gianfaldoni, S; Wollina, U; Lotti, J; Gianfaldoni, R; Lotti, T; Fioranelli, M; Roccia, M G

To retrieve the history of venous ulcers and of skin lesions in general, we must go back to the appearance of human beings on earth. It is interesting to note that cutaneous injuries evolved parallel to human society. An essential first step in the pathogenesis of ulcers was represented by the transition of the quadruped man to Homo Erectus. This condition was characterized by a greater gravitational pressure on the lower limbs, with consequences on the peripheral venous system. Furthermore, human evolution was characterized by an increased risk of traumatic injuries, secondary to his natural need to create fire and hunt (e.g. stones, iron, fire, animal fighting). Humans then began to fight one another until they came to real wars, with increased frequency of wounds and infectious complications. The situation degraded with the introduction of horse riding, introduced by the Scites, who first tamed animals in the 7th century BC. This condition exhibited iliac veins at compression phenomena, favouring the venous stasis. With time, man continued to evolve until the modern age, which is characterized by increased risk factors for venous wounds such as poor physical activity and dietary errors (1, 2).

Novel Surgical Treatment for Refractory Heel Ulcers in Werner’s Syndrome

Directory of Open Access Journals (Sweden)

Keisuke Oe

2013-01-01

Full Text Available Patients with Werner’s syndrome frequently develop chronic leg ulcers that heal poorly. We present a patient who suffered from this rare syndrome and developed typical heel ulcers. Treatment of the ulcer is challenging, as flap options are limited over the lower third of the leg and skin grafting is not easy as there is a lack of healthy granulations. We successfully treated the ulcer with osteomyelitis by drilling the bone and applying an ultrathin split thickness skin graft with the thigh skin as the donor site.

A multicenter, randomized, controlled clinical trial evaluating the use of dehydrated human amnion/chorion membrane allografts and multilayer compression therapy vs. multilayer compression therapy alone in the treatment of venous leg ulcers.

Science.gov (United States)

Serena, Thomas E; Carter, Marissa J; Le, Lam T; Sabo, Matthew J; DiMarco, Daniel T

2014-01-01

Venous leg ulcers produce significant clinical and economic burdens on society and often require advanced wound therapy. The purpose of this multicenter, randomized, controlled study is to evaluate the safety and efficacy of one or two applications of dehydrated human amnion/chorion membrane allograft and multilayer compression therapy vs. multilayer compression therapy alone in the treatment of venous leg ulcers. The primary study outcome was the proportion of patients achieving 40% wound closure at 4 weeks. Of the 84 participants enrolled, 53 were randomized to receive allograft and 31 were randomized to the control group of multilayer compression therapy alone. At 4 weeks, 62% in the allograft group and 32% in the control group showed a greater than 40% wound closure (p = 0.005), thus showing a significant difference between the allograft-treated groups and the multilayer compression therapy alone group at the 4-week surrogate endpoint. After 4 weeks, wounds treated with allograft had reduced in size a mean of 48.1% compared with 19.0% for controls. Venous leg ulcers treated with allograft had a significant improvement in healing at 4 weeks compared with multilayer compression therapy alone. © 2014 by the Wound Healing Society.

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

Macro- and microperfusion during application of a new compression system, designed for patients with leg ulcer and concomitant peripheral arterial occlusive disease.

Science.gov (United States)

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

2013-01-01

To investigate macro- and microperfusion during 14 days of treatment with a new 2-layer compression system (3M™ Coban™ 2 Lite), designed for patients with leg ulcer and concomitant peripheral arterial occlusive disease. A single-centre, open-label, prospective pilot study was performed with 15 subjects suffering from peripheral arterial occlusive disease with an ankle brachial pressure index (ABPI) of 0.5-0.8, who volunteered to have their 'study leg' bandaged with the new system. Coincident leg ulcer or chronic venous disease was not mandatory. All subjects received the new compression system, which stayed in place from 1 up to 4 days according to scheduled study visits. The system was reapplied by study personnel at each clinical visit (days 1, 2, 3, 4, 7, 10 and 14). The study participation stopped after 14 days. At each clinical visit safety assessments were performed: measurement of acral pulsation to capture macroperfusion; laser Doppler fluxmetry to capture microperfusion; clinical signs of pressure related skin damage, hypoxia-related pain and sub-bandage pressure measurement. In addition, the leg volume was measured and a comfort questionnaire was completed. An average sub-bandage pressure in standing position of approximately 30 mmHg was measured at the B1 location immediately after bandage application. Laser Doppler fluxmetry demonstrated positive effects on microcirculation regarding vasomotion and respiratory reflux. No change of the cardiac signal appeared. For acrale pulsations a high intraindividual variability was found with no clear interference to the bandage application. No pressure-related skin damage or hypoxia-related pain was detected. After application of the new compression system in subjects with moderate PAOD, laser Doppler fluxmetry indicated significant improvements of the microcirculation. High variability and lack of correlation to clinical symptoms was found for the acral pulsation. The new compression system revealed a high

Ulcerative colitis masked by giant urticaria.

Science.gov (United States)

Caroselli, C; Plocco, M; Pratticò, F; Bruno, C; Antonaglia, C; Rota, F; Curreli, I; Caroselli, A; Bruno, G

2007-01-01

The occurrence of giant urticaria and ulcerative colitis is very infrequent. A 23 year-old female reported the initial eruption of short-lived cutaneous itchy weals on her arms. Then lesions ran together and became confluent, extending to her legs, followed by undefined abdominal pain and a slight increase of body temperature. Exams showed hystologically confirmed ulcerative colitis, with perinuclear anti-neutrophil cytoplasmic antibody positivity. Ulcerative colitis therapy led not only to the remission of the colitic symptoms, but also to the prompt recovery of skin manifestations. Urticaria was the epiphenomenon of ulcerative colitis.

Opinions in Denmark on the causes of peptic ulcer disease. A survey among Danish physicians and patients

DEFF Research Database (Denmark)

Christensen, A H; Gjørup, T; Andersen, I B

1994-01-01

The aim of the study was to investigate opinions among Danish patients and physicians on causes of peptic ulcer disease. Fifty-nine patients with an ulcer history and 77 physicians with a special interest in gastroenterology participated. They were given a questionnaire listing 16 possible causes...... of peptic ulcer and indicated for each whether they believed it was a contributory cause of the disease. The patients stated 0-10 causes each (median, 4), and the physicians 3-12 causes (median, 6) (p ... stated more causes than did their male colleagues (p peptic ulcer disease, whereas only around 40% believed that coffee/tea, alcohol, smoking, side effects...

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

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

Science.gov (United States)

2011-01-01

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-12 Physical

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.

Pain-relieving properties of topically applied morphine on arterial leg ulcers: a pilot study.

NARCIS (Netherlands)

Jansen, M.M.; Horst, J.C. van der; Valk, P.G.M. van der; Kuks, P.F.M.; Zylicz, Z.; Sorge, A.A. van

2009-01-01

OBJECTIVE: To assess whether topical morphine is pharmacologically effective in relieving pain from ulcers caused by arterial insufficiency and identify whether this effect is centrally or peripherally mediated. METHOD: The analgesic effect of a topically applied hydrogel containing 0.5% of morphine

Comparative Clinical Study of the Wound Healing Effects of a Novel Micropore Particle Technology: Effects on Wounds, Venous Leg Ulcers, and Diabetic Foot Ulcers

Science.gov (United States)

Bilyayeva, Olga O; Neshta, Viacheslav V; Golub, Alexander A; Sams-Dodd, Frank

2017-08-01

The purpose of this study was to determine the wound healing effects of Acapsil, a white, odorless powder based on micropore particle technology (MPPT) (Willingsford Ltd, Southampton, UK) by comparing it to Gentaxane (Gentaksan, Borshchagovsky CCP, Kyiv, Ukraine) (polydimethylsiloxane powder with gentamicin antibiotic) and Ioddicerin (Farmak, Kyiv, Ukraine) (iodine with dimethyl sulfoxide [DMSO]). The study included 266 patients with primarily trophic ulcers caused by pancreatic diabetes and venous insufficiency of the lower extremities, carbuncles, phlegmons, infected third- or fourth-degree heat burns, and infiltrations of postoperative wounds. The products were applied once daily to the wound until it was clean (ie, free from necrosis, pus, and fibrinogenous thickenings). The number of days (mean ± standard deviation) to a clean wound was 3.0 ± 0.9 for MPPT (n = 88) compared with 7.0 ± 1.2 and 8.0 ± 1.1 for Gentaxane (n = 90) and iodine/DMSO (n = 88), respectively. Thus, MPPT reduced the time to reach a clean wound by 57% and 62%, respectively. Products were used once daily until a clean wound was reached, which also reflects the number of applications. Days to onset of granulation for MPPT, Gentaxane, and iodine/DMSO were 4.5 ± 0.8, 9.2 ± 1.4, and 10.3 ± 1.5 days, respectively; and days to onset of epithelialization were 7.8 ± 1.1, 14.1 ± 1.9, and 16.4 ± 2.7 days, respectively. Subgroup analysis of patients with diabetic foot and venous leg ulcers found that each of these demonstrated the same pattern of healing as the overall study. The number of hospitalization days was 14.6 ± 5.6 for MPPT, 21.0 ± 10.7 for Gentaxane, and 24.0 ± 7.9 for iodine/DMSO. Compared with Gentaxane, patients receiving MPPT had a 31% reduction in hospitalization duration and a 39% reduction compared with iodine/DMSO. These findings demonstrate that MPPT represents a valuable new approach to wound care.

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

Definition and Facts for Peptic Ulcers (Stomach Ulcers)

Science.gov (United States)

... an H. pylori infection never develop a peptic ulcer. Peptic ulcers caused by H. pylori are uncommon in ... saliva or other bodily fluids. 3 Who develops peptic ulcers caused by tumors? People who have Zollinger-Ellison ...

A patient with foot ulcer and severe metabolic alkalosis.

Science.gov (United States)

John, Ruby Samuel; Simoes, Sonia; Reddi, Alluru S

2012-01-01

We report a case of triple acid-base disorder with metabolic alkalosis as the primary disorder in a 65-year-old man due to ingestion and application to leg ulcers of baking soda (calcium bicarbonate). The blood pH was 7.65 with hypochloremia, hypokalemia, and prerenal azotemia. He was treated with isotonic saline with K replacement, and the patient improved without any adverse clinical consequences. We discuss the causes, mechanisms, and management of Cl-responsive (depletion) metabolic alkalosis.

Opinions in Denmark on the causes of peptic ulcer disease. A survey among Danish physicians and patients

DEFF Research Database (Denmark)

Christensen, A H; Gjørup, T; Andersen, I B

1994-01-01

stated more causes than did their male colleagues (p stress, were contributory causes of peptic ulcer disease, whereas only around 40% believed that coffee/tea, alcohol, smoking, side effects...... of medicine, and working conditions played a causal role. Around 95% of the physicians indicated that medical drugs and smoking were contributory causes of peptic ulcer disease, and around 80% that alcohol and psychologic factors were so. Only 30-40% of the physicians believed that coffee/tea, food habits......, infection, and working conditions could play a causal role in ulcer disease. It is concluded that the opinion on causal agents in peptic ulcer disease differ considerably among both patients and physicians. Opinions on causes of diseases may influence the way we treat and advise our patients, and attempts...

Ulcer due to chronic venous disease: a sociodemographic study in northeastern Brazil.

Science.gov (United States)

de Souza, Edson Marques; Yoshida, Winston Bonetti; de Melo, Valdinaldo Aragão; Aragão, José Aderval; de Oliveira, Luiz Augusto Bitencurt

2013-07-01

Venous ulcers account for 70% of chronic leg ulcers and affect about 2-7% of the population, causing much socioeconomic impact and reducing patients' quality of life. In this study we aimed to describe the clinical features of venous ulcers and sociodemographic characteristics of patients with ulcers due to chronic venous disease (CVD). This cross-sectional, observational study was conducted at the Vascular Surgery Service, Universidade Federal de Sergipe, in northeastern Brazil. The study included a consecutive series of 154 patients with active venous ulcers (CEAP C6) in the lower limb due to CVD. Sociodemographic characteristics (age, gender, race, monthly income, education, occupation, and caregiver) and clinical data (affected limb, ulcer site, etiopathogenesis, recurrence, and time elapsed since the first episode of ulcer) were collected. A possible correlation of time elapsed since the first episode of ulcer and number of recurrences with primary or secondary etiology was analyzed by Mann-Whitney U-test. Of the 154 patients analyzed, 79% were female, 94% were ethnically black or brown, 90% had a monthly income less than or equal to minimum wage, 47% were illiterate, 35% had not completed elementary school, 50% had informal jobs, 19.5% were retired, and 18.2% received sick pay from the social security system. The mean age was 53.7 years. Both limbs were affected similarly, and venous ulcers were located predominantly on the medial aspect of the leg (84%). The median time elapsed since the first episode of ulcer was 36 months, being significantly higher in patients with venous ulcers of secondary etiology (P < 0.0003). The prevalence of recurrence was also significantly higher in patients with venous ulcers of secondary etiology (P < 0.001). According to CEAP classification, 65% of ulcers were primary (Ep), 94.1% demonstrated reflux involving the superficial system (As), 92% had incompetent perforators (Ap), 35% demonstrated reflux involving the deep system

Pyoderma gangrenosum-like ulcer in a patient with X-linked agammaglobulinemia: identification of Helicobacter bilis by mass spectrometry analysis.

Science.gov (United States)

Murray, Patrick R; Jain, Ashish; Uzel, Gulbu; Ranken, Raymond; Ivy, Cristina; Blyn, Lawrence B; Ecker, David J; Sampath, Rangarajan; Lee, Chyi-Chia Richard; Turner, Maria L

2010-05-01

Pyoderma gangrenosum-like ulcers and cellulitis of the lower extremities associated with recurrent fevers in patients with X-linked (Bruton) agammaglobulinemia have been reported to be caused by Helicobacter bilis (formerly classified as Flexispira rappini and then Helicobacter strain flexispira taxon 8). Consistent themes in these reports are the difficulty in recovering this organism in blood and wound cultures and in maintaining isolates in vitro. We confirmed the presence of this organism in a patient's culture by using a novel application of gene amplification polymerase chain reaction and electrospray ionization time-of-flight mass spectrometry. An adolescent boy with X-linked agammaglobulinemia presented with indurated plaques and a chronic leg ulcer whose origin was strongly suspected to be an H bilis organism. Histologic analysis demonstrated positive Warthin-Starry staining of curvilinear rods, which grew in culture but failed to grow when subcultured. They could not be identified by conventional techniques. A combination of gene amplification by polymerase chain reaction and electrospray ionization time-of-flight mass spectrometry confirmed the identity of this organism. This novel technology was useful in the identification of a difficult-to-grow Helicobacter organism, the cause of pyoderma gangrenosum-like leg ulcers in patients with X-linked agammaglobulinemia. Correct identification of this organism as the cause of pyoderma gangrenosum-like ulcers in patients with X-linked agammaglobulinemia is of great importance for the early initiation of appropriate and curative antibiotic therapy.

Root Cause Analysis of Gastroduodenal Ulceration After Yttrium-90 Radioembolization

Energy Technology Data Exchange (ETDEWEB)

Lam, Marnix G. E. H. [Stanford University School of Medicine, Division of Interventional Radiology (United States); Banerjee, Subhas [Stanford University School of Medicine, Division of Gastroenterology and Hepatology (United States); Louie, John D.; Abdelmaksoud, Mohamed H. K. [Stanford University School of Medicine, Division of Interventional Radiology (United States); Iagaru, Andrei H. [Stanford University School of Medicine, Division of Nuclear Medicine and Molecular Imaging (United States); Ennen, Rebecca E.; Sze, Daniel Y., E-mail: dansze@stanford.edu [Stanford University School of Medicine, Division of Interventional Radiology (United States)

2013-12-15

IntroductionA root cause analysis was performed on the occurrence of gastroduodenal ulceration after hepatic radioembolization (RE). We aimed to identify the risk factors in the treated population and to determine the specific mechanism of nontarget RE in individual cases. Methods: The records of 247 consecutive patients treated with yttrium-90 RE for primary (n = 90) or metastatic (n = 157) liver cancer using either resin (n = 181) or glass (n = 66) microspheres were reviewed. All patients who developed a biopsy-proven microsphere-induced gastroduodenal ulcer were identified. Univariate and multivariate analyses were performed on baseline parameters and procedural data to determine possible risk factors in the total population. Individual cases were analyzed to ascertain the specific cause, including identification of the culprit vessel(s) leading to extrahepatic deposition of the microspheres. Results: Eight patients (3.2 %) developed a gastroduodenal ulcer. Stasis during injection was the strongest independent risk factor (p = 0.004), followed by distal origin of the gastroduodenal artery (p = 0.004), young age (p = 0.040), and proximal injection of the microspheres (p = 0.043). Prolonged administrations, pain during administration, whole liver treatment, and use of resin microspheres also showed interrelated trends in multivariate analysis. Retrospective review of intraprocedural and postprocedural imaging showed a probable or possible culprit vessel, each a tiny complex collateral vessel, in seven patients. Conclusion: Proximal administrations and those resulting in stasis of flow presented increased risk for gastroduodenal ulceration. Patients who had undergone bevacizumab therapy were at high risk for developing stasis.

Root Cause Analysis of Gastroduodenal Ulceration After Yttrium-90 Radioembolization

International Nuclear Information System (INIS)

Lam, Marnix G. E. H.; Banerjee, Subhas; Louie, John D.; Abdelmaksoud, Mohamed H. K.; Iagaru, Andrei H.; Ennen, Rebecca E.; Sze, Daniel Y.

2013-01-01

IntroductionA root cause analysis was performed on the occurrence of gastroduodenal ulceration after hepatic radioembolization (RE). We aimed to identify the risk factors in the treated population and to determine the specific mechanism of nontarget RE in individual cases. Methods: The records of 247 consecutive patients treated with yttrium-90 RE for primary (n = 90) or metastatic (n = 157) liver cancer using either resin (n = 181) or glass (n = 66) microspheres were reviewed. All patients who developed a biopsy-proven microsphere-induced gastroduodenal ulcer were identified. Univariate and multivariate analyses were performed on baseline parameters and procedural data to determine possible risk factors in the total population. Individual cases were analyzed to ascertain the specific cause, including identification of the culprit vessel(s) leading to extrahepatic deposition of the microspheres. Results: Eight patients (3.2 %) developed a gastroduodenal ulcer. Stasis during injection was the strongest independent risk factor (p = 0.004), followed by distal origin of the gastroduodenal artery (p = 0.004), young age (p = 0.040), and proximal injection of the microspheres (p = 0.043). Prolonged administrations, pain during administration, whole liver treatment, and use of resin microspheres also showed interrelated trends in multivariate analysis. Retrospective review of intraprocedural and postprocedural imaging showed a probable or possible culprit vessel, each a tiny complex collateral vessel, in seven patients. Conclusion: Proximal administrations and those resulting in stasis of flow presented increased risk for gastroduodenal ulceration. Patients who had undergone bevacizumab therapy were at high risk for developing stasis

Clinical audit of leg ulceration prevalence in a community area: a case study of good practice.

Science.gov (United States)

Hindley, Jenny

2014-09-01

This article presents the findings of an audit on venous leg ulceration prevalence in a community area as a framework for discussing the concept and importance of audit as a tool to inform practice and as a means to benchmark care against national or international standards. It is hoped that the discussed audit will practically demonstrate how such procedures can be implemented in practice for those who have not yet undertaken it, as well as highlighting the unexpected extra benefits of this type of qualitative data collection that can often unexpectedly inform practice and influence change. Audit can be used to measure, monitor and disseminate evidence-based practice across community localities, facilitating the identification of learning needs and the instigation of clinical change, thereby prioritising patient needs by ensuring safety through the benchmarking of clinical practice.

Update on chancroid: an important cause of genital ulcer disease.

Science.gov (United States)

Langley, C

1996-08-01

Chancroid is a major cause of genital ulcer disease worldwide, and occurred at epidemic rates in the United States in the late 1980s. Though the recent epidemic in the U.S. appears to be waning, a number of areas continue to report significant numbers of cases. Chancroid is a particular concern, because, like other diseases that cause genital ulceration, it is associated with an increased risk for transmission or acquisition of human immunodeficiency virus (HIV). Recent studies have advanced the understanding of chancroid epidemiology, and new diagnostic tests may improve the ability to recognize and appropriately treat chancroid. Increased awareness of chancroid, with appropriate treatment for suspected lesions, along with public health efforts to implement prevention in high-risk populations, will be critical to prevent ongoing transmission of chancroid, and potentially ongoing transmission of HIV.

Marjolin's Ulcers in South Eastern Nigeria - A 15 Year Review at the ...

African Journals Online (AJOL)

TNHJOURNALPH

and Department of** Pathology, National Orthopaedic Hospital, Enugu, Nigeria. ABSTRACT ... chronic ulcer while 33(47%) originated from previous scars ... current trends in the pattern of this disease. ..... Venous and non-venous leg ulcers:.

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

Marjolin’s ulcer in chronic wounds – review of available literature

Directory of Open Access Journals (Sweden)

Dariusz Bazaliński

2017-09-01

Full Text Available Marjolin’s ulcer is a rare, aggressive skin cancer developing in scar tissue, chronic ulcers and areas affected by inflammations. Its incidence is estimated to range from 1% to 2% of all burn scars. It most frequently takes the form of squamous cell carcinoma which sometimes is diagnosed during examination of lesions developing in scars and hard-to-heal chronic wounds (pressure sores, leg ulcers. Therapeutic management of Marjolin’s ulcer requires well-designed treatment plan to ensure optimal medical care and good quality of life for the patient. The high risk of metastases and damage to the structure of vitally important organs determines the need for early diagnosis and prompt surgical intervention with supplementary therapy. The purpose of the study was to examine etiopathogenesis of Marjolin’s ulcer and principles of its treatment. The authors focused on the aspect of malignant degeneration in chronic wounds (leg ulcers, pressure sores as a very rare, aggressive form of Marjolin’s ulcer. A review of the available literature on the issue of Marjolin ulcers was conducted using the key words; Marjolin ulcers, pressure sore, chronic wound. Malignant degeneration in chronic wounds is a very rare aggressive form of Marjolin ulcer. Increased oncological alertness should be displayed by nursing and medical personnel taking care of patients with chronic wounds.

Ugh! Ulcers

Science.gov (United States)

... believed that ulcers were caused by stress and spicy foods. Then, in 1982, two doctors (Barry Marshall and ... not develop ulcers. Doctors still aren't sure why, but they think that part ... of pain relievers , like aspirin or ibuprofen, can cause ulcers in some ...

[A project to reduce the incidence of facial pressure ulcers caused by prolonged surgery with prone positioning].

Science.gov (United States)

Lee, Wen-Yi; Lin, Pao-Chen; Weng, Chia-Hsing; Lin, Yi-Lin; Tsai, Wen-Lin

2012-06-01

We observed in our institute a 13.6% incidence of prolonged surgery (>4 hours) induced facial pressure ulcers that required prone positioning. Causes identified included: (1) customized silicon face pillows used were not suited for every patient; (2) our institute lacked a standard operating procedure for prone positioning; (3) our institute lacked a postoperative evaluation and audit procedure for facial pressure ulcers. We designed a strategy to reduce post-prolonged surgery facial pressure ulcer incidence requiring prone positioning by 50% (i.e., from 13.6% to 6.8%). We implemented the following: (1) Created a new water pillow to relieve facial pressure; (2) Implemented continuing education pressure ulcer prevention and evaluation; (3) Established protocols on standard care for prone-position patients and proper facial pressure ulcer identification; (4) Established a face pressure ulcers accident reporting mechanism; and (5) Established an audit mechanism facial pressure ulcer cases. After implementing the resolution measures, 116 patients underwent prolonged surgery in a prone position (mean operating time: 298 mins). None suffered from facial pressure ulcers. The measures effectively reduced the incidence of facial pressure ulcers from 13.6% to 0.0%. The project used a water pillow to relieve facial pressure and educated staff to recognize and evaluate pressure ulcers. These measures were demonstrated effective in reducing the incidence of facial pressure ulcers caused by prolonged prone positioning.

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.

Peptic Ulcers

Science.gov (United States)

... people of any age — even kids — can develop ulcers. About Peptic Ulcers An ulcer is a sore, which means it's ... that most people can be cured. Causes of Peptic Ulcers in Kids Although stress and certain foods may ...

Opinions in Denmark on the causes of peptic ulcer disease. A survey among Danish physicians and patients

DEFF Research Database (Denmark)

Christensen, A H; Gjørup, T; Andersen, I B

1994-01-01

of medicine, and working conditions played a causal role. Around 95% of the physicians indicated that medical drugs and smoking were contributory causes of peptic ulcer disease, and around 80% that alcohol and psychologic factors were so. Only 30-40% of the physicians believed that coffee/tea, food habits...... stated more causes than did their male colleagues (p smoking, side effects......, infection, and working conditions could play a causal role in ulcer disease. It is concluded that the opinion on causal agents in peptic ulcer disease differ considerably among both patients and physicians. Opinions on causes of diseases may influence the way we treat and advise our patients, and attempts...

MR angiography of the pelvic and lower leg arteries: starting with time-resolved imaging of the lower leg is recommended

International Nuclear Information System (INIS)

Schmitt, R.; Christopoulos, G.; Brunner, S.; Froehner, S.; Dobritz, M.; Fellner, F.

2001-01-01

58 patients suffering from peripheral arterial vascular disease were examined using contrast-enhanced MR angiography with the intention of optimizing the visualization of lower leg arteries. Different from the customary acquisition order, were first the arteries of the lower legs depicted with three time-resolved phases. Afterwards, the iliacal and femoral vessels were imaged by applying the floating-table technique in two steps. In all cases, the lower leg arteries were depicted without overlying veins. By injecting the contrast agent in two phases, imaging quality of the iliofemoral arteries was not significantly reduced. - In conclusion, we would recommend the hybrid technique of peripheral contrast-enhanced MRA with primarily starting the acquisition of the lower legs in cases of foot infections or ulcerations where the transit time is reduced bi- or unilaterally. (orig.) [de

District nurses' experiences of caring for leg ulcers in accordance with clinical guidelines: a grounded theory study.

Science.gov (United States)

Lagerin, Annica; Hylander, Ingrid; Törnkvist, Lena

2017-12-01

This qualitative study used the grounded theory method to investigate district nurses' experiences of caring for leg ulcers in accordance with clinical guidelines at seven primary health care centres in Stockholm, Sweden. Group interviews were conducted with 30 nurses. The results describe how district nurses strive to stay on track in order to follow clinical guidelines and remain motivated despite prolonged wound treatment and feelings of hopelessness. Three main obstacles to following the guidelines were found. District nurses used compensating strategies so the obstacles would not lead to negative consequences. If the compensating strategies were insufficient, perceived prolonged wound treatment and feelings of hopelessness could result. District nurses then used motivating strategies to overcome these feelings of hopelessness. Sometimes, despite the motivating strategies, treatment in accordance with guidelines could not be achieved. With some patients, district nurses had to compromise and follow the guidelines as far as possible.

Calciphylaxis and Martorell Hypertensive Ischemic Leg Ulcer: Same Pattern - One Pathophysiology.

Science.gov (United States)

Hafner, Jürg

2016-01-01

This review presents a closer look at four diseases which are probably closely related to one another pathophysiologically: (a) calciphylaxis (distal pattern); (b) calciphylaxis (proximal pattern); (c) Martorell hypertensive ischemic leg ulcer; (d) calciphylaxis with normal renal and parathyroid function (synonym: eutrophication). The four diseases have largely the same risk factors: (1) arterial hypertension, (2) diabetes mellitus (types 1 and 2), (3) secondary or tertiary hyperparathyroidism (in end-stage kidney disease) and (4) oral anticoagulation with vitamin K antagonists. They share the same clinical patterns: necrotizing livedo, skin infarctions at typical locations and acral gangrene in calciphylaxis. They also share the same histopathology: ischemic subcutaneous arteriolosclerosis and small-artery disease and 'miniaturizing' Mönckeberg medial calcinosis. The treatment concept for the acute phase of the diseases is also broadly similar. In addition to an optimized control of the cardiovascular risk factors, a proactive wound approach (necrosectomy, negative pressure wound treatment with vacuum dressings, and early skin grafts supported by systemic antibiotic therapy) leads most rapidly and effectively to a reduction of the initially severe wound pain, and finally to complete healing of the wound. Oral anticoagulation with vitamin K antagonists should be stopped. In extensive cases, the use of intravenous sodium thiosulfate is recommended. All four diagnoses are little known in the medical schools of most countries. The need to improve familiarity with these four closely related disorders is therefore great. In particular, the risk of confusion with pyoderma gangrenosum is a major diagnostic problem which can lead to false and even damaging treatment. © 2016 S. Karger AG, Basel.

Use of hydrocapillary dressing in the management of highly exuding ulcers

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...

Is Helicobacter pylori Infection the Primary Cause of Duodenal Ulceration or a Secondary Factor? A Review of the Evidence

Directory of Open Access Journals (Sweden)

Vikram Kate

2013-01-01

Full Text Available Helicobacter pylori (H. pylori has a role in the multifactorial etiology of peptic ulcer disease. A link between H. pylori infection and duodenal ulcer disease is now established. Other contributing factors and their interaction with the organism may initiate the ulcerative process. The fact that eradication of H. pylori infection leads to a long-term cure in the majority of duodenal ulcer patients and the fact that the prevalence of infection is higher in ulcer patients than in the normal population are cogent arguments in favor of it being the primary cause of the ulceration. Against this concept there are issues that need explanation such as the reason why only a minority of infected persons develop duodenal ulceration when infection with H. pylori is widespread. There is evidence that H. pylori infection has been prevalent for several centuries, yet duodenal ulceration became common at the beginning of the twentieth century. The prevalence of duodenal ulceration is not higher in countries with a high prevalence of H. pylori infection. This paper debate puts forth the point of view of two groups of workers in this field whether H. pylori infection is the primary cause of duodenal ulcer disease or a secondary factor.

Stomach ulcer

Science.gov (United States)

... erode the stomach wall. A major cause of stomach ulcers is the bacteria called Helicobacter pylori . Treatment regimens for ulcers caused this bacterium usually include medications to suppress the stomach acid as well as antibiotics to eradicate the ...

Sustained compression and healing of chronic venous ulcers.

OpenAIRE

Blair, S. D.; Wright, D. D.; Backhouse, C. M.; Riddle, E.; McCollum, C. N.

1988-01-01

STUDY OBJECTIVE--Comparison of four layer bandage system with traditional adhesive plaster bandaging in terms of (a) compression achieved and (b) healing of venous ulcers. DESIGN--Part of larger randomised trial of five different dressings. SETTING--Outpatient venous ulcer clinic in university hospital. PATIENTS--(a) Pressure exerted by both bandage systems was measured in the same 20 patients. (b) Healing with the four layer bandage was assessed in 148 legs in 126 consecutive patients (mean ...

Leucocyte- and platelet-rich fibrin (L-PRF) as a regenerative medicine strategy for the treatment of refractory leg ulcers: a prospective cohort study.

Science.gov (United States)

Pinto, Nelson R; Ubilla, Matias; Zamora, Yelka; Del Rio, Verónica; Dohan Ehrenfest, David M; Quirynen, Marc

2017-07-20

Chronic wounds (VLU: venous leg ulcer, DFU: diabetic foot ulcer, PU: pressure ulcer, or complex wounds) affect a significant proportion of the population. Despite appropriate standard wound care, such ulcers unfortunately may remain open for months or even years. The use of leukocyte- and platelet-rich fibrin (L-PRF) to cure skin ulcers is a simple and inexpensive method, widely used in some countries but unknown or neglected in most others. This auto-controlled prospective cohort study explored and quantified accurately for the first time the adjunctive benefits of topical applications of L-PRF in the management of such refractory ulcers in a diverse group of patients. Forty-four consecutive patients with VLUs (n = 28, 32 wounds: 17 ≤ 10 cm 2 and 15 > 10 cm 2 ), DPUs (n = 9, 10 wounds), PUs (n = 5), or complex wounds (n = 2), all refractory to standard treatment for ≥3 months, received a weekly application of L-PRF membranes. L-PRF was prepared following the original L-PRF method developed more than 15 years ago (400g, 12 minutes) using the Intra-Spin L-PRF centrifuge/system and the XPression box kit (Intra-Lock, Boca Raton, FL, USA; the only CE/FDA cleared system for the preparation of L-PRF). Changes in wound area were recorded longitudinally via digital planimetry. Adverse events and pain levels were also registered. All wounds showed significant improvements after the L-PRF therapy. All VLUs ≤ 10 cm 2 , all DFUs, as well as the two complex wounds showed full closure within a 3-month period. All wounds of patients with VLUs > 10 cm 2 who continued therapy (10 wounds) could be closed, whereas in the five patients who discontinued therapy improvement of wound size was observed. Two out of the five PUs were closed, with improvement in the remaining three patients who again interrupted therapy (surface evolution from 7.35 ± 4.31 cm 2 to 5.78 ± 3.81 cm 2 ). No adverse events were observed. A topical application of L-PRF on

Synovial cyst of the hip joint as a rare cause of unlateral leg edema; A case report

Energy Technology Data Exchange (ETDEWEB)

Kang, Ji Hun; Chang, Il Soo; Park, Sang Woo; Yun, Ik Jin; Park, Hyung Kyu; Kim, Wan Seop; Lee, Hui Jin; Kim, Na Ra; Moon, Sung Gyu [Konkuk University School of Medicine, Seoul (Korea, Republic of)

2015-06-15

A synovial cyst of the hip joint is a rare cause of unilateral leg edema, and it is usually associated with arthropathies such as rheumatoid arthritis and osteoarthritis. An asymptomatic synovial cyst of the hip joint that is not associated with an arthritic condition occurs infrequently. In this paper, we described the case of a 52-year-old woman who presented with unilateral right leg edema caused by a synovial cyst of the hip joint.

Lower extremity arterial and venous ulcers.

Science.gov (United States)

Sieggreen, Mary

2005-06-01

The prevalence of peripheral arterial disease in the general population is high, but the awareness of primary care providers of the disease process is low. The disease is not recognized by primary care providers. Early recognition and treatment of venous diseases that progress to postphlebotic syndrome, such as after a deep vein thrombosis, will prevent venous ulcers that add considerable expense to the health care system. Vascular assessment, including routine ABI measurement of patients who are in risk categories for vascular disease will identify those patients so that prevention programs can be put into place early. Major contributions to the understanding and management of leg ulcers and wound healing have been made in the last decade. However, there is still confusion as to the exact mechanism behind ulcer development and the best method to manage, cure,and prevent these ulcers has yet to be found.

Venous Leg Ulcers: Effectiveness of new compression therapy/moist ...

African Journals Online (AJOL)

(Cutimed Sorbact) and compression bandages (Comprilan,. Tensoplast) in the initial oedema phase, followed by a compression stocking system delivering 40mmHg (JOBST. UlcerCARE). Due to their high stiffness characteristics, these compression products exert a high working pressure during walking and a comfortably ...

Anti-ulcer Activity.

Science.gov (United States)

2016-01-01

This chapter explains the procedure of ethanol-induced ulcer to check the protective effect of drugs over induced ulcer in rats. Ulcer is defined as the erosion in the lining of the stomach or duodenum and is caused by the disruptions of the gastric mucosal defence and repair systems. Ulceration of stomach is called gastric ulcer and that of duodenum is called duodenal ulcer and together peptic ulcer. In clinical practice, peptic ulcer is one of the most prevalent gastrointestinal disorders, which commonly occurs in developed countries.

Risk for colorectal cancer in ulcerative colitis: changes, causes and management strategies.

Science.gov (United States)

Lakatos, Peter-Laszlo; Lakatos, Laszlo

2008-07-07

The risk of colorectal cancer for any patient with ulcerative colitis is known to be elevated, and is estimated to be 2% after 10 years, 8% after 20 years and 18% after 30 years of disease. Risk factors for cancer include extent and duration of ulcerative colitis, primary sclerosing cholangitis, a family history of sporadic colorectal cancer, severity of histologic bowel inflammation, and in some studies, young age at onset of colitis. In this review, the authors discuss recent epidemiological trends and causes for the observed changes. Population-based studies published within the past 5 years suggest that this risk has decreased over time, despite the low frequency of colectomies. The crude annual incidence rate of colorectal cancer in ulcerative colitis ranges from approximately 0.06% to 0.16% with a relative risk of 1.0-2.75. The exact mechanism for this change is unknown; it may partly be explained by the more widespread use of maintenance therapy and surveillance colonoscopy.

[A case of lipoma of the stomach prolapsing into the duodenal bulb and causing a duodenal ulcer].

Science.gov (United States)

Yamane, Tateki; Uchiyama, Kan; Furuya, Toru; Ishii, Takayuki; Omura, Nobuo; Nakano, Masataka; Fukamachi, Shinsuke; Suwa, Tatsushi; Okusa, Toshifumi

2009-11-01

We report a case of lipoma in the antrum of the stomach which prolapsed into the duodenal bulb and caused a duodenal ulcer, which was speculated to have been induced by the friction of its tip against the duodenal mucosa. Although the duodenal ulcer healed after the administration of a proton pump inhibitor, the symptoms of epigastric discomfort continued, which was suggested to be due to the prolapse. Therefore, a laparoscopic operation was conducted. The incidence of lipoma of the stomach is rare, and cases of its prolapse into the duodenum are few. Furthermore, it is extremely rare for it to cause a duodenal ulcer. Because these features made this case clinically interesting, we report it here.

Total contact cast wall load in patients with a plantar forefoot ulcer and diabetes.

Science.gov (United States)

Begg, Lindy; McLaughlin, Patrick; Vicaretti, Mauro; Fletcher, John; Burns, Joshua

2016-01-01

The total contact cast (TCC) is an effective intervention to reduce plantar pressure in patients with diabetes and a plantar forefoot ulcer. The walls of the TCC have been indirectly shown to bear approximately 30 % of the plantar load. A new direct method to measure inside the TCC walls with capacitance sensors has shown that the anterodistal and posterolateral-distal regions of the lower leg bear the highest load. The objective of this study was to directly measure these two regions in patients with Diabetes and a plantar forefoot ulcer to further understand the mechanism of pressure reduction in the TCC. A TCC was applied to 17 patients with Diabetes and a plantar forefoot ulcer. TCC wall load (contact area, peak pressure and max force) at the anterodistal and posterolateral-distal regions of the lower leg were evaluated with two capacitance sensor strips measuring 90 cm(2) (pliance®, novel GmbH, Germany). Plantar load (contact area, peak pressure and max force) was measured with a capacitance sensor insole (pedar®, novel GmbH, Germany) placed inside the TCC. Both pedar® and pliance® collected data simultaneously at a sampling rate of 50Hz synchronised to heel strike. The magnitude of TCC wall load as a proportion of plantar load was calculated. The TCC walls were then removed to determine the differences in plantar loading between the TCC and the cut down shoe-cast for the whole foot, rearfoot, midfoot and forefoot (region of interest). TCC wall load was substantial. The anterodistal lower leg recorded 48 % and the posterolateral-distal lower leg recorded 34 % of plantar contact area. The anterodistal lower leg recorded 28 % and the posterolateral-distal lower leg recorded 12 % of plantar peak pressure. The anterodistal lower leg recorded 12 % and the posterolateral-distal lower leg recorded 4 % of plantar max force. There were significant differences in plantar load between the TCC and the cut down shoe-cast for the whole foot, rearfoot, midfoot and

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

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.

Evaluation of the suitability of root cause analysis frameworks for the investigation of community-acquired pressure ulcers: a systematic review and documentary analysis.

Science.gov (United States)

McGraw, Caroline; Drennan, Vari M

2015-02-01

To evaluate the suitability of root cause analysis frameworks for the investigation of community-acquired pressure ulcers. The objective was to identify the extent to which these frameworks take account of the setting where the ulcer originated as being the person's home rather than a hospital setting. Pressure ulcers involving full-thickness skin loss are increasingly being regarded as indicators of nursing patient safety failure, requiring investigation using root cause analysis frameworks. Evidence suggests that root cause analysis frameworks developed in hospital settings ignore the unique dimensions of risk in home healthcare settings. A systematic literature review and documentary analysis of frameworks used to investigate community-acquired grade three and four pressure ulcers by home nursing services in England. No published papers were identified for inclusion in the review. Fifteen patient safety investigative frameworks were collected and analysed. Twelve of the retrieved frameworks were intended for the investigation of community-acquired pressure ulcers; seven of which took account of the setting where the ulcer originated as being the patient's home. This study provides evidence to suggest that many of the root cause analysis frameworks used to investigate community-acquired pressure ulcers in England are unsuitable for this purpose. This study provides researchers and practitioners with evidence of the need to develop appropriate home nursing root cause analysis frameworks to investigate community-acquired pressure ulcers. © 2014 John Wiley & Sons Ltd.

Heel ulcers - Pressure ulcers or symptoms of peripheral arterial disease? An exploratory matched case control study.

Science.gov (United States)

Twilley, Heidi; Jones, Sarahjane

2016-05-01

To investigate the relationship between pressure ulcers of the heel and peripheral arterial disease (PAD) and determine the feasibility of conducting a statistically powered matched case control study. Evidence indicates a relationship between chronic leg ulcers and vascular disease. The relationship between pressure ulcers of the heel and vascular disease is less well established. A matched case control study. Data were collected between March 2014 and January 2015. 15 patients identified as having a grade 2, 3 or 4 pressure ulcer of the heel were compared with 15 matched controls without pressure ulcers of the heel. The primary clinical outcome measure was the ankle brachial pressure index (ABPI), where an ABPI 1.3 was considered clinically indicative of PAD. The primary feasibility outcome measure was the rate of recruitment. Eighty seven patients were reported as having foot and heel ulcers; 36 of whom were identified as having pressure ulcers of the heel, 15 (42%) of whom were recruited to the study. Patients presenting with pressure ulcers of the heel were significantly more likely to simultaneously have previously undiagnosed PAD compared with age, gender and ethnicity matched controls without pressure ulcers of the heel (odds ratio: 11, 95% confidence interval 1.99-60.57). The formation of pressure ulcers of the heel could, in some patients, be related to the presence of PAD rather than a consequence of poor quality care. Healthcare professionals should assess the patient to exclude or confirm PAD. Copyright © 2016 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

Analgesic efficacy of equimolar 50% nitrous oxide/oxygen gas premix (Kalinox®) as compared with a 5% eutectic mixture of lidocaine/prilocaine (EMLA®) in chronic leg ulcer debridement.

Science.gov (United States)

Traber, Juerg; Held, Ulrike; Signer, Maria; Huebner, Tobias; Arndt, Stefan; Neff, Thomas A

2017-08-01

Chronic foot and leg ulcers are a common health problem worldwide. A mainstay of chronic ulcer therapy is sharp mechanical wound debridement requiring potent analgesia. In this prospective, controlled, single-centre, crossover design study, patients were assigned to either the administration of topical analgesia with 5% lidocaine/prilocaine cream or the inhalation of an analgesic 50% N 2 O/O 2 gas premix. Primary outcome parameter was level of pain at maximum wound depth during debridement as measured by a visual analogue scale. Secondary outcomes included level of pain after debridement, overall duration of treatment session, duration and completeness of debridement, and the patient's subjective perception of analgesic quality during debridement. Pain level increased from 0·60/0·94 (first/second debridement; baseline) to 1·76/2·50 (debridement) with 5% lidocaine/prilocaine and from 1·00/1·35 (baseline) to 3·95/3·29 (debridement) with 50% N 2 O/O 2 gas premix. Patient satisfaction was 90·48%/94·44% (first/second debridement) with topical 5% lidocaine/prilocaine analgesia and 90·48%/76·47% with the inhalation of 50% N 2 O/O 2 gas premix. Debridement was completed in a significantly higher percentage of 85·71%/88·89% (first/second debridement) with 5% lidocaine/prilocaine than with 50% N 2 O/O 2 gas premix (42·86%/58·82%) (odds ratio 6·7; P = 0·001). This study provides sound evidence that analgesia with topically administered 5% lidocaine/prilocaine cream is superior to the use of inhaled 50% N 2 O/O 2 gas premix in chronic leg ulcer debridement. © 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Location-dependent depth and undermining formation of pressure ulcers.

Science.gov (United States)

Takahashi, Yoshiko; Isogai, Zenzo; Mizokami, Fumihiro; Furuta, Katsunori; Nemoto, Tetsuya; Kanoh, Hiroyuki; Yoneda, Masahiko

2013-08-01

We examined the location-specific properties of pressure ulcers, focusing on depth and undermining formation, which are often unfavorable factors for ulcer healing. We conducted a retrospective observational study of 2 independent databases on pressure ulcers. Databases from a 200-bed hospital (database A) and a 300-bed hospital (database B) were collected during different time periods. Relationships between ulcer location, ulcer depth, and undermining formation were analyzed. All pressure ulcers were accurately diagnosed and classified according to their locations. A total of 282 pressure ulcers in 189 patients from database A and 232 pressure ulcers in 154 patients from database B were analyzed. It was found that pressure ulcers primarily developed over the sacrum. Ratio of stages III and IV pressure ulcers was high in pressure ulcers of the foot, ankle, and crus on the lower leg. Among the deep pressure ulcers, undermining formation was frequently observed on the greater trochanter, ilium, and sacrum. In contrast, pressure ulcers of the foot, ankle, and crus did not exhibit undermining formation. Our results revealed marked differences in pressure ulcer properties depending on their location. Factors affecting depth and undermining of pressure ulcers appear to be related to anatomical and physical properties of the bone and subcutaneous tissue. Copyright © 2013 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

Compression therapy in mixed ulcers increases venous output and arterial perfusion.

Science.gov (United States)

Mosti, Giovanni; Iabichella, Maria Letizia; Partsch, Hugo

2012-01-01

This study was conducted to define bandage pressures that are safe and effective in treating leg ulcers of mixed arterial-venous etiology. In 25 patients with mixed-etiology leg ulcers who received inelastic bandages applied with pressures from 20 to 30, 31 to 40, and 41 to 50 mm Hg, the following measurements were performed before and after bandage application to ensure patient safety throughout the investigation: laser Doppler fluxmetry (LDF) close to the ulcer under the bandage and at the great toe, transcutaneous oxygen pressure (TcPo(2)) on the dorsum of the foot, and toe pressure. Ejection fraction (EF) of the venous pump was performed to assess efficacy on venous hemodynamics. LDF values under the bandages increased by 33% (95% confidence interval [CI], 17-48; P pressure ranges applied. At toe level, a significant decrease in flux of -20% (95% CI, -48 to 9; P bandage pressure >41 mm Hg. Toe pressure values and TcPo(2) showed a moderate increase, excluding a restriction to arterial perfusion induced by the bandages. Inelastic bandages were highly efficient in improving venous pumping function, increasing the reduced ejection fraction by 72% (95% CI, 50%-95%; P pressure of 21 to 30 mm Hg and by 103% (95% CI, 70%-128%; P ulceration, an ankle-brachial pressure index >0.5 and an absolute ankle pressure of >60 mm Hg, inelastic compression of up to 40 mm Hg does not impede arterial perfusion but may lead to a normalization of the highly reduced venous pumping function. Such bandages are therefore recommended in combination with walking exercises as the basic conservative management for patients with mixed leg ulcers. Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Transarterial embolization of massive gastric ulcer bleeding in gastrostomy patients caused by a balloon replacement tube: a case report

Energy Technology Data Exchange (ETDEWEB)

Youn, Byong Jong; Hur, Jin; Lee, Kwang Hun; Won, Jong Yun [Yonsei University College of Medicine, Seoul (Korea, Republic of)

2007-02-15

We present the case of a 77-year-old woman with massive gastric ulcer bleeding caused by a balloon replacement tube that required emergent transcatheter left gastric arterial embolization in stop the ulcer bleeding.

Ulcerative dermatitis caused by feline herpesvirus type 1 in a domestic cat

Directory of Open Access Journals (Sweden)

Fernando Froner Argenta

2017-08-01

Full Text Available A case of ulcerative dermatitis caused by feline herpesvirus type 1 (FeHV-1 in an adult male domestic shorthair cat is reported. The cat was rescued from the streets and presented with ulcerative lesions at the nasal planum and tongue in addition to a history of occasional sneezing. Thirty days after of the first clinical evaluation, the cat died as a result of acute myeloid leukemia. During necropsy, ulcerative lesions were found on the superior lip, the skin of the nasal planum, and at the periorbital region. Ulcerations were also noted on the tongue and hard palate. Histological examination revealed extensive epidermal necrosis, which involved the subjacent dermis and adnexal structures; the inflammatory infiltrate consisted of neutrophils, mast cells, and lymphocytes. Amphophilic intranuclear inclusion bodies were occasionally observed in intact epithelial cells. In the immunohistochemical evaluation, positive intracytoplasmic immunolabeling was detected in the sebaceous and follicular epithelial cells as well as in the bronchiolar epithelial cells. Samples of lymphoid tissue tested positive for the presence of feline leukemia virus and feline immunodeficiency virus by immunohistochemistry. Pulmonary tissue fragments were immunolabeled for feline calicivirus. Samples obtained from a cutaneous lesion were subjected to virus isolation in a cellular culture, which revealed the cytopathic effects characteristic of herpesvirus. FeHV-1 was detected in the samples by polymerase chain reaction.

Peptic Ulcer Disease

Science.gov (United States)

... Site ACG Patients Home / Digestive Health Topic / Peptic Ulcer Disease Peptic Ulcer Disease Basics Overview An “ulcer” is an open ... for pain in patients at risk for peptic ulcer disease. Peptic – caused by acid. PPIs – P roton P ump ...

Evaluation of treatment with carboxymethylcellulose on chronic venous ulcers*

Science.gov (United States)

Januário, Virginia; de Ávila, Dione Augusto; Penetra, Maria Alice; Sampaio, Ana Luisa Bittencourt; Noronha Neta, Maria Isabel; Cassia, Flavia de Freire; Carneiro, Sueli

2016-01-01

BACKGROUND: Among the chronic leg ulcers, venous ulcers are the most common and constitute a major burden to public health. Despite all technology available, some patients do not respond to established treatments. In our study, carboxymethylcellulose was tested in the treatment of refractory chronic venous ulcers. OBJECTIVE: To evaluate the efficacy of carboxymethylcellulose 20% on the healing of chronic venous ulcers refractory to conventional treatments. METHODS: This is an analytical, pre-experimental study. Thirty patients were included with refractory venous ulcers, and applied dressings with carboxymethylcellulose 20% for 20 weeks. The analysis was based on measurement of the area of ulcers, performed at the first visit and after the end of the treatment. RESULTS: There was a reduction of 3.9 cm2 of lesion area (p=0.0001), corresponding to 38.8% (p=0.0001). There was no interruption of treatment and no increase in lesion area in any patient. CONCLUSIONS: Carboxymethylcellulose 20% represents a low cost and effective therapeutic alternative for the treatment of refractory chronic venous ulcers. However, controlled studies are necessary to prove its efficacy. PMID:26982773

Use of Collagen Extracellular Matrix Dressing for the Treatment of a Recurrent Venous Ulcer in a 52-Year-Old Patient.

Science.gov (United States)

González, Arturo

2016-01-01

This case study describes treatment for a 52-year-old man with a recurrent venous leg ulcer using a collagen dressing with extracellular matrix. The patient was admitted to the wound care service for a 3-week-old recurrent venous ulcer. Treatment included application of a collagen dressing with extracellular matrix twice weekly or as needed by the patient; application of a secondary dressing (4 × 4 gauze); and coverage with an expandable netting or gauze using a conforming stretch gauze bandage and latex-free dressing retention tape. The initial venous leg ulcer in this patient required 10 weeks to achieve closure. Ninety-eight percent resolution of the recurrent ulcer had occurred within 4 weeks of treatment, with complete closure at 7 weeks. The average healing time for recurrent venous ulcers is reported in the literature to be longer than initial venous ulcers. In the case provided, collagen ECM dressings promoted complete wound healing in 49 days.

Topical treatment of chronic venous ulcers with sucralfate: a placebo controlled randomized study.

Science.gov (United States)

Tumino, Giovanni; Masuelli, Laura; Bei, Roberto; Simonelli, Lucilla; Santoro, Alberto; Francipane, Silvana

2008-07-01

Venous leg ulcers are an important medical issue due to their high incidence in the elderly and the lack of a standard curative approach. Apart from surgical therapy, different medical treatments to effect ulcer wound repair and regeneration are currently being investigated. Sucralfate is a cytoprotective agent employed to prevent or treat several gastrointestinal diseases such as gastroesophageal reflux, gastritis, peptic ulcer, stress ulcer and dyspepsia. In this study we evaluated the efficacy, safety and tolerability of topical sucralfate (SUC-LIS 95) on the healing of chronic venous leg ulcers in 50 patients by a double-blind, placebo-controlled, randomized study. Our results indicated that the daily application of SUC-LIS 95 to non-infected post-phlebitis/vascular ulcers, for a median period of 42.0 days, led to complete healing in 95.6% of patients, against only 10.9% of cases with a matched placebo. A significant improvement was obtained in the SUC-LIS 95-treated patient group with regard to local tissue inflammation as well as pain and burning, and consequently, in ulcer size and the evolution of granulation tissue. Our findings were corroborated for selected patients by the morphological analysis of biopsies obtained before and after treatment. Using ultrastructural analysis we demonstrated that the topical use of SUC-LIS 95 was able to affect neoangiogenesis, increase wound contraction, promote re-epithelialization of the wound area and diminish the inflammatory reaction. Overall, our results indicated that patients with chronic venous ulcers show improvement after the use of topical sucralfate.

A single-arm trial indirect comparison investigation: a proof-of-concept method to predict venous leg ulcer healing time for a new acellular synthetic matrix matched to standard care control

OpenAIRE

Shannon, R; Nelson, A

2017-01-01

To compare data on time to healing from two separate cohorts: one treated with a new acellular synthetic matrix plus standard care (SC) and one matched from four large UK pragmatic, randomised controlled trials [venous leg ulcer (VLU) evidence network]. We introduce a new proof-of-concept strategy to a VLU clinical evidence network, propensity score matching and sensitivity analysis to predict the feasibility of the new acellular synthetic matrix plus SC for success in future randomised, cont...

[Magnetic therapy in treatment of patients with leg ulcers].

Science.gov (United States)

Alekseenko, A V; Gusak, V V; Tarabanchuk, V V; Iftodiĭ, A G; Sherban, N G; Stoliar, V F

1998-01-01

Various magnetic (continuous current, alternating current and "running" impulse) fields were applied in 74 patients with trophic ulcers of lower limbs. 10-12 days after the beginning of the magnetic therapy wound surface has completely cleaned from necrotic tissues, surrounding inflammatory changes eliminated, epithelization of the wounds began. The most pronounced clinical effect was observed after the use of "running" impulse of magnetic field.

Necrotizing cellulitis with multiple abscesses on the leg caused by Serratia marcescens.

Science.gov (United States)

Hau, Estelle; Bouaziz, Jean-David; Lafaurie, Matthieu; Saussine, Anne; Masson, Vincent; Rausky, Jonathan; Bagot, Martine; Guibal, Fabien

2016-03-01

Serratia marcescens is an unusual cause of severe skin infection initially described in immunocompromised patients. We report a case of necrotizing cellulitis of the leg caused by S marcescens in a 68-year-old woman with diabetes mellitus and a history of chronic lymphoedema of the leg. We reviewed the literature and found 49 cases of severe skin infections from S marcescens that included 20 cases of necrotizing fasciitis (NF) as well as 29 cases of severe skin infections without NF (non-NF cases). Patients were immunocompromised in 59% to 70% of cases. The mortality rate was high in NF cases (60%) versus non-NF cases (3%). Surgery was required in 95% of NF cases and in 24% of non-NF cases. The other clinical manifestations of S marcescens skin infection reported in the literature included disseminated papular eruptions in patients infected with human immunodeficiency virus with folliculitis on the trunk. Serratia marcescens is naturally resistant to amoxicillin alone and amoxicillin associated with clavulanic acid. Broad-spectrum antibiotics are indicated to treat S marcescens skin infections, and surgery should be promptly considered in cases of severe skin infections if appropriate antibiotic therapy does not lead to rapid improvement.

Cost consequences due to reduced ulcer healing times - analyses based on the Swedish Registry of Ulcer Treatment.

Science.gov (United States)

Öien, Rut F; Forssell, Henrik; Ragnarson Tennvall, Gunnel

2016-10-01

Resource use and costs for topical treatment of hard-to-heal ulcers based on data from the Swedish Registry of Ulcer Treatment (RUT) were analysed in patients recorded in RUT as having healed between 2009 and 2012, in order to estimate potential cost savings from reductions in frequency of dressing changes and healing times. RUT is used to capture areas of improvement in ulcer care and to enable structured wound management by registering patients with hard-to-heal leg, foot and pressure ulcers. Patients included in the registry are treated in primary care, community care, private care, and inpatient hospital care. Cost calculations were based on resource use data on healing time and frequency of dressing changes in Swedish patients with hard-to-heal ulcers who healed between 2009 and 2012. Per-patient treatment costs decreased from SEK38 223 in 2009 to SEK20 496 in 2012, mainly because of shorter healing times. Frequency of dressing changes was essentially the same during these years, varying from 1·4 to 1·6 per week. The total healing time was reduced by 38%. Treatment costs for the management of hard-to-heal ulcers can be reduced with well-developed treatment strategies resulting in shortened healing times as shown in RUT. © 2015 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

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

Self care of patients with chronic venous ulcers in the home environment.

Directory of Open Access Journals (Sweden)

Thiago Gonçalves do Nascimento Piropo

2012-01-01

Full Text Available The venous ulcer is a skin lesion that affects the lower third of the legs. Is associated with chronic venous insufficiency, is the leading cause of ulcers of the lower limbs. Can interfere with the quality of life of patients, because it generates negative repercussions on social and economic sphere. The aim of this study was to identify self-care in the home environment of patients with venous ulcers, to assess the occurrence of alternative therapy use and verifythe involvement of domestic trauma. Methodologically, this study takes a quantitative and qualitative analytical cross-sectional held at the Clinical School of Physiotherapy, State University of Southwest Bahia / UESB / Jequié-BA, from January 2007 to September 2008. Data were collected through a questionnaire and semi-structured interviews. The results showed that 100% of the participants played self care of their injuries, including with respect to occlusion and bandages when needed. However, 6.25% said they had not received adequate information to perform self-care. Concluded that it is necessary to interact and produce a mechanism between education and health assistance for the development of the practice of self-care in family life at home.

[Effect of heijiang pill on radiation skin ulcer in rats].

Science.gov (United States)

Fu, Qi; Yang, Yang; Xu, Yong-Mei

2008-05-01

To investigate the relationship between single dosage of 60Co radiation and the degree of radiation-induced skin ulcers, and to evaluate the curative effect of Heijiang Pill (HJP) on skin ulcer induced by various dosages of radiation in rats. Sixty-six Wistar female rats were randomly divided into three groups, the blank control group (n = 6) and the two radiation groups, each 30 rats, with their right hind leg exposed respectively to 60 Gy and 40 Gy of 60 Co radiation. The time of emergence and degree of skin ulcer were recorded. Then rats in the two radiation groups were subdivided into the HJP group, the Ethacridine group and the model group, 10 in each group, they received corresponding treatment after ulceration, and the incidence, pathology, cure rate and cure time of skin ulcer were observed in the 90 days of observation. The incidence of skin ulcer was higher and occurred earlier in rats radiated with 60 Gy than that with 40 Gy (P ulcer healing rate in rats treated with HJP was higher than that treated with Ethacridine (P cure time in the HJP group was shorter (P ulcers. HJP can effectively cure radiation skin ulcer, and the effect is especially significant on the ulcer induced by low dose radiation.

Leg ulcers associated with Klinefelter’s syndrome: a case report and review of the literature

OpenAIRE

Shanmugam, Victoria K; Tsagaris, Katina C; Attinger, Christopher E

2011-01-01

We present the case of a young man with type II diabetes, stage III chronic kidney disease, hypertension, obstructive sleep apnea and diabetes who presented to the Georgetown University Hospital Center for Wound Healing with refractory lower extremity ulcers. Autoimmune work-up was negative. However, chromosome analysis showed a genetic variant of Klinefelter’s syndrome (48 XXYY). Lower extremity ulceration is a recognised complication of Klinefelter’s syndrome. The pathogenesis of ulcers in ...

An Unusual Cause of Infective Endocarditis: Proteus mirabilis Bacteremia from an Infected Pressure Ulcer

Directory of Open Access Journals (Sweden)

Chun-Hao Liu

2015-12-01

Full Text Available Proteus species is a common cause of urinary tract and wound infections in humans. We herein present the case of a 71-year-old male who had fever, a new-onset heart murmur, bacteremia, and a vegetation over his native aortic valve in echocardiography. This rare case demonstrated that infective endocarditis could be caused by Proteus mirabilis from an infected pressure ulcer.

Epithelial Regeneration After Gastric Ulceration Causes Prolonged Cell-Type AlterationsSummary

Directory of Open Access Journals (Sweden)

Eitaro Aihara

2016-09-01

Full Text Available Background & Aims: The peptic ulcer heals through a complex process, although the ulcer relapse often occurs several years later after healing. Our hypothesis is that even after visual evidence of healing of gastric ulceration, the regenerated epithelium is aberrant for an extended interval, increasing susceptibility of the regenerated epithelium to damage and further diseases. Methods: Gastric ulcers were induced in mice by serosal topical application of acetic acid. Results: Gastric ulcers induced by acetic acid visually healed within 30 days. However, regenerated epithelial architecture was poor. The gene profile of regenerated tissue was abnormal, indicating increased stem/progenitor cells, deficient differentiated gastric cell types, and deranged cell homeostasis. Despite up-regulation of PDX1 in the regenerated epithelium, no mature antral cell type was observed. Four months after healing, the regenerated epithelium lacks parietal cells, trefoil factor 2 (TFF2 and (sex-determining region Y-box 9 (SOX9 remain up-regulated deep in the gastric gland, and the Na/H exchanger 2 (a TFF2 effector in gastric healing remains down-regulated. Gastric ulcer healing was strongly delayed in TFF2 knockout mice, and re-epithelialization was accompanied with mucous metaplasia. After Helicobacter pylori inoculum 30 days after ulceration, we observed that the gastric ulcer selectively relapses at the same site where it originally was induced. Follow-up evaluation at 8 months showed that the relapsed ulcer was not healed in H pylori–infected tissues. Conclusions: These findings show that this macroscopically regenerated epithelium has prolonged abnormal cell distribution and is differentially susceptible to subsequent damage by H pylori. Keywords: Gastric Ulcer Healing, Metaplasia, H pylori, SOX9, TFF2, NHE2

[Quality of self-applied compression bandages in patients with chronic venous ulcers : Results of a prospective clinical study].

Science.gov (United States)

Stoffels-Weindorf, M; Stoffels, I; Jockenhöfer, F; Dissemond, J

2018-04-01

For effective compression therapy in patients with venous leg ulcers, sufficient pressure is essential. In everyday life, it is often the patients themselves who apply the compression bandages. Many of these patients have restriction in their movement and had been rarely trained adequately. Hence, there was the question of how efficient are the autonomously applied compression bandages of those patients. In all, 100 consecutive patients with venous leg ulcer were asked to apply compression bandages on their own leg. We documented both the achieved compression and formal criteria of correct performance. A total of 59 women and 41 men with an average age of 70.3 years were included in the study. Overall 43 patients were not able to apply a compression bandage because of physical limitations. The measured pressure values in the remaining 57 patients ranged between 6 and 93 mm Hg (mean 28.3 mm Hg). Eleven patients reached the prescribed effective compression pressure. Of these, formal errors were found in 6 patients, so that only 5 patients had correctly applied the compression bandages. Our data show that most patients with venous leg ulcers are not able to apply effective compression therapy with short-stretch bandages to themselves. Multilayer systems, adaptive compression bandages, and ulcer stocking systems today are possibly easier and more effective therapy options. Alternatively short-stretch bandages could be applied by trained persons but only under the control with pressure measuring probes.

[The causes of recurrent ulcerative gastroduodenal bleeding].

Science.gov (United States)

Lipnitsky, E M; Alekberzade, A V; Gasanov, M R

To explore microcirculatory changes within the first 48 hours after admission, to compare them with clinical manifestations of bleeding and to define the dependence of recurrent bleeding from the therapy. The study included 108 patients with ulcerative gastroduodenal bleeding who were treated at the Clinical Hospital #71 for the period 2012-2014. There were 80 (74.1%) men and 28 (25.9%) women. Age ranged 20-87 years (mean 54.4±16.8 years). Patients younger than 45 years were predominant (33.4%). J. Forrest classification (1974) was used in endoscopic characterization of bleeding. Roccal Prognostic Scale for gastroduodenal bleeding was applied in all patients at admission to assess the risk of possible recurrence. Patients were divided into 2 groups. Group 1 included 53 (49.1%) patients without recurrent bleeding; group 2-55 (50.1%) patients who had recurrent bleeding within the first two days of treatment. Investigation of microcirculation showed the role of vegetative component including blood circulation centralization, blood flow slowing, blood cells redistribution providing sufficient blood oxygenation. By the end of the first day we observed pronounced hemodilution, decreased blood oxygenation, blood flow restructuring with its acceleration above 1 ml/s, violation of tissue oxygenation, signs of hypovolemia. These changes were significantly different from group 2 and associated with circulatory decentralization with possible pulmonary microcirculation disturbances and interstitial edema. This processes contribute to disruption of tissue oxygenation. We assume that recurrent bleeding in group 2 was caused by fluid therapy in larger volumes than it was necessary in this clinical situation. Infusion therapy should be significantly reduced for the debut of gastroduodenal ulcerative bleeding. Sedative therapy is advisable to reduce the influence of central nervous system.

Approach to leg edema

Directory of Open Access Journals (Sweden)

Fulvio Pomero

2017-09-01

Full Text Available Edema is defined as a palpable swelling caused by an increase in interstitial fluid volume. Leg edema is a common problem with a wide range of possible causes and is the result of an imbalance in the filtration system between the capillary and interstitial spaces. Major causes of edema include venous obstruction, increased capillary permeability and increased plasma volume secondary to sodium and water retention. In both hospital and general practice, the patient with a swollen leg presents a common dilemma in diagnosis and treatment. The cause may be trivial or life-threatening and it is often difficult to determine the clinical pathway. The diagnosis can be narrowed by categorizing the edema according to its duration, distribution (unilateral or bilateral and accompanying symptoms. This work provides clinically oriented recommendations for the management of leg edema in adults.

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.

Increased Mortality in Diabetic Foot Ulcer Patients: The Significance of Ulcer Type

Science.gov (United States)

Chammas, N. K.; Hill, R. L. R.; Edmonds, M. E.

2016-01-01

Diabetic foot ulcer (DFU) patients have a greater than twofold increase in mortality compared with nonulcerated diabetic patients. We investigated (a) cause of death in DFU patients, (b) age at death, and (c) relationship between cause of death and ulcer type. This was an eleven-year retrospective study on DFU patients who attended King's College Hospital Foot Clinic and subsequently died. A control group of nonulcerated diabetic patients was matched for age and type of diabetes mellitus. The cause of death was identified from death certificates (DC) and postmortem (PM) examinations. There were 243 DFU patient deaths during this period. Ischaemic heart disease (IHD) was the major cause of death in 62.5% on PM compared to 45.7% on DC. Mean age at death from IHD on PM was 5 years lower in DFU patients compared to controls (68.2 ± 8.7 years versus 73.1 ± 8.0 years, P = 0.015). IHD as a cause of death at PM was significantly linked to neuropathic foot ulcers (OR 3.064, 95% CI 1.003–9.366, and P = 0.049). Conclusions. IHD is the major cause of premature mortality in DFU patients with the neuropathic foot ulcer patients being at a greater risk. PMID:27213157

Cost analysis of negative-pressure wound therapy with instillation for wound bed preparation preceding split-thickness skin grafts for massive (>100 cm(2)) chronic venous leg ulcers.

Science.gov (United States)

Yang, C Kevin; Alcantara, Sean; Goss, Selena; Lantis, John C

2015-04-01

Massive (≥100 cm(2)) venous leg ulcers (VLUs) demonstrate very low closure rates with standard compression therapy and are costly to manage. Negative-pressure wound therapy (NPWT), followed by a split-thickness skin graft (STSG), can be a cost-effective alternative to this standard care. We performed a cost analysis of these two treatments. A retrospective review was performed of 10 ulcers treated with surgical debridement, 7 days of inpatient NPWT with topical antiseptic instillation (NPWTi), and STSG, with 4 additional days of inpatient NPWT bolster over the graft. Independent medical cost estimators were used to compare the cost of this treatment protocol with standard outpatient compression therapy. The average length of time ulcers were present before patients entered the study was 38 months (range, 3-120 months). Eight of 10 patients had complete VLU closure by 6 months after NPWTi with STSG. The 6-month costs of the proposed treatment protocol and standard twice-weekly compression therapy were estimated to be $27,000 and $28,000, respectively. NPWTi with STSG treatment is more effective for closure of massive VLUs at 6 months than that reported for standard compression therapy. Further, the cost of the proposed treatment protocol is comparable with standard compression therapy. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

[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.

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.

Venous leg ulcer management in clinical practice in the UK: costs and outcomes.

Science.gov (United States)

Guest, Julian F; Fuller, Graham W; Vowden, Peter

2018-02-01

The aim of this study was to estimate the patterns of care and annual levels of health care resource use attributable to managing venous leg ulcers (VLUs) in clinical practice by the UK's National Health Service (NHS) and the associated costs of patient management. This was a retrospective cohort analysis of the records of 505 patients in The Health Improvement Network (THIN) Database. Patients' characteristics, wound-related health outcomes and health care resource use were quantified, and the total NHS cost of patient management was estimated at 2015/2016 prices. Overall, 53% of all VLUs healed within 12 months, and the mean time to healing was 3·0 months. 13% of patients were never prescribed any recognised compression system, and 78% of their wounds healed. Of the 87% who were prescribed a recognised compression system, 52% of wounds healed. Patients were predominantly managed in the community by nurses with minimal clinical involvement of specialist clinicians. Up to 30% of all the VLUs may have been clinically infected at the time of presentation, and only 22% of patients had an ankle brachial pressure index documented in their records. The mean NHS cost of wound care over 12 months was an estimated £7600 per VLU. However, the cost of managing an unhealed VLU was 4·5 times more than that of managing a healed VLU (£3000 per healed VLU and £13 500 per unhealed VLU). This study provides important insights into a number of aspects of VLU management in clinical practice that have been difficult to ascertain from other studies and provides the best estimate available of NHS resource use and costs with which to inform policy and budgetary decisions. © 2017 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Evaluation of a muscle pump-activating device for non-healing venous leg ulcers.

Science.gov (United States)

Harris, Connie; Duong, Rochelle; Vanderheyden, Gwen; Byrnes, Beth; Cattryse, Renee; Orr, Ava; Keast, David

2017-12-01

This evaluation involves an innovative muscle pump-activating device (geko™) as an adjunctive therapy with best practices for non-healing venous leg ulcers (VLUs). Stimulating the common peroneal nerve (at the fibular head), the geko™ device creates a response that acts as foot and calf muscle pumps, increasing venous, arterial and microcirculatory flow. The aim was to evaluate and determine if the geko™ is effective in this population and if it should be added to the medical supply formulary. In all, 12 patients with 18 recalcitrant VLUs (defined as less than 30% reduction in wound size in 30 days with best practices) in two community settings in Ontario consented to the evaluation and were treated with the geko™ for up to 20 weeks. A total of 44% of wounds healed, and 39% decreased in size. One patient non-adherent with the geko™ and best practices had deterioration in his or her wounds. With the patients as their own control, the mean weekly healing rate with the geko™ was 9·35% (±SD 0·10) compared to 0·06% (±SD 0·10) prior to baseline, which was statistically significant (P devices in 7 of 12 (58%) patients. One patient stopped the device due to rash, while another had to take breaks from using the device. Subsequently, the manufacturer (FirstKind Ltd) has developed a new device and protocol specific to the requirements of wound therapy to minimise this response. This small case series demonstrated the highly significant effectiveness of the geko™ device in these hard-to-heal VLUs. Further evaluations to determine dose and patient selection criteria are underway. © 2017 The Authors. International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Association between ulcer site and outcome in complicated peptic ulcer disease

DEFF Research Database (Denmark)

Lolle, Ida; Møller, Morten Hylander; Rosenstock, Steffen Jais

2016-01-01

OBJECTIVE: Mortality rates in complicated peptic ulcer disease are high. This study aimed to examine the prognostic importance of ulcer site in patients with peptic ulcer bleeding (PUB) and perforated peptic ulcer (PPU). MATERIALS AND METHODS: DESIGN: a nationwide cohort study with prospective...... and adjusted association between ulcer site (gastric and duodenal) and the outcome measures of interest were assessed by binary logistic regression analysis. RESULTS: Some 20,059 patients with PUB and 4273 patients with PPU were included; 90-d mortality was 15.3% for PUB and 29.8% for PPU; 30-d mortality...... was 10.2% and 24.7%, respectively. Duodenal bleeding ulcer, as compared to gastric ulcer (GU), was associated with a significantly increased risk of all-cause mortality within 90 and 30 d, and with re-intervention: adjusted odds ratio (OR) 1.47 (95% confidence interval 1.30-1.67); p 

Elderly people and ulcer caused by pressure at home care service

Directory of Open Access Journals (Sweden)

Ana Débora Alcantara Coêlho

2012-09-01

Full Text Available This research aimed at estimating the prevalence of pressure ulcers in a home care service. Cross-sectional study carried out in July/August 2009 with 194 bedridden aged patients. For data collection, the Braden Scale and an instrument consisting of demographics, clinical data, and preventive measures for pressure ulcers were applied. Data was analyzed using SPSS16.0 and presented as descriptive statistics. From the total sample, 69.6% (n = 135 were female; 68% (n = 132 ≥ 80 years old; 33% (n=64 were Alzheimer patients, and 26.3% (n = 51 had sequels of stroke; 31.4% (n = 61 had pressure ulcers, from which 54.1% (n = 33 were developed in the hospital. A prevalence of 31.4% and moderate risk (13.2% for pressure ulcers was identified. It is recommended longitudinal study for evaluating the relationship between the Braden Scale indicators and the development of pressure ulcers.

Contact Lens Related Corneal Ulcer

OpenAIRE

Loh, KY; Agarwal, P

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...

The prevalence of foot ulceration in patients with rheumatoid arthritis.

Science.gov (United States)

Firth, Jill; Hale, Claire; Helliwell, Philip; Hill, Jackie; Nelson, E Andrea

2008-02-15

To establish the prevalence of foot ulceration in patients with rheumatoid arthritis (RA) in secondary care. A postal survey of all patients with RA (n = 1,130) under the care of rheumatologists in Bradford, West Yorkshire, UK was performed. The prevalence data were validated through clinical examination, case-note review, and contact with health professionals. The false-negative rate was investigated in a subsample of patients (n = 70) who denied any history of ulceration. The postal survey achieved a 78% response rate. Following validation, the point prevalence of foot ulceration was 3.39% and the overall prevalence was 9.73%. The false-positive rate was initially high at 21.21%, but use of diagrammatic questionnaire data to exclude leg ulceration reduced the rate to 10.76%. The false-negative rate was 11.76%. The most common sites for ulceration were the dorsal aspect of hammer toes, the metatarsal heads, and the metatarsophalangeal joint in patients with hallux abducto valgus, with 33% of patients reporting multiple sites of ulceration. Patients with open-foot and healed-foot ulceration had significantly longer RA disease duration, reported significantly greater use of special footwear, and had a higher prevalence of foot surgery than ulcer-free patients. Foot ulceration affects a significant proportion of patients with RA. Further work is needed to establish risk factors for foot ulceration in RA and to target foot health provision more effectively.

The effect of a nurse-directed intervention to reduce pain and improve behavioral and physical outcomes in patients with critically colonized/infected chronic leg ulcers.

Science.gov (United States)

Kelechi, Teresa J; Mueller, Martina; Spencer, Cam; Rinard, Bobbie; Loftis, Greg

2014-01-01

We compared a WOC nurse-directed, patient-centered intervention called MECALF (motivational enhancement and conditioning activity for leg function) compared to conditioning activities for lower leg function (CALF) alone. Outcomes were study feasibility, pain, motivation, self-efficacy, physical activity, leg strength, and range of motion. Comparative study. The sample was drawn from 2 wound centers in the Southeastern United States. Twenty-one patients (n = 12 MECALF site A and n = 9 CALF site B) with painful lower legs and critically colonized/infected wounds participated in the study. All patients received usual wound care per center protocol. The MECALF intervention was delivered by WOC nurses for 6 weeks at site A and a handout of CALF depicting the conditioning activities was provided by site staff (not WOC nurses) to patients at site B. We assessed study feasibility with postsurvey questionnaires given to WOC nurses (training usefulness, ease of use of ME with patients) and subjects (able to perform activities, use logs). Pre- and postintervention outcome data were collected by study staff using pain, motivation, and self-efficacy scales, functional measures of physical activity, and physical measures of strength and range of motion. The study was found to be somewhat feasible by the WOC nurses and patients. WOC nurses had time management problems using MECALF during usual patient care. Patients reported that they were able to perform CALF. Overall pain was statistically significantly reduced (P = .046) in both groups of patients with painful critically colonized/infected leg ulcers measured at week 8, 2 weeks after the study period. The CALF group experienced a slightly greater reduction in pain intensity than did the MECALF group. No statistically significant differences between the groups were observed in behavioral outcomes for motivation (P = .641) and self-efficacy (P = .643), or for physical outcomes including overall ankle strength (P = .609) and

A Woman with Black Beads in Her Stomach: Severe Gastric Ulceration Caused by Yttrium-90 Radioembolization

Directory of Open Access Journals (Sweden)

Indu S. Voruganti

2018-01-01

Full Text Available Radioembolization (RE is a selective internal radiation therapy (SIRT delivering targeted, high-dose, intra-arterial radiation directly to the vascular supply of liver tumors. Complications can occur due to aberrant deposition or migration of radiation microspheres into nontarget locations, including normal hepatic parenchyma, lungs, pancreas, and upper gastrointestinal (UGI tract. We report a case of gastric ulcers due to yttrium-90 (90Y seed migration to the stomach to alert clinicians to this rare cause of gastric injury. A 57-year-old woman with stage IV breast cancer with liver and lung metastases presented to the hospital with 2 months of worsening nausea and vomiting. Two months prior, she had received SIRT with 90Y microspheres without complications. Upper GI endoscopy showed diffuse gastritis and extensive antral ulceration. Biopsies revealed black, spherical foreign bodies, consistent with 90Y microspheres, documenting radiation injury. Radiation-induced UGI ulceration is caused by direct radiation injury from beta-radiation. Delay in diagnosis may be due to the nonspecificity of symptoms and temporal delay of symptom onset from SIRT, which was 2 months in our patient. Also, complaints may be attributed erroneously to adjuvant chemotherapy or widespread metastatic disease. Clinicians must consider radiation-associated toxicity in any SIRT-treated patient developing abdominal symptoms.

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

Science.gov (United States)

2012-04-25

... antimicrobial components, what are the benefits and harms of using systemic antibiotics when compared with using.../ . The Key Questions Question 1 For patients with chronic venous leg ulcers, what are the benefits and... clinical signs of cellulitis that are being treated with compression systems, what are the benefits and...

Claw Lesions Causing Clinical Lameness in Lactating Holstein Frisian Crossbred Cows

Directory of Open Access Journals (Sweden)

Umar Nazir Zahid

2014-01-01

Full Text Available The objective of this study was to identify claw lesions causing clinical lameness in lactating Holstein Frisian (HF crossbred cows in dairy cattle. Seventy dairy farmers were interviewed at the monthly meetings of Progressive Dairy Farmers Association of Ludhiana, Punjab, India. Ten dairy farms were randomly selected as per probability proportional to size and a total of 450 lactating HF crossbred cows were taken into the study. All the lactating cows were scored for locomotion and rear leg view index. Trimming was done in all the clinically lame animals (animals with locomotion scores 2 and 3 and equal number of animals selected randomly from those with locomotion scores 0 and 1. Various claw lesions were evaluated in both the groups. There was a significant relationship between locomotion score and rear leg view index to identify lameness. Sole ulcers and white line fissures were the lesions responsible for clinical lameness. Other lesions did not cause clinical lameness but increased the asymmetry in lactating HF crossbred cows. Both locomotion score and rear leg view index could be reliably used to identify clinical lameness in lactating cattle.

Increasing trunk flexion transforms human leg function into that of birds despite different leg morphology.

Science.gov (United States)

Aminiaghdam, Soran; Rode, Christian; Müller, Roy; Blickhan, Reinhard

2017-02-01

Pronograde trunk orientation in small birds causes prominent intra-limb asymmetries in the leg function. As yet, it is not clear whether these asymmetries induced by the trunk reflect general constraints on the leg function regardless of the specific leg architecture or size of the species. To address this, we instructed 12 human volunteers to walk at a self-selected velocity with four postures: regular erect, or with 30 deg, 50 deg and maximal trunk flexion. In addition, we simulated the axial leg force (along the line connecting hip and centre of pressure) using two simple models: spring and damper in series, and parallel spring and damper. As trunk flexion increases, lower limb joints become more flexed during stance. Similar to birds, the associated posterior shift of the hip relative to the centre of mass leads to a shorter leg at toe-off than at touchdown, and to a flatter angle of attack and a steeper leg angle at toe-off. Furthermore, walking with maximal trunk flexion induces right-skewed vertical and horizontal ground reaction force profiles comparable to those in birds. Interestingly, the spring and damper in series model provides a superior prediction of the axial leg force across trunk-flexed gaits compared with the parallel spring and damper model; in regular erect gait, the damper does not substantially improve the reproduction of the human axial leg force. In conclusion, mimicking the pronograde locomotion of birds by bending the trunk forward in humans causes a leg function similar to that of birds despite the different morphology of the segmented legs. © 2017. Published by The Company of Biologists Ltd.

S100A8/A9 is an important host defence mediator in neuropathic foot ulcers in patients with type 2 diabetes mellitus

DEFF Research Database (Denmark)

Trøstrup, Hannah; Holstein, Per; Christophersen, Lars

2016-01-01

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...

Randomized trial of four-layer and two-layer bandage systems in the management of chronic venous ulceration.

Science.gov (United States)

Moffatt, Christine J; McCullagh, Lynn; O'Connor, Theresa; Doherty, Debra C; Hourican, Catherine; Stevens, Julie; Mole, Trevor; Franks, Peter J

2003-01-01

To compare a four-layer bandage system with a two-layer system in the management of chronic venous leg ulceration, a prospective randomized open parallel groups trial was undertaken. In total, 112 patients newly presenting to leg ulcer services with chronic leg ulceration, screened to exclude the presence of arterial disease (ankle brachial pressure index ulceration other than venous disease, were entered into the trial. Patients were randomized to receive either four-layer (Profore) or two-layer (Surepress) high-compression elastic bandage systems. In all, 109 out of 112 patients had at least one follow-up. After 24 weeks, 50 out of 57 (88%) patients randomized to the four-layer bandage system with follow-up had ulcer closure (full epithelialization) compared with 40 out of 52 (77%) on the two-layer bandage, hazard ratio = 1.18 (95% confidence interval 0.69-2.02), p = 0.55. After 12 weeks, 40 out of 57 (70%) patients randomized to the four-layer bandage system with follow-up had ulcer closure compared with 30 out of 52 (58%) on the two-layer bandage, odds ratio = 4.23 (95% confidence interval 1.29-13.86), p = 0.02. Withdrawal rates were significantly greater on the two-layer bandage (30 out of 54; 56%) compared with the four-layer bandage system (8 out of 58; 14%), p bandaging system (15 out of 54; 28%) compared with four-layer bandaging (5 out of 54; 9%), p = 0.01. The higher mean cost of treatment in the two-layer bandaging system arm over 24 weeks ($1374 [ pound 916] vs. $1314 [ pound 876]) was explained by the increased mean number of bandage changes (1.5 vs. 1.1 per week) with the two-layer system. In conclusion, the four-layer bandage offers advantages over the two-layer bandage in terms of reduced withdrawal from treatment, fewer adverse incidents, and lower treatment cost.

CONTACT LENS RELATED CORNEAL ULCER

Directory of Open Access Journals (Sweden)

AGARWAL P

2010-01-01

Full Text Available 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. The presenting symptoms of contact lens related corneal ulcers include eye discomfort, foreign body sensation and lacrimation. More serious symptoms are redness (especially circum-corneal injection, severe pain, photophobia, eye discharge and blurring of vision. The diagnosis is established by a thorough slit lamp microscopic examination with fluorescein staining and corneal scraping for Gram stain and culture of the infective organism. Delay in diagnosing and treatment can cause permanent blindness, therefore an early referral to ophthalmologist and commencing of antimicrobial therapy can prevent visual loss.

The silver-releasing foam dressing, Contreet Foam, promotes faster healing of critically colonised venous leg ulcers

DEFF Research Database (Denmark)

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

2005-01-01

in all respects. After 4 weeks, there was a significantly greater reduction in ulcer area in the Contreet Foam group (45%) than in the Allevyn Hydrocellular group (25%). After 1 and 4 weeks, odour was present in significantly less of the ulcers in the Contreet Foam group (17% and 19%, respectively...

Bleeding peptic ulcer caused by ectopic gastric mucosa in a duplicated segment of jejunum

International Nuclear Information System (INIS)

Newmark, H.; Ching, G.; Halls, J.; Levy, I.J.

1981-01-01

The authors present a case in which a patient suffered a bleeding jejunal ulcer caused by heterotopic gastric mucosa in a congenital duplication of a segment of jejunum. This is the first case diagnosed preoperatively by two different radiographic means. These lesions were shown by both pertechnetate flow and barium small bowel studies. The rarity of these entities and the modalities used for diagnosis are described

Restless Legs Syndrome

Science.gov (United States)

... disorder, particularly if they experience onset at an early age; many years may pass before symptoms occur regularly. top What causes restless legs syndrome? In most cases, the cause of RLS is unknown (called primary RLS). However, RLS has a genetic component and ...

Ulcers

Science.gov (United States)

... of the stomach and intestines. In certain circumstances stress can help cause ulcers. But this usually only happens when illness involving severe emotional or physical stress is involved — such as when someone too sick ...

Dual pathology: cervicofacial actinomycosis and nicorandil-induced oral ulceration.

Science.gov (United States)

Cupples, H E V; McGahey, D T

2008-04-01

Oral ulceration has many causes and is a common presenting symptom in otolaryngology. This article presents an unusual case of dual pathology oral ulceration in an elderly patient. Oral malignancy was initially suspected, but the history, examination and investigation showed that the oral ulceration was caused by actinomycosis infection and by nicorandil use. Cervicofacial acinomycosis is a rare, suppurative bacterial disease in which abscesses can form in the tissues and break through the skin, creating pus-discharging lesions. Nicorandil is a potassium channel blocker used in the treatment of ischaemic heart disease. It has been recently recognised as a cause of persistent ulcerative stomatitis. This case highlights the importance of a high index of suspicion for unusual and reversible causes of oral ulceration, and of dual pathology as a cause. Such vigilance enables early recognition and treatment of potentially reversible conditions.

Ultrasonography of Skin Changes in Legs with Chronic Venous Disease.

Science.gov (United States)

Caggiati, A

2016-10-01

In daily practice, ultrasonography (US) is used only to designate the location and pattern of venous lesions. Skin US is not performed between routine venous investigations. Skin morphology is evaluated by the same probes used for routine Duplex evaluation of superficial veins. US findings from evident skin lesions are comparatively evaluated with those from the surrounding apparently normal skin and from the contralateral leg. Inflammation and dermal edema can be found in the apparently normal skin of C2 legs. Swollen legs show thickening of the subcutaneous layer as a result of diffuse soaking or anechoic cavities, with or without dermal edema. Chronic hypodermitis is characterized by inflammatory edema in initial phases, and by liposclerosis in advanced cases. Recrudescence of inflammation provokes focal rarefactions of the subcutaneous layer, possibly related to ulcer opening. In legs with venous disorders, sonography refines clinical evaluation of the skin and may reveal changes not highlighted by inspection. Some of these changes could require further investigation because they have not yet been explained or described. Skin sonography should improve knowledge of the natural history of skin changes, as well as contribute to a better grading of venous diseases severity In particular, US evidence of cutaneous and subcutaneous changes in C2 legs should be considered to stratify the treatment in C2 legs, by identifying those in which varicose veins are not simply a cosmetic problem. Copyright © 2016 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Non-contact ulcer area calculation system for neuropathic foot ulcer.

Science.gov (United States)

Shah, Parth; Mahajan, Siddaram; Nageswaran, Sharmila; Paul, Sathish Kumar; Ebenzer, Mannam

2017-08-11

Around 125,785 new cases in year 2013-14 of leprosy were detected in India as per WHO report on leprosy in September 2015 which accounts to approximately 62% of the total new cases. Anaesthetic foot caused by leprosy leads to uneven loading of foot leading to ulcer in approximately 20% of the cases. Much efforts have gone in identifying newer techniques to efficiently monitor the progress of ulcer healing. Current techniques followed in measuring the size of ulcers, have not been found to be so accurate but are still is followed by clinicians across the globe. Quantification of prognosis of the condition would be required to understand the efficacy of current treatment methods and plan for further treatment. This study aims at developing a non contact technique to precisely measure the size of ulcer in patients affected by leprosy. Using MATLAB software, GUI was designed to process the acquired ulcer image by segmenting and calculating the pixel area of the image. The image was further converted to a standard measurement using a reference object. The developed technique was tested on 16 ulcer images acquired from 10 leprosy patients with plantar ulcers. Statistical analysis was done using MedCalc analysis software to find the reliability of the system. The analysis showed a very high correlation coefficient (r=0.9882) between the ulcer area measurements done using traditional technique and the newly developed technique, The reliability of the newly developed technique was significant with a significance level of 99.9%. The designed non-contact ulcer area calculating system using MATLAB is found to be a reliable system in calculating the size of ulcers. The technique would help clinicians have a reliable tool to monitor the progress of ulcer healing and help modify the treatment protocol if needed. Copyright © 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Pathophysiology diabetic foot ulcer

Science.gov (United States)

Syafril, S.

2018-03-01

Diabetes Mellitus (DM) is known to have many complications. Diabetes and its complications are rapidly becoming the world’s most significant cause of morbidity and mortality, and one of the most distressing is Diabetic Foot Ulcer (DFU). Chronic wound complications are a growing concern worldwide, and the effect is a warning to public health and the economy. The etiology of a DFU is multifaceted, and several components cause added together create a sufficient impact on ulceration: neuropathy, vasculopathy, immunopathy, mechanical stress, and neuroarthropathy. There are many classifications of the diabetic foot. About 50% of patients with foot ulcers due to DM present clinical signs of infection. It is essential to manage multifactorial etiology of DFU to get a good outcome.

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.

Leg pain

Science.gov (United States)

... in the blood Medicines (such as diuretics and statins) Muscle fatigue or strain from overuse, too much exercise, or holding a muscle in the same position for a long time An injury can also cause leg pain from: A torn or overstretched muscle ( strain ) Hairline ...

Intractable Postoperative Wounds Caused by Self-Inflicted Trauma in a Patient with Cutaneous Munchausen Syndrome Presenting as a Pyoderma Gangrenosum-Like Lesion

Directory of Open Access Journals (Sweden)

Keiko Inui

2016-04-01

Full Text Available A 50-year-old Japanese woman consulted the emergency department of our hospital for bleeding due to an intractable postoperative wound on the lower abdomen; the postoperative wound was owing to a laparoscopic cholecystectomy performed 1 year previously for acute cholecystitis. She presented with a painful ulcer on her right lower abdomen. She also presented with multiple scars, skin grafts on the extremities, and a missing left lower leg, the causes for all of which were unexplained. The results of her blood test were normal, except for the hemoglobin level. Histology of the skin biopsy specimen from the ulcer did not show any specific findings. The previous surgeon who had performed the laparoscopic cholecystectomy revealed that surgical wound dehiscence had occurred during her admission. After a body restraint had been applied, the ulcer improved. Medical records indicated that she had been admitted to the department of plastic surgery at our hospital for skin grafting of a leg ulcer. During that admission, she refused to consult with the department of psychiatry, although the staff suspected mental disorders. Therefore, we diagnosed her with cutaneous Munchausen syndrome. After vacuum-assisted closure (VAC therapy had been performed to prevent her from traumatizing the ulcer again, it rapidly became granulated and reepithelialized. Munchausen syndrome is characterized by feigning physical symptoms to seek attention. Patients self-inflict numerous lesions, keep getting admitted to different hospitals, and feign acute illness, usually spectacular diseases. VAC therapy may be effective for preventing patients with cutaneous Munchausen syndrome from traumatizing their wounds.

Intractable Postoperative Wounds Caused by Self-Inflicted Trauma in a Patient with Cutaneous Munchausen Syndrome Presenting as a Pyoderma Gangrenosum-Like Lesion.

Science.gov (United States)

Inui, Keiko; Hanafusa, Takaaki; Namiki, Takeshi; Ueno, Makiko; Igawa, Ken; Yokozeki, Hiroo

2016-01-01

A 50-year-old Japanese woman consulted the emergency department of our hospital for bleeding due to an intractable postoperative wound on the lower abdomen; the postoperative wound was owing to a laparoscopic cholecystectomy performed 1 year previously for acute cholecystitis. She presented with a painful ulcer on her right lower abdomen. She also presented with multiple scars, skin grafts on the extremities, and a missing left lower leg, the causes for all of which were unexplained. The results of her blood test were normal, except for the hemoglobin level. Histology of the skin biopsy specimen from the ulcer did not show any specific findings. The previous surgeon who had performed the laparoscopic cholecystectomy revealed that surgical wound dehiscence had occurred during her admission. After a body restraint had been applied, the ulcer improved. Medical records indicated that she had been admitted to the department of plastic surgery at our hospital for skin grafting of a leg ulcer. During that admission, she refused to consult with the department of psychiatry, al-though the staff suspected mental disorders. Therefore, we diagnosed her with cutaneous Munchausen syndrome. After vacuum-assisted closure (VAC) therapy had been performed to prevent her from traumatizing the ulcer again, it rapidly became granulated and reepithelialized. Munchausen syndrome is characterized by feigning physical symptoms to seek attention. Patients self-inflict numerous lesions, keep getting admitted to different hospitals, and feign acute illness, usually spectacular diseases. VAC therapy may be effective for preventing patients with cutaneous Munchausen syndrome from traumatizing their wounds.

Review : Pressure Ulcer and Its treatment

OpenAIRE

Bijan Khorasani; Ali Ghafouri

2004-01-01

Pressure ulcer is a signifcant problem in elderly and critically ill patients, causing pain, decreasing quality of life and leading to prolonged hospital stay. Treatment of pressure ulcer to improve health status is a cost-effective approach. So, preventing the ulcers will be economical. Pressure ulcer is considered as a damage or necrosis of skin and its layers, which happens when there is a considerable pressure over the tissues. If the capillary arterie's pressure reaches 70 mmHg (2 ti...

Epizootic ulcerative syndrome caused by Aphanomyces invadans in captive bullseye snakehead Channa marulius collected from south Florida, USA

Science.gov (United States)

Saylor, Ryan K.; Miller, Debra L.; Vandersea, Mark W.; Bevelhimer, Mark S.; Schofield, Pamela J.; Bennett, Wayne A.

2010-01-01

Epizootic ulcerative syndrome (EUS) caused by the oomycete Aphanomyces invadans is an invasive, opportunistic disease of both freshwater and estuarine fishes. Originally documented as the cause of mycotic granulomatosis of ornamental fishes in Japan and as the cause of EUS of fishes in southeast Asia and Australia, this pathogen is also present in estuaries and freshwater bodies of the Atlantic and gulf coasts of the USA. We describe a mass mortality event of 343 captive juvenile bullseye snakehead Channa marulius collected from freshwater canals in Miami-Dade County, Florida. Clinical signs appeared within the first 2 d of captivity and included petechiae, ulceration, erratic swimming, and inappetence. Histological examination revealed hyphae invading from the skin lesions deep into the musculature and internal organs. Species identification was confirmed using a species-specific PCR assay. Despite therapeutic attempts, 100% mortality occurred. This represents the first documented case of EUS in bullseye snakehead fish collected from waters in the USA. Future investigation of the distribution and prevalence of A. invadans within the bullseye snakehead range in south Florida may give insight into this pathogen-host system.

Analysis of patient knowledge on interdisciplinary care and self-care in venous leg ulcers

Directory of Open Access Journals (Sweden)

Joanna Michalik

2017-08-01

It is therefore reasonable to say that the treatment of ulcers should be comprehensive and organized, consistent with the principles of modern medicine, and should be based on procedures and standards.

[A case of acute pancreatitis caused by 5-aminosalicylic acid suppositories in a patient with ulcerative colitis].

Science.gov (United States)

Kim, Kook Hyun; Kim, Tae Nyeun; Jang, Byung Ik

2007-12-01

Oral 5-aminosalicylic acid (5-ASA) has been known as a first-choice drug for ulcerative colitis. However, hypersensitivity reactions, including pancreatitis, hepatitis, and skin rash, have been reported with 5-ASA. Topical formulations of 5-ASA like suppositories have been rarely reported to induce adverse reactions because of their limited absorption rate. We recently experienced a case of acute pancreatitis caused by 5-ASA suppositories in a patient with ulcerative colitis. A 26-year-old male was admitted with abdominal pain and diagnosed as ulcerative colitis. Acute pancreatitis occurred soon after 24 hours of treatment with oral mesalazine. Drug-induced pancreatitis was suspected and administration of mesalazine was discontinued. Then 5-ASA suppositories were started instead of oral mesalazine. Twenty-four hours after taking 5-ASA suppositories, he experienced severe abdominal pain, fever, and elevation of amylase levels. The suppositories were immediately stopped and symptoms resolved over next 48 hours. Herein, we suggest that, in patients treated with 5-ASA suppositories who complain of severe abdominal pain, drug-induced pancreatitis should be suspected.

Review : Pressure Ulcer and Its treatment

Directory of Open Access Journals (Sweden)

Bijan Khorasani

2004-10-01

Full Text Available Pressure ulcer is a signifcant problem in elderly and critically ill patients, causing pain, decreasing quality of life and leading to prolonged hospital stay. Treatment of pressure ulcer to improve health status is a cost-effective approach. So, preventing the ulcers will be economical. Pressure ulcer is considered as a damage or necrosis of skin and its layers, which happens when there is a considerable pressure over the tissues. If the capillary arterie's pressure reaches 70 mmHg (2 times more than the normal pressure pressure ulcer happens and depending on the depth of the ulcer, will be divided into 4 stages. The most important point for preventing the ulcers is reducing the pressure. Patients should be repositioned to relieve or minimize the tissue pressure. Considering the type of the ulcer, the necessary treatment (dressing, Antibiotic Therapy, debridement or surgery should be performed.

Cancer complicating chronic ulcerative and scarifying mucocutaneous disorders

International Nuclear Information System (INIS)

Kaplan, R.P.

1987-01-01

Skin affected by a burn cancer is scarred, ulcerated, and often appears as erythema ab igne clinically in adjacent skin. The latent period in burn scar malignancy is much longer for SCC than BCC. Malignant melanoma and various sarcomas are reported to arise in burn scars, too. The other extreme on the temperature scale can less often result in enough permanent acral damage that poor wound healing may eventually result in cancer, usually SCC. About 1% of patients with chronic osteomyelitis develop cancer, usually SCC in sinus tracts. As with tumors arising in burn scars and chronic leg ulcers of varied etiology, black patients are disproportionately overrepresented in osteomyelitic malignancy. In nearly all of the patients with radiation-induced skin cancer, concomitant radiodermatitis is present. As with burn scar and osteomyelitic cancer, x-ray related cancer has a long latent period. Similar to burn scar cancer, SCC predominates in osteomyelitis and occurs on the extremities. BCC, when it arises, is more common on the face and neck in burn- and radiation-induced tumors. Multiple tumors are frequent as is recurrence in x-ray malignancy. Mortality is high: one out of three to four patients with burn scar, osteomyelitic, and radiation cancer die of dermatosis-related malignancy. Recently, radioactivity-contaminated gold rings have been implicated in causing SCC. Carcinoma tends to occur in irradiated benign dermatoses whereas sarcomas tend to complicate irradiated malignancies. Stasis ulceration and anogenital fistulae may rarely lead to cancer, SCC in the former and adenocarcinoma in the latter. SCC can rarely develop in four related conditions (acne conglobata, dissecting perifolliculitis of the scalp, hidradenitis suppurativa, and pilonidal sinus) after a lengthy latent period; prognosis is poor with a high metastatic rate. 147 references

Cost-of-illness studies in chronic ulcers: a systematic review.

Science.gov (United States)

Chan, B; Cadarette, S; Wodchis, W; Wong, J; Mittmann, N; Krahn, M

2017-04-01

To systematically review the published academic literature on the cost of chronic ulcers. A literature search was conducted in MEDLINE, EMBASE, HealthSTAR, Econlit and CINAHL up to 12 May 2016 to identify potential studies for review. Cost search terms were based on validated algorithms. Clinical search terms were based on recent Cochrane reviews of interventions for chronic ulcers. Titles and abstracts were screened by two reviewers to determine eligibility for full text review. Study characteristics were summarised. The quality of reporting was evaluated using a modified cost-of-illness checklist. Mean costs were adjusted and inflated to 2015 $US and presented for different durations and perspectives. Of 2267 studies identified, 36 were eligible and included in the systematic review. Most studies presented results from the health-care public payer or hospital perspective. Many studies included hospital costs in the analysis and only reported total costs without presenting condition-specific attributable costs. The mean cost of chronic ulcers ranged from $1000 per year for patient out of pocket costs to $30,000 per episode from the health-care public payer perspective. Mean one year cost from a health-care public payer perspective was $44,200 for diabetic foot ulcer (DFU), $15,400 for pressure ulcer (PU) and $11,000 for leg ulcer (LU). There was large variability in study methods, perspectives, cost components and jurisdictions, making interpretation of costs difficult. Nevertheless, it appears that the cost for the treatment of chronic ulcers is substantial and greater attention needs to be made for preventive measures.

Radiation induced esophageal ulcer

International Nuclear Information System (INIS)

Kawano, Tatsuyuki; Endo, Mitsuo; Yamazaki, Shigeru

1990-01-01

A 77-year-old woman was referred to us on Dec. 22, 1986 because of dysphagia and esophageal ulcer. She had a previous history of left radical mastectomy for breast cancer, followed by postoperative 60 Co irradiation to parasternal and supraclavicular regions with 50 Gy about 15 years before. UGIs and endoscopy showed a small ulcer surrounded by submucosal tumor-like protrusion in the esophagus at the thoracic inlet. Examination one month later revealed the ulcer which became larger despite medical treatment, now measuring 1 cm in diameter. Severe dysphagia continued. Right thoractomy and subtotal esophagectomy were performed on Jan 13, 1987. Histological examination revealed nonspecific ulcer, 5 cm in diameter, surrounded by fibrous granulation tissue. Proliferation of dilated capillary vessels was also seen in the bottom of the ulcer, the surrounding wall of which was free from remarkable infiltration of inflammatory cells. Based on these findings and previous medical history, the patient was diagnosed as having a postirradiation ulcer which appeared 15 years after irradiation. Dysphagia was considered due to esophageal dysfunction caused by severe fibrosis of the proper muscle layer. (author)

Lower extremity ulceration caused by medical scooter injury: a case series.

Science.gov (United States)

Paparone, Pamela

2013-01-01

The motorized mobility scooter (MMS) provides considerable benefits to patients with mobility limitations. Nevertheless, safety concerns related to MMS use are an issue. With increased use because of increased life expectancy and chronic illness, there are a growing number of reports of MMS-related injuries, ranging from lacerations and contusions to fatalities. Comorbidities may also exacerbate wound care. Prevention of these injuries is greatly needed. The author presents 5 patients with lower-extremity ulceration caused by MMS injuries. To prevent these injuries, health care providers must carefully evaluate and monitor patients. Clinicians and MMS manufacturers also need to educate and train patients on the safe use of MMS devices, including the regular use of footwear. Copyright © 2013 Mosby, Inc. All rights reserved.

Gastroduodenal ulceration in foals.

Science.gov (United States)

Becht, J L; Byars, T D

1986-07-01

Gastroduodenal ulceration is becoming recognised as an important disease in foals during the first few months of life. Aetiopathogenesis is presumed to be similar to peptic disease in humans associated with back diffusion of hydrogen ions into the mucosa. Many factors have been incriminated as predisposing foals to ulceration but few have been proven. To date, use of non-steroidal anti-inflammatory agents has been the only documented cause of gastroduodenal ulceration in foals. The clustering of affected foals on certain farms suggests an infectious aetiology but attempts to identify a causative organism have been unsuccessful. Four clinical syndromes defined for foals with gastroduodenal ulceration include: silent ulcers, which occur most often in the non-glandular stomach along the margo plicatus and are identified as incidental findings at necropsy; active ulcers which are often manifested by abdominal pain, excessive salivation and bruxism; perforating ulcers which usually result in a severe, diffuse peritonitis; and pyloric or duodenal obstruction from a healing ulcer. General approaches to therapy of a foal with active ulceration consist of reduction of gastric acidity and enhancement of mucosal protection. Antacids and type 2 histamine receptor antagonists are used most often to neutralise or decrease acid secretion, respectively. Sucralfate, a locally active sulphated sucrose preparation, is commonly used as a cytoprotective agent. The efficacy and safety of many products used have not been evaluated adequately in foals. Perforating ulcers are usually associated with death or humane destruction of the foal because of fulminating peritonitis. Surgical intervention and bypass procedures are indicated in foals that develop pyloric or duodenal obstructions from healing ulcers.

Superficial skin ulcers

International Nuclear Information System (INIS)

Samaila, Modupeola O.; Rafindadi, Abdulmumini H.; Oluwole, Olabode P.; Adewuyi, Sunday A.

2007-01-01

Objective was to determine the underlying cause of superficial skin ulcers over a 15-year period. A retrospective histopathological analysis of 670 cases of superficial skin ulcers diagnosed in the Dept. of Pathology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria from January 1991 to December 2005. A total of 670 superficial skin ulcers were analyzed. The mail to female gender ratio was 409:261(1.5:1.0) and a peakage frequency of 44.3 %( 297) in the 5th and 6th decades. Spectrum of lesions encountered was categorized into inflammatory, infections, benign and malignant diseases. The malignant lesions were 309 (46.1%), non-specific inflammation 302 (45.1%), granulation tissue 25 (3.7%) and pseudoepitheliomatous hyperplasia 14 (2.1%). A total of 18(2.7%) specific infections were encountered, which included bacterial, fungal and viral infection. Benign lesions were 2(0.3%), comprising of neurofibroma and Bowen's disease. The most common malignant lesion was squamous cell carcinoma 203 (30.3%) with a male to female ratio of 128:75 (1.7:1.0). Of these 161 were well differentiated tumors. The lower limb was the prevalent site distribution of all the ulcers. Superficial ulcers may be harbinger of malignant diseases. Squamous cell carcinoma remains the most common malignant lesion arising from chronic superficial ulcers from our setting. Adequate tissue biopsy and early diagnosis may reduce the attendant morbidity of these ulcers. (author)

Hot topics in venous ulcer treatment: an international survey

OpenAIRE

Stefano Ricci; Francesco Serino; Leo Moro; Fausto Passariello

2013-01-01

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 t...

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...

A systematic approach for the diagnosis and treatment of idiopathic peptic ulcers

Science.gov (United States)

Chung, Chen-Shuan; Chiang, Tsung-Hsien; Lee, Yi-Chia

2015-01-01

An idiopathic peptic ulcer is defined as an ulcer with unknown cause or an ulcer that appears to arise spontaneously. The first step in treatment is to exclude common possible causes, including Helicobacter pylori infection, infection with other pathogens, ulcerogenic drugs, and uncommon diseases with upper gastrointestinal manifestations. When all known causes are excluded, a diagnosis of idiopathic peptic ulcer can be made. A patient whose peptic ulcer is idiopathic may have a higher risk for complicated ulcer disease, a poorer response to gastric acid suppressants, and a higher recurrence rate after treatment. Risk factors associated with this disease may include genetic predisposition, older age, chronic mesenteric ischemia, smoking, concomitant diseases, a higher American Society of Anesthesiologists score, and higher stress. Therefore, the diagnosis and management of emerging disease should systematically explore all known causes and treat underlying disease, while including regular endoscopic surveillance to confirm ulcer healing and the use of proton-pump inhibitors on a case-by-case basis. PMID:26354049

Mouth ulcers

Science.gov (United States)

... Gingivostomatitis Herpes simplex ( fever blister ) Leukoplakia Oral cancer Oral lichen planus Oral thrush A skin sore caused by histoplasmosis may ... mouth Images Oral thrush Canker sore (aphthous ulcer) Lichen planus on the oral mucosa Mouth sores References Daniels TE, Jordan RC. ...

Peritonitis by jejunal ulcer perforation in a child: a case report

Directory of Open Access Journals (Sweden)

Ndèye Aby Ndoye

2017-01-01

Full Text Available Ulcer perforation is a rare cause of peritonitis in children. The cases reported in the literature are caused by peptic ulcer. We report on a case of peritonitis caused by jejunal ulcer perforation, discovered in a girl's abdomen during an acute surgical procedure. The treatment consisted of a resection of the perforation followed by an end-to-end anastomosis. Postoperative period was uneventful.

Drug induced neutropenia manifesting as oral ulcerations

Directory of Open Access Journals (Sweden)

Rachna Kaul

2009-01-01

Full Text Available As dental practitioners, we often come across oral ulcerations of varied etiology. Among all the causes of oral ulcers, those due to neutropenia are significant. Neutropenia can occur in many systemic conditions and also in patients on long-term therapy of certain drugs like phenytoin. The diagnosis of neutropenia in time leads to early recognition of the cause of this fatal condition. Here, we report a case of a 50-year-old female patient who developed oral ulcerations secondary to phenytoin-induced neutropenia. Early diagnosis of the condition led to discontinuation of the offending drug and significant improvement in her blood picture and also prevented her from falling prey to many other systemic infections that neutropenia can cause.

Oropharynx Ulceration

Directory of Open Access Journals (Sweden)

Lauren Sylwanowicz

2017-09-01

Full Text Available History of present illness: A 31-year-old male presented to the emergency department (ED with worsening constant left sided throat pain over the past four months. The patient reports that he was brushing his teeth when his dog jumped onto his back causing his toothbrush to puncture the back of his throat, resulting in immediate bleeding and discomfort. The bleeding subsided and the patient did not seek medical care. The pain radiated to his left ear and the back of the neck. He also noted a change in his voice. The day before presenting to the ED the patient noted subjective fevers, hemoptysis and drooling, which led him to seek medical care. Significant findings: The photograph demonstrates an area of ulcerative tissue at the left palatine tonsil without surrounding erythema or purulent drainage. The computed tomography (CT scan shows a large ulceration of the left soft palate and palatine tonsil (red arrow. There is no evidence of skull base osteomyelitis. There is suppurative lymphadenopathy with partial left jugular vein compression due to mass effect (yellow highlight. There is mild nasopharyngeal airway narrowing with architectural distortion (blue arrow, but no other evidence of airway obstruction. Discussion: The oral cavity is prone to trauma leading to the formation of superficial ulcerations. There are many causes of mechanical trauma, most commonly accidental biting. Chemical, electrical and thermal insults are also possibilities. Poor fitting dental devices and fractured or malformed teeth can also be etiologies.1 Traumatic ulcerations are most common in children given bruxism and thumb sucking. However, a broad differential must be considered including malignant and premalignant lesions, infections of the oral mucosa, aphthous ulcerations and autoimmune diseases.2, 3 Chronic ulcerations are associated with superimposed infection, but there has not been established an association of malignant transformation of the oral mucosa after

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

Directory of Open Access Journals (Sweden)

Serra R

2014-05-01

Full Text Available Raffaele Serra,1,2,* Luca Gallelli,3,* Angela Conti,1 Giovanni De Caridi,4 Mafalda Massara,4 Francesco Spinelli,4 Gianluca Buffone,1 Francesco Giuseppe Caliò,5 Bruno Amato,6 Simona Ceglia,7 Giuseppe Spaziano,8 Luca Scaramuzzino,9 Alessia Giovanna Ferrarese,10 Raffaele Grande,1 Stefano de Franciscis1,2 1Interuniversity Center of Phlebolymphology (CIFL, International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Catanzaro, Italy; 2Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy; 3Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy; 4Cardiovascular and Thoracic Department, University of Messina, Messina, Italy; 5Unit of Vascular Surgery, S Anna Hospital, Catanzaro, Italy; 6Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy; 7Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy; 8Department of Experimental Medicine, Second University of Naples, Naples, Italy; 9University Campus BioMedico of Rome, Rome, Italy; 10Department of General Surgery, University of Turin, Turin, Italy *These authors contributed equally to this work Background: Mixed venous and arterial ulcers account for approximately 15%–30% of all venous leg ulcerations. Several studies have shown that matrix metalloproteinases (MMPs and neutrophil gelatinase-associated lipocalin (NGAL play a central role in the pathophysiology of venous and arterial diseases. Some studies have shown the efficacy of glycosaminoglycans, such as sulodexide (SDX, in treating patients with leg ulcers. The aim of this study was to evaluate clinical effects of SDX and its correlation with MMPs and NGAL expression in patients with mixed arterial and venous leg ulcers. Methods: Patients eligible for this study were of both sexes, older than 20 years, and with a

The Demographic and Clinical Presentation of Ulcerative Keratitis in ...

African Journals Online (AJOL)

Background: Ulcerative keratitis and subsequent corneal scarring is at present the leading cause of ocular morbidity and unilateral blindness in developing countries. In developed countries, HIV infection has been associated with severe ulcerative keratitis. The demographic and clinical presentation of Ulcerative keratitis ...

Amyloid Goiter Secondary to Ulcerative Colitis

Directory of Open Access Journals (Sweden)

Bunyamin Aydin

2016-01-01

Full Text Available Diffuse amyloid goiter (AG is an entity characterized by the deposition of amyloid in the thyroid gland. AG may be associated with either primary or secondary amyloidosis. Secondary amyloidosis is rarely caused by inflammatory bowel diseases. Secondary amyloidosis is relatively more common in the patients with Crohn’s disease, whereas it is highly rare in patients with ulcerative colitis. Diffuse amyloid goiter caused by ulcerative colitis is also a rare condition. In the presence of amyloid in the thyroid gland, medullary thyroid cancer should be kept in mind in the differential diagnosis. Imaging techniques and biochemical tests are not very helpful in the diagnosis of secondary amyloid goiter and the definitive diagnosis is established based on the histopathologic analysis and histochemical staining techniques. In this report, we present a 35-year-old male patient with diffuse amyloid goiter caused by secondary amyloidosis associated with ulcerative colitis.

Pressure ulcer prevention in frail older people.

Science.gov (United States)

Barry, Maree; Nugent, Linda

2015-12-16

Pressure ulcers are painful and cause discomfort, have a negative effect on quality of life, and are costly to treat. The incidence and severity of preventable pressure ulcers is an important indicator of quality of care; it is essential that healthcare providers monitor prevalence and incidence rates to ensure that care strategies implemented are effective. Frail older people are at increased risk of developing pressure ulcers. This article discusses the complexities of preventing pressure ulcers in frail older people and emphasises the importance of structured educational programmes that incorporate effective clinical leadership and multidisciplinary teamwork.

The Traumatic Tube: Bleeding Rectal Ulcer Caused by Flexi-Seal Device

Directory of Open Access Journals (Sweden)

Abhinav Tiwari

2017-01-01

Full Text Available Diarrhea and fecal incontinence are common in critically ill patients and present a challenging problem in patient management. The Flexi-Seal® Fecal Management System is a device to divert the stools away from the patient, thus improving the care to patients with fecal incontinence. There have been only few case reports describing the complications with the use of this device. Here, we present a case of a 77-year-old woman who was admitted due to massive hematochezia while on anticoagulation. She was found to have a large rectal ulcer caused by the Flexi-Seal device, used during the last hospital stay for fecal incontinence. Flexi-Seal device can be effective for the management of incontinence; however, caution should be exercised during handling and pressure from the retention balloon should be relieved periodically.

Causes of ring-related leg injuries in birds - evidence and recommendations from four field studies.

Directory of Open Access Journals (Sweden)

Michael Griesser

Full Text Available One of the main techniques for recognizing individuals in avian field research is marking birds with plastic and metal leg rings. However, in some species individuals may react negatively to rings, causing leg injuries and, in extreme cases, the loss of a foot or limb. Here, we report problems that arise from ringing and illustrate solutions based on field data from Brown Thornbills (Acanthiza pusilla (2 populations, Siberian Jays (Perisoreus infaustus and Purple-crowned Fairy-wrens (Malurus coronatus. We encountered three problems caused by plastic rings: inflammations triggered by material accumulating under the ring (Purple-crowned Fairy-wrens, contact inflammations as a consequence of plastic rings touching the foot or tibio-tarsal joint (Brown Thornbills, and toes or the foot getting trapped in partly unwrapped flat-band colour rings (Siberian Jays. Metal rings caused two problems: the edges of aluminium rings bent inwards if mounted on top of each other (Brown Thornbills, and too small a ring size led to inflammation (Purple-crowned Fairy-wrens. We overcame these problems by changing the ringing technique (using different ring types or larger rings, or using different adhesive. Additionally, we developed and tested a novel, simple technique of gluing plastic rings onto metal rings in Brown Thornbills. A review of studies reporting ring injuries (N = 23 showed that small birds (35 g tend to get rings stuck over their feet. We give methodological advice on how these problems can be avoided, and suggest a ringing hazard index to compare the impact of ringing in terms of injury on different bird species. Finally, to facilitate improvements in ringing techniques, we encourage online deposition of information regarding ringing injuries of birds at a website hosted by the European Union for Bird Ringing (EURING.

Medical device-related pressure ulcers

Directory of Open Access Journals (Sweden)

Black JM

2016-08-01

Full Text Available Joyce M Black,1 Peggy Kalowes2 1Adult Health and Illness Department, College of Nursing, University of Nebraska Medical Center, Omaha, NE, 2Nursing Research and Innovation, Long Beach Memorial Miller Children’s & Women’s Hospital, Long Beach, CA, USA Abstract: Pressure ulcers from medical devices are common and can cause significant morbidity in patients of all ages. These pressure ulcers appear in the shape of the device and are most often found from the use of oxygen delivery devices. A hospital program designed to reduce the number of pressure ulcers from medical devices was successful. The program involved the development of a team that focused on skin, the results were then published for the staff to track their performance, and it was found that using foam dressings helped reduce the pressure from the device. The incidence of ulcers from medical devices has remained at zero at this hospital since this program was implemented. Keywords: pressure ulcer, medical device related

A Clinical Approach to Vulvar Ulcers.

Science.gov (United States)

Stewart, Kristen M A

2017-09-01

This article discusses the differential diagnosis of vulvar ulcers and describes a general clinical approach to this common but nonspecific examination finding. The differential diagnosis includes sexually and nonsexually transmitted infections, dermatitides, trauma, neoplasms, hormonally induced ulcers, and drug reactions. Patient history and physical examination provide important clues to the cause of a vulvar ulcer. However, laboratory testing is usually required for accurate diagnosis because the clinical presentation is often nonspecific and may be atypical due to secondary conditions. Copyright © 2017 Elsevier Inc. All rights reserved.

Studies of a new multi-layer compression bandage for the treatment of venous ulceration.

Science.gov (United States)

Scriven, J M; Bello, M; Taylor, L E; Wood, A J; London, N J

2000-03-01

This study aimed to develop an alternative graduated compression bandage for the treatment of venous leg ulcers. Alternative bandage components were identified and assessed for optimal performance as a graduated multi-layer compression bandage. Subsequently the physical characteristics and clinical efficacy of the optimal bandage combination was prospectively examined. Ten healthy limbs were used to develop the optimal combination and 20 limbs with venous ulceration to compare the physical properties of the two bandage types. Subsequently 42 consecutive ulcerated limbs were prospectively treated to examine the efficacy of the new bandage combination. The new combination produced graduated median (range) sub-bandage pressures (mmHg) as follows: ankle 59 (42-100), calf 36 (27-67) and knee 35 (16-67). Over a seven-day period this combination maintained a comparable level of compression with the Charing Cross system, and achieved an overall healing rate at one year of 88%. The described combination should be brought to the attention of healthcare professionals treating venous ulcers as a possible alternative to other forms of multi-layer graduated compression bandages pending prospective, randomised clinical trials.

Intractable Postoperative Wounds Caused by Self-Inflicted Trauma in a Patient with Cutaneous Munchausen Syndrome Presenting as a Pyoderma Gangrenosum-Like Lesion

OpenAIRE

Inui, Keiko; Hanafusa, Takaaki; Namiki, Takeshi; Ueno, Makiko; Igawa, Ken; Yokozeki, Hiroo

2016-01-01

A 50-year-old Japanese woman consulted the emergency department of our hospital for bleeding due to an intractable postoperative wound on the lower abdomen; the postoperative wound was owing to a laparoscopic cholecystectomy performed 1 year previously for acute cholecystitis. She presented with a painful ulcer on her right lower abdomen. She also presented with multiple scars, skin grafts on the extremities, and a missing left lower leg, the causes for all of which were unexplained. The resu...

Helicobacter pylori infection as a cause of gastritis, duodenal ulcer, gastric cancer and nonulcer dyspepsia: a systematic overview.

Science.gov (United States)

Veldhuyzen van Zanten, S J; Sherman, P M

1994-01-15

To evaluate current evidence for a causal relation between Helicobacter pylori infection and gastritis, duodenal ulcer, gastric cancer and nonulcer dyspepsia. A MEDLINE search for articles published in English between January 1983 and December 1992 with the use of MeSH terms Helicobacter pylori, gastritis, duodenal ulcer, gastric cancer, dyspepsia and clinical trial; abstracts were excluded. Six journals and Current Contents were searched manually for pertinent articles published in that time frame. Original studies with at least 25 patients, case reports and reviews that examined the relation between H. pylori and the four gastrointestinal disorders; 350 articles were on gastritis, 122 on duodenal ulcer, 44 on gastric cancer and 96 on nonulcer dyspepsia. The quality of the studies was rated independently on a four-point scale. The strength of the evidence was assessed using a six-point scale for each of the eight established guidelines for determining a causal relation. There was conclusive evidence of a causal relation between H. pylori infection and histologic gastritis. Koch's postulates for the identification of a microorganism as the causative agent of a disease were fulfilled for H. pylori as a causative agent of gastritis. There was strong evidence that H. pylori is the main cause of duodenal ulcers not induced by nonsteroidal anti-inflammatory drugs, but all of Koch's postulates were not fulfilled. There was moderate epidemiologic evidence of an association between chronic H. pylori infection and gastric cancer. There was a lack of convincing evidence of a causal association between H. pylori and nonulcer dyspepsia. The evidence supports a strong causal relation between H. pylori infection and gastritis and duodenal ulcer and a moderate relation between such infection and gastric cancer. Further studies are needed to clarify the role of H. pylori in these disorders. Thus far, there is no evidence of a causal relation between H. pylori and nonulcer

[Diagnosis and Treatment of Peptic Ulcer Disease: Present and Future Perspective].

Science.gov (United States)

Kim, Byung Wook

2016-06-25

Peptic ulcer disease is one of the most commonly encountered diseases in gastroenterology clinics. After the discovery of Helicobacter pylori by Warren and Marshall, it has been identified as the most important cause of peptic ulcer. Eradication of H. pylori markedly reduces the post-treatment recurrence rate of peptic ulcer. However, as human populations age, the incidence of cardiovascular and musculoskeletal diseases increases and consequent use of aspirin and non-steroidal anti-in-flammatory drugs increases. Thus causes and presenting patterns of peptic ulcer have changed. In this review, I describe new diagnostic and therapeutic strategies for peptic ulcer disease and explore future perspectives.

Trophic ulcers in the carpal tunnel syndrome

Directory of Open Access Journals (Sweden)

Abelardo Q.-C. Araújo

1993-09-01

Full Text Available A patient with carpal tunnel syndrome (CTS and trophic ulcers is described. Despite the healing of the ulcers after surgery for CTS, the severe sensory deficit and the electrophysiological tests have not shown any significant improvement. We think these findings argue against the hypothesis of the sensory deficit being responsible for the trophic ulcers. We favor a major role for the sympathetic disturbances as the main cause for those lesions.

Massive Upper Gastrointestinal Bleeding from a Splenic Artery Pseudoaneurysm Caused by a Penetrating Gastric Ulcer: Case Report and Review of Literature

International Nuclear Information System (INIS)

Sawicki, Marcin; Marlicz, Wojciech; Czapla, Norbert; Łokaj, Marek; Skoczylas, Michał M.; Donotek, Maciej; Kołaczyk, Katarzyna

2015-01-01

Splenic artery aneurysm and pseudoaneurysm are rare pathologies. True aneurysms are usually asymptomatic. Aneurysm rupture occurring in 2–3% of cases results in bleeding into the lesser sack, peritoneal space or adjacent organs typically presenting as abdominal pain and hemodynamic instability. In contrast, pseudoaneurysms are nearly always symptomatic carrying a high risk of rupture of 37–47% and mortality rate of 90% if untreated. Therefore, prompt diagnosis and treatment are essential in the management of patients with splenic artery pseudoaneurysm. Typical causes include pancreatitis and trauma. Rarely, the rupture of a pseudoaneurysm presents as upper gastrointestinal (UGI) bleeding. Among causes, peptic ulcer is the casuistic one. This report describes a very rare case of recurrent UGI bleeding from a splenic artery pseudoaneurysm caused by a penetrating gastric ulcer. After negative results of endoscopy and ultrasound, the diagnosis was established in CT angiography. The successful treatment consisted of surgical ligation of the bleeding vessel and suture of the ulcer with preservation of the spleen and pancreas, which is rarely tried in such situations. The most important factor in identifying a ruptured splenic artery pseudoaneurysm as a source of GI bleeding is considering the diagnosis. UGI hemorrhage from splenic artery pseudoaneurysm can have a relapsing course providing false negative results of endoscopy and ultrasound if performed between episodes of active bleeding. In such cases, immediate CT angiography is useful in establishing diagnosis and in application of proper therapy before possible recurrence

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.

THE CLINICAL MANIFESTATIONS AND COURSE OF DUODENAL ULCER DISEASE AFTER PERFORATED ULCER

Directory of Open Access Journals (Sweden)

L. A. Lyubskaya

2014-01-01

Full Text Available Objective: to compare clinical manifestations, course, mental status in duodenal ulcer (DU patients with a history of perforated ulcer and its uncomplicated course.Subjects and methods. One hundred and thirteen patents with DU were examined. Group 1 included 61 patients with uncomplicated DUand Group 2 comprised 52 patients with a history of perforated ulcer. A comparison group consisted of 20 patients who had undergone laparotomy. Physical and mental status examinations, esophagogastroduodenoscopy (EGDS, and 24-hour pH-metry were performed.Results. Classical pain syndrome was observed in 75 % of the patients with uncomplicated DU. Prior to perforation, the pain and dyspeptic syndromes were distinguished only by a significantly lower degree in Group 2; following perforation, the pain syndrome was recorded more frequently, it was more extensive, meal-unrelated, and similar to that in the patients who had undergone laparotomy and had diminished appetite (36.5 %. EGDS showed that the complicated course was accompanied by the significantly higher incidence of erosive esophagitis (21.2 %, gastritis (51.9 %, duodenitis (25.0 %, multiple ulcers (28.8 %, and larger ulcers. 24-hour pH-metry indicated that the level of hyperacidity in Group 2 was higher and the circadian intragastric pH variations were less marked than those in uncomplicated DU. The patients with a history of perforated ulcer showed a high rate of anxiety and depressive changes. Conclusion. In complicated DU, marked monotonic hyperacidity causes common erosive-ulcerative lesions in the gastroduodenal area in relatively mild pain syndrome, late referrals, and long-term ulcer healing. After perforation followed by wound closure, the pain and dyspeptic syndromes become more pronounced, which is associated with anxiety and depressive changes in the mental status, as well as with early referrals and less healing time.

A Study of Changes in Stomach Wall at Sites Other Than the Ulcer in Chronic Duodenal Ulcer Patients

OpenAIRE

Mishra, Jagmohan; Panigrahi, Souvagya

2011-01-01

It is known that at least 90% of duodenal ulcers are caused by infection with the bacterium Helicobacter pylori. Eradicating this organism usually results in complete resolution of the disease (Rosengren, Br J Gen Pract 46(409):491–492, 1996). To study the different changes if any in stomach wall at sites other than the ulcer in chronic duodenal ulcer patients by upper Gastro-Intenstinal Endoscopy followed by histopathological examination of different parts of stomach. This study was a retros...

Vulval Ulcers | Rogers | Obstetrics and Gynaecology Forum

African Journals Online (AJOL)

The vulval ulcers that are seen in obstetrics and gynaecological practice in South Africa are most commonly caused by sexually transmitted diseases, especially herpes simplex infection. These ulcers have become more common due to the Human immunodeficiency virus (HIV) epidemic, and are also responsible for ...

Sustained compression and healing of chronic venous ulcers.

Science.gov (United States)

Blair, S. D.; Wright, D. D.; Backhouse, C. M.; Riddle, E.; McCollum, C. N.

1988-01-01

STUDY OBJECTIVE--Comparison of four layer bandage system with traditional adhesive plaster bandaging in terms of (a) compression achieved and (b) healing of venous ulcers. DESIGN--Part of larger randomised trial of five different dressings. SETTING--Outpatient venous ulcer clinic in university hospital. PATIENTS--(a) Pressure exerted by both bandage systems was measured in the same 20 patients. (b) Healing with the four layer bandage was assessed in 148 legs in 126 consecutive patients (mean age 71 (SE 2); range 30-96) with chronic venous ulcers that had resisted treatment with traditional bandaging for a mean of 27.2 (SE 8) months. INTERVENTIONS--(a) Four layer bandage system or traditional adhesive plaster bandaging for pressure studies; (b) four layer bandaging applied weekly for studies of healing. END POINTS--(a) Comparison of pressures achieved at the ankle for up to one week; (b) complete healing within 12 weeks. MEASUREMENTS AND MAIN RESULTS--(a) Four layer bandage produced higher initial pressures at the ankle of 42.5 (SE 1) mm Hg compared with 29.8 (1.8) for the adhesive plaster (p less than 0.001; 95% confidence interval 18.5 to 6.9). Pressure was maintained for one week with the four layer bandage but fell to 10.4 (3.5) mm Hg at 24 hours with adhesive plaster bandaging. (b) After weekly bandaging with the four layer bandage 110 of 48 venous ulcers had healed completely within 12 (mean 6.3 (0.4)) weeks. CONCLUSION--Sustained compression of over 40 mm Hg achieved with a multilayer bandage results in rapid healing of chronic venous ulcers that have failed to heal in many months of compression at lower pressures with more conventional bandages. PMID:3144330

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.

Acyclovir in the prevention of duodenal ulcer recurrence

DEFF Research Database (Denmark)

Rune, S J; Linde, J; Bonnevie, O

1990-01-01

This study tests the hypothesis that reactivation of a latent herpes simplex virus infection may be a cause of recurrent duodenal ulceration. Patients with recently healed duodenal ulcer were entered into a double blind, randomised study of maintenance treatment with the antiviral drug acyclovir...... (400 mg bid) versus placebo, to determine if suppression of herpes virus infection would influence the natural history of the ulcer disease. One hundred and fifteen patients entered the trial and 76 patients completed it according to the protocol. Endoscopy was performed when ulcer symptoms recurred...

Severe Upper Gastrointestinal Hemorrhage from Linear Gastric Ulcers in Large Hiatal Hernias: a Large Prospective Case Series of Cameron Ulcers

Science.gov (United States)

Camus, Marine; Jensen, Dennis M.; Ohning, Gordon V.; Kovacs, Thomas O.; Ghassemi, Kevin A.; Jutabha, Rome; Machicado, Gustavo A.; Dulai, Gareth S.; Hines, Joel O.

2013-01-01

Background and study aims Cameron ulcers are a rare but clinically significant cause of severe upper gastrointestinal hemorrhage (SUGIH). Our aims were to describe (1) the diagnosis, treatment and outcomes of patients with Cameron ulcers causing hospitalization for SUGIH, (2) the differences between patients with occult vs. overt bleeding and (3) between patients treated surgically and medically. Patients and methods Over the past 17 years, all consecutive patients hospitalized in our two tertiary referral medical centers for severe UGIH or severe obscure GIH and entered into our large prospective databasis were screened for Cameron ulcer diagnosis. Results Cameron ulcers were diagnosed in 25 patients of 3960 patients with SUGIH (0.6%). 21 patients had follow-up (median [IQR] time of 20.4 months [8.5–31.8]). Patients were more often elderly females with chronic anemia, always had large hiatal hernias, and were usually referred for obscure SUGIH. Twelve (57.2%) patients were referred to surgery for rebleeding and recurrent blood loss while treated with high dose of proton pump inhibitors (PPI). 9 (42.8%) other patients continued PPI without any rebleeding during the follow-up. Patients with overt bleeding had significantly more prior hospitalizations for SUGIH, more often stigmata of hemorrhage on ulcers, and more red blood cell transfusions than patients with occult bleeding. However, there was no difference in rebleeding and mortality rates between the two groups. Conclusions Cameron ulcers in large hiatal hernias are an uncommon cause of SUGIH. Most of patients are referred for obscure GIH. The choice of medical vs. surgical therapy should be individualized. PMID:23616128

Increased short- and long-term mortality in 8146 hospitalised peptic ulcer patients.

Science.gov (United States)

Malmi, H; Kautiainen, H; Virta, L J; Färkkilä, M A

2016-08-01

Incidence and complications of peptic ulcer disease (PUD) have declined, but mortality from peptic ulcer bleeding has remained unchanged. The few recent studies on mortality associated with both uncomplicated and complicated patients with peptic ulcer disease provide contradictory results. To evaluate short- and long-term mortality, and the main causes of death in peptic ulcer disease. In this retrospective epidemiologic cohort study, register data on 8146 adult patients hospitalised with peptic ulcer disease during 2000-2008 were collected in the capital region of Finland. All were followed in the National Cause of Death Register until the end of 2009. The data were linked with the nationwide Drug Purchase Register of the Finnish Social Insurance Institution. Mean follow-up time was 4.9 years. Overall mortality was substantially increased, standardised mortality ratio 2.53 (95% CI: 2.44-2.63); 3.7% died within 30 days, and 11.8% within 1 year. At 6 months, the survival of patients with perforated or bleeding ulcer was lower compared to those with uncomplicated ulcer; hazard ratios were 2.06 (1.68-2.04) and 1.32 (1.11-1.58), respectively. For perforated duodenal ulcers, both the short- and long-term survival was significantly impaired in women. The main causes of mortality at 1 year were malignancies and cardiovascular diseases. Previous use of statins was associated with significant reduction in all-cause mortality. One-year mortality in patients hospitalised with peptic ulcer disease remained high with no change. This peptic ulcer disease cohort had a clearly decreased survival rate up to 10 years, especially among women with a perforated duodenal ulcer, most likely explained by poorer survival due to underlying comorbidity. © 2016 John Wiley & Sons Ltd.

Pictorial essay: Ultrasonography in 'tennis leg'.

Science.gov (United States)

Shah, Jeshil R; Shah, Bipin R; Shah, Ankit B

2010-11-01

Tennis leg is caused by a rupture of the medial head of the gastrocnemius muscle, usually at its distal musculotendinous junction region. However, tears in this muscle and its tendon are also included under the term 'tennis leg'. It is seen regularly in practice and is an important cause of a painful calf. The common USG findings include: disruption of the pinnate pattern of the distal medial gastrocnemius, usually near the junction of the triceps surae (which is the echogenic line between the gastrocnemius, the soleus, and the plantaris muscles), fluid tracking along the fascia, adjacent hematoma, and intramuscular tears as well as hematomas. USG is useful for confirming the diagnosis, excluding other causes of a painful calf, for assessing the severity of the disease, and in follow-up.

[Treatment for patients who have arterial ulcers].

Science.gov (United States)

Antolínez de Abia, Noelia

2009-01-01

Arterial ulcers are produced due to chronic ischemia in lower limbs. This causes a progressive, slow decrease in blood flow and oxygen supply to lower limbs. The main symptom consists of an intermittent claudication, or muscle pain while walking which ceases upon resting, but, when these symptoms appear; this wound usually is advanced and medical professionals basically use surgical, pharmaceutical and local treatments to cure this ulcer. In this article, the author presents a guide to diagnosis, treatment and prevention of arterial ulcers.

Peptic ulcer in the gallbladder. A case report

DEFF Research Database (Denmark)

Larsen, E H; Diederich, P J; Sørensen, Flemming Brandt

1985-01-01

Gastric mucosa can be found in the gallbladder as a congenital heterotopia. A case of a perforated peptic ulcer in the gallbladder with concomitant hemorrhage in heterotopic gastric mucosa causing hematemesis and melena is presented.......Gastric mucosa can be found in the gallbladder as a congenital heterotopia. A case of a perforated peptic ulcer in the gallbladder with concomitant hemorrhage in heterotopic gastric mucosa causing hematemesis and melena is presented....

Development of an IoT early-warning temperature home-monitoring system for diabetic foot ulcer-or Charcot-feet patients

DEFF Research Database (Denmark)

Dittmann, Lars; Petersen, Martin Nordal; Yderstræde, Knud Bonnet

2017-01-01

In severe cases, diabetic patients can develop ulcers at the feet and lower leg regions.This,together with a condition called Charcot-foot, can lead to severe wounds, numbness and eventually amputation. There are ways to treat the condition, but the key element is early-warning and early treatment....

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

Adaptive leg coordination with a biologically inspired neurocontroller

Science.gov (United States)

Braught, Grant; Thomopoulos, Stelios C.

1996-10-01

Natural selection is responsible for the creation of robust and adaptive control systems. Nature's control systems are created only from primitive building blocks. Using insect neurophysiology as a guide, a neural architecture for leg coordination in a hexapod robot has been developed. Reflex chains and sensory feedback mechanisms from various insects and crustacea form the basis of a pattern generator for intra-leg coordination. The pattern generator contains neural oscillators which learn from sensory feedback to produce stepping patterns. Using sensory feedback as the source of learning information allows the pattern generator to adapt to changes in the leg dynamics due to internal or external causes. A coupling between six of the single leg pattern generators is used to produce the inter-leg coordination necessary to establish stable gaits.

AEROBIC BACTERIAL ISOLATES FROM INFECTED WOUNDS

African Journals Online (AJOL)

boaz

most frequently reported as the cause of delay wound healing (6-9, 3). ... All isolates were resistant to Ampicillin, Amoxicillin- clavulanate and .... Ulcer bed infection. Report of a case of enlarging venous leg ulcer colonized by ... Ann. Burns Fire.

Is perforated marginal ulcer after the surgery of gastroduodenal ulcer associated with inadequate treatment for Helicobacter pylori eradication?

Science.gov (United States)

Aydinli, Bulent; Yilmaz, Omer; Ozturk, Gurkan; Yildigan, M Ilhan; Gursan, Nesrin; Basoglu, Mahmut

2007-09-01

A marginal ulcer developing after an initial operation for gastroduodenal ulcer is a serious threat to the patient, and a challenge to surgeons. Helicobacter pylori is the primary cause of peptic ulcer disease. However, its role in ulcer recurrence, especially of marginal ulcer (MU), after peptic ulcer surgery is unclear. This study aimed to determine any association between H. pylori infection and perforated MU by comparing the prevalence of H. pylori and nonsteroidal anti-inflammatory drugs (NSAIDs) use in patients with perforated (PMU) and in those with nonperforated MU (NPMU). The study retrospectively evaluated the records of 16 patients with PMU who underwent surgical treatment and 24 patients with NPMU who underwent medical treatment in Atatürk University, School of Medicine, Department of General Surgery and Gastroenterology, between January 1995 and December 2004. The rate of H. pylori in the PMU group was significantly higher than that of the NPMU group (P PMU compared with NPMU patients (P PMU (P PMU operation especially in cases with impaired hemodynamics, severe peritoneal contamination, and/or a diameter smaller than 1 cm and avoiding the use of NSAIDs will surely reduce the risk of relapsing ulcers.

Pressure ulcer prevention knowledge among Jordanian nurses: a cross- sectional study

OpenAIRE

Qaddumi, Jamal; Khawaldeh, Abdullah

2014-01-01

Background Pressure ulcer remains a significant problem in the healthcare system. In addition to the suffering it causes patients, it bears a growing financial burden. Although pressure ulcer prevention and care have improved in recent years, pressure ulcer still exists and occurs in both hospital and community settings. In Jordan, there are a handful of studies on pressure ulcer. This study aims to explore levels of knowledge and knowledge sources about pressure ulcer prevention, as well as ...

[Neurosis and genetic theory of etiology and pathogenesis of ulcer disease].

Science.gov (United States)

Kolotilova, M L; Ivanov, L N

2014-01-01

Based on the analysis of literature data and our own research, we have developed the original concept of etiology and pathogenesis of peptic ulcer disease. An analysis of the literature shows that none of the theories of pathogenesis of peptic ulcer disease does not cover the full diversity of the involved functions and their shifts, which lead to the development of ulcers in the stomach and the duodenum. Our neurogenic-genetic theory of etiology and pathogenesis of gastric ulcer and duodenal ulcer very best explains the cause-and-effect relationships in the patient peptic ulcer, allowing options for predominance in one or the other case factors of neurosis or genetic factors. However, it is clear that the only other: combination of neurogenic factor with genetically modified reactivity of gastroduodenal system (the presence of the target organ) cause the chronicity of the sores. The theory of peptic ulcer disease related to psychosomatic pathologies allows us to develop effective schema therapy, including drugs with psychocorrective action. On the basis of our theory of the role of Helicobacter pylori infection is treated as a pathogenetic factor in the development of peptic ulcer disease.

Atypical cause of forearm skin ulceration in a leukaemic child: mucormycosis. A case report.

Science.gov (United States)

Zirak, C; Brutus, J P; De Mey, A

2005-01-01

Primary cutaneous mucormycosis is an uncommon, deep and aggressive fungal infection occurring mainly in immunosuppressed or diabetic patients. Rapid diagnosis and therapy are necessary to prevent a fatal outcome. An eight-year-old leukaemic child presented with a dark necrotic ulcer on the volar-ulnar aspect of the left forehand. The lesion had developed over seven days, beginning as a vasculo-haemorrhagic erythematous plaque. There was no known history of trauma to the area, but skin necrosis from external compression caused by an intravenous line could not be completely ruled out. The lesion rapidly progressed to a 5 x 8 cm painful necrotic ulcer with an erythematous border. Treatment with ichthyol dressing and intra-venous antibiotherapy failed to improve the condition. Wide debridement was performed and specimens were sent for microbiology and pathology examinations. Microscopic examination demonstrated broad, irregularly walled, non-septate fungal hyphae that were consistent with Mucor. Amphotericin B was administrated intravenously (1 mg/kg/day) and hydrogel and hydrophile adhesive polyurethane foam dressings were applied. After 12 days, the soft tissue defect was covered with a split-thickness skin graft, harvested from the lateral aspect of the thigh. Diagnosis of this infection is based on complete histopathological and microbiological studies. Awareness, and a high index of suspicion are required because of the potential fulminant and fatal course.

Amelogenin, an extracellular matrix protein, in the treatment of venous leg ulcers and other hard-to-heal wounds: experimental and clinical evidence

DEFF Research Database (Denmark)

Romanelli, M.; Dini, V.; Vowden, P.

2008-01-01

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...... 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...... 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 Udgivelsesdato: 2008...

Haemophilus ducreyi: from sexually transmitted infection to skin ulcer pathogen.

Science.gov (United States)

Lewis, David A; Mitjà, Oriol

2016-02-01

This article provides an overview of the biology, epidemiology, clinical features, diagnostic tests, and treatment of Haemophilus ducreyi infection, with special reference to the decline of chancroid and the recent emergence of H. ducreyi as a pathogen responsible for chronic limb ulceration clinically similar to yaws. Chancroid has declined in importance as a sexually transmitted infection in most countries where it was previously endemic. Chancroid may be caused by either class I or class II H. ducreyi isolates; these two classes diverged from each other approximately 1.95 million years ago. H. ducreyi has recently emerged as a cause of chronic skin ulceration in the Pacific region and Africa. Based on sequencing of whole genomes and defined genetic loci, it appears that the cutaneous H. ducreyi strains diverged from the class I genital strains relatively recently. H. ducreyi should be considered as a major cause of chronic limb ulceration in both adults and children and appropriate molecular diagnostic assays are required to determine ulcer aetiology. The high prevalence of H. ducreyi-related cutaneous ulceration in yaws-endemic countries has challenged the validity of observational surveys to monitor the effectiveness of the WHO's yaws eradication campaign.

Pressure ulcers: Back to the basics.

Science.gov (United States)

Agrawal, Karoon; Chauhan, Neha

2012-05-01

Pressure ulcer in an otherwise sick patient is a matter of concern for the care givers as well as the medical personnel. A lot has been done to understand the disease process. So much so that USA and European countries have established advisory panels in their respective continents. Since the establishment of these organizations, the understanding of the pressure ulcer has improved significantly. The authors feel that the well documented and well publicized definition of pressure ulcer is somewhat lacking in the correct description of the disease process. Hence, a modified definition has been presented. This disease is here to stay. In the process of managing these ulcers the basic pathology needs to be understood well. Pressure ischemia is the main reason behind the occurrence of ulceration. Different extrinsic and intrinsic factors have been described in detail with review of literature. There are a large number of risk factors causing ulceration. The risk assessment scales have eluded the surgical literature and mostly remained in nursing books and websites. These scales have been reproduced for completion of the basics on decubitus ulcer. The classification of the pressure sores has been given in a comparative form to elucidate that most of the classifications are the same except for minor variations. The management of these ulcers is ever evolving but the age old saying of "prevention is better than cure" suits this condition the most.

Pressure ulcers: Back to the basics

Directory of Open Access Journals (Sweden)

Karoon Agrawal

2012-01-01

Full Text Available Pressure ulcer in an otherwise sick patient is a matter of concern for the care givers as well as the medical personnel. A lot has been done to understand the disease process. So much so that USA and European countries have established advisory panels in their respective continents. Since the establishment of these organizations, the understanding of the pressure ulcer has improved significantly. The authors feel that the well documented and well publicized definition of pressure ulcer is somewhat lacking in the correct description of the disease process. Hence, a modified definition has been presented. This disease is here to stay. In the process of managing these ulcers the basic pathology needs to be understood well. Pressure ischemia is the main reason behind the occurrence of ulceration. Different extrinsic and intrinsic factors have been described in detail with review of literature. There are a large number of risk factors causing ulceration. The risk assessment scales have eluded the surgical literature and mostly remained in nursing books and websites. These scales have been reproduced for completion of the basics on decubitus ulcer. The classification of the pressure sores has been given in a comparative form to elucidate that most of the classifications are the same except for minor variations. The management of these ulcers is ever evolving but the age old saying of "prevention is better than cure" suits this condition the most.

Pressure ulcers: Back to the basics

Science.gov (United States)

Agrawal, Karoon; Chauhan, Neha

2012-01-01

Pressure ulcer in an otherwise sick patient is a matter of concern for the care givers as well as the medical personnel. A lot has been done to understand the disease process. So much so that USA and European countries have established advisory panels in their respective continents. Since the establishment of these organizations, the understanding of the pressure ulcer has improved significantly. The authors feel that the well documented and well publicized definition of pressure ulcer is somewhat lacking in the correct description of the disease process. Hence, a modified definition has been presented. This disease is here to stay. In the process of managing these ulcers the basic pathology needs to be understood well. Pressure ischemia is the main reason behind the occurrence of ulceration. Different extrinsic and intrinsic factors have been described in detail with review of literature. There are a large number of risk factors causing ulceration. The risk assessment scales have eluded the surgical literature and mostly remained in nursing books and websites. These scales have been reproduced for completion of the basics on decubitus ulcer. The classification of the pressure sores has been given in a comparative form to elucidate that most of the classifications are the same except for minor variations. The management of these ulcers is ever evolving but the age old saying of “prevention is better than cure” suits this condition the most. PMID:23162223

Association between ulcer site and outcome in complicated peptic ulcer disease: a Danish nationwide cohort study.

Science.gov (United States)

Lolle, Ida; Møller, Morten Hylander; Rosenstock, Steffen Jais

2016-10-01

Mortality rates in complicated peptic ulcer disease are high. This study aimed to examine the prognostic importance of ulcer site in patients with peptic ulcer bleeding (PUB) and perforated peptic ulcer (PPU). a nationwide cohort study with prospective and consecutive data collection. all patients treated for PUB and PPU at Danish hospitals between 2003 and 2014. demographic and clinical data reported to the Danish Clinical Registry of Emergency Surgery. 90- and 30-d mortality and re-intervention. the crude and adjusted association between ulcer site (gastric and duodenal) and the outcome measures of interest were assessed by binary logistic regression analysis. Some 20,059 patients with PUB and 4273 patients with PPU were included; 90-d mortality was 15.3% for PUB and 29.8% for PPU; 30-d mortality was 10.2% and 24.7%, respectively. Duodenal bleeding ulcer, as compared to gastric ulcer (GU), was associated with a significantly increased risk of all-cause mortality within 90 and 30 d, and with re-intervention: adjusted odds ratio (OR) 1.47 (95% confidence interval 1.30-1.67); p ulcers (DUs) in PPU patients: adjusted OR 0.99 (0.84-1.16); p = 0.698, OR 0.93 (0.78 to 1.10); p = 0.409, and OR 0.97 (0.80-1.19); p = 0.799, respectively. DU site is a significant predictor of death and re-intervention in patients with PUB, as compared to GU site. This does not seem to be the case for patients with PPU.

Multiple bacterial species reside in chronic wounds

DEFF Research Database (Denmark)

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

2006-01-01

. aeruginosa were found to be significantly larger than ulcers without the presence of P. aeruginosa (P wound is colonised by multiple bacterial species and that once they are established many of them persist in the wound. Our results suggest that the presence...... of P. aeruginosa in venous leg ulcers can induce ulcer enlargement and/or cause delayed healing....

[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.

Campylobacter pylori as possible factor in peptic ulcer recurrence

NARCIS (Netherlands)

Rauws, E. A.

1989-01-01

The author reviews the literature up to 1988 about the close association of Campylobacter pylori with chronic active gastritis, duodenitis and peptic ulcer disease. No firm data however demonstrate that Campylobacter pylori causes duodenal ulcer but long term eradication of this bacterium prevents

Sequential changes in histologic pattern and extracellular matrix deposition during the healing of chronic venous ulcers.

OpenAIRE

Herrick, S. E.; Sloan, P.; McGurk, M.; Freak, L.; McCollum, C. N.; Ferguson, M. W.

1992-01-01

As part of a major clinical trial, sequential biopsies were taken from the margins of venous leg ulcers during their healing. The changing patterns of tissue architecture and extracellular matrix synthesis during healing were documented histologically and immunocytochemically. Initial biopsies were similar in appearance: prominent fibrin cuffs, variable inflammation, hemosiderin, and red blood cell extravasation. So called "fibrin cuffs" were highly organized structures composed of laminin, f...

Ulcer detection with 99mTc-sucralfate

International Nuclear Information System (INIS)

Tietze, P.; Gratz, K.F.; Hundeshagen, H.; Freise, J.

1988-01-01

Sucralfate is an agent commonly used in the therapy of gastrointestinal ulcers. It binds itself to proteins in the ulcer crater. A selective labeling with pure 99m Tc-pertechnetate is possible. For an unequivocal ulcer localization or exclusion, images have to be taken in the upright and supine positions. Encouragement of gastric emptying is useful. Images should be taken at least twice, the last one 4 h after ingestion. The method might be used when endoscopy is difficult, incomplete or contraindicated, and for follow-up during therapy. We recommend it also in the search for the cause of intermittent bleeding. (orig.) [de

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....

Do Unilateral Herpetic Stromal Keratitis and Neurotrophic Ulcers Cause Bilateral Dry Eye?

Science.gov (United States)

Jabbarvand, Mahmoud; Hashemian, Hesam; Khodaparast, Mehdi; Rafatnejad, Amin; Beheshtnejad, Amirhooshang; Salami, Amir

2015-07-01

To evaluate and compare the ocular surface condition in herpetic interstitial stromal keratitis and neurotrophic ulcer groups and their normal fellow eyes. In this observational, cross-sectional case-control study, 85 consecutive patients were included, including 56 cases of treated herpetic interstitial keratitis and 29 patients with neurotrophic ulcers. Fifty-six age- and sex-matched participants were also recruited from a normal population as the control group. We evaluated and scored the subjective and objective measures of dry eye for both eyes of all patients. Then, we compared the score of the groups with one another and also with the control group. The main outcome measures were the discomfort level, visual symptoms of dry eye, conjunctival injection, conjunctival staining, corneal staining, corneal tear signs of dry eye, meibomian gland dysfunction, tear break-up time, Schirmer test score with anesthesia, and tear osmolarity. The normal fellow eye of the herpetic keratitis group had significantly higher discomfort levels (1.4 ± 0.9 vs. 1.3 ± 0.5, P = 0.003), visual symptoms (1.7 ± 0.8 vs. 1.3 ± 0.7, P = 0.002), tear break-up time (8.3 ± 3.2 vs. 12.1 ± 3.3 seconds, P = 0.003), Schirmer test scores (9.2 ± 3.9 vs. 12.9 ± 3 mm, P = 0.04), and tear osmolarity (9.2 ± 3.9 vs. 12.9 ± 3 mm, P = 0.003) in comparison with normal controls. The normal fellow eyes of the neurotrophic ulcer group had significantly worse values for discomfort level (1.9 ± 0.9 vs. 1.3 ± 0.5, P eyes of patients with neurotrophic ulcer and interstitial herpetic keratitis have a significantly poorer ocular surface condition compared with that of normal controls.

Necrotic Ulcerated Lesion in a Young Boy Caused by Cowpox Virus Infection

Directory of Open Access Journals (Sweden)

Anne-Laure Favier

2011-09-01

Full Text Available The case presented here points towards the fact that skin lesion observed with a cowpox virus is a rare event but should be considered more as the number of cases has increased in the last years. Cowpox virus (CPXV belongs to the Poxviridae family. The transmission of CPXV to humans is caused by wild rodents or mostly by domestic animals and pet rats. In humans, CPXV is responsible for localized skin lesions regularly accompanied by lymphadenopathy. The lesions remain localized but self-inoculation from the primary lesions could occur. Then physicians have to be vigilant concerning bandages. In this case report, a necrotic and ulcerated lesion of a CPXV infection in a young boy is reported. The CPXV was possibly transmitted by wild rodents. The importance of performing the diagnosis is also pointed out. Virus information was obtained from phylogenetic analyses showing that the CPXV isolate was distinct from outbreaks of human cowpox which occurred in 2009 in France and Germany but was close to the CPXV Brighton Red strain. For several years, cases of viral zoonosis caused by CPXV have increased and physicians should be made aware that people could be infected without history of direct contact with animals.

Gastroretentive drug delivery systems for therapeutic management of peptic ulcer.

Science.gov (United States)

Garg, Tarun; Kumar, Animesh; Rath, Goutam; Goyal, Amit K

2014-01-01

A peptic ulcer, stomach ulcer, or gastric ulcer, also known as peptic ulcer disease (PUD), is a very common chronic disorder of the stomach which is mainly caused by damage or impairment of the stomach lining. Various factors such as pepsin, gastric acid, H. pylori, NSAIDs, prostaglandins, mucus, bicarbonate, and blood flow to mucosa play an important role in causing peptic ulcers. In this review article, our main focus is on some important gastroretentive drug delivery systems (GRDDS) (floating, bioadhesive, high density, swellable, raft forming, superporous hydrogel, and magnetic systems) which will be helpful in gastroretention of different dosage forms for treatment of peptic ulcer. GRDDS provides a mean for controlled release of compounds that are absorbed by active transport in the upper intestine. It also enables controlled delivery for paracellularly absorbed drugs without a decrease in bioavailability. The above approaches are specific for targeting and leading to a marked improvement in the quality of life for a large number of patients. In the future, it is expected that they will become of growing significance, finally leading to improved efficiencies of various types of pharmacotherapies.

Pyoderma gangrenosum: A commonly overlooked ulcerative condition

Directory of Open Access Journals (Sweden)

Daniel Zunsheng Tay

2014-01-01

Full Text Available Background: Pyoderma ga ngrenosum (PG is a rare, inflammatory, destructive neutrophilic dermatosis, which mimics other ulcerative conditions. Materials and Methods: In a retrospective study based on patients diagnosed with PG over a 3-year period (2010-2013, we evaluated demographics, anatomical sites, number of lesions, subtypes, histopathology, associated conditions, treatment regimens, healing time, and recurrence. Results: Of our five patients, there were three males and two females, age ranging between 19 and 58 years (mean age 38 years. Four had single lesions localized to the lower limbs while one had multiple lesions (more than five over bilateral hands and legs. Ulcerative subtype was observed in all the patients. One exhibited pathergy. Skin biopsies were done in four patients, revealing dense neutrophilic infiltrates in three cases and leukocytoclastic vasculitis in one. Associated systemic diseases were observed in all patients, four having inflammatory bowel disease and one having both systemic lupus erythematosus and anti-phospholipid syndrome. The patients were all treated with systemic corticosteroids either alone or in combination with immunosuppressants (e.g., azathioprine, mycophenolate mofetil, tacrolimus, and wound dressing. Split-thickness skin graft was done in one patient. Complete healing was achieved in all patients, ranging from one to 3 months after diagnosis. No recurrence was reported. Conclusions: Systemic corticosteroids, either alone or in combination with steroid-sparing agents are the mainstay of treatment. Should family physicians encounter a rapidly progressing ulcer that has poor response to usual wound management, timely referral to dermatology should be made.

Assessing the causes of breeding failure among the rough-legged buzzard (Buteo lagopus during the nestling period

Directory of Open Access Journals (Sweden)

Ivan Pokrovsky

2012-03-01

Full Text Available When food becomes scarce, the youngest nestlings in facultatively siblicidal raptor species typically die and such events are usually attributed to siblicide. Here we present results from an investigation in the Arctic tundra, in which rough-legged buzzard (Buteo lagopus breeding success was monitored with regular visits to nests and time-lapse cameras that continuously recorded the activity of chicks and their parents. The study took place in the Nenetsky Nature Reserve (68°20′N, 53°18′E in the Russian Arctic, in 2007 10. It included 26 cases of chick mortality in 19 nests. The camera monitoring led us to discover instances of scavenging of chicks that had died due to starvation or bad weather in two nests. Camera monitoring also led us to discover how a sequence of abrupt weather shifts, between hot and sunny conditions and heavy rain, probably caused the death of nestlings in two nests. Detailed nest monitoring is required to avoid the mistaken attribution of such deaths to siblicide. Such extreme weather events may become more common with climate change and represent a new potential factor affecting rough-legged buzzards breeding success in the southern Arctic.

Maximal loads acting on legs of powered roof support unit in longwalls with bumping hazards

Institute of Scientific and Technical Information of China (English)

StanislawSzweda

2001-01-01

In the article the results of measurements of the resultant force in the legs of a powered roof support unit, caused by a dynamic interaction bf the rock mass, are discussed. The measurements have been taken in the Iongwalls mined with a roof fall, characterized by the highest degree of bumping hazard. It has been stated that the maximal force in the legs Fro, recorded during a dynamic interaction of the rock mass, is proportional to the initial static force in the legs Fst.p Therefore a need for a careful selection of the initial load of the powered roof support, according to the local mining and geological conditions, results from such a statement. Setting the legs with the supporting load exceeding the indispensable value for keeping the direct roof solids in balance, deteriorating the operational parameters of a Iongwall system also has a disadvantageous influence on the value of the force in the legs and the rate of its increase, caused by a dynamic interaction of the rock mass. A correct selection of the initial load causes a decrease in the intensity of a dynamic interaction of the rock mass on powered roof supports, which also has an advanta igeous influence on their life, Simultaneously with the measurements of the resultant force in the legs, the vertical acceleration of the canopy was also recorded. It has enabled to prove that the external dynamic forces may act on the unit both from the roof as well as from the floor. The changes of the force in the legs caused by dynamic phenomena intrinsically created in the roof and changes of the force in the legs caused by blasting explosives in the roof of the working, have been analyzed separately. It has been stated that an increase in the loads of legs, caused by intrinsic phenomena is significantly higher than a force increase in the legs caused by blasting. It means that powered roof supports, to be operated in the workings, where the bumping hazard occurs, will also transmit the loads acting on a unit

Aberrant mucin assembly in mice causes endoplasmic reticulum stress and spontaneous inflammation resembling ulcerative colitis.

Directory of Open Access Journals (Sweden)

Chad K Heazlewood

2008-03-01

Full Text Available MUC2 mucin produced by intestinal goblet cells is the major component of the intestinal mucus barrier. The inflammatory bowel disease ulcerative colitis is characterized by depleted goblet cells and a reduced mucus layer, but the aetiology remains obscure. In this study we used random mutagenesis to produce two murine models of inflammatory bowel disease, characterised the basis and nature of the inflammation in these mice, and compared the pathology with human ulcerative colitis.By murine N-ethyl-N-nitrosourea mutagenesis we identified two distinct noncomplementing missense mutations in Muc2 causing an ulcerative colitis-like phenotype. 100% of mice of both strains developed mild spontaneous distal intestinal inflammation by 6 wk (histological colitis scores versus wild-type mice, p < 0.01 and chronic diarrhoea. Monitoring over 300 mice of each strain demonstrated that 25% and 40% of each strain, respectively, developed severe clinical signs of colitis by age 1 y. Mutant mice showed aberrant Muc2 biosynthesis, less stored mucin in goblet cells, a diminished mucus barrier, and increased susceptibility to colitis induced by a luminal toxin. Enhanced local production of IL-1beta, TNF-alpha, and IFN-gamma was seen in the distal colon, and intestinal permeability increased 2-fold. The number of leukocytes within mesenteric lymph nodes increased 5-fold and leukocytes cultured in vitro produced more Th1 and Th2 cytokines (IFN-gamma, TNF-alpha, and IL-13. This pathology was accompanied by accumulation of the Muc2 precursor and ultrastructural and biochemical evidence of endoplasmic reticulum (ER stress in goblet cells, activation of the unfolded protein response, and altered intestinal expression of genes involved in ER stress, inflammation, apoptosis, and wound repair. Expression of mutated Muc2 oligomerisation domains in vitro demonstrated that aberrant Muc2 oligomerisation underlies the ER stress. In human ulcerative colitis we demonstrate similar

Buruli Ulcer (Mycobacterium ulcerans Infection)

Science.gov (United States)

... oedema will ulcerate within 4 weeks with the classical, undermined borders. Occasionally, bone is affected causing gross ... has not been proven by randomized trial. Morbidity management, disability prevention and rehabilitation Interventions such as wound ...

Perforated peptic ulcer.

Science.gov (United States)

Søreide, Kjetil; Thorsen, Kenneth; Harrison, Ewen M; Bingener, Juliane; Møller, Morten H; Ohene-Yeboah, Michael; Søreide, Jon Arne

2015-09-26

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, either by laparoscopic or open repair, and proper sepsis management are essential for good outcome. Selected patients can be managed non-operatively or with novel endoscopic approaches, but validation of such methods in trials is needed. Quality of care, sepsis care bundles, and postoperative monitoring 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. Copyright © 2015 Elsevier Ltd. All rights reserved.

Skin aspergillosis induced in the region of radiation ulcer

International Nuclear Information System (INIS)

Niimura, Yumiko; Nakauchi, Yohichi; Ushijima, Tsugako

1980-01-01

A case of skin aspergillosis in the region of radiation ulcer which was caused by Aspergillus fumigatus was reported. The patient was a 51 year-old man. This fungal infection was probably induced by a local factor, that is, chronic radiation ulcer. Histological findings suggested that Aspergillus fumigatus which increased saprophytically at the beginning possessed parasitic nature gradually, invaded into connective tissues in the deep layer of true skin, and made radiation ulcer more intractable. (Tsunoda, M.)

Haemophilus ducreyi cutaneous ulcer contracted at Seram Island, Indonesia, presented in the Netherlands.

Science.gov (United States)

van Hattem, Jarne M; Langeveld, Tessa J C; Bruisten, Sylvia M; Kolader, Marion; Grobusch, Martin P; de Vries, Henry J C; de Bree, Godelieve J

2018-04-01

We describe the first case of a cutaneous ulcer caused by Haemophilus ducreyi imported from Indonesia to the Netherlands. Skin infections caused by H. ducreyi are uncommon in travellers and have been described in just a few case reports and were all contracted on the Pacific Islands. A 22-year-old healthy male visited the Center of Tropical Medicine and Travel Medicine in February 2017 with a cutaneous ulcer of the right lateral malleolus 4 weeks after returning from Indonesia (Seram and Ambon Islands). He had noticed a small skin abrasion on the right ankle after slipping on a rock during a jungle trip on Seram Island. Back in the Netherlands, a painful ulcer developed at the same body location, and despite treatment with flucloxacillin, his complaints worsened. A swab that was taken for culture showed growth of small grey colonies that were characterised as H. ducreyi with matrix-assisted laser desorption/ionisation time-of-flight (MALDI-TOF) mass spectrometry. Treatment with ciprofloxacin for the diagnosis of H. ducreyi cutaneous ulcer was started, and the ulcer clearly diminished, leaving only a small healing ulcer. H. ducreyi is normally the causative agent of genital ulcers but is increasingly recognised as a cause of chronic skin ulcers, e.g., in Papua New Guinea. In our patient, the infection was very likely contracted in the Maluku province of Indonesia and imported into the Netherlands. No reports of infection with H. ducreyi from Indonesia could be found in literature, but this case indicates that H. ducreyi is present in at least one of the northeastern islands of Indonesia, which is important for local healthcare. Additionally, it illustrates the role of this agent as a cause of cutaneous ulcers in previously healthy travellers.

The comparison of manual lymph drainage and ultrasound therapy on the leg swelling caused by wearing high heels.

Science.gov (United States)

Lee, Dong-Yeop; Han, Ji-Su; Jang, Eun-Ji; Seo, Dong-Kwon; Hong, Ji-Heon; Lee, Sang-Sook; Lee, Dong-Geol; Yu Lee, Jae-Ho

2014-01-01

One of the major symptoms when women are wearing high heels for a long time is leg swelling. The purpose of this study was to compare the effect of manual lymph drainage with ultrasound therapy. The forty-five healthy women of twenties were participated in this study and divided randomly into three groups; manual lymph drainage group (n=15), ultrasound therapy group (n=15) and control group (n=15). Swelling was measured before wearing the high heels (10 cm-height), after one-hour of wearing the high heels, wearing the high heels of one-hour after the intervention of 15 minutes. Also swelling was calculated by using a tape measure, volumeter and body composition analyzer. Statistical analysis of the comparison between the three groups was performed by one-way ANOVA. Also comparison to the mean value in swelling according to the time was performed by repeated measure ANOVA. As the result of this study, a significant changes have emerged within each of manual lymph drainage, ultrasound therapy and control group (p 0.05). But the mean value of manual lymph drainage group showed the tendency of fast recovering before causing swelling. Therefore, we consider that the clinical treatment of manual lymph drainage and ongoing studies will be made since manual lymph drainage is very effective in releasing the leg swelling caused by wearing high heels and standing for a long time at work.

Perforated pyloroduodenal peptic ulcer and sonography.

Science.gov (United States)

Kuzmich, Siarhei; Harvey, Chris J; Fascia, Daniel T M; Kuzmich, Tatsiana; Neriman, Deena; Basit, Rizwan; Tan, Kai Lee

2012-11-01

The purpose of this article is to illustrate the spectrum of sonographic findings in perforated pyloroduodenal peptic ulcer and discuss the potential role of sonography in the diagnosis. Although sonography is not the first-line investigation of choice in suspected perforated peptic ulcer, understanding of the characteristic appearances seen during general abdominal sonography may aid the reader in the diagnosis of this important and sometimes overlooked cause of nonspecific abdominal pain. This may shorten time to the diagnosis and ultimate surgical management.

Dry skin and pressure ulcer risk: A multi-center cross-sectional prevalence study in German hospitals and nursing homes.

Science.gov (United States)

Lechner, Anna; Lahmann, Nils; Neumann, Konrad; Blume-Peytavi, Ulrike; Kottner, Jan

2017-08-01

Pressure ulcers are a serious health problem in medical and nursing care. Therefore, effective prevention is crucial. Major pressure ulcer risk factors have been identified but the particular role of dry skin (xerosis cutis) is unclear. To investigate possible associations between dry skin and pressure ulcers focusing on the sacrum/trochanter and at heel/ankle skin areas. Two multicenter cross-sectional studies. In 2014 and 2015 thirty nursing homes and thirteen hospitals in Germany participated. In total 3837 participants were included. Mean age was 76.1 (SD 15.5) years. Skin assessments and data collection were performed by trained nurses based on a standardized data collection form. Descriptive comparisons and multilevel logistic regressions predicting pressure ulcers at sacrum/trochanter and ankle/heel were conducted. The prevalence of skin dryness at the trunk was significantly higher for subjects with pressure ulcers category 2+ at the sacral area compared to without (39.0% vs. 24.4%, p=0.010). Adjusted to demographic variables, mobility and type of institution dry skin at the trunk was no longer associated with pressure ulceration (OR 1.11 (95% CI 0.62-2.00)). 71.9% of patients with heel/ankle pressure ulcers category 2+ were affected by dry skin at legs or feet, compared to 42.8% of subjects without pressure ulcers (pStudy results indicate that dry skin at the feet may be considered as a risk factor for heel pressure ulcer development. Skin dryness may be less important for sacral pressure ulcers. Therefore, the variable skin status should be better defined in future studies and pressure ulcer risk models. Results further support differences in pressure ulcer aetiologies between anatomical locations. Copyright © 2017 Elsevier Ltd. All rights reserved.

Bacteremia due to Staphylococcus cohnii ssp. urealyticus caused by infected pressure ulcer: case report and review of the literature.

Science.gov (United States)

Soldera, Jonathan; Nedel, Wagner Luis; Cardoso, Paulo Ricardo Cerveira; d'Azevedo, Pedro Alves

2013-01-01

CONTEXT Coagulase-negative staphylococci are common colonizers of the human skin and have become increasingly recognized as agents of clinically significant nosocomial infections. CASE REPORT The case of a 79-year-old male patient with multi-infarct dementia who presented systemic inflammatory response syndrome is reported. This was attributed to bacteremia due to Staphylococcus cohnii ssp. urealyticus, which was grown on blood cultures originating from an infected pressure ulcer. The few cases of Staphylococcus cohnii infection reported in the literature consist of bacteremia relating to catheters, surgical prostheses, acute cholecystitis, brain abscess, endocarditis, pneumonia, urinary tract infection and septic arthritis, generally presenting a multiresistant profile, with nearly 90% resistance to methicillin. CONCLUSIONS The reported case is, to our knowledge, the first case of true bacteremia due to Staphylococcus cohnii subsp. urealyticus caused by an infected pressure ulcer. It shows that this species may be underdiagnosed and should be considered in the differential diagnosis for community-acquired skin infections.

Bacteremia due to Staphylococcus cohnii ssp. urealyticus caused by infected pressure ulcer: case report and review of the literature

Directory of Open Access Journals (Sweden)

Jonathan Soldera

Full Text Available CONTEXTCoagulase-negative staphylococci are common colonizers of the human skin and have become increasingly recognized as agents of clinically significant nosocomial infections.CASE REPORTThe case of a 79-year-old male patient with multi-infarct dementia who presented systemic inflammatory response syndrome is reported. This was attributed to bacteremia due to Staphylococcus cohnii ssp. urealyticus, which was grown on blood cultures originating from an infected pressure ulcer. The few cases of Staphylococcus cohnii infection reported in the literature consist of bacteremia relating to catheters, surgical prostheses, acute cholecystitis, brain abscess, endocarditis, pneumonia, urinary tract infection and septic arthritis, generally presenting a multiresistant profile, with nearly 90% resistance to methicillin.CONCLUSIONSThe reported case is, to our knowledge, the first case of true bacteremia due to Staphylococcus cohnii subsp. urealyticus caused by an infected pressure ulcer. It shows that this species may be underdiagnosed and should be considered in the differential diagnosis for community-acquired skin infections.

Non-steroidal anti-inflammatory drugs and ulcer complications: a risk factor analysis for clinical decision-making

DEFF Research Database (Denmark)

Hansen, J M; Hallas, J; Lauritsen, Jens

1996-01-01

Use of non-steroidal anti-inflammatory drugs (NSAIDs) is recognized as an important cause of peptic ulcer complications. The aim of this nested case-control study was to identify risk factors for NSAID-related ulcer complications.......Use of non-steroidal anti-inflammatory drugs (NSAIDs) is recognized as an important cause of peptic ulcer complications. The aim of this nested case-control study was to identify risk factors for NSAID-related ulcer complications....

Maximal loads acting on legs of powered roof support unit in longwalls with bumping hazards

Institute of Scientific and Technical Information of China (English)

Stanislaw Szweda

2001-01-01

In the article the results of measurements of the resultant force in th e legs of a powered roof support unit, caused by a dynamic interaction of the ro ck mass, are discussed. The measurements have been taken in the longwalls mined with a roof fall, characterized by the highest degree of bumping hazard. It has been stated that the maximal force in the legs Fm, recorded during a dynam ic interaction of the rock mass, is proportional to the initial static force in the legs Fst,p. Th erefore a need for a careful selection of the initial load of the powered roof s upport, according to the local mining and geological conditions, results from su ch a statement. Setting the legs with the supporting load exceeding the indispen sable value for keeping the direct roof solids in balance, deteriorating the ope rational parameters of a longwall system also has a disadvantageous influence on the value of the force in the legs and the rate of its increase, caused by a dy namic interaction of the rock mass. A correct selection of the initial load caus es a decrease in the intensity of a dynamic interaction of the rock mass on powe red roof supports, which also has an advantageous influence on their life. 　　Simultaneously with the measurements of the resultant force in the legs, the vertical acceleration of the canopy was also recorded. It has enabled to prove that the exte rnal dynamic forces may act on the unit both from the roof as well as from the f loor. The changes of the force in the legs caused by dynamic phenomena intrinsic ally created in the roof and changes of the force in the legs caused by blasting explosives in the roof of the working, have been analyzed separately. It has been stated that an increase in the loads of legs, caused by intrinsi c phenomena is significantly higher than a force increase in the legs caused by blasting. It means that powered roof supports, to be operated in the workings, w here the bumping hazard occurs, will also transmit the loads

Local blockage of EMMPRIN impedes pressure ulcers healing in a rat model

OpenAIRE

Zhao, Xi-Lan; Luo, Xiao; Wang, Ze-Xin; Yang, Guo-Li; Liu, Ji-Zhong; Liu, Ya-Qiong; Li, Ming; Chen, Min; Xia, Yong-Mei; Liu, Jun-Jie; Qiu, Shu-Ping; Gong, Xiao-Qing

2015-01-01

Excessive extracellular matrix degradation caused by the hyperfunction of matrix metalloproteinases (MMPs) has been implicated in the failure of pressure ulcers healing. EMMPRIN, as a widely expressed protein, has emerged as an important regulator of MMP activity. We hypothesize that EMMPRIN affects the process of pressure ulcer healing by modulating MMP activity. In the rat pressure ulcer model, the expression of EMMPRIN in ulcers detected by Western blot was elevated compared with that obse...

Association of Helicobacter pylori infection with peptic ulcer disease ...

African Journals Online (AJOL)

Background: Helicobacter pylori infection has been identified as an important risk factor for the development of peptic ulcer disease and is probably the most important cause of relapse in those previously treated for peptic ulcer disease. The aim of this study was to determine the association of Helicobacter pylori infection as ...

Protocols for pressure ulcer prevention: are they evidence-based?

Science.gov (United States)

Chaves, Lidice M; Grypdonck, Mieke H F; Defloor, Tom

2010-03-01

This study is a report of a study to determine the quality of protocols for pressure ulcer prevention in home care in the Netherlands. If pressure ulcer prevention protocols are evidence-based and practitioners use them correctly in practice, this will result a reduction in pressure ulcers. Very little is known about the evidence-based content and quality of the pressure ulcer prevention protocols. In 2008, current pressure ulcer prevention protocols from 24 home-care agencies in the Netherlands were evaluated. A checklist developed and validated by two pressure ulcer prevention experts was used to assess the quality of the protocols, and weighted and unweighted quality scores were computed and analysed using descriptive statistics. The 24 pressure ulcer prevention protocols had a mean weighted quality score of 63.38 points out of a maximum of 100 (sd 5). The importance of observing the skin at the pressure points at least once a day was emphasized in 75% of the protocols. Only 42% correctly warned against the use of materials that were 'less effective or that could potentially cause harm'. Pressure ulcer prevention commands a reasonable amount of attention in home care, but the incidence of pressure ulcers and lack of a consistent, standardized document for use in actual practice indicate a need for systematic implementation of national pressure ulcer prevention standards in the Netherlands to ensure adherence to the established protocols.

The prevalence of pressure ulcers in the paediatric population.

Science.gov (United States)

Habiballah, Laila; Tubaishat, Ahmad

2016-05-01

A paucity of research related to the problem of pressure ulcers in paediatrics is found, with a variety of reported prevalence rates. To record the prevalence, location and categories of PU in the inpatient paediatric wards, and to identify the characteristics of pressure ulcer patients. A descriptive point prevalence study. All paediatric inpatient wards in two hospitals in Jordan. One of which is a university-affiliated hospital and the other a paediatric public hospital. Isolation, burn and emergency units, outpatients' clinics and psychiatric wards were excluded. One sixty six paediatric patients aged from one day up to 18 years from both hospitals. Patients who met the inclusion criteria were included and examined for the existence of pressure ulcers on one day in each hospital by the primary investigator. The European Pressure Ulcer Advisory Panel classification system was used to categorise each identified ulcer. The characteristics of ulcers were collected as well. Sixteen ulcers were identified in 11 patients, giving a prevalence rate of 6.6%.When Category I ulcers were excluded, the prevalence rate dropped to 2.4%. All except one of the PU patients were being treated in critical care units (n = 10, 90.9%), and most of the ulcers were category one (n = 7, 63.6%) and caused by devices (n = 7, 63.6). The face was the most frequently reported location of PUs (n = 6, 54.5%), followed by the occiput (n = 2, 18.2%). Most PU patients were male (n = 6, 54.5%), and less than 12 months old (n = 8, 72.7%). PU patients had experienced longer hospital stays than patients free from PU (U = 499.0, p = 0.02). Jordanian paediatric patients do have pressure ulcers, with a prevalence rate congruent with previously reported international rates. Most of the ulcers found were caused by devices used in critical care units. This should encourage nurses to pay extra attention to their paediatric patients when they are connected to medical devices. Copyright �

Decubital shoulder ulcers in sows - a review of classification, pain and welfare consequences

DEFF Research Database (Denmark)

Herskin, Mette S; Bonde, Marianne; Jørgensen, Erik

2011-01-01

Decubital shoulder ulcers are lesions on the shoulders of sows kept in production systems, reported to have a relatively high prevalence, and to some extent be comparable with human pressure ulcers. In sows, the ulcers are caused by pressure inflicted by the flooring, leading to oxygen deficiency...

Ulcer detection with /sup 99m/Tc-sucralfate

Energy Technology Data Exchange (ETDEWEB)

Tietze, P.; Gratz, K.F.; Hundeshagen, H.; Freise, J.

1988-02-01

Sucralfate is an agent commonly used in the therapy of gastrointestinal ulcers. It binds itself to proteins in the ulcer crater. A selective labeling with pure /sup 99m/Tc-pertechnetate is possible. For an unequivocal ulcer localization or exclusion, images have to be taken in the upright and supine positions. Encouragement of gastric emptying is useful. Images should be taken at least twice, the last one 4 h after ingestion. The method might be used when endoscopy is difficult, incomplete or contraindicated, and for follow-up during therapy. We recommend it also in the search for the cause of intermittent bleeding.

Pressure Ulcer Prevention

Science.gov (United States)

2009-01-01

Executive Summary In April 2008, the Medical Advisory Secretariat began an evidence-based review of the literature concerning pressure ulcers. Please visit the Medical Advisory Secretariat Web site, http://www.health.gov.on.ca/english/providers/program/mas/tech/tech_mn.html to review these titles that are currently available within the Pressure Ulcers series. Pressure ulcer prevention: an evidence based analysis The cost-effectiveness of prevention strategies for pressure ulcers in long-term care homes in Ontario: projections of the Ontario Pressure Ulcer Model (field evaluation) Management of chronic pressure ulcers: an evidence-based analysis (anticipated pubicstion date - mid-2009) Purpose A pressure ulcer, also known as a pressure sore, decubitus ulcer, or bedsore, is defined as a localized injury to the skin/and or underlying tissue occurring most often over a bony prominence and caused by pressure, shear, or friction, alone or in combination. (1) Those at risk for developing pressure ulcers include the elderly and critically ill as well as persons with neurological impairments and those who suffer conditions associated with immobility. Pressure ulcers are graded or staged with a 4-point classification system denoting severity. Stage I represents the beginnings of a pressure ulcer and stage IV, the severest grade, consists of full thickness tissue loss with exposed bone, tendon, and or muscle. (1) In a 2004 survey of Canadian health care settings, Woodbury and Houghton (2) estimated that the prevalence of pressure ulcers at a stage 1 or greater in Ontario ranged between 13.1% and 53% with nonacute health care settings having the highest prevalence rate (Table 1). Executive Summary Table 1: Prevalence of Pressure Ulcers* Setting Canadian Prevalence,% (95% CI) Ontario Prevalence,Range % (n) Acute care 25 (23.8–26.3) 23.9–29.7 (3418) Nonacute care† 30 (29.3–31.4) 30.0–53.3 (1165) Community care 15 (13.4–16.8) 13.2 (91) Mixed health care‡ 22 (20.9�

Ubx regulates differential enlargement and diversification of insect hind legs.

Directory of Open Access Journals (Sweden)

Najmus Mahfooz

2007-09-01

Full Text Available Differential enlargement of hind (T3 legs represents one of the hallmarks of insect evolution. However, the actual mechanism(s responsible are yet to be determined. To address this issue, we have now studied the molecular basis of T3 leg enlargement in Oncopeltus fasciatus (milkweed bug and Acheta domesticus (house cricket. In Oncopeltus, the T3 tibia displays a moderate increase in size, whereas in Acheta, the T3 femur, tibia, and tarsus are all greatly enlarged. Here, we show that the hox gene Ultrabithorax (Ubx is expressed in the enlarged segments of hind legs. Furthermore, we demonstrate that depletion of Ubx during embryogenesis has a primary effect in T3 legs and causes shortening of leg segments that are enlarged in a wild type. This result shows that Ubx is regulating the differential growth and enlargement of T3 legs in both Oncopeltus and Acheta. The emerging view suggests that Ubx was co-opted for a novel role in regulating leg growth and that the transcriptional modification of its expression may be a universal mechanism for the evolutionary diversification of insect hind legs.

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.

Gastric emptying in patients with gastric ulcer

Energy Technology Data Exchange (ETDEWEB)

Harding, L.K.; Anselmi, M.; Donovan, I.A.; Alexander-Williams, J. (Dudley Road Hospital, Birmingham (UK); Birmingham General Hospital (UK))

1982-06-01

The estimated volume of meal in the stomach 30 mins after sup(113m)In-DTPA administration was determined in patients with gastric ulcer and normal controls by 1) relating counts in the stomach to those in the whole field of view of the gamma camera and 2) aspirations. In the normal controls there was no significant difference between the two methods but in the gastric ulcer patients, the gamma camera method predicted significantly more meal in the stomach than was recovered by aspiration. It was suggested that the large low lying stomach found in gastric ulcer disease causes extensive overlap of the small bowel and invalidates measurements of gastric emptying made by a gamma camera.

Gastric emptying in patients with gastric ulcer

International Nuclear Information System (INIS)

Harding, L.K.; Anselmi, M.; Donovan, I.A.; Alexander-Williams, J.

1982-01-01

The estimated volume of meal in the stomach 30 mins after sup(113m)In-DTPA administration was determined in patients with gastric ulcer and normal controls by 1) relating counts in the stomach to those in the whole field of view of the gamma camera and 2) aspirations. In the normal controls there was no significant difference between the two methods but in the gastric ulcer patients, the gamma camera method predicted significantly more meal in the stomach than was recovered by aspiration. It was suggested that the large low lying stomach found in gastric ulcer disease causes extensive overlap of the small bowel and invalidates measurements of gastric emptying made by a gamma camera. (U.K.)

Management of radiation ulcers

International Nuclear Information System (INIS)

Shack, R.B.

1982-01-01

Despite more efficient and safer technics of radiation therapy, the problem of radiation-induced injury to the skin and soft tissue persists. The problem of adequate coverage of these painful, ischemic, and fibrotic ulcers remains challenging. Split-thickness skin grafts are seldom sufficient coverage, as the graft almost always has areas that do not take. Although these areas may eventually heal by epithelialization, the result is never ideal. Most often flap coverage is required, but elevation of local flaps is jeopardized because the tissue surrounding the ulcer crater frequently has been sufficiently compromised to cause loss of at least part of the flap. In the past, this necessitated use of pedicled flaps, tubed and transposed from a distance. With the development of axial-pattern musculocutaneous and muscle flaps, as well as microvascular free flaps, the difficulty in dealing with these ulcers has been decreased. Surgeons can now recommend earlier use of adequate debridement, many times of the entire irradiated area, and immediate coverage with a well vascularized axial-pattern musculocutaneous flap or revascularized free flap

Pressure ulcers induced by drug administration: A new concept and report of four cases in elderly patients.

Science.gov (United States)

Mizokami, Fumihiro; Takahashi, Yoshiko; Hasegawa, Keiko; Hattori, Hideyuki; Nishihara, Keiji; Endo, Hidetoshi; Furuta, Katsunori; Isogai, Zenzo

2016-04-01

Drug-induced akinesia is a potential cause of pressure ulcers. However, pressure ulcers that are caused by drug-induced akinesia are not considered an adverse drug reaction (ADR). We propose that drug-induced pressure ulcers (DIPU) are pressure ulcers that are caused by an external force that is experienced after drug administration, and we considered resolution of these ulcers after drug discontinuation to be a supportive finding. In this report, we reviewed the medical records of pressure ulcer cases from a 300-bed hospital. Among 148 patients, four patients with pressure ulcers met the criterion for DIPU. In these cases, the suspected DIPU were related to treatment with olanzapine, fluvoxamine, valproic acid, clotiazepam, triazolam and rilmazafone. These drugs were administrated to manage the patients' behavioral and psychological symptoms that accompanied dementia. The DIPU in these patients were categorized as stage IV according to the National Pressure Ulcer Advisory Panel criteria. Discontinuation of the causal drugs led to significant improvements or complete healing of the pressure ulcers, and the patients subsequently recovered their mobility. Therefore, we propose that DIPU are potential ADR that have been overlooked in clinical practice. Thus, recognition of DIPU as an ADR may be important in preventing and appropriately managing pressure ulcers among elderly patients. © 2015 Japanese Dermatological Association.

Task driven optimal leg trajectories in insect-scale legged microrobots

Science.gov (United States)

Doshi, Neel; Goldberg, Benjamin; Jayaram, Kaushik; Wood, Robert

Origami inspired layered manufacturing techniques and 3D-printing have enabled the development of highly articulated legged robots at the insect-scale, including the 1.43g Harvard Ambulatory MicroRobot (HAMR). Research on these platforms has expanded its focus from manufacturing aspects to include design optimization and control for application-driven tasks. Consequently, the choice of gait selection, body morphology, leg trajectory, foot design, etc. have become areas of active research. HAMR has two controlled degrees-of-freedom per leg, making it an ideal candidate for exploring leg trajectory. We will discuss our work towards optimizing HAMR's leg trajectories for two different tasks: climbing using electroadhesives and level ground running (5-10 BL/s). These tasks demonstrate the ability of single platform to adapt to vastly different locomotive scenarios: quasi-static climbing with controlled ground contact, and dynamic running with un-controlled ground contact. We will utilize trajectory optimization methods informed by existing models and experimental studies to determine leg trajectories for each task. We also plan to discuss how task specifications and choice of objective function have contributed to the shape of these optimal leg trajectories.

THE EFFECTS OF SINGLE LEG HOP PROGRESSION AND DOUBLE LEGS HOP PROGRESSION EXERCISE TO INCREASE SPEED AND EXPLOSIVE POWER OF LEG MUSCLE

Directory of Open Access Journals (Sweden)

Nining W. Kusnanik

2015-05-01

Full Text Available The main purpose of this study was to determine the effect of single leg hop progression and double legs hop progression exercise to increase speed and explosive power of leg muscles. Plyometric is one of the training methods that can increase explosive power. There are many models of plyometric training including single leg hop progression and double leg hop progression. This research was experimental using match subject design techniques. The subjects of this study were 39 students who joined basketball school club. There were 3 groups in this study: Group 1 were 13 students who given sin¬gle leg hop progression exercise, Group 2 were 13 students who given double legs hop progression exercise, Group 3 were 13 students who given conventional exercise. The data was collected during pre test and post test by testing 30m speed running and vertical jump. The data was analyzed using Analysis of Varians (Anova. It was found that there were significantly increased on speed and explosive power of leg muscles of Group 1 and Group 2. It can be stated that single leg hop progression exercise was more effective than double leg hop progression exercise. The recent findings supported the hypothesis that single leg hop progression and double legs hop progression exercise can increase speed and explosive power of leg muscles. These finding were supported by some previous studies (Singh, et al, 2011; Shallaby, H.K., 2010. The single leg hop progression is more effective than double legs hop progression. This finding was consistent with some previous evidences (McCurdy, et al, 2005; Makaruk et al, 2011.

Sciatic nerve block causing heel ulcer after total knee replacement in 36 patients.

Science.gov (United States)

Todkar, Manoj

2005-12-01

Femoral and sciatic nerve blocks are often used for postoperative analgesia following total knee replacement surgery. In this report, we focus on cases of heel ulcers which occurred following the implementation of peripheral nerve block in concert with knee replacement surgery. In some instances, heel ulcers have resulted in delayed rehabilitation and prolonged hospital stays in this group of patients, which makes this phenomenon a potential burden on the healthcare system. Pressure points in the foot should be protected after the implementation of nerve blocks to prevent pressure sores. An awareness of this unusual complication related to knee replacement surgery is necessary to prevent its occurrence and avoid delays in patient rehabilitation and recovery.

Radiation induced esophageal ulcer; Report of a case

Energy Technology Data Exchange (ETDEWEB)

Kawano, Tatsuyuki; Endo, Mitsuo; Yamazaki, Shigeru (Tokyo Medical and Dental Univ. (Japan). School of Medicine) (and others)

1990-04-01

A 77-year-old woman was referred to us on Dec. 22, 1986 because of dysphagia and esophageal ulcer. She had a previous history of left radical mastectomy for breast cancer, followed by postoperative {sup 60}Co irradiation to parasternal and supraclavicular regions with 50 Gy about 15 years before. UGIs and endoscopy showed a small ulcer surrounded by submucosal tumor-like protrusion in the esophagus at the thoracic inlet. Examination one month later revealed the ulcer which became larger despite medical treatment, now measuring 1 cm in diameter. Severe dysphagia continued. Right thoractomy and subtotal esophagectomy were performed on Jan 13, 1987. Histological examination revealed nonspecific ulcer, 5 cm in diameter, surrounded by fibrous granulation tissue. Proliferation of dilated capillary vessels was also seen in the bottom of the ulcer, the surrounding wall of which was free from remarkable infiltration of inflammatory cells. Based on these findings and previous medical history, the patient was diagnosed as having a postirradiation ulcer which appeared 15 years after irradiation. Dysphagia was considered due to esophageal dysfunction caused by severe fibrosis of the proper muscle layer. (author).

Support surfaces for pressure ulcer prevention.

Science.gov (United States)

McInnes, Elizabeth; Jammali-Blasi, Asmara; Bell-Syer, Sally E M; Dumville, Jo C; Middleton, Victoria; Cullum, Nicky

2015-09-03

, although two trials indicated that foam overlays caused adverse skin changes. Meta-analysis of three trials suggest that Australian standard medical sheepskins prevent pressure ulcers (RR 0.56 95% CI 0.32 to 0.97).  People at high risk of developing pressure ulcers should use higher-specification foam mattresses rather than standard hospital foam mattresses. The relative merits of higher-specification constant low-pressure and alternating-pressure support surfaces for preventing pressure ulcers are unclear, but alternating-pressure mattresses may be more cost effective than alternating-pressure overlays in a UK context. Medical grade sheepskins are associated with a decrease in pressure ulcer development. Organisations might consider the use of some forms of pressure relief for high risk patients in the operating theatre.

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

Influence of Soft or Hard Floors before and after First Calving on Dairy Heifer Locomotion, Claw and Leg Health

Directory of Open Access Journals (Sweden)

Christer Bergsten

2015-08-01

Full Text Available Claw health, an important dairy cow welfare parameter, may be affected by early-life foot/leg stresses. To investigate this, groups of pregnant heifers were allocated to deep straw bedding (Soft or cubicles (Hard, both with scraped concrete feeding alleys. After the grazing season, they were re-housed in cubicle systems, half on slatted concrete (Hard and half on slatted rubber (Soft alleys. Claw measurements, contact area and pressure distribution claw/flooring, claw disorders and leg lesions were recorded at the start and end of each housing season. Locomotion and leg lesions were also scored monthly after calving. Prevalence of sole haemorrhages was higher among pregnant heifers in cubicles than in deep straw. After calving, first-calvers on Hard floors had higher odds for lameness (OR = 3.6; P < 0.01, sole haemorrhages/ulcers (OR = 2.2; P < 0.05, white-line haemorrhages (OR = 2.8; P < 0.01 and leg lesions (OR = 2.6; P < 0.02 than those on Soft floors. Lowest prevalence and severity of sole and white-line haemorrhages (non-significant in first-calvers was found in those on Soft floors and reared on Hard floors and the highest prevalence and severity on those on Hard floors reared on Soft floors. Soft flooring after calving is of most importance for healthy feet and legs.

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

Complex endoscopic treatment of acute gastrointestinal bleeding of ulcer origin

Directory of Open Access Journals (Sweden)

V. V. Izbitsky

2013-06-01

Full Text Available Gastrointestinal bleeding (GIB is determined in 20-30% of patients with peptic ulcer disease. Acute gastrointestinal bleeding is on the first place as the main cause of deaths from peptic ulcer ahead of the other complications. Rebleeding occurs in 30-38% of patients. Materials and Methods For getting of the objective endoscopic picture in patients with bleeding gastroduodenal ulcers we used the classification of J.A. Forrest in our study: Type I - active bleeding: • I a - pulsating jet; • I b - stream. Type II - signs of recent bleeding: • II a - visible (non-bleeding visible vessel; • II b - fixed thrombus - a clot; • II c - flat black spot (black bottom ulcers. Type III - ulcer with a clean (white down. Integrated endoscopic hemostasis included: irrigation of ulcer defect and area around it with 3% hydrogen peroxide solution in a volume of 10 - 30ml; Injection of 2-4 mL of diluted epinephrine (1:10000 for hemostasis; use of Argon plasma coagulation. Results and Discussion Integrated endoscopic stop of bleeding was performed in 57 patients who were examined and treated at the Department of Surgery from 2006 to 2012. In 16 patients bleeding was caused by gastric ulcer. Gastric ulcer type I localization according to classification (HD Johnson, 1965 was determined in 9 patients, type II - in 2 patients, type III – in 5 patients. In 31 patients bleeding was caused by duodenal peptic ulcer, in 4 patients - erosive gastritis, 1 - erosive esophagitis, and in 5 patients - gastroenteroanastomosis area peptic ulcer. Final hemostasis was achieved in 55 (96.5% patients. In 50 (87.7% patients it was sufficient to conduct a single session of complex endoscopic treatment. In 5 (8.8% patients – it was done two times. In 2 (3.5% cases operation was performed due to the recurrent bleeding. The source of major bleeding in these patients was: chronic, duodenal ulcer penetrating into the head of the pancreas in one case complicated by subcompensated

Methanol extract of Bauhinia purpurea leaf possesses anti-ulcer activity.

Science.gov (United States)

Zakaria, Z A; Abdul Hisam, E E; Norhafizah, M; Rofiee, M S; Othman, F; Hasiah, A H; Vasudevan, M

2012-01-01

The aim of the present study was to determine the anti-ulcer activity of a methanol extract of Bauhinia purpurea leaf (MEBP). MEBP was administered at doses of 100, 500 and 1,000 mg/kg and its effects on acute toxicity, absolute ethanol- and indomethacin-induced gastric ulceration, and pyloric ligation tests in rats were investigated. At a dose of 5,000 mg/kg, MEBP did not cause any signs of toxicity in rats when given orally. Oral administration of MEBP exerted anti-ulcer activity (p < 0.05) in all models tested. However, a dose-dependent protection was observed only in the indomethacin-induced gastric ulceration model. Histological studies supported the observed anti-ulcer activity of MEBP. In the pyloric ligation assay, MEBP significantly increased gastric wall mucus secretion (p < 0.05), but did not affect the acidity of the gastric contents. MEBP exhibited anti-ulcer activity, which could be due to the presence of flavonoids, saponins or other polyphenols, thereby validating the traditional use of B. purpurea in the treatment of ulcers. Copyright © 2012 S. Karger AG, Basel.

Delayed recurrence of ulcerative colitis manifested by tracheobronchitis, bronchiolitis, and bronchiolectasis

Directory of Open Access Journals (Sweden)

Iclal Ocak MD,

2017-12-01

Full Text Available Ulcerative colitis can cause inflammation of small and large airways, characterized by mucosal inflammation, tracheobronchial stenosis, bronchiestasis, and bronchiolitis. We present a case of tracheobronchitis and bronchiolitis associated with ulcerative colitis in a 58-year-old nonsmoking man, 17 years after the total colectomy and complete resolution of intestinal findings. Computed tomography demonstrated wall thickening of trachea and left main stem bronchus, and multiple bronchi around the both hilum with mild to moderate stenosis. Fiberoptic bronchial biopsy showed inflammation of the airways, similar to histologic findings of ulcerative colitis within colon. Keywords: Ulcerative colitis, Trachea, Lung

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

Beliefs and attitudes toward Buruli ulcer in Ghana

NARCIS (Netherlands)

Stienstra, Y; van der Graaf, WTA; Asamoa, K; van der Werf, TS

Buruli ulcer is a devastating emerging disease in tropical countries. Quantitative and qualitative data were obtained by interviewing patients with this disease and control subjects in Ghana. Common perceived causes were witchcraft and curses. Other reported causes were personal hygiene,

Local blockage of EMMPRIN impedes pressure ulcers healing in a rat model.

Science.gov (United States)

Zhao, Xi-Lan; Luo, Xiao; Wang, Ze-Xin; Yang, Guo-Li; Liu, Ji-Zhong; Liu, Ya-Qiong; Li, Ming; Chen, Min; Xia, Yong-Mei; Liu, Jun-Jie; Qiu, Shu-Ping; Gong, Xiao-Qing

2015-01-01

Excessive extracellular matrix degradation caused by the hyperfunction of matrix metalloproteinases (MMPs) has been implicated in the failure of pressure ulcers healing. EMMPRIN, as a widely expressed protein, has emerged as an important regulator of MMP activity. We hypothesize that EMMPRIN affects the process of pressure ulcer healing by modulating MMP activity. In the rat pressure ulcer model, the expression of EMMPRIN in ulcers detected by Western blot was elevated compared with that observed in normal tissue. To investigate the role of EMMPRIN in regulating ulcer healing, specific antibodies against EMMPRIN were used via direct administration on the pressure ulcer. Local blockage of EMMPRIN resulted in a poor ulcer healing process compared with control ulcers, which was the opposite of our expectation. Furthermore, inhibiting EMMPRIN minimally impacted MMP activity. However, the collagen content in the pressure ulcer was reduced in the EMMPRIN treated group. Angiogenesis and the expression of angiogenic factors in pressure ulcers were also reduced by EMMPRIN local blockage. The results in the present study indicate a novel effect of EMMPRIN in the regulation of pressure ulcer healing by controlling the collagen contents and angiogenesis rather than MMPs activity.

Pressure ulcers and Charcot's definitions: report on two cases

Directory of Open Access Journals (Sweden)

Hélio Afonso Ghizoni Teive

Full Text Available CONTEXT AND OBJECTIVE: Pressure ulcers are lesions caused by inadequate blood flow and tissue malnourishment secondary to prolonged pressure on skin, soft connective tissues, muscle and/or bones. The authors report two distinct clinical situations of severely compromised neurological patients who shared several predisposing factors for pressure ulcers, but with opposite outcomes regarding the development of pressure ulcers. CASE REPORTS: The first case was a young patient in a persistent vegetative state who developed pressure ulcers that resulted in secondary sepsis and death. The second case was a patient with a diagnosis of amyotrophic lateral sclerosis who, in spite of being bedridden for several months with severe immobility, never developed pressure ulcers. These intriguing contrary clinical situations had already been defined by Charcot in the nineteenth century, with his creation of the expression "decubitus ominosus". He indicated that patients with amyotrophic lateral sclerosis usually did not develop this form of complication, as was illustrated by the cases presented here.

Antibiotic Sensitivity in Pseudomonas aeruginosa of Diabetic Patient’s Foot Ulcer

OpenAIRE

Pratiwi Apridamayanti; Khairunnisa Azani Meilinasary; Rafika Sari

2016-01-01

Diabetes Mellitus (DM) patients are at risk to have the diabetic ulcer. The main reason for DM’s patient with ulcer complication to be treated and healed in hospital is bacterial infection. One of many bacteria that infects diabetic ulcer is Pseudomonas aeruginosa. This conditian can be treated by antibiotic. The using antibiotic is often inaccurate causing the microbe resistance. To choose the right antibiotic, it needs to test the antibiotic’s sensitivity towards Pseudomonas aeruginosa. The...

Modern issues on the treatment of peptic ulcer bleedings

Directory of Open Access Journals (Sweden)

Potakhin S.N.

2014-03-01

Full Text Available Despite the success of therapeutic treatment of peptic ulcer and the introduction of endoscopic technologies, the problem of peptic ulcer hemorrhage remains valid. A large number of publications in foreign literature are dedicated to epidemiology and prevention of bleeding, evaluation of modern tactics and search for new methods of treatment. The works relating to organization of aid to patients with peptic ulcer bleeding are of particular interest. According to the recent data not all clinics even in economically developed countries manage to follow the recommendations of an international consensus-2010 for non-variceal bleeding treatment of upper gastrointestinal tract. Among the causes of non-compliance of international recommendations there are subjective and objective factors, the understanding of which can significantly affect the optimization of aid to patients with peptic ulcer bleeding.

Temperature- and pH-sensitive wearable materials for monitoring foot ulcers

Directory of Open Access Journals (Sweden)

Salvo P

2017-01-01

Full Text Available Pietro Salvo,1,2 Nicola Calisi,1 Bernardo Melai,1 Valentina Dini,3 Clara Paoletti,1 Tommaso Lomonaco,1 Andrea Pucci,1 Fabio Di Francesco,1 Alberto Piaggesi,4 Marco Romanelli3 1Department of Chemistry and Industrial Chemistry, University of Pisa, 2Institute of Clinical Physiology, National Council of Research, 3Wound Healing Research Unit, Department of Dermatology, University of Pisa, 4Diabetic Foot Section, Department of Medicine, University of Pisa, Pisa, Italy Abstract: Foot ulcers account for 15% of comorbidities associated with diabetes. Presently, no device allows the status of foot ulcers to be continuously monitored when patients are not hospitalized. In this study, we describe a temperature and a pH sensor capable of monitoring diabetic foot and venous leg ulcers developed in the frame of the seventh framework program European Union project SWAN-iCare (smart wearable and autonomous negative pressure device for wound monitoring and therapy. Temperature is measured by exploiting the variations in the electrical resistance of a nanocomposite consisting of multiwalled carbon nanotubes and poly(styrene-b-(ethylene-co-butylene-b-styrene. The pH sensor used a graphene oxide (GO layer that changes its electrical potential when pH changes. The temperature sensor has a sensitivity of ~85 Ω/°C in the range 25°C–50°C and a high repeatability (maximum standard deviation of 0.1% over seven repeated measurements. For a GO concentration of 4 mg/mL, the pH sensor has a sensitivity of ~42 mV/pH and high linearity (R2=0.99. Keywords: diabetic foot ulcer, wearable sensors, wound temperature, wound pH

Hydroxyurea-induced oral ulceration.

Science.gov (United States)

Badawi, Maha; Almazrooa, Soulafa; Azher, Fatima; Alsayes, Fatin

2015-12-01

Hydroxyurea is an antimetabolite that is widely used in the treatment of many benign and malignant conditions. This drug is usually well tolerated but has a number of side effects that vary in incidence. In cases of clinically significant adverse events, hydroxyurea is usually discontinued either temporarily or permanently, depending on treatment need versus harm caused by side effects. Here, we report a case of oral ulceration associated with hydroxyurea treatment in a patient who had chronic myelogenous leukemia. The patient rapidly developed an oral ulcer 12 days after administration of the drug. Hydroxyurea was discontinued, and the oral lesion appreciably decreased in size and severity. Physicians and dentists should be aware of the association between hydroxyurea and oral lesions. Copyright © 2015 Elsevier Inc. All rights reserved.

Chronic cheek ulcer caused by odontogenic cutaneous sinus tract

Directory of Open Access Journals (Sweden)

Tomoya Sato

2015-06-01

Odontogenic cutaneous sinus tracts are often misdiagnosed, and they lead to facial wounds and scarring. Therefore, we must be aware of the possibility of this condition. A dental origin must be considered for chronic ulcers involving the cheek, chin and submental areas. The clinical course of this patient suggests two important clinical issues for prompt diagnosis. First, physical examination, including palpation and probing, are helpful for exploration of sinus tracts. Second, computed tomography is useful to detect the sinus tract and affected teeth. Computed tomography provides radiographic evidence of the relationship between the tooth and cutaneous region, and it may be superior to radiography.

Hereditary Lymphedema of the Leg – A Case Report

Directory of Open Access Journals (Sweden)

Birgit Heinig

2017-07-01

Full Text Available Primary of hereditary lymphedema is a rare but progressive disease. It is yet not curable. We present a 48-year-old male patient with hereditary lymphedema of his left leg, that was realised by minor trauma (able twist when he was seven years old. He had never been treated for lymphedema but experienced multiple erysipelas during his life. After diagnostic procedures to exclude other causes of leg swelling, the diagnosis of hereditary lymphedema of the leg, stage III was confirmed. We initialized complex decongestive therapy. During two weeks of intensive treatment, the circumference of the left leg could be reduced by 10 cm. This case illustrates the "natural course" hereditary lymphedema. But it raises the hope that even after decades of ignorance, the patients benefits from complex decongestive treatment. Therapeutic nihilism is unnecessary and poses lymphedema patients to risks of infection and secondary malignancies like Stewart-Trewes syndrome.

Rapid deterioration of Mooren?s ulcers after conjunctival flap: a review of 2 cases

OpenAIRE

Li, Saiqun; Deng, Yuqing; Du, Caiyuan; Huang, Haixiang; Zhong, Jing; Chen, Ling; Wang, Bowen; Yuan, Jin

2017-01-01

Background Conjunctival flaps are a widely used treatment for numerous corneal ulcers that are caused by microorganismal infections. However, whether it can be performed on immune-mediated corneal ulcers is controversial. Case presentation We present two cases of Mooren?s ulcer that were treated using conjunctival flap in an attempt to prevent further corneal perforation at their local hospital. A rapid acceleration in ulcer progression was observed after a conjunctival flap was applied. Ulti...

Genotyping of Helicobacter pylori Strains Isolated from Patients with Gastric Ulcer and Non Ulcer Disease using RFLP-PCR of ureAB, vacA , cagA Genes

Directory of Open Access Journals (Sweden)

Sh. Farshad

2008-10-01

Full Text Available Introduction & Objective: Different studies show that the reasons for clinically diverse outcomes of infections caused by H. pylori may include host and environmental factors as well as differences in the prevalence or expression of bacterial virulence factors. The aim of this study was to study the distribution of different genotypes of major virulence factors cagA, vacA and ureAB among H. pylori strains isolated from patients with gastric ulcer (ulcerative disease and patients with gastritis (non ulcerative disease.Materials & Methods: In this cross sectional study 65 H. pylori strains, 30 from patients with gastric ulcer and 35 from patients with non ulcerative gastritis disease were investigated by RFLP-PCR.Results: The prevalence of vacA-positive strains in ulcerative patients was significantly more than that in non ulcerative patients (P0.05.Conclusion: It seems that in the patients under our study the presence of cagA gene may not necessarily be a risk factor for ulcer disease, while a homologous genotype of vacA appears to be associated with an increase risk of ulcer development. Lastly, despite the existence of a high degree of genomic variability within ureAB, conserved DNA banding profiles are distributed in our areas.

Association of sociodemographic factors with hope for cure, religiosity, and spirituality in patients with venous ulcers.

Science.gov (United States)

Salomé, Geraldo Magela; de Almeida, Sergio Aguinaldo; Ferreira, Lydia Masako

2015-02-01

The objective of the study was to evaluate the association of sociodemographic factors with hope for cure and levels of religiosity and spirituality in patients with venous leg ulcers (VLUs). This was a primary, prospective, descriptive, analytical, clinical, nonrandomized study. The study was performed at a nursing care and education center of a university hospital in interior Minas Gerais, Brazil. A convenience sample of 50 adult patients with VLUs and Doppler ankle-brachial index ranging from 0.8 to 1.0 participated in the study. Patients with mixed ulcers, arterial ulcers, and diabetic foot ulcers were excluded from the study. A questionnaire assessing sociodemographic and clinical characteristics of patients, the Spirituality Self-rating Scale (SSRS), and the Herth Hope Index (HHI) were administered to all patients. The mean SSRS score was 10.20, and the mean HHI was 25.5, corresponding to low levels of spirituality and moderate hope for cure, respectively. Patients aged between 50 and 59 years, men, nonsmokers, and those who were unemployed had the lowest mean SSRS scores. The lowest mean HHI values were reported by patients whose ulcers had exudate and odor, those aged 20 to 39 years, retired, and living with the wound for 1 year or less. Patients who had no religion or were not practicing a religion and those who considered living with an ulcer as a punishment reported low SSRS scores. The results showed that most patients with VLUs had low levels of spirituality, did not perceive divine intervention in their daily life or practice religious activities such as prayer, and had moderate hope for cure.

Rapid deterioration of Mooren's ulcers after conjunctival flap: a review of 2 cases.

Science.gov (United States)

Li, Saiqun; Deng, Yuqing; Du, Caiyuan; Huang, Haixiang; Zhong, Jing; Chen, Ling; Wang, Bowen; Yuan, Jin

2017-06-15

Conjunctival flaps are a widely used treatment for numerous corneal ulcers that are caused by microorganismal infections. However, whether it can be performed on immune-mediated corneal ulcers is controversial. We present two cases of Mooren's ulcer that were treated using conjunctival flap in an attempt to prevent further corneal perforation at their local hospital. A rapid acceleration in ulcer progression was observed after a conjunctival flap was applied. Ultimately, the two patients underwent corneal transplantation, which required the postoperative use of topical immunosuppressants and resulted in a final cure. In the current report, we also discussed this incorrect surgical choice via a review of conventional interventions that are used to treat Mooren's ulcer. These two cases demonstrate that keratoplasty combined with topical immunosuppressants is effective in treating Mooren's ulcer. Application of conjunctival flaps or autografting could promote progression of ulceration in Mooren's ulcers.

Impact of Facial Conformation on Canine Health: Corneal Ulceration

Science.gov (United States)

Packer, Rowena M. A.; Hendricks, Anke; Burn, Charlotte C.

2015-01-01

Concern has arisen in recent years that selection for extreme facial morphology in the domestic dog may be leading to an increased frequency of eye disorders. Corneal ulcers are a common and painful eye problem in domestic dogs that can lead to scarring and/or perforation of the cornea, potentially causing blindness. Exaggerated juvenile-like craniofacial conformations and wide eyes have been suspected as risk factors for corneal ulceration. This study aimed to quantify the relationship between corneal ulceration risk and conformational factors including relative eyelid aperture width, brachycephalic (short-muzzled) skull shape, the presence of a nasal fold (wrinkle), and exposed eye-white. A 14 month cross-sectional study of dogs entering a large UK based small animal referral hospital for both corneal ulcers and unrelated disorders was carried out. Dogs were classed as affected if they were diagnosed with a corneal ulcer using fluorescein dye while at the hospital (whether referred for this disorder or not), or if a previous diagnosis of corneal ulcer(s) was documented in the dogs’ histories. Of 700 dogs recruited, measured and clinically examined, 31 were affected by corneal ulcers. Most cases were male (71%), small breed dogs (mean± SE weight: 11.4±1.1 kg), with the most commonly diagnosed breed being the Pug. Dogs with nasal folds were nearly five times more likely to be affected by corneal ulcers than those without, and brachycephalic dogs (craniofacial ratio dogs. A 10% increase in relative eyelid aperture width more than tripled the ulcer risk. Exposed eye-white was associated with a nearly three times increased risk. The results demonstrate that artificially selecting for these facial characteristics greatly heightens the risk of corneal ulcers, and such selection should thus be discouraged to improve canine welfare. PMID:25969983

Gastric Ulcers Syndrome in Donkeys

Directory of Open Access Journals (Sweden)

Abelardo Morales Briceño

2015-09-01

Full Text Available This study aimed to describe gastric ulcer in donkeys. 10 donkeys (Equus asinus were studied in Bodonal de la Sierra, Badajoz-Extremadura, Spain. They were referred for necropsy and dead due to non-digestive causes. 4 males and 6 females were examined. The ages were classified of 4-16 years old. The stomach and gastric mucosa was evaluated for classified Merrit, 2003. Samples of gastric tissue were collected. The samples fixed in formalin were processed by conventional histological techniques and examined by histopathology. None of the donkeys presented clinical signs for gastric ulcers syndrome. Of the 10 donkeys studied, 10% had Grade 0; 30% Grade 1; 40% Grade 2; 10% Grade 3; and 10% Grade 4. In 30% (3/10 parasites such as Gasterophilus sp. were observed. The histological slices revealed severe damage on the gastric mucosa, a loss of continuity of the gastric mucosa with corium exposure, and subchorionic edema with parakeratotic hyperkeratosis, together with a mixed lymphoplasmocytic mononuclear infiltrate. In conclusion, we reported gastric ulcers syndrome in donkeys in Spain.

Buruli ulcer: wound care and rehabilitation

Directory of Open Access Journals (Sweden)

Frimpong M

2016-06-01

Full Text Available Michael Frimpong,1 Fred Stephen Sarfo,2 Mabel Sarpong Duah,1 Mark Wansbrough-Jones,3 Richard O Phillips2 1Kumasi Centre for Collaborative Research in Tropical Medicine, 2Department of Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; 3Institute for Infection and Immunity, St George’s University of London, London, UK Abstract: Buruli ulcer caused by Mycobacterium ulcerans is a neglected tropical disease characterized by extensive ulceration involving predominantly the upper and lower limbs of patients. The disease is common in rural tropical communities in West and Central Africa, where access to proper health care is limited. Pathogenesis of the characteristic painless ulcers is linked to the elaboration by M. ulcerans of a lipid toxin called mycolactone that has potent cytopathic, immunosuppressive, and analgesic effects on a host of cells in cutaneous tissues. Mycolactone is known to profoundly inhibit secretion of a plethora of proteins that are essential for wound healing. Even though a combination antibacterial therapy of streptomycin and rifampicin for 8 weeks is effective for treatment, it relies on good and appropriate wound management to prevent secondary bacterial infections and improve healing. Evidence-based interventions for wound care in Buruli ulcer disease are often lacking and have relied on expert advice and recommendations. Surgical interventions are limited to debridement of necrotic tissue and grafting of extensive ulcers, usually after antibiotic therapy. Patients’ rehabilitation is an important component of care to reduce disabilities associated with the disease and proper integration into the community after treatment. Keywords: Buruli ulcer, Mycobacterium ulcerans disease, Mycobacterium ulcerans, wound care, rehabilitation, disability

Effects of Topic Simvastatin for the Treatment of Chronic Vascular Cutaneous Ulcers: A Pilot Study.

Science.gov (United States)

Raposio, Edoardo; Libondi, Guido; Bertozzi, Nicolò; Grignaffini, Eugenio; Grieco, Michele P

2015-12-01

Recent research suggests that statins might be useful in the process of wound healing, playing a positive immune-modulatory role, improving microvascular function and reducing oxidative stress. The aim of this pilot study was to evaluate the efficacy of topic application of Simvastatin-based cream in the treatment of chronic vascular cutaneous ulcers, comparing this type of treatment to a collagen-based dressing, proven to be effective for ulcer treatment. A total of 20 ulcers were studied in 2 Groups of randomly-chosen patients for a period of one month. In the first Group a 0.5% Simvastatin-based cream was topically administered, while the second Group (control) was treated with an absorbable type I bovine collagen-based medication. Each week, wound healing progress was observed in both Groups, and the ulcers photographed. Wound healing rate was calculated by considering the absolute change in area and by the formula "healing ratio (%) = [(Area 0 - Area t4 )/Area 0 ] × 100," both sets of data being related to the days comprised in the study in order to calculate healing rate per day. Statistical analysis was performed by Student t test. Study endpoint equaling the time-course changes of ulcer areas. At the end of the study, when considering absolute change in area, the experimental Group appeared to heal better and faster than the control Group although differences between the Groups were not statistically significant. Conversely, rates of wound healing in the experimental and control Groups were 46.88% and 64% respectively, revealing statistically significant differences. ( P topic application of a simvastatin-based cream proved to be well- tolerated but not effective in the management of vascular leg ulcers in a 4 week-period.

The Relationship among Leg Strength, Leg Power and Alpine Skiing Success.

Science.gov (United States)

Gettman, Larry R.; Huckel, Jack R.

The purpose of this study was to relate leg strength and power to alpine skiing success as measured by FIS points. Isometric leg strength was represented by the knee extension test described by Clarke. Leg power was measured by the vertical jump test and the Margaria-Kalamen stair run. Results in the strength and power tests were correlated with…

Compression Stockings and Pressure Ulcers: Case Series of a Neglected Issue.

Science.gov (United States)

Rathore, Farooq A; Ahmad, Faria; Khan, Omer J

2017-10-10

Pressure ulcers develop in patients who endure long periods of immobilization, often caused by conditions such as musculoskeletal and neurological diseases. Pressure ulcers adversely affect the patient and increase caregiver burden and healthcare costs. Typical sites for these ulcers include the sacrum, trochanters, and heels; they also occur on the nape of the neck, penis, nostrils, helix of the ear, and upper back. Compression stockings are commonly used to prevent and stop the progression of venous disorders, including deep vein thrombosis, but their role in the development of pressure ulcers is not well known. We describe three case reports of pressure ulcer development due to prolonged application of compression stockings. In each case, the nursing staff who were primarily responsible for the prevention of pressure ulcers applied the stockings continuously without any intermittent relief. Moreover, the stockings did not include manufacturer instructions, such as recommended exposure times and applications. We recommend that nursing staff be trained in pressure relief and prevention of pressure ulcers, including rare occurrences, and that manufacturers give detailed guidance regarding the safe use of compression stockings.

Should care homes adopt a static-led approach to pressure ulcer prevention?

Science.gov (United States)

Keen, Delia Catherine

A static-led approach refers to the provision of high-specification foam mattresses for the whole of a population at risk of pressure damage. Such mattresses have been found to reduce the risk of pressure ulceration and cost less overall than standard mattresses, even in populations where only 1 in 100 patients develops a pressure ulcer. Reduced pressure ulcer prevalence and reduced costs resulting from decreased expenditure on dynamic mattresses following the implementation of a static-led approach have been reported. Pressure ulcers cause pain, a reduced quality of life, loss of independence, depression and social isolation for those in whom they develop. Organizations are increasingly having to pay out large sums of money following litigation surrounding pressure ulcers. This article explains why NHS healthcare providers and private care organizations need to work together to consider implementing a static-led approach to pressure ulcer prevention within care homes in order to reduce pressure ulcer incidence cost-effectively within their local populations.

Controversies in the Helicobacter pylori/duodenal ulcer story.

Science.gov (United States)

Hobsley, Michael; Tovey, Frank I; Holton, John

2008-12-01

In patients with Helicobacter pylori-positive duodenal ulcer (DU), the organism must be eradicated to achieve rapid, stable healing. However, evidence is against much else that is commonly accepted. (1) Does H. pylori cause the ulcer? Evidence against includes archaeopathology, geographical prevalence, temporal relationships and H. pylori-negative DU patients. DU can recur after eradication of H. pylori infection, and DUs may remain healed after reduction of acid secretion despite persistent infection. The faster healing of ulcers when H. pylori has been eradicated is due to the organism's interference with neoangiogenesis and the healing of wounded epithelial cells. (2) Does H. pylori infection persist until pharmacologically eradicated? Studies based on current infection show that H. pylori infection is a labile state that can change in 3 months. High rates of gastric acid secretion result in spontaneous cure, whereas low rates permit re-infection. Hydrochloric acid, necessary for producing a DU, is strongly associated with the likelihood of an ulcer. At the start, patients owe their ulcer to gastric hypersecretion of hydrochloric acid; approximately 60% may be H. pylori-negative. If acid is suppressed, the less acid milieu encourages invasion by H. pylori, especially if the strain is virulent.

An Incidental Finding of AL-associated Amyloidosis Presenting as Gastric Ulcers

Directory of Open Access Journals (Sweden)

Nadia Huq

2018-01-01

Full Text Available Gastrointestinal tract amyloidosis has been reported in rare instances and related symptoms are usually nonspecific to the disease process. We present a patient who initially had melena on anticoagulation and endoscopy revealed a bleeding gastric ulcer. Hemostasis was achieved. The patient had a recurrence of symptoms despite being off anticoagulation months later and at that time repeat endoscopy showed multiple gastric ulcers with surrounding friable mucosa. Biopsy results were significant for light chain associated-amyloidosis. This case represents a rare cause of gastric ulcer.

Rupture of the medial gastrocnemius muscle during namaz praying: an unusual cause of tennis leg.

Science.gov (United States)

Yilmaz, Cengiz; Orgenc, Yaman; Ergenc, Ruken; Erkan, Nazif

2008-12-01

The aim of this retrospective study is to report a unique group of patients in whom rupture of the medial gastrocnemius muscle (tennis leg) occurred during namaz praying. We reviewed the sonographic and/or MR imaging findings of 543 patients who were referred for the evaluation of leg pain and swelling during the last 7 years. Fourteen patients with a final diagnosis of tennis leg that occured during namaz praying were included in this study. Nine of 14 (64.2%) patients had incomplete and the remainder 5 (35.8%) patients had a partial tear at the musculotendinous junction (MTJ). Four of 14 (28.6%) patients were mistaken for deep vein thrombosis (DVT) on the basis of clinical findings and presentation. Associated fluid collection between the gastrocnemius and soleus muscle was noted in 11 (78.5%) patients. Isolated fluid collection between the gastrocnemius and soleus muscle without disruption of the gastrocnemius muscle was seen in 1 patient. Rupture of the medial gastrocnemius muscle may occur during namaz praying. The clinical presentation is not always characteristic and may simulate DVT. US and MRI are useful diagnostic tools to establish the correct diagnosis and prompt further treatment.

Restless Legs Syndrome -- Causes and Symptoms

Science.gov (United States)

... miles): 10 25 50 Share: Essentials in Sleep Insomnia Overview & Facts Symptoms & Causes Diagnosis & Self Tests Treatment Sleep Apnea Overview & Facts ... Self Test & Diagnosis Treatment Snoring Overview and Facts Causes and Symptoms Self Tests & ... Insomnia Short Sleeper Hypersomnias Narcolepsy Insufficient ...

Pharmacological inhibition of soluble epoxide hydrolase or genetic deletion reduces diclofenac-induced gastric ulcers.

Science.gov (United States)

Goswami, Sumanta Kumar; Rand, Amelia Ann; Wan, Debin; Yang, Jun; Inceoglu, Bora; Thomas, Melany; Morisseau, Christophe; Yang, Guang-Yu; Hammock, Bruce D

2017-07-01

This research was conducted to evaluate the hypothesis that gastric ulcers caused by the NSAID diclofenac sodium (DCF) can be prevented by the soluble epoxide hydrolase inhibitor TPPU. Mice were administered a single dose of 10, 30 or 100mg/kg of DCF. Once an ulcerative dose of DCF was chosen, mice were pretreated with TPPU for 7days at 0.1mg/kg to evaluate anti-ulcer effects of the sEH inhibitor on anatomy, histopathology, pH, inflammatory markers and epithelial apoptosis of stomachs. Diclofenac caused ulceration of the stomach at a dose of 100mg/kg and a time post dose of 6h. Ulcers generated under these conditions were associated with a significant increase in the levels of TNF-α and IL-6 in serum and increased apoptosis compared to control mice. Pretreatment with TPPU resulted in a decrease of ulceration in mice treated with DCF with a significant decrease in the level of apoptosis, TNF-α and IL-6 in the serum in comparison to diclofenac-treated mice. TPPU did not affect the pH of the stomach, whereas omeprazole elevated the pH of the stomach as expected. A similar anti-ulcer effect was observed in sEH gene knockout mice treated with DCF. The sEH inhibitor TPPU decreases the NSAID-induced stomach ulcers. Copyright © 2017 Elsevier Inc. All rights reserved.

Pressure ulcers in four Indonesian hospitals: prevalence, patient characteristics, ulcer characteristics, prevention and treatment.

Science.gov (United States)

Amir, Yufitriana; Lohrmann, Christa; Halfens, Ruud Jg; Schols, Jos Mga

2017-02-01

The objective of this article was to study characteristics of pressure ulcer patients and their ulcers, pressure ulcer preventive and treatment measures in four Indonesian general hospitals. A multicentre cross-sectional design was applied to assess pressure ulcers and pressure ulcer care in adult patients in medical, surgical, specialised and intensive care units. Ninety-one of the 1132 patients had a total of 142 ulcers. Half (44·0%) already had pressure ulcers before admission. The overall prevalence of category I-IV pressure ulcers was 8·0% (95% CI 6·4-9·6), and the overall nosocomial pressure ulcer prevalence was 4·5% (95% CI 3·3-5·7). Most pressure ulcer patients had friction and shear problems, were bedfast, had diabetes and had more bedridden days. Most ulcers (42·3%) were category III and IV. One third of the patients had both pressure ulcers and moisture lesions (36·3%) and suffered from pain (45·1%). The most frequently used prevention measures were repositioning (61·5%), skin moisturising (47·3%), patient education (36·3%) and massage (35·2%). Most pressure ulcer dressings involved saline-impregnated or antimicrobial gauzes. This study shows the complexities of pressure ulcers in Indonesian general hospitals and reveals that the quality of pressure ulcer care (prevention and treatment) could be improved by implementing the recent evidence-based international guideline. © 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Comparison platelet indices in diabetic patients with and without diabetic foot ulcer

Science.gov (United States)

Mardia, A. I.; Gatot, D.; Lindarto, D.

2018-03-01

Diabetes Mellitus is a group of metabolic disease which incidence increases every year. Some diabetic patients have diabetic foot ulcer as acomplication. The occurrence of ulcers in diabetic patients can be caused by the presence of thrombosis due to increased platelet function. Therefore, a cross-sectional study on 40 diabetic patients was performed at RSUP Adam Malik Medan to see whether there were differences in platelet indices between diabetic patients with and without diabetic foot ulcers. Platelets indices were examined and looked for differences in diabetic patients with and without diabetic foot ulcers. Data were analyzed using Chi-Square and Mann-Whitney U test with 95% CI. P-valuediabetic patients with diabetic foot ulcers indicating more reactive and aggregatable platelet function.

Cause for controversy? Infliximab in the treatment of ulcerative colitis: an update

Directory of Open Access Journals (Sweden)

Garrett Lawlor

2009-12-01

Full Text Available Garrett Lawlor, Alan C MossBeth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USAAbstract: Infliximab is a monoclonal antibody against tumor necrosis factor (TNF which has become an established therapy for Crohn’s disease over the last 10 years. Given the similarities between Crohn’s disease and ulcerative colitis (UC, it is no surprise that gastroenterologists have used infliximab in patients with UC who have failed other therapies. Although the initial controlled trials with infliximab in steroid-refractory disease were unimpressive, subsequent controlled trials have demonstrated the efficacy of infliximab in both moderate to severe disease, and as rescue-therapy to avoid colectomy. The long-term remission rates, colectomy-sparing effects, and the impact of concomitant immunomodulator therapy, remain to be determined in these patients. Whether infliximab is a superior strategy to cyclosporine in patients with steroidrefractory disease is controversial. This review examines the data on the efficacy and safety of infliximab as an induction and maintenance agent for UC.Keywords: ulcerative colitis, infliximab, biologics

The one-leg standing radiograph

OpenAIRE

Pinsornsak, P.; Naratrikun, K.; Kanitnate, S.; Sangkomkamhang, T.

2016-01-01

Objectives The purpose of this study was to compare the joint space width between one-leg and both-legs standing radiographs in order to diagnose a primary osteoarthritis of the knee. Methods Digital radiographs of 100 medial osteoarthritic knees in 50 patients were performed. The patients had undergone one-leg standing anteroposterior (AP) views by standing on the affected leg while a both-legs standing AP view was undertaken while standing on both legs. The severity of the osteoarthritis wa...

Anti-inflammatory Activities and Gastric Ulcer-inducing Properties of Tetraacetylquercetin and Tetrapivaloylquercetin

Directory of Open Access Journals (Sweden)

Rina Herowati

2016-12-01

Full Text Available Quercetin (3,3’4’,5,7-pentahydroxyflavone has been reported to show anti-inflammatory activity. However, its low oral bioavailability limits the application of quercetin in therapy. Ester derivatives of quercetin have been reported to have higher bioavailability than quercetin. This research aimed to study the anti-inflammatory activities and gastric ulcer-inducing properties of tetraacetylquercetinas well as tetrapivaloylquercetin. Synthesis of tetra-acyl derivatives of quercetin was conducted using acetic anhydride or pivaloyl chloride in the presence of pyridine and the structure was confirmed by 1H-NMR and 13C-NMR spectroscopy as well as elemental analysis. At a dose of 20 mg/kg bw, oral administration of quercetin only showed 20% inhibition activity on carragenan induced rat paw edema, while tetraacetyl and tetrapivaloyl derivatives at equimolar dose showed 11-33% and 5-15% inhibition activity respectively. Contrary to the gastric ulcer healing-promoting action of quercetin, tetraacetylquercetin caused mild gastric ulcers. However, no gastric ulcer was observed after administration of tetrapivaloylquercetin. It was concluded that acylation enhances the anti-inflammatory activity of quercetin but causes mild gastric ulcers in the case of tetraacetylation.

Single-leg squats can predict leg alignment in dancers performing ballet movements in "turnout".

Science.gov (United States)

Hopper, Luke S; Sato, Nahoko; Weidemann, Andries L

2016-01-01

The physical assessments used in dance injury surveillance programs are often adapted from the sports and exercise domain. Bespoke physical assessments may be required for dance, particularly when ballet movements involve "turning out" or external rotation of the legs beyond that typically used in sports. This study evaluated the ability of the traditional single-leg squat to predict the leg alignment of dancers performing ballet movements with turnout. Three-dimensional kinematic data of dancers performing the single-leg squat and five ballet movements were recorded and analyzed. Reduction of the three-dimensional data into a one-dimensional variable incorporating the ankle, knee, and hip joint center positions provided the strongest predictive model between the single-leg squat and the ballet movements. The single-leg squat can predict leg alignment in dancers performing ballet movements, even in "turned out" postures. Clinicians should pay careful attention to observational positioning and rating criteria when assessing dancers performing the single-leg squat.

Ulcers of stomach body

International Nuclear Information System (INIS)

Oster, A.N.; Rizaev, M.N.

1986-01-01

Symptoms of the roentgenologic image in differential diagnosis of nonmalignant ulcers and stomach carcinomas ulcerated are presented. Problems on X-ray semiotics of ulcerations, data on X-ray represenetation of ulcer evolution as well as postulcer changes in the stomach are interpreted

Friction-induced skin injuries-are they pressure ulcers? An updated NPUAP white paper.

Science.gov (United States)

Brienza, David; Antokal, Steven; Herbe, Laura; Logan, Susan; Maguire, Jeanine; Van Ranst, Jennifer; Siddiqui, Aamir

2015-01-01

Friction injuries are often misdiagnosed as pressure ulcers. The reason for the misdiagnosis may be a misinterpretation of classic pressure ulcer literature that reported friction increased the susceptibility of the skin to pressure damage. This analysis assesses the classic literature that led to the inclusion of friction as a causative factor in the development of pressure ulcers in light of more recent research on the effects of shear. The analysis in this article suggests that friction can contribute to pressure ulcers by creating shear strain in deeper tissues, but friction does not appear to contribute to pressure ulcers in the superficial layers of the skin. Injuries to the superficial layers of the skin caused by friction are not pressure ulcers and should not be classified or treated as such.

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.

Aberrant femoral torsion presenting with frog-leg squatting mimicking gluteal muscle contracture.

Science.gov (United States)

Chiang, Chia-Ling; Tsai, Meng-Yuan; Chang, Wei-Ning; Chen, Clement Kuen-Huang

2012-04-01

Patients with frog-leg squatting have restricted internal rotation and adduction of the affected hips during sitting or squatting. In the surgical literature, the cause generally has been presumed to arise from and be pathognomonic for gluteal muscle contracture. However, we have encountered patients with frog-leg squatting but without gluteal muscle contracture. We therefore raised the following questions: What are the imaging features of patients with frog-leg squatting? Do conditions other than gluteal muscle contracture manifest frog-leg squatting? We retrospectively reviewed the MR images of 67 patients presenting with frog-leg squatting from April 1998 to July 2010. There were four females and 63 males; their mean age was 22.2 years (range, 4-50 years). During MRI readout, we observed aberrant axes of some femoral necks and obtained additional CT to measure femoral torsion angles in 59 of the 67 patients. MR images of 27 (40%) patients had signs of gluteal muscle contracture. Twenty-two (33%) patients (40 femora) had aberrant femoral torsion, including diminished anteversion (range, 6°-0°; average, 3.9°) in 11 femora of eight patients and femoral retroversion (range, muscle contracture or aberrant femoral torsion. The observation of aberrant femoral torsion was not anticipated before imaging studies. In addition to gluteal muscle contracture, aberrant femoral torsion can be a cause of frog-leg squatting. Level II, diagnostic study. See the guidelines for Authors for a complete description of levels of evidence.

Use of customised pressure-guided elastic bandages to improve efficacy of compression bandaging for venous ulcers.

Science.gov (United States)

Sermsathanasawadi, Nuttawut; Chatjaturapat, Choedpong; Pianchareonsin, Rattana; Puangpunngam, Nattawut; Wongwanit, Chumpol; Chinsakchai, Khamin; Ruangsetakit, Chanean; Mutirangura, Pramook

2017-08-01

Compression bandaging is a major treatment of chronic venous ulcers. Its efficacy depends on the applied pressure, which is dependent on the skill of the individual applying the bandage. To improve the quality of bandaging by reducing the variability in compression bandage interface pressures, we changed elastic bandages into a customised version by marking them with circular ink stamps, applied when the stretch achieves an interface pressure between 35 and 45 mmHg. Repeated applications by 20 residents of the customised bandage and non-marked bandage to one smaller and one larger leg were evaluated by measuring the sub-bandage pressure. The results demonstrated that the target pressure range is more often attained with the customised bandage compared with the non-marked bandage. The customised bandage improved the efficacy of compression bandaging for venous ulcers, with optimal sub-bandage pressure. © 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

CLINICOMICROBIOLOGICAL STUDY OF DIABETIC FOOT ULCERS

Directory of Open Access Journals (Sweden)

Nirmal Kumar Palaniappan

2017-11-01

Full Text Available BACKGROUND Type 2 diabetes mellitus is a chronic disease caused by a combination of lifestyle and genetic factors affecting all organs in the body. Foot ulcers are one of the common and serious long-term complications of diabetes leads to recurrent and chronic infections, which results in limb loss when treatment is delayed. The aim of this study is to find out the clinical outcome and microbiological profile in patients admitted with diabetic foot ulcers. MATERIALS AND METHODS The study conducted between November 2008 to November 2009 over 50 patients with history of foot ulceration and diabetes. 50 patients were admitted with diabetic foot ulcer over a period of one year between November 2008-2009. They were studied after getting written consent. A predesigned pro forma was used to get the parameters comprising age, gender, duration, type of diabetes mellitus, presence of neuropathy, nephropathy (serum creatinine, urine albumin, retinopathy (screening funduscopy by ophthalmologist. RESULTS Among 50 patients admitted and treated for diabetic foot ulcers with mean stay of 18 days, 29 (58% had complete healing on conservative management, 18 (36% underwent minor amputation (toes, 3 (6% had major amputation (below knee/above knee. No mortality among the study groups encountered. Gram-negative aerobes E. coli (36%, Pseudomonas (52%, Klebsiella (28%, Proteus vulgaris (20% and Acinetobacter (16% were most frequently isolated followed by gram-positive aerobes MRSA (14%, Enterococcus (6%, Strep pyogenes (4% and no anaerobic growth. CONCLUSION Diabetic foot infections are frequently polymicrobial and predominantly gram-negative aerobic bacteria at presentation. Multidrug resistance pseudomonas aeruginosa and MRSA in diabetic foot ulcer is at its emergence and life threatening. Initial aggressive multimodal approach with surgical intervention, culture specific and sensitive targeted combined broad-spectrum antibiotics decreases the morbidity and mortality

Non invasive blood flow assessment in diabetic foot ulcer using laser speckle contrast imaging technique

Science.gov (United States)

Jayanthy, A. K.; Sujatha, N.; Reddy, M. Ramasubba; Narayanamoorthy, V. B.

2014-03-01

Measuring microcirculatory tissue blood perfusion is of interest for both clinicians and researchers in a wide range of applications and can provide essential information of the progress of treatment of certain diseases which causes either an increased or decreased blood flow. Diabetic ulcer associated with alterations in tissue blood flow is the most common cause of non-traumatic lower extremity amputations. A technique which can detect the onset of ulcer and provide essential information on the progress of the treatment of ulcer would be of great help to the clinicians. A noninvasive, noncontact and whole field laser speckle contrast imaging (LSCI) technique has been described in this paper which is used to assess the changes in blood flow in diabetic ulcer affected areas of the foot. The blood flow assessment at the wound site can provide critical information on the efficiency and progress of the treatment given to the diabetic ulcer subjects. The technique may also potentially fulfill a significant need in diabetic foot ulcer screening and management.

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 in the leg Is older Has ...

Transdermal deferoxamine prevents pressure-induced diabetic ulcers.

Science.gov (United States)

Duscher, Dominik; Neofytou, Evgenios; Wong, Victor W; Maan, Zeshaan N; Rennert, Robert C; Inayathullah, Mohammed; Januszyk, Michael; Rodrigues, Melanie; Malkovskiy, Andrey V; Whitmore, Arnetha J; Walmsley, Graham G; Galvez, Michael G; Whittam, Alexander J; Brownlee, Michael; Rajadas, Jayakumar; Gurtner, Geoffrey C

2015-01-06

There is a high mortality in patients with diabetes and severe pressure ulcers. For example, chronic pressure sores of the heels often lead to limb loss in diabetic patients. A major factor underlying this is reduced neovascularization caused by impaired activity of the transcription factor hypoxia inducible factor-1 alpha (HIF-1α). In diabetes, HIF-1α function is compromised by a high glucose-induced and reactive oxygen species-mediated modification of its coactivator p300, leading to impaired HIF-1α transactivation. We examined whether local enhancement of HIF-1α activity would improve diabetic wound healing and minimize the severity of diabetic ulcers. To improve HIF-1α activity we designed a transdermal drug delivery system (TDDS) containing the FDA-approved small molecule deferoxamine (DFO), an iron chelator that increases HIF-1α transactivation in diabetes by preventing iron-catalyzed reactive oxygen stress. Applying this TDDS to a pressure-induced ulcer model in diabetic mice, we found that transdermal delivery of DFO significantly improved wound healing. Unexpectedly, prophylactic application of this transdermal delivery system also prevented diabetic ulcer formation. DFO-treated wounds demonstrated increased collagen density, improved neovascularization, and reduction of free radical formation, leading to decreased cell death. These findings suggest that transdermal delivery of DFO provides a targeted means to both prevent ulcer formation and accelerate diabetic wound healing with the potential for rapid clinical translation.

Atypical Gastric Ulcer in an Elderly Cocaine User

Directory of Open Access Journals (Sweden)

Vinaya Gaduputi

2013-01-01

Full Text Available Cocaine or Benzoylmethylecgonine is an alkaloid extracted from the leaves of the Erythroxylon plant, which can cause gastrointestinal ischemia from severe arterial vasoconstriction via stimulation of alpha-adrenergic receptors in the gastric and mesenteric arteries. We report this case of a 65-year-old man who presented with a single massive ulcer at the incisura of the stomach as a result of cocaine use. The size and location of this ulcer were atypical and illustrate the potential for serious gastrointestinal manifestations from cocaine use.

Endoscopic management of acute peptic ulcer bleeding.

Science.gov (United States)

Lu, Yidan; Chen, Yen-I; Barkun, Alan

2014-12-01

This review discusses the indications, technical aspects, and comparative effectiveness of the endoscopic treatment of upper gastrointestinal bleeding caused by peptic ulcer. Pre-endoscopic considerations, such as the use of prokinetics and timing of endoscopy, are reviewed. In addition, this article examines aspects of postendoscopic care such as the effectiveness, dosing, and duration of postendoscopic proton-pump inhibitors, Helicobacter pylori testing, and benefits of treatment in terms of preventing rebleeding; and the use of nonsteroidal anti-inflammatory drugs, antiplatelet agents, and oral anticoagulants, including direct thrombin and Xa inhibitors, following acute peptic ulcer bleeding. Copyright © 2014 Elsevier Inc. All rights reserved.

History of Helicobacter pylori, duodenal ulcer, gastric ulcer and gastric cancer.

Science.gov (United States)

Graham, David Y

2014-05-14

Helicobacter pylori (H. pylori) infection underlies gastric ulcer disease, gastric cancer and duodenal ulcer disease. The disease expression reflects the pattern and extent of gastritis/gastric atrophy (i.e., duodenal ulcer with non-atrophic and gastric ulcer and gastric cancer with atrophic gastritis). Gastric and duodenal ulcers and gastric cancer have been known for thousands of years. Ulcers are generally non-fatal and until the 20th century were difficult to diagnose. However, the presence and pattern of gastritis in past civilizations can be deduced based on the diseases present. It has been suggested that gastric ulcer and duodenal ulcer both arose or became more frequent in Europe in the 19th century. Here, we show that gastric cancer and gastric ulcer were present throughout the 17th to 19th centuries consistent with atrophic gastritis being the predominant pattern, as it proved to be when it could be examined directly in the late 19th century. The environment before the 20th century favored acquisition of H. pylori infection and atrophic gastritis (e.g., poor sanitation and standards of living, seasonal diets poor in fresh fruits and vegetables, especially in winter, vitamin deficiencies, and frequent febrile infections in childhood). The latter part of the 19th century saw improvements in standards of living, sanitation, and diets with a corresponding decrease in rate of development of atrophic gastritis allowing duodenal ulcers to become more prominent. In the early 20th century physician's believed they could diagnose ulcers clinically and that the diagnosis required hospitalization for "surgical disease" or for "Sippy" diets. We show that while H. pylori remained common and virulent in Europe and the United States, environmental changes resulted in changes of the pattern of gastritis producing a change in the manifestations of H. pylori infections and subsequently to a rapid decline in transmission and a rapid decline in all H. pylori-related diseases.

Gastric emptying after artificial ulceration in rats: differences due to the site of the ulcer and the effects of prokinetic drugs.

Science.gov (United States)

Uchida, Masayuki; Kobayashi, Orie; Shimizu, Kimiko

2017-01-01

Background This study aimed to evaluate the effects of the position of an acetic acid-induced gastric ulcer and the effects of prokinetic drugs on gastric emptying. Materials and Methods Male Sprague-Dawley rats were used in this study. Acetic acid ulcers were induced either in the region between the fundus and pylorus on the anterior wall of the stomach or in the glandular region on the greater curvature of the stomach to determine whether there were regional differences in the effect of the ulcers. Gastric emptying was evaluated with a breath test using [1- 13 C] acetic acid. In addition, the effects of the prokinetic drugs, metoclopramide and mosapride, on gastric emptying were also evaluated. Results Acetic acid induced ulcers in the region between the fundus and pylorus on the anterior wall of the stomach significantly delayed gastric emptying as compared with control rats, but not the acetic acid induced ulcers in the glandular region on the greater curvature of the stomach. Metoclopramide and mosapride did not improve the delayed gastric emptying even at doses that enhanced gastric emptying in normal rats. Conclusion These findings show that gastric emptying is influenced by the position of the ulcer and the region between the fundus and pylorus on the anterior wall plays an important role in gastric emptying. Moreover, it was found that metoclopramide and mosapride do not improve the delayed gastric emptying caused by acetic acid ulcers induced on the anterior wall in the region between the fundus and pylorus.

Effects of a pulsatile electrostatic field on ischemic injury to the diabetic foot: evaluation of refractory ulcers.

Science.gov (United States)

Liani, Mario; Trabassi, Ernesto; Cusaro, Claudio; Zoppis, Elisabetta; Maduli, Elisabetta; Pezzato, Roberto; Piccoli, Paola; Maraschin, Maddalena; Bau, Piero; Cortese, Pietro; Cogo, Albero; Salvati, Filippo; Liani, Rossella

2014-10-01

The macro- and microcirculation disease, in patients with type 2 diabetes mellitus (T2DM), induces ischemic wounds of the lower limbs. We have tried to reduce the aggregation of red blood cells and to improve the O2 supply to the tissues and speed the healing of ulcers in T2DM patients. We enrolled 25 obese subjects without glucose intolerance (group A; BMI greater than 30 kg/m2), 20 obese adults intolerant to glucose (group B) and two subgroups, groups C and D, with T2DM and with leg ulcers. The groups A, B and C were treated with PESF. Body weight, O2 extraction, the capillary pulse, blood pressure and the surface of the ulcers were monitored. The technique PESF shows to have positive effects on the metabolism, on the reduction of body weight in the groups A and B, increasing extraction of O2 in group C and increase the speed of healing of wounds in group C compared to group D. In group A, there was a significant reduction in systolic and diastolic blood pressure. The technique PESF has affected the metabolic processes and the speed of wound healing ulcer in patients with T2DM. Copyright © 2013 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

Ulcerative colitis: pathogenesis, diagnosis, and current treatment.

Science.gov (United States)

Griffel, L H; Das, K M

1996-01-01

Ulcerative colitis is a chronic inflammatory disease of the colon that affects the rectum and a variable length of contiguous colon. The disease is characterized by rectal bleeding and diarrhea during periods of exacerbation; these symptoms usually abate with treatment. The pathogenic mechanism of ulcerative colitis is believed to be an aberrant immune response in which antibodies are formed against colonic epithelial protein(s). The disease usually presents during the second and third decades of life, with a smaller peak after the age of 60 years. There is a genetic component to ulcerative colitis, with a higher incidence among family members and, particularly, first-degree relatives. Diagnosis depends on several factors, most notably symptoms, demonstration of uniformly inflamed mucosa beginning in the rectum, and exclusion of other causes of colitis, such as infection. There is no medical cure for ulcerative colitis, but medical therapy is effective and can improve or eliminate symptoms in more than 80% of patients. Surgery offers a cure but carries the high price of total colectomy. New surgical methods, such as ileoanal anastomosis, allow for maintenance of bowel continuity and better patient satisfaction.

Thyroid Storm Precipitated by Duodenal Ulcer Perforation

Directory of Open Access Journals (Sweden)

Shoko Natsuda

2015-01-01

Full Text Available Thyroid storm is a rare and life-threatening complication of thyrotoxicosis that requires prompt treatment. Thyroid storm is also known to be associated with precipitating events. The simultaneous treatment of thyroid storm and its precipitant, when they are recognized, in a patient is recommended; otherwise such disorders, including thyroid storm, can exacerbate each other. Here we report the case of a thyroid storm patient (a 55-year-old Japanese male complicated with a perforated duodenal ulcer. The patient was successfully treated with intensive treatment for thyroid storm and a prompt operation. Although it is believed that peptic ulcer rarely coexists with hyperthyroidism, among patients with thyroid storm, perforation of a peptic ulcer has been reported as one of the causes of fatal outcome. We determined that surgical intervention was required in this patient, reported despite ongoing severe thyrotoxicosis, and reported herein a successful outcome.

Thyroid storm precipitated by duodenal ulcer perforation.

Science.gov (United States)

Natsuda, Shoko; Nakashima, Yomi; Horie, Ichiro; Ando, Takao; Kawakami, Atsushi

2015-01-01

Thyroid storm is a rare and life-threatening complication of thyrotoxicosis that requires prompt treatment. Thyroid storm is also known to be associated with precipitating events. The simultaneous treatment of thyroid storm and its precipitant, when they are recognized, in a patient is recommended; otherwise such disorders, including thyroid storm, can exacerbate each other. Here we report the case of a thyroid storm patient (a 55-year-old Japanese male) complicated with a perforated duodenal ulcer. The patient was successfully treated with intensive treatment for thyroid storm and a prompt operation. Although it is believed that peptic ulcer rarely coexists with hyperthyroidism, among patients with thyroid storm, perforation of a peptic ulcer has been reported as one of the causes of fatal outcome. We determined that surgical intervention was required in this patient, reported despite ongoing severe thyrotoxicosis, and reported herein a successful outcome.

A case of von Willebrand disease discovered during treatment of a sacral pressure ulcer.

Science.gov (United States)

Murakami, Masahiro; Fukaya, Sumiko; Furuya, Masaichi; Hyakusoku, Hiko

2010-12-01

A sacral pressure ulcer developed in a patient hospitalized for cerebral infarction. Each time necrotic tissue was debrided from the ulcer, pressure hemostasis was necessary to stop the bleeding. As treatment continued, the pressure required to stop the bleeding caused the ulcer to worsen, leading to a downward spiral in the patient's condition. While trying to determine the cause of this problem, we discovered that the patient had von Willebrand disease. Medication controlled the bleeding, and the pressure ulcer began to heal at the same time. It was clear to us that conservative treatment would lead to a complete cure but that the healing process would take a long time and require continued administration of an expensive drug. We decided, therefore, to close the wound with a fasciocutaneous flap so that the patient could be quickly transferred to a rehabilitation hospital. About 1 month after surgery, epithelialization was complete, we were able to discontinue medication, and the patient was discharged. This experience demonstrates the importance of determining the cause of any deviation from the normal course of healing in pressure ulcers. It also indicates that the use of fasciocutaneous flaps, which involve little intraoperative bleeding in short surgeries, is appropriate in cases like this one.

Genital ulcers in women: clinical, microbiologic and histopathologic characteristics.

Science.gov (United States)

Gomes, Christiane Maria Moreira; Giraldo, Paulo César; Gomes, Francis de Assis Moraes; Amaral, Rose; Passos, Mauro Romero Leal; Gonçalves, Ana Katherine da Silveira

2007-04-01

Female genital ulcer is a disease that affects a large number of women, and its etiologic diagnosis can be difficult. The disease may increase the risk of acquiring HIV. Genital ulcer may be present in sexually transmitted diseases (STD)--syphilis, chancroid, genital herpes, donovanosis, lymphogranuloma venereum; and other non-STD disorders (NSTD)--Behçet's syndrome, pemphigus, Crohn's disease, erosive lichen planus and others. This study evaluated the clinical-histopathologic-microbiologic characteristics of female genital ulcers. A cross-sectional descriptive prospective study was conducted during a six-month period to investigate the first 53 women without a definitive diagnosis, seeking medical care for genital ulcers at a genital infections outpatient facility in a university hospital. A detailed and specific history was taken, followed by a dermatologic and gynecologic examination. In addition to collecting material from the lesions for microbiologic study, a biopsy of the ulcer was performed for histopathologic investigation. The average age of the patients was 32.7 years, 56.6% had junior high school education and higher education. The most frequent etiology was herpetic lesion, followed by auto-immune ulcers. At the time of their first consultation, around 60% of the women were using inadequate medication that was inconsistent with the final diagnosis. Histologic diagnosis was conclusive in only 26.4% of the patients (14/53). Cure was obtained in 99% of the cases after proper therapy. The female genital ulcers studied were equally distributed between sexually transmitted and non-sexually transmitted causes. Herpes was the most frequent type of genital ulcer, affecting women indiscriminately, mostly between the ages of 20 and 40 years. The etiologic diagnosis of herpetic ulcers is difficult to make even when various diagnostic methods are applied. It is imperative that NSTD should be included in the differential diagnoses of female genital ulcers. The

Genital ulcers in women: clinical, microbiologic and histopathologic characteristics

Directory of Open Access Journals (Sweden)

Christiane Maria Moreira Gomes

Full Text Available Female genital ulcer is a disease that affects a large number of women, and its etiologic diagnosis can be difficult. The disease may increase the risk of acquiring HIV. Genital ulcer may be present in sexually transmitted diseases (STD - syphilis, chancroid, genital herpes, donovanosis, lymphogranuloma venereum and other non-STD disorders (NSTD - Behçet's syndrome, pemphigus, Crohn's disease, erosive lichen planus and others. This study evaluated the clinical-histopathologic-microbiologic characteristics of female genital ulcers. A cross-sectional descriptive prospective study was conducted during a six-month period to investigate the first 53 women without a definitive diagnosis, seeking medical care for genital ulcers at a genital infections outpatient facility in a university hospital. A detailed and specific history was taken, followed by a dermatologic and gynecologic examination. In addition to collecting material from the lesions for microbiologic study, a biopsy of the ulcer was performed for histopathologic investigation. The average age of the patients was 32.7 years, 56.6% had junior high school education and higher education. The most frequent etiology was herpetic lesion, followed by auto-immune ulcers. At the time of their first consultation, around 60% of the women were using inadequate medication that was inconsistent with the final diagnosis. Histologic diagnosis was conclusive in only 26.4% of the patients (14/53. Cure was obtained in 99% of the cases after proper therapy. The female genital ulcers studied were equally distributed between sexually transmitted and non-sexually transmitted causes. Herpes was the most frequent type of genital ulcer, affecting women indiscriminately, mostly between the ages of 20 and 40 years. The etiologic diagnosis of herpetic ulcers is difficult to make even when various diagnostic methods are applied. It is imperative that NSTD should be included in the differential diagnoses of female

Prevalence of pressure ulcers in three university teaching hospitals in Ireland.

LENUS (Irish Health Repository)

Gallagher, Paul

2012-02-03

AIM: Pressure ulceration is a significant, but preventable, cause of morbidity and resource utilisation in hospital populations. Data on pressure ulcer prevalence in Ireland are limited. This study aims to determine (i) the point-prevalence of pressure ulcers in three teaching hospitals in Ireland and (ii) risk factors for their development. METHODS: Eight teams of one doctor and one nurse visited 672 adult patients over a 2-day period in three teaching hospitals. Each patient was examined and pressure ulcers graded with the European Pressure Ulcer Advisory Panel system. Mental test score, Barthel index, type of support surface, length of stay, documentation of risk assessment and serum albumin were recorded. RESULTS: Point-prevalence of pressure ulceration was 18.5%. Seventy-seven percent of pressure ulcers were hospital-acquired, 49% grade 1, 37% grade 2, 11% grade 3 and 3% grade 4. Reduced mobility, urinary incontinence, cognitive impairment, low serum albumin and length of stay were significantly associated with pressure ulcers. Multivariate logistic regression analysis found reduced mobility (odds ratio 8.84; 95% CI 5.04-15.48, p<0.0001) and length of stay (odds ratio 1.02; 95% CI 1.01-1.02, p<0.0001) to be predictive of the presence of pressure ulcers. Age, gender and risk assessment documentation were not associated with pressure ulcers. Sixty-five percent of patients with pressure ulcers were positioned on appropriate support surfaces. DISCUSSION: Point-prevalence of pressure ulceration was 18.5%, similar to international data. Regular audit of prevalence, prevention and management strategies may raise awareness, influence resource allocation and ultimately improve patient care.

The influence of polymorbidity, revascularization, and wound therapy on the healing of arterial ulceration

Directory of Open Access Journals (Sweden)

Joerg Tautenhahn

2008-06-01

Full Text Available Joerg Tautenhahn1, Ralf Lobmann2, Brigitte Koenig3, Zuhir Halloul1, Hans Lippert1, Thomas Buerger11Department of General, Visceral and Vascular Surgery; 2Department of Endocrinology and Metabolism; 3Institute for Medical Microbiology, Medical School, Otto-von-Guericke University, Magdeburg, GermanyObjective: An ulcer categorized as Fontaine’s stage IV represents a chronic wound, risk factor of arteriosclerosis, and co-morbidities which disturb wound healing. Our objective was to analyze wound healing and to assess potential factors affecting the healing process.Methods: 199 patients were included in this 5-year study. The significance levels were determined by chi-squared and log-rank tests. The calculation of patency rate followed the Kaplan-Meier method.Results: Mean age and co-morbidities did not differ from those in current epidemiological studies. Of the patients with ulcer latency of more than 13 weeks (up to one year, 40% required vascular surgery. Vascular surgery was not possible for 53 patients and they were treated conservatively. The amputation rate in the conservatively treated group was 37%, whereas in the revascularizated group it was only 16%. Ulcers in patients with revascularization healed in 92% of cases after 24 weeks. In contrast, we found a healing rate of only 40% in the conservatively treated group (p < 0.001. Revascularization appeared more often in diabetic patients (n = 110; p < 0.01 and the wound size and number of infections were elevated (p = 0.03. Among those treated conservatively, wound healing was decelerated (p = 0.01/0.02; χ² test.Conclusions: The success of revascularization, presence of diabetes mellitus, and wound treatment proved to be prognostic factors for wound healing in arterial ulcers.Keywords: arterial leg ulcer, wound management, risk factors, revascularization

Care planning for pressure ulcers in hospice: the team effect.

Science.gov (United States)

Eisenberger, Andrew; Zeleznik, Jomarie

2004-09-01

The standards of care for patients at risk for or with a pressure ulcer in hospitals and nursing homes focus on prevention and ulcer healing using an interdisciplinary approach. Although not a primary hospice condition, pressure ulcers are not uncommon in dying patients. Their management in hospices, particularly the involvement of family caregivers, has not been studied. The objective of this study is to identify the factors that influence care planning for the prevention and treatment of pressure ulcers in hospice patients and develop a taxonomy to use for further study. A telephone survey was conducted with 18 hospice directors of clinical services and 10 direct-care nurses. Descriptive qualitative data analysis using grounded theory was utilized. The following three themes were identified: (1) the primary role of the hospice nurse is an educator rather than a wound care provider; (2) hospice providers perceive the barriers and burdens of family caregiver involvement in pressure ulcer care to be bodily location of the pressure ulcer, unpleasant wound characteristics, fear of causing pain, guilt, and having to acknowledge the dying process when a new pressure ulcer develops; and (3) the "team effect" describes the collaboration between family caregivers and the health care providers to establish individualized achievable goals of care ranging from pressure ulcer prevention to acceptance of a pressure ulcer and symptom palliation. Pressure ulcer care planning is a model of collaborative decision making between family caregivers and hospice providers for a condition that occurs as a secondary condition in hospice. A pressure ulcer places significant burdens on family caregivers distinct from common end-of-life symptoms whose treatment is directed at the patient. Because the goals of pressure ulcer care appear to be individualized for a dying patient and their caregivers, the basis of quality-of-care evaluations should be the process of care rather than the outcome

Comparison of low-strength compression stockings with bandages for the treatment of recalcitrant venous ulcers.

Science.gov (United States)

Brizzio, Eugenio; Amsler, Felix; Lun, Bertrand; Blättler, Werner

2010-02-01

To compare the proportion and rate of healing, pain, and quality of life of low-strength medical compression stockings (MCS) with traditional bandages applied for the treatment of recalcitrant venous leg ulcers. A single-center, randomized, open-label study was performed with consecutive patients. Sigvaris prototype MCS providing 15 mm Hg-25 mm Hg at the ankle were compared with multi-layer short-stretch bandages. In both groups, pads were placed above incompetent perforating veins in the ulcer area. The initial static pressure between the dressing-covered ulcer and the pad was 29 mm Hg and 49 mm Hg with MCS and bandages, respectively. Dynamic pressure measurements showed no difference. Compression was maintained day and night and changed every week. The primary endpoint was healing within 90 days. Secondary endpoints were healing within 180 days, time to healing, pain (weekly Likert scales), and monthly quality of life (ChronIc Venous Insufficiency Quality of Life [CIVIQ] questionnaire). Of 74 patients screened, 60 fulfilled the selection criteria and 55 completed the study; 28 in the MCS and 27 in the bandage group. Ulcers were recurrent (48%), long lasting (mean, 27 months), and large (mean, 13 cm2). All but one patient had deep venous reflux and/or incompetent perforating veins in addition to trunk varices. Characteristics of patients and ulcers were evenly distributed (exception: more edema in the MCS group; P = .019). Healing within 90 days was observed in 36% with MCS and in 48% with bandages (P = .350). Healing within 180 days was documented in 50% with MCS and in 67% with bandages (P = .210). Time to healing was identical. Pain scored 44 and 46 initially (on a scale in which 100 referred to maximum and 0 to no pain) and decreased within the first week to 20 and 28 in the MCS and bandage groups, respectively (P ulcers only. Our study illustrates the difficulty of bringing large and long-standing venous ulcers to heal. The effect of compression with MCS was

Maintenance therapy with sucralfate in duodenal ulcer: genuine prevention or accelerated healing of ulcer recurrence?

Science.gov (United States)

Bynum, T E; Koch, G G

1991-08-08

We sought to compare the efficacy of sucralfate to placebo for the prevention of duodenal ulcer recurrence and to determine that the efficacy of sucralfate was due to a true reduction in ulcer prevalence and not due to secondary effects such as analgesic activity or accelerated healing. This was a double-blind, randomized, placebo-controlled, parallel groups, multicenter clinical study with 254 patients. All patients had a past history of at least two duodenal ulcers with at least one ulcer diagnosed by endoscopic examination 3 months or less before the start of the study. Complete ulcer healing without erosions was required to enter the study. Sucralfate or placebo were dosed as a 1-g tablet twice a day for 4 months, or until ulcer recurrence. Endoscopic examinations once a month and when symptoms developed determined the presence or absence of duodenal ulcers. If a patient developed an ulcer between monthly scheduled visits, the patient was dosed with a 1-g sucralfate tablet twice a day until the next scheduled visit. Statistical analyses of the results determined the efficacy of sucralfate compared with placebo for preventing duodenal ulcer recurrence. Comparisons of therapeutic agents for preventing duodenal ulcers have usually been made by testing for statistical differences in the cumulative rates for all ulcers developed during a follow-up period, regardless of the time of detection. Statistical experts at the United States Food and Drug Administration (FDA) and on the FDA Advisory Panel expressed doubts about clinical study results based on this type of analysis. They suggested three possible mechanisms for reducing the number of observed ulcers: (a) analgesic effects, (b) accelerated healing, and (c) true ulcer prevention. Traditional ulcer analysis could miss recurring ulcers due to an analgesic effect or accelerated healing. Point-prevalence analysis could miss recurring ulcers due to accelerated healing between endoscopic examinations. Maximum ulcer

Radiating leg pain and positive straight leg raising in spondylolysis in children.

Science.gov (United States)

Halperin, N; Copeliovitch, L; Schachner, E

1983-09-01

Three children presented with low back pain radiating to the leg and with spasm of the hamstring and paravertebral muscles. Since the pain could not be ascribed to trauma, it was necessary to exclude the presence of infection or tumors. All the signs--localization of the pain, tenderness on one side of the back, X-ray film findings of unilateral or bilateral spondylolysis, and localized positive bone scan--pointed to spondylolysis as the cause of pain. All three children exhibited symptoms resembling those found in the facet syndrome described by Mooney and Robertson.

Biotechnological aspects of plants metabolites in the treatment of ulcer: A new prospective

Directory of Open Access Journals (Sweden)

Amit Kishore Singh

2018-06-01

Full Text Available Ulcer is one of the most common diseases affecting throughout the world population. The allopathic treatment of ulcer adversely affects the health by causing harmful side effects. Currently, many herbal plants and secondary metabolites have been used for the ulcer treatment. In the present review, many herbal plants and their parts (root, rhizome, bark, leaves and fruits have been listed in the table are currently being used for ulcer treatment. These metabolites are responsible for ulcer-neutralization or anti-inflammatory properties. In silico study, plant metabolites showed interaction between protodioscin (secondary metabolites of Asparagus racemosus and interferon-γ (virulent factor of gastric ulcer during molecular docking. All the residues of interferon-γ exhibited hydrophobic interactions with plant metabolites. These interactions helps in understanding the plant secondary metabolites vis a vis will open a new door in the research field of new drug discovery and designing for the ulcer treatment.

Pneumorrhachis Secondary From Sacral Decubitus Ulcer

OpenAIRE

Moayedi, Siamak; Babin, Lisa

2016-01-01

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. Emergen...

Other Causes of Leg Pain

Science.gov (United States)

... are visible just under the surface of the skin Spinal stenosis —narrowing in the spine, causing pressure on the nerves and spine, with resulting numbness and pain Lumbar disease Osteoarthritis QUESTIONS TO ASK YOUR HEALTH CARE PROVIDER Does my medical history raise my risk for P.A.D.? Do ...

Pressure ulcer prevention knowledge among Jordanian nurses: a cross- sectional study

Science.gov (United States)

2014-01-01

Background Pressure ulcer remains a significant problem in the healthcare system. In addition to the suffering it causes patients, it bears a growing financial burden. Although pressure ulcer prevention and care have improved in recent years, pressure ulcer still exists and occurs in both hospital and community settings. In Jordan, there are a handful of studies on pressure ulcer. This study aims to explore levels of knowledge and knowledge sources about pressure ulcer prevention, as well as barriers to implementing pressure ulcer prevention guidelines among Jordanian nurses. Methods Using a cross-sectional study design and a self-administered questionnaire, data was collected from 194 baccalaureate and master’s level staff nurses working in eight Jordanian hospitals. From September to October of 2011, their knowledge levels about pressure ulcer prevention and the sources of this knowledge were assessed, along with the barriers which reduce successful pressure ulcer care and prevention. ANOVA and t-test analysis were used to test the differences in nurses’ knowledge according to participants’ characteristics. Means, standard deviation, and frequencies were used to describe nurses’ knowledge levels, knowledge sources, and barriers to pressure ulcer prevention. Results The majority (73%, n = 141) of nurses had inadequate knowledge about pressure ulcer prevention. The mean scores of the test for all participants was 10.84 out of 26 (SD = 2.3, range = 5–17), with the lowest score in themes related to PU etiology, preventive measures to reduce amount of pressure/shear, and risk assessment. In-service training was the second source of education on pressure ulcer, coming after university training. Shortage of staff and lack of time were the most frequently cited barriers to carrying out pressure ulcer risk assessment, documentation, and prevention. Conclusions This study highlights concerns about Jordanian nurses’ knowledge of pressure ulcer prevention. The

Factors Associated With Quality of Life in Patients With Diabetic Foot Ulcers

Directory of Open Access Journals (Sweden)

Nasiriziba

2015-01-01

Full Text Available Background Diabetic foot ulcer (DFU is a serious and costly complication in diabetes which affects approximately 15% of patients with diabetes and affects their quality of life (QOL. Objectives The purpose of this study was to investigate the factors associated with QOL in patients with DFU. Patients and Methods This cross-sectional study was performed on 60 patients (32 males and 28 females hospitalized for DFU, performed through convenience sampling. Data related factors and the QOL questionnaire for patients with DFU were abridged. This questionnaire has 29 questions in six dimensions of enjoying life, physical health, daily activities dependence, negative emotions, concern about wound, and wound caring, which evaluate the QOL in patients with DFU. The scoring method for this tool is five optional Likert. Descriptive and analytic statistical methods were used to analyze the data. Results Of the 60 patients with DFU, 53% were male and 47% female with an average age of 58.08 ± 11.95 years and average QOL of 41.1 ± 9.15. Statistical analysis showed that age (P = 0.002, employment (P ≤ 0001, socioeconomic status (P = 0.016, leg ulcer (P ≤ 0001, and the number of foot ulcer (P = 0.017 had a statistically significant relationship with QOL and its dimensions. Other variables did not have a significant relationship with QOL, but some of them such as smoking during negative emotions (P = 0.046 and marital status affecting the foot care difficulties (P = 0.03 had significant statistical relationships with QOL. Conclusions Diabetic foot ulcer affects different aspects of life and can reduce patient’s QOL. To improve the care behaviors and have a better control of foot ulcers and improve the QOL for these patients, taking into account factors such as age, occupation, marital status, number of wounds, and economic status is essential to plan for care and health needs in these patients.

Cure of Helicobacter pylori-associated ulcer disease through eradication.

Science.gov (United States)

Malfertheiner, P; Leodolter, A; Peitz, U

2000-02-01

The eradication of Helicobacter pylori (H. pylori) infection has led to a dramatic benefit for patients with gastroduodenal ulcer disease, as the majority of these patients receive a lifelong cure. Relapses after successful H. pylori cure may be caused by either recrudescence or reinfection, both rare events nowadays, or be attributed to non-steroidal anti-inflammatory drugs or aspirin intake. In certain geographical areas, H. pylori-negative relapses are proposed as a new, pathophysiological and not yet elucidated entity. The cure of H. pylori infection in uncomplicated duodenal ulcer diseases consists of 7 days of proton pump inhibitor (PPI) based triple therapy, containing two antibiotics from clarithromycin, amoxicillin and metronidazole. In gastric ulcer, it is recommended that the PPI is continued for a further 3 weeks as these ulcers have a prolonged healing time. Rescue therapies after failure need to take into consideration the resistance pattern of the micro-organism and are offered in the form of quadruple therapy or a high-dose PPI with amoxicillin.

Skin grafting and tissue replacement for treating foot ulcers in people with diabetes

NARCIS (Netherlands)

Santema, Trientje B.; Poyck, Paul P. C.; Ubbink, Dirk T.

2016-01-01

Foot ulceration is a major problem in people with diabetes and is the leading cause of hospitalisation and limb amputations. Skin grafts and tissue replacements can be used to reconstruct skin defects for people with diabetic foot ulcers in addition to providing them with standard care. Skin

Gastric ulcer treatment: cure of Helicobacter pylori infection without subsequent acid-suppressive therapy: is it effective?

Science.gov (United States)

van Zanten, Sander Veldhuyzen; van der Knoop, Bloeme

2008-06-01

Whether it is a requirement to continue with anti-secretory therapy following anti-Helicobacter therapy in H. pylori positive gastric ulcers is an important question. As gastric ulcers tend to heal more slowly than duodenal ulcers, may be asymptomatic or only causing mild symptoms and success at curing H. pylori with current fist line therapies is 80% at best, clinicians will likely err on the side of caution and continue acid suppressive therapy to ensure healing of gastric ulcers. This is certainly recommended when dealing with bleeding ulcers.

Single-leg squats can predict leg alignment in dancers performing ballet movements in “turnout”

Science.gov (United States)

Hopper, Luke S; Sato, Nahoko; Weidemann, Andries L

2016-01-01

The physical assessments used in dance injury surveillance programs are often adapted from the sports and exercise domain. Bespoke physical assessments may be required for dance, particularly when ballet movements involve “turning out” or external rotation of the legs beyond that typically used in sports. This study evaluated the ability of the traditional single-leg squat to predict the leg alignment of dancers performing ballet movements with turnout. Three-dimensional kinematic data of dancers performing the single-leg squat and five ballet movements were recorded and analyzed. Reduction of the three-dimensional data into a one-dimensional variable incorporating the ankle, knee, and hip joint center positions provided the strongest predictive model between the single-leg squat and the ballet movements. The single-leg squat can predict leg alignment in dancers performing ballet movements, even in “turned out” postures. Clinicians should pay careful attention to observational positioning and rating criteria when assessing dancers performing the single-leg squat. PMID:27895518

A Cutaneous Ulcer Resulting from Mycobacterium ulcerans—Leishmania braziliensis Coinfection in South America

Science.gov (United States)

Mougin, Benjamin; Avenel-Audran, Martine; Hasseine, Lilia; Martin, Ludovic; Cottin, Jane; Pomares, Christelle; Delaunay, Pascal; Marty, Pierre; Ravel, Christophe; Chabasse, Dominique; Abgueguen, Pierre

2011-01-01

Buruli ulcer is a tropical skin disease caused by Mycobacterium ulcerans. Its mode of transmission is not yet clearly understood. We report here a cutaneous ulcer in a European traveler in South America resulting from a coinfection detected specifically for Mycobacterium ulcerans and Leishmania braziliensis DNA with real-time polymerase chain reaction. This observation of a unique cutaneous ulcer raises the issue about possible modes of transmission of those two pathogens by the same vector. PMID:22049045

Single nucleotide polymorphism markers for low-dose aspirin-associated peptic ulcer and ulcer bleeding.

Science.gov (United States)

Shiotani, Akiko; Murao, Takahisa; Fujita, Yoshihiko; Fujimura, Yoshinori; Sakakibara, Takashi; Nishio, Kazuto; Haruma, Ken

2014-12-01

In our previous study, the SLCO1B1 521TT genotype and the SLCO1B1*1b haplotype were significantly associated with the risk of peptic ulcer in patients taking low-dose aspirin (LDA). The aim of the present study was to investigate pharmacogenomic profile of LDA-induced peptic ulcer and ulcer bleeding. Patients taking 100 mg of enteric-coated aspirin for cardiovascular diseases and with a peptic ulcer or ulcer bleeding and patients who also participated in endoscopic surveillance were studied. Genome-wide analysis of single nucleotide polymorphisms (SNPs) was performed using the Affymetrix DME Plus Premier Pack. SLCO1B1*1b haplotype and candidate genotypes of genes associated with ulcer bleeding or small bowel bleeding identified by genome-wide analysis were determined using TaqMan SNP Genotyping Assay kits, polymerase chain reaction-restriction fragment length polymorphism, and direct sequencing. Of 593 patients enrolled, 111 patients had a peptic ulcer and 45 had ulcer bleeding. The frequencies of the SLCO1B1*1b haplotype and CHST2 2082 T allele were significantly greater in patients with peptic ulcer and ulcer bleeding compared to the controls. After adjustment for significant factors, the SLCO1B1*1b haplotype was associated with peptic ulcer (OR 2.20, 95% CI 1.24-3.89) and CHST2 2082 T allele with ulcer bleeding (2.57, 1.07-6.17). The CHST2 2082 T allele as well as SLCO1B1*1b haplotype may identify patients at increased risk for aspirin-induced peptic ulcer or ulcer bleeding. © 2014 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

Localization of Haemophilus ducreyi in naturally acquired chancroidal ulcers.

Science.gov (United States)

Bauer, Margaret E; Townsend, Carisa A; Ronald, Allan R; Spinola, Stanley M

2006-08-01

Haemophilus ducreyi causes the sexually transmitted genital ulcer disease chancroid. In human inoculation experiments, bacteria colocalize with neutrophils and macrophages but remain extracellular. The organism also colocalizes with collagen and fibrin but not with keratinocytes, fibroblasts, laminin, or fibronectin. These relationships are established by 48 h postinoculation and persist through the pustular stage of disease. To extend these observations to the ulcerative stage of disease, and to compare results in the human model with those of natural disease, we obtained biopsies from patients with naturally acquired chancroid. All ulcers were culture positive for H. ducreyi and histologically very similar to pustules from the human model. Staining with H. ducreyi-specific monoclonal antibodies demonstrated H. ducreyi within 5 biopsies. The organism was chiefly found within the granulocytic infiltrate of the ulcer. Dual staining for H. ducreyi and eukaryotic tissue components showed that H. ducreyi colocalized with neutrophils and fibrin at the ulcerative stage of disease. No bacteria were associated with keratinocytes, fibroblasts, or collagen. Overall, these findings are consistent with results from the human model. This is the first reported study to localize bacteria specifically identified as H. ducreyi within naturally acquired chancroid.

Stasis dermatitis and ulcers

Science.gov (United States)

... ulcers; Ulcers - venous; Venous ulcer; Venous insufficiency - stasis dermatitis; Vein - stasis dermatitis ... veins. Some people with venous insufficiency develop stasis dermatitis. Blood pools in the veins of the lower ...

Peptic Ulcer

Science.gov (United States)

A peptic ulcer is a sore in the lining of your stomach or your duodenum, the first part of your ... Comes and goes for several days or weeks Peptic ulcers happen when the acids that help you digest ...

Diet in the Aetiology of Ulcerative Colitis: A European Prospective Cohort Study

DEFF Research Database (Denmark)

Hart, Andrew R; Luben, Robert; Olsen, Anja

2008-01-01

Background/Aims: The causes of ulcerative colitis are unknown, although it is plausible that dietary factors are involved. Case-control studies of diet and ulcerative colitis are subject to recall biases. The aim of this study was to examine the prospective relationship between the intake...... was supplied and the subjects were followed up for the development of ulcerative colitis. Each incident case was matched with four controls and dietary variables were divided into quartiles. Results: A total of 139 subjects with incident ulcerative colitis were identified. No dietary associations were detected......, apart from a marginally significant positive association with an increasing percentage intake of energy from total polyunsaturated fatty acids (trend across quartiles OR = 1.19 (95% CI = 0.99-1.43) p = 0.07). Conclusions: No associations between ulcerative colitis and diet were detected, apart from...

Peptic ulcer in the gallbladder. A case report

DEFF Research Database (Denmark)

Larsen, E H; Diederich, P J; Sørensen, Flemming Brandt

1985-01-01

Gastric mucosa can be found in the gallbladder as a congenital heterotopia. A case of a perforated peptic ulcer in the gallbladder with concomitant hemorrhage in heterotopic gastric mucosa causing hematemesis and melena is presented....

Genetic parameters for claw and leg health, foot and leg conformation, and locomotion in Danish Holsteins

DEFF Research Database (Denmark)

Laursen, M. V.; Boelling, D.; Mark, Thomas

2009-01-01

was defined as absence of hock infection, swollen hock, and bruising. The potential indicators were locomotion and foot and leg conformation, represented by rear leg side view, rear leg rear view, foot angle, and apparent hock quality and bone structure. The study was conducted using records from 429......,877 Danish Holstein cows in first lactation. Binary health traits were divided into 3 subcategories: claw health, leg health, and absence of all claw and leg disorders. Genetic (r(g)) and phenotypic correlations were estimated using a bivariate linear sire model and REML. Estimated heritabilities were 0.......01 for all 3 combined claw and leg health traits (on the observed binary scale), 0.09 for locomotion, 0.14 for rear leg rear view, 0.19 for rear leg side view, 0.13 for foot angle, 0.22 for apparent hock quality, and 0.27 for apparent bone structure. Heritabilities were 0.06 and 0.01 for claw health and leg...

Painless Legs and Moving Toes as an Initial Presentation of Ischemic Stroke

Directory of Open Access Journals (Sweden)

Se Mi Oh

2009-05-01

Full Text Available Painless legs and moving toes is an unusual syndrome, which has not previously been reported as an initial presentation of ischemic stroke. We encountered a 78-year-old woman who developed dysarthria and involuntary movement of her left toes that was clinically regarded as painless legs and moving toes. These symptoms appeared abruptly and simultaneously as the initial symptoms of stroke, and improved gradually with conservative management by intravenous hydration for a month. We suggest that, in our case, a cortical brain lesion caused by ischemic stroke might be associated with the development of painless legs and moving toes.

Transdermal deferoxamine prevents pressure-induced diabetic ulcers

Science.gov (United States)

Duscher, Dominik; Neofytou, Evgenios; Wong, Victor W.; Maan, Zeshaan N.; Rennert, Robert C.; Januszyk, Michael; Rodrigues, Melanie; Malkovskiy, Andrey V.; Whitmore, Arnetha J.; Galvez, Michael G.; Whittam, Alexander J.; Brownlee, Michael; Rajadas, Jayakumar; Gurtner, Geoffrey C.

2015-01-01

There is a high mortality in patients with diabetes and severe pressure ulcers. For example, chronic pressure sores of the heels often lead to limb loss in diabetic patients. A major factor underlying this is reduced neovascularization caused by impaired activity of the transcription factor hypoxia inducible factor-1 alpha (HIF-1α). In diabetes, HIF-1α function is compromised by a high glucose-induced and reactive oxygen species-mediated modification of its coactivator p300, leading to impaired HIF-1α transactivation. We examined whether local enhancement of HIF-1α activity would improve diabetic wound healing and minimize the severity of diabetic ulcers. To improve HIF-1α activity we designed a transdermal drug delivery system (TDDS) containing the FDA-approved small molecule deferoxamine (DFO), an iron chelator that increases HIF-1α transactivation in diabetes by preventing iron-catalyzed reactive oxygen stress. Applying this TDDS to a pressure-induced ulcer model in diabetic mice, we found that transdermal delivery of DFO significantly improved wound healing. Unexpectedly, prophylactic application of this transdermal delivery system also prevented diabetic ulcer formation. DFO-treated wounds demonstrated increased collagen density, improved neovascularization, and reduction of free radical formation, leading to decreased cell death. These findings suggest that transdermal delivery of DFO provides a targeted means to both prevent ulcer formation and accelerate diabetic wound healing with the potential for rapid clinical translation. PMID:25535360

Ulcerative colitis flair induced by mesalamine suppositories hypersensitivity.

Science.gov (United States)

Ding, Hao; Liu, Xiao-Chang; Mei, Qiao; Xu, Jian-Ming; Hu, Xiang-Yang; Hu, Jing

2014-04-07

Mesalamine suppositories have been used widely for the treatment of distal ulcerative colitis and considered to be safer than systemic administration for its limited systemic absorption. However, previous studies have shown that mesalamine suppository occasionally causes severe hypersensitivity reactions including fever, rashes, colitis exacerbation and acute eosinophilic pneumonia. Here we present a 25-year-old woman with ulcerative colitis with bloody diarrhea accompanied by abdominal pain and fever which were aggravated after introduction of mesalamine suppositories. In light of symptom exacerbation of ulcerative colitis, increased inflammatory injury of colon mucosa shown by colonoscopy and elevated peripheral eosinophil count after mesalamine suppositories administration, and the Naranjo algorithm score of 10, the possibility of hypersensitivity reaction to mesalamine suppositories should be considered, warning us to be aware of this potential reaction after administration of mesalamine formulations even if it is the suppositories.

Stable walking with asymmetric legs

International Nuclear Information System (INIS)

Merker, Andreas; Rummel, Juergen; Seyfarth, Andre

2011-01-01

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.