Note: This page contains sample records for the topic leg ulcer caused from
While these samples are representative of the content of,
they are not comprehensive nor are they the most current set.
We encourage you to perform a real-time search of
to obtain the most current and comprehensive results.
Last update: November 12, 2013.

Management of leg ulcers  

Microsoft Academic Search

Leg ulcer is a leading cause of morbidity among older subjects, especially women in the Western world. About 400 years BC, Hippocrates wrote, “In case of an ulcer, it is not expedient to stand, especially if the ulcer be situated on the leg”. Hippocrates himself had a leg ulcer. The best treatment of any leg ulcer depends upon the accurate

P K Sarkar; S Ballantyne



Secondary hyperparathyroidism: Uncommon cause of a leg ulcer  

PubMed Central

INTRODUCTION Most leg ulcers are vascular based. Only if vascular therapy fails other causes are considered. We report the case of a female with incapacitating leg ulcers caused by a rare condition which was only diagnosed after failing treatment. PRESENTATION OF CASE The female had an extensive previous history including diabetes, renal insufficiency and cardiovascular disease and presented with three large and painful ulcers on her left lower leg. Standard treatment with antibiotics, wound excision and additional treatment with hyperbaric oxygen were ineffective. One month post hospital-admission calciphylaxis cutis caused by renal failure induced secondary hyperparathyroidism was diagnosed. Surgical treatment by a parathyroidectomy induced rapid regeneration of the ulcers. DISCUSSION Our patient's vast comorbidity and previous history had expanded differential considerations causing a delay in diagnosis. Our patient's previous history led us to believe her ulcers were vascular based, however her chronic renal failure appeared responsible for her condition. CONCLUSION Although less probable than venous insufficiency and concomittant leg ulcers or other differential considerations, calciphylaxis cutis should be part of the differential diagnosis in any end stage renal disease-patient with unexplained ulcers as an effective therapy is readily available.

van Rijssen, L.B.; Brenninkmeijer, E.E.A.; Nieveen van Dijkum, E.J.M.



Venous leg ulcer pain.  


Venous disease and venous leg ulcers are frequently painful. The pain experienced may be constant or intermittent. Constant pain can originate from vascular structures (superficial, deep phlebitis), pitting edema, collagen (lipodermatosclerosis), infection, or scarring (atrophie blanche). Ulcer region pain is often episodic and may be due to surgical or other debridement procedures. Intermittent pain is often related to dressing removal or recent applications of new dressings. An approach to pain control will consider the cause of pain and utilize local measures, regional approaches to edema control, and systemic medication aimed at constant, episodic, or intermittent pain triggers. PMID:12856289

Ryan, Siobhan; Eager, Cathy; Sibbald, R Gary



Leg ulcers and lymphoedema  

Microsoft Academic Search

Leg ulcers are a common and costly problem that can be influenced by a number of medical conditions. It is imperative that the correct diagnosis is made and therefore a thorough medical history plus careful examination of the wound and the surrounding skin is required. At each visit the maximal longitudinal length should be recorded and the wound documented photographically.

Kate Short; Richard Bull



The causes of skin damage and leg ulceration in chronic venous disease.  


Chronic venous disease with skin changes of the leg is a common condition affecting up to 1 in 20 people in westernized countries. The causes of this problem are not fully understood, although research in recent years has revealed a number of important mechanisms that contribute to the disease process. Patients with chronic venous disease suffer persistently raised pressures in their deep and superficial veins in the lower limb. Leucocytes become "trapped" in the circulation of the leg during periods of venous hyper-tension produced by sitting or standing. Studies of the plasma levels of neutrophil granule enzymes shows that these are increased during periods of venous hypertension, suggesting that this causes activation of the neutrophils. Investigation of the leucocyte surface ligands CD11b and CD62L shows that the more activated neutrophils and monocytes are sequestered during venous hypertension. Measurement of plasma levels of the soluble parts of the endothelial adhesion molecules VCAM, ICAM, and ELAM show that these are all elevated in patients with chronic venous disease compared to controls. Following 30 minutes of venous hypertension produced by standing, these levels are further increased. These data suggest that venous hypertension causes neutrophil and monocyte activation, which in turn causes injury to the endothelium. Chronic injury to the endothelium leads to a chronic inflammatory condition of the skin that we know clinically as lipodermatosclerosis. This is mediated by perivascular inflammatory cells, principally macrophages, in the skin microcirculation. These stimulate fibroblasts in the skin leading to tissue remodeling and laying down of fibrous tissue. Vascular endothelial growth factor stimulates proliferation of capillaries within the skin. Skin in this state has the potential to ulcerate in response to minor injury. PMID:16928672

Smith, Philip Coleridge



Necrobiotic xanthogranuloma as an unusual cause of refractive chronic bilateral leg ulceration.  


Necrobiotic xanthogranuloma is a progressive histiocytic granulomatous disease with frequent extracutaneous involvement. We have documented an unusual case of necrobiotic xanthogranuloma in a 58-year-old man with a history of recalcitrant and chronic arm and leg ulcerations in the absence of characteristic periorbital involvement. Our patient demonstrates a therapeutic challenge and may display a new necrobiotic inflammatory disorder not previously characterized. PMID:23222162

Ghiasi, Nazli; Alavi, Afsaneh; Coutts, Patricia M; Ghazarian, Danny; Sibbald, R Gary



Iatrogenic Arteriovenous Fistula as a Cause for Leg Ulcers: A Case Report  

PubMed Central

An 80-year-old man presented with painful leg ulceration due to steal phenomenon from a groin arteriovenous fistula (AVF) 10 years following a coronary angiogram. The diagnosis of the AVF was confirmed by duplex examination of the groin vessels which demonstrated characteristic flow pattern in the femoral arterial and venous system. Angiography further confirmed the site of the fistulous communication and this was managed by a covered stent graft. We discuss the incidence of AVF, risk factors for its development, relevant diagnostic investigations and management options along with strategies to reduce the incidence of AVF following percutaneous punctures.

Mylankal, Kurian J; Johnson, Brian; Ettles, Duncan F



Iatrogenic arteriovenous fistula as a cause for leg ulcers: a case report.  


An 80-year-old man presented with painful leg ulceration due to steal phenomenon from a groin arteriovenous fistula (AVF) 10 years following a coronary angiogram. The diagnosis of the AVF was confirmed by duplex examination of the groin vessels which demonstrated characteristic flow pattern in the femoral arterial and venous system. Angiography further confirmed the site of the fistulous communication and this was managed by a covered stent graft. We discuss the incidence of AVF, risk factors for its development, relevant diagnostic investigations and management options along with strategies to reduce the incidence of AVF following percutaneous punctures. PMID:23555445

Mylankal, Kurian J; Johnson, Brian; Ettles, Duncan F



The Causes of Skin Damage and Leg Ulceration in Chronic Venous Disease  

Microsoft Academic Search

Chronic venous disease with skin changes of the leg is a common condition affecting up to 1 in 20 people in westernized countries. The causes of this problem are not fully understood, although research in recent years has revealed a number of important mechanisms that contribute to the disease process. Patients with chronic venous disease suffer persistently raised pressures in

Philip Coleridge Smith



Leg ulcerations in livedoid vasculitis.  


Leg ulcerations associated with livedoid vasculitis may undergo a benign or very serious course depending on the presence of underlying disease. The disease has fairly distinctive clinical and histopathologic features, and it should be considered in cases of ulcerations refractory to conventional treatment. Most of these cases may eventually heal after a long course of intermittent eruptions and ulcerations. However, in rare instances, the loss of limbs may be unavoidable. PMID:3889951

Cabbabe, E B; Clift, S D



Venous leg ulcers.  


In 1837, Piorry, a French professor of medicine stated, "It is rather difficult to understand why the investigation of veins has been passed over almost in silence, while such a great diagnostic value has been attached to the investigation of arteries." Even today, our understanding of venous disease pales in comparison to our understanding of arterial disease. This is despite the fact that millions of Americans are afflicted with chronic venous insufficiency and hundreds of thousands suffer from debilitating lower extremity venous ulcers. A better understanding of the pathophysiology of venous disease is necessary to provide appropriate and efficient medical care for patients suffering from lower extremity venous ulcerations. PMID:14614698

Gonsalves, Carin F



Clinical predictors of leg ulcer healing.  


Background Identification of factors associated with healing can help in understanding the causes of delayed healing in chronic leg ulceration, and can allow for programmes to be developed to modify these factors to improve patient outcomes. Objectives To determine factors associated with healing in patients with chronic leg ulceration of all types within a defined patient population. Methods The patients were identified within the combined acute/community leg ulcer service within Wandsworth Primary Care Trust. All identified patients agreed to be interviewed and those who were able underwent clinical and noninvasive testing to determine the cause of the ulceration. Follow ups were to a maximum of 48 weeks, with time to healing given as the principal outcome measure. Analysis was by the Cox proportional hazards model for both univariate and multivariate analysis. Results were expressed as hazard ratio with 95% confidence intervals derived from the models. Results In total, 113 patients took part in this study. Univariate analysis revealed statistically significant differences for delayed healing according to the ulcer duration (P = 0.002), complexity of the ulcer aetiology (P = 0.035), presence of lipodermatosclerosis (P = 0.02), history of deep vein thrombosis (DVT) (P = 0.03) and thrombophlebitis (P = 0.03). Multivariate analysis showed that ulcer duration (P = 0.014), DVT (P = 0.008) and a lack of Pseudomonas on wound swab (P = 0.005) were independently associated with delayed healing. Conclusions The results indicate the complexity of determining risk factors for poor healing in patients with chronic leg ulceration. There appears to be little scope for interventions to improve healing from the factors identified. PMID:19785616

Moffatt, C J; Doherty, D C; Smithdale, R; Franks, P J



[Mixed leg ulcers].  


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

Willenberg, Torsten



Prevalence of leg ulceration in a London population  

Microsoft Academic Search

Summary Background: Current prevalence estimates of chronic leg ulceration are frequently based on studies from the 1980s. During the last decade, major changes have occurred in the application of evidence-based practice to this condition. Aim: To determine the prevalence and cause of leg ulceration in a defined geographical population after 8 years of providing standardized evidence based protocols of care.




Chronic ulcer of the leg: clinical history  

Microsoft Academic Search

Six hundred patients with chronic leg ulcers were studied by detailed history and examination as part of a population survey. In 22% ulceration began before the age of 40, and in this group the sex incidence was equal. Over age 40 there was an increasing preponderance of women. Ulcers were significantly more common in the left leg in women but

M J Callam; D R Harper; J J Dale; C V Ruckley



Leg ulcer after care: the role of compression hosiery.  


The management of venous leg ulcers is an important issue for many healthcare professionals. However, the care and management does not stop when the ulcer has healed. Prevention of recurrence and lifelong compression is an important issue that is often neglected. This article reviews the anatomy and physiology of the venous system, investigates the causes of venous leg ulcers and describes the principles of graduated compression. Compression hosiery and its role in the treatment of varicose veins is also looked at as well as deep vein thrombosis and preventing recurrence of the venous leg ulcer. PMID:11261055

Williams, C


Sickle cell disease and leg ulcers.  


Sickle cell disease is a genetic disorder of hemoglobin synthesis leading to a deformation of the red blood cell. This disorder is associated with painful, slow-to-heal leg ulcers. This article discusses the wound bed preparation paradigm as a guide to the treatment of sickle cell-associated leg ulcers. PMID:22914039

Ladizinski, Barry; Bazakas, Andrea; Mistry, Nisha; Alavi, Afsaneh; Sibbald, R Gary; Salcido, Richard



Chronic venous insufficiency and venous leg ulceration  

Microsoft Academic Search

Venous ulcers are the most common form of leg ulcers. Venous disease has a significant impact on quality of life and work productivity. In addition, the costs associated with the long-term care of these chronic wounds are substantial. Although the exact pathogenic steps leading from venous hypertension to venous ulceration remain unclear, several hypotheses have been developed to explain the

Isabel C. Valencia; Anna Falabella; Robert S. Kirsner; William H. Eaglstein



Causes of venous ulceration: a new hypothesis  

Microsoft Academic Search

Previous hypotheses about the causes of venous ulceration are inconsistent with recently published data. In patients with chronic venous insufficiency the number of functioning capillary loops visible in the skin on microscopy fell after the legs had been dependent for 30 minutes. Another study had shown that leucocytes became trapped in the circulation in dependent legs. A new hypothesis linking

P D Coleridge Smith; P Thomas; J H Scurr; J A Dormandy



Other Causes of Leg Pain  


... Home Current Issue Past Issues Special Section Other Causes of Leg Pain Past Issues / Summer 2008 Table of ... A.D. Other non-P.A.D. common causes of leg pain may include: A muscle cramp (also ...


Venous leg ulcers and the family physician.  


Family physicians often are the first contact for patients with venous leg ulcerations (VLUs). A random survey of 2,000 family physicians was conducted to determine patterns for diagnosis and treatment of VLUs, including type of leg ulcer (arterial, venous, diabetic), whether compression therapy was ordered, whether a Doppler system was available to aide in diagnosis, and which health care professional ultimately cared for the patient. Of the 325 family physicians who participated, 96% (311/325) see patients with VLUs, averaging 1.5 VLUs per week. Compression therapy is prescribed by 96% of family physicians, and 83% (259/325) refer these patients to other health care professionals. Only 27% (89/325) have a Doppler system in the office to measure the ankle-brachial index (ABI). These findings document for the first time in the United States the large number of patients with VLUs seen by family physicians. PMID:10326351

McGuckin, M; Kerstein, M D


Deciphering the impaired cytokine cascades in chronic leg ulcers (review).  


Chronic leg ulcers are typically wounds that do not heal at a normal rate. Impaired healing appears to be due to primary microvascular changes and it is aggravated by ongoing bacteria-driven vasculitis. The various cytokines identified in experimental wounds are also present in leg ulcers. VEGF is strongly implicated as a promoter of blood vessel growth in patients with venous disease. In addition, there is good evidence of increased expression of bFGF, TGF-beta1, and PDGF in lipodermatosclerosis. All of these growth factors are involved in wound healing. Upregulated TGF-beta1 is probably one of the main causes of the fibrosis observed in lipodermatosclerosis. In leg ulcers, cytokines appear to be trapped in the perivascular fibrinoid deposits. It is not the nature and amount of cytokines that are inadequate in leg ulcers, but rather their spatial distribution. Dermal dendrocytes (DD) are resident factor XIIIa-enriched macrophages. They likely play a role in tissue repair when boosted adequately. New therapies aiming at helping the release of cytokines by DD apparently promote and improve the healing phase. PMID:12632091

Quatresooz, Pascale; Henry, Frédérique; Paquet, Philippe; Pierard-Franchimont, Claudine; Harding, Keith; Pierard, Gérald E



Venous Leg Ulcerations: A Treatment Update  

Microsoft Academic Search

Opinion statement  Selecting the appropriate treatment for venous leg ulcerations is essential for optimal wound healing and patient quality\\u000a of life. Compression therapy remains the mainstay of treatment for these wounds. Compression methods should be carefully selected\\u000a and tailored for compatibility with patients’ daily life. Pain management should not be neglected. When response to compression\\u000a therapy is limited, adjuvant therapy such

Ronda S. Farah; Mark D. P. Davis



Nicorandil-induced leg ulceration without mucosal involvement.  


We report a case of leg ulceration occurring in a patient without mucosal ulcers, in whom nicorandil appeared to be the main aetiological factor. Having failed to heal on compression therapy, the ulcer rapidly improved and healed after the discontinuation of nicorandil. Most cases of nicorandil-induced ulcers reported in the literature develop on mucosal surfaces, including oral, vulval, perianal and peristomal ulcers. There are rare reports of cutaneous ulceration attributable to nicorandil, occurring concurrently with mucosal ulcers. To our knowledge, this is the first case of nicorandil-induced leg ulceration affecting the skin without mucosal involvement. PMID:21564175

Mikeljevic, J; Highet, A S



Leg ulcer plastic surgery descent by laser therapy  

Microsoft Academic Search

Low energy laser therapy (LELT) was used to treat chronic leg ulcers. Seven patients, aged 59 to 96 years, with 11 leg ulcers were referred for laser therapy by plastic surgeons. They had a history of ulceration of 3 - 50 years and five of the patients had breakdown of previous skin grafts. Laser treatments were administered with a microprocessor-controlled

Jacqui Telfer; Natalia Filonenko; Norman M. Salansky



Oxpentifylline treatment of venous ulcers of the leg  

Microsoft Academic Search

OBJECTIVE--To determine the effect of oxpentifylline on the healing of venous ulcers of the leg. DESIGN--Double blind, randomised, prospective, placebo controlled, parallel group study. SETTING--Four outpatient clinics treating leg ulcers in England and the Republic of Ireland. PATIENTS--80 Consecutive patients with clinical evidence of venous ulceration of the leg in whom appreciable arterial disease was excluded by the ratio of

M P Colgan; J A Dormandy; P W Jones; I G Schraibman; D G Shanik; R A Young



Restless Legs Syndrome -- Causes and Symptoms  


Restless Legs Syndrome - Causes & Symptoms Causes What causes of restless legs syndrome varies from person to person. In some cases ... with brain cell communication that can lead to restless legs syndrome. If you think you have restless legs syndrome ...


Venous leg ulcer: Incidence and prevalence in the elderly  

Microsoft Academic Search

Background: Venous leg ulcer is a disease most common in those aged 65 years and older. However, the incidence and prevalence have not been well established. Objective: Our purpose was to estimate the prevalence and incidence of venous leg ulcers in the elderly. Methods: We studied the General Practice Research Database, validated our case ascertainment strategy, and estimated the annual

David J. Margolis; Warren Bilker; Jill Santanna; Mona Baumgarten



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


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. PMID:23552003

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



Painful leg ulceration: a prospective, longitudinal cohort study.  


This study aimed to explore the relationship between pain mechanism, pain intensity, and leg ulcer characteristics using a 6-month longitudinal cohort study in a community setting in the north of England. Patients with leg ulceration referred consecutively to district nurses were invited to participate (n=96). The main outcome measures were pain intensity using daily visual analogue scores, leg ulcer characteristics (etiology, size, location, duration), and LANSS (Leeds Assessment of Neuropathic Symptoms and Signs). Results suggested that type, duration, position, and size of the leg ulcer had no effect on average daily pain scores. Using the LANSS questionnaire, 43.5% of respondents reported symptoms suggestive of a neuropathic mechanism to their pain. Patients with neuropathic symptoms had higher average daily pain scores (p<0.001). Fewer people had healed ulcers at 6 months with neuropathic symptoms compared with those with no neuropathic symptoms (30.8 vs. 52.1%). It would seem that the severity of pain can not be predicted by the type, size, position, or duration of ulceration. Patients who scored positively for neuropathic symptoms had higher average daily pain scores and fewer had healed leg ulcers at 6 months compared with those who did not experience neuropathic signs and symptoms. PMID:17352749

Briggs, Michelle; Bennett, Michael I; Closs, S José; Cocks, Kim


Martorell hypertensive ischemic leg ulcer: an underdiagnosed Entity©.  


Martorell hypertensive ischemic leg ulcer represents rapidly progressive and extremely painful ulcers that are frequently underdiagnosed. These occur most commonly on the lateral-dorsal calf and are associated with hypertension and diabetes. This article will synthesize a review of the literature for the accurate diagnosis and treatment of this painful debilitating condition. PMID:23151767

Alavi, Afsaneh; Mayer, Dieter; Hafner, Jürg; Sibbald, R Gary



Collaborative working to improve leg ulcer outcomes for injecting drug users.  


This case study features a 37-year-old drug user with a chronic leg ulcer caused by injecting Heroin into his leg veins. The case study demonstrates collaborative working between two specialist services based in Leicester. This joint working and knowledge sharing has allowed for appropriate leg ulcer management in this erratic and vulnerable group of mainly young people. Many factors need to be taken into account when prescribing a dressing regimen for this group, and the successes and complications encountered are described. PMID:17551426

Wheatley, Carolyn


A systematic review of compression treatment for venous leg ulcers.  

PubMed Central

OBJECTIVE: To estimate the clinical and cost effectiveness of compression systems for treating venous leg ulcers. METHODS: Systematic review of research. Search of 19 electronic databases including Medline, CINAHL, and Embase. Relevant journals and conference proceedings were hand searched and experts were consulted. MAIN OUTCOME MEASURES: Rate of healing and proportion of ulcers healed within a time period. STUDY SELECTION: Randomised controlled trials, published or unpublished, with no restriction on date or language, that evaluated compression as a treatment for venous leg ulcers. RESULTS: 24 randomised controlled trials were included in the review. The research evidence was quite weak: many trials had inadequate sample size and generally poor methodology. Compression seems to increase healing rates. Various high compression regimens are more effective than low compression. Few trials have compared the effectiveness of different high compression systems. CONCLUSIONS: Compression systems improve the healing of venous leg ulcers and should be used routinely in uncomplicated venous ulcers. Insufficient reliable evidence exists to indicate which system is the most effective. More good quality randomised controlled trials in association with economic evaluations are needed, to ascertain the most cost effective system for treating venous leg ulcers.

Fletcher, A.; Cullum, N.; Sheldon, T. A.



Oxpentifylline treatment of venous ulcers of the leg.  

PubMed Central

OBJECTIVE--To determine the effect of oxpentifylline on the healing of venous ulcers of the leg. DESIGN--Double blind, randomised, prospective, placebo controlled, parallel group study. SETTING--Four outpatient clinics treating leg ulcers in England and the Republic of Ireland. PATIENTS--80 Consecutive patients with clinical evidence of venous ulceration of the leg in whom appreciable arterial disease was excluded by the ratio of ankle to brachial systolic pressure being greater than 0.8. INTERVENTIONS--All patients received either oxpentifylline 400 mg three times a day by mouth or a matching placebo for six months (or until their reference ulcer healed if this occurred sooner) in addition to a locally standardised method of compression bandaging. MAIN OUTCOME MEASURES--The primary end point was complete healing of the reference ulcer within six months. The secondary end point was the change in the area of the ulcer over the six month observation period. RESULTS--Complete healing of the reference ulcer occurred in 23 of the 38 patients treated with oxpentifylline and in 12 of the 42 patients treated with a placebo. Life table analysis showed that the proportion of ulcers healed at six months was 64% in the group treated with oxpentifylline compared with 34% in the group treated with a placebo (log rank test chi 2 = 4.78, p = 0.03), which was significant (odds ratio = 1.81, 95% confidence interval 1.20 to 2.71). CONCLUSION--Oxpentifylline used in conjunction with compression bandaging improves the healing of venous ulcers of the leg.

Colgan, M P; Dormandy, J A; Jones, P W; Schraibman, I G; Shanik, D G; Young, R A



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


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. PMID:24156166

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



A Team Approach to the Management of Intractable Leg Ulcers  

PubMed Central

Objectives: The management of intractable leg ulcers requires a team approach which includes vascular surgeons and plastic surgeons. We retrospectively reviewed the results of the management of intractable leg ulcers by plastic surgeons. Patients and Methods: A total of 73 patients with intractable leg ulcers, (79 limbs) were treated at the Department of Plastic Surgery at our institution. Skin perfusion pressure (SPP) around the ulcer on the limb was measured before and after arterial reconstructive procedures. Local ulcer management involved intra-wound continuous negative pressure and irrigation therapy or negative pressure wound therapy. We examined the rates of wound healing and associated prognostic factors. Results: There were 21 limbs without ischemia (non-peripheral arterial disease [Non-PAD] group) and 58 limbs with ischemia (PAD group). The healing rates were 66% in the PAD group and 81% in the Non-PAD group, but the difference between the groups was not significant. A total of 41 limbs in the PAD group underwent revascularization, which involved bypass surgery in 18 limbs and endovascular therapy in 23 limbs. The salvage rate of the revascularized limbs was 83% at 1 year. The primary patency rates at 1 year were 87% for bypass surgery and 58% for endovascular therapy. The healing rate of the revascularized limbs was 66%, and the presence of concomitant hemodialysis, infected ulcers, and limbs without improved SPP were shown to be poor prognostic factors. Limbs treated with bypass surgery had a better healing rate than limbs treated with endovascular therapy, but the difference was not significant. Conclusion: Good ulcer-healing rates were achieved by effective revascularization and aggressive local management. These results suggest that a team approach is useful for the management of intractable leg ulcers. (English translation of Jpn J Vasc Surg 2011; 20: 913-920)

Kiyokawa, Kensuke; Akaiwa, Keiichi; Ishida, Masaru; Furuyama, Tadashi; Onohara, Toshihiro



Leg ulcers in sickle cell disease: current patterns and practices.  


Leg ulcers are a debilitating complication of patients with sickle cell disease, and their frequency in North America was reported to be 2.5% by the Cooperative Study of Sickle Cell Disease more than 20 years ago. We sought to determine if the frequency of leg ulcers in sickle cell patients in the United States had declined and to assess which treatments providers use most commonly. We sent an e-mail survey to health professionals belonging to the national Sickle Cell Adult Provider Network. Responses were obtained from 31 of them (26.0%). Most of them (96.0%) reported having some patients with leg ulcers. Providers reported a total of 185 patients with active leg ulcers and 224 in the previous 5 years, for a total of 409 patients. Hb SS (homozygous sickle cell anemia) was the most common genotype of affected individuals, followed by Hb SC (double heterozygote for Hb S [?6(A3)Glu?Val, GAG>GTG; HBB: c.20A>T] and Hb C [?6(A3)Glu?Lys, GAG>AAG; HBB: c.19G>A]). Males showed a 2:1 predominance. Two-thirds of patients were treated with either hydroxyurea (HU) or transfusion therapy and most used compression stockings and topical therapies as directed by wound care services. We conclude that leg ulcers continue to be a debilitating complication of young adults with sickle cell disease, despite improved supportive care and the widespread use of disease modifying agents such HU and transfusion. While some providers offer office-based ulcer care, the majority prefer specialty consultation including podiatry, plastic surgery and dermatology. Despite their frequency, there is no clear consensus among providers as to the best treatment. PMID:23600469

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



[Leg ulcers in patient affected by polycythemia vera in treatment with hydroxycarbamide. Case report].  


Leg ulcers are a frequent and serious complication of polycythemia vera (PV). They are caused by a synergic action of vascular, neurological and infectious physiopathologic mechanisms. Furthermore, cytostatic therapies commonly employed to control the myeloproliferative disease negatively interfere on the development of granulation tissue, slowing down the recovery of the ulcer. We describe the case of a 70 years old woman with PV, who had calcaneous and perimalleolar ulcers. They were so painful that they made it almost impossible for her to sleep and walk normally. These ulcers were particularly resistant to common topical therapy. Further and accurate investigations showed that these ulcers were a complication of hydroxycarbamide therapy employed and they were not a complication of the ematologic disease. Leg ulcers during hydroxycarbamide therapy are a relatively frequent but underestimated condition. Pathogenesis is bound to numerous factors, i.o. cellular damage and tissutal hypoxia, consequent of drug induced macroerythrosis. In our patient drug substitution and prosecution of topic therapies allowed the recovery of the leg ulcers, particularly serious for both, extensiveness and symptoms. PMID:20426925

Chiummariello, S; Arleo, S; Alfano, C



Venous leg ulcer care: How evidence-based is nursing practice?  

Microsoft Academic Search

Objectives: The objectives of this study were to (1) determine how congruent community-provided leg ulcer care was with best practice for venous leg ulcers and (2) identify organizational and clinical factors associated with the provision of best practice for venous leg ulcers. Design: The practice variation study group was an audit of nursing agency client records to determine the provision

Karen R. Lorimer; Margaret B. Harrison; Ian D. Graham; Elaine Friedberg; Barbara Davies



Leg ulcer plastic surgery descent by laser therapy  

NASA Astrophysics Data System (ADS)

Low energy laser therapy (LELT) was used to treat chronic leg ulcers. Seven patients, aged 59 to 96 years, with 11 leg ulcers were referred for laser therapy by plastic surgeons. They had a history of ulceration of 3 - 50 years and five of the patients had breakdown of previous skin grafts. Laser treatments were administered with a microprocessor-controlled device. A 22 red ((lambda) equals 660 nm) laser head was utilized to provide a dose of (4 - 6) J/cm2 and 7 infrared ((lambda) equals 880 nm) head to provide a dose of (4 - 8) J/cm2. The patients were treated three to five times per week, 25 - 30 treatments per course. Three patients underwent two courses of laser therapy with three weeks interval between them. All patients, after 5 - 10 laser treatments, have gotten relief of pain and decreased the amount of analgesics used. All ulcers in six patients were completely healed and two ulcers in the seventh patient decreased in size by 75%. One may conclude the developed laser methodology might be used as a preventative measure to avoid plastic surgery or improve its success.

Telfer, Jacqui; Filonenko, Natalia; Salansky, Norman M.



Chronic leg ulcers in adult patients with rheumatological diseases - a 7-year retrospective review.  


Chronic leg ulcers in patients with rheumatological diseases can cause significant morbidity. We performed a retrospective case review to describe the epidemiology, clinical features and outcome of chronic leg ulcers in this group of patients. Twenty-nine patients with underlying rheumatological conditions, namely, rheumatoid arthritis (15 patients), systemic lupus erythematosus (8 patients), overlap syndromes (3 patients), systemic sclerosis (1 patient) and ankylosing spondylitis (1 patient) were included. The ulcers were mostly located around the ankle (55·2%) and calves (37·9%). The predominant aetiology of the ulcers, in decreasing order of frequency, was venous disease, multifactorial, vasculitis or vasculopathy, infective, pyoderma gangrenosum, ischaemic microangiopathy and iatrogenic. Treatment modalities included aggressive wound bed preparation, compression therapy (17 patients), changes in immunosuppressive therapy (15 patients), hyperbaric oxygen therapy (4 patients) and cellular skin grafting (2 patients). Management of chronic leg ulcers in rheumatological patients is challenging and the importance of careful clinicopathological correlation and treatment of the underlying cause cannot be overemphasised. PMID:23237056

Chia, Hui Y; Tang, Mark By



Leg Ulceration in Rheumatoid Arthritis – An Underreported Multicausal Complication with Considerable Morbidity: Analysis of Thirty-Six Patients and Review of the Literature  

Microsoft Academic Search

Background: Rheumatoid arthritis (RA) is a systemic inflammatory disease which may present with extra-articular symptoms, including cutaneous manifestations. Ulcerated rheumatoid nodules, necrotic vasculitic lesions and pyoderma gangrenosum are fairly characteristic and well-recognized causes of skin ulcers in RA. However, most RA patients develop leg ulcers due to other pathophysiological factors posing a diagnostic and therapeutic challenge and leading to considerable

Cornelia S. Seitz; Nikolaus Berens; Eva-B. Bröcker; Axel Trautmann




PubMed Central

Synopsis Skin ulceration is a major source of morbidity and is often difficult to manage. Ulcers due to an inflammatory etiology or microvascular occlusion are particularly challenging in terms of diagnosis and treatment. The management of such ulcers requires careful assessment of associated systemic conditions and a thorough analysis of the ulcer's clinical and histologic findings. In this report, we discuss several examples of inflammatory ulcers and the approach to their diagnosis and treatment.

Panuncialman, Jaymie; Falanga, Vincent



Laboratory and Echocardiography Markers in Sickle Cell Patients with Leg Ulcers  

PubMed Central

Chronic leg ulcers are a debilitating complication of sickle cell disease, associated with increased morbidity and perhaps mortality that affect 8 to 50% of patients. We evaluated the characteristics of SCD patients with a history of leg ulceration, including hemolytic rate, estimated pulmonary artery systolic pressure, and other parameters in a cohort of 505 adults with SCD. Ninety four subjects (18%) had either active ulcers at enrollment or history of leg ulceration. Patients affected were older and predominantly had homozygous SS, lower body mass index, and pulse oximetry, higher tricuspid regurgitation velocities, markers of hemolysis, serum uric acid and serum NT-proBNP, when compared to subjects without such history. In this prospective cohort of adults with SCD, we confirm that leg ulcers are still frequent and are associated with elevated TRVand markers of hemolysis. We describe a novel association of leg ulcer with hyperuricemia and oxygen desaturation and suggest potential implications for uric acid as a marker of vascular dysfunction.

Minniti, Caterina P.; Taylor, James G.; Hildesheim, Mariana; O'Neal, Patricia; Wilson, Jonathan; Castro, Oswaldo; Gordeuk, Victor; Kato, Gregory J.



Double-filtration plasmapheresis in the treatment of leg ulcers in cryoglobulinemia.  


Hepatitis C virus (HCV) is the major cause of cryoglobulinemia. Skin lesions are frequent and can be cured from the removal of cryoglobulins by therapeutic apheresis. We describe a case of HCV-positive type I cryoglobulinemia with severe leg ulcers, not responsive to antiviral and immunosuppressive treatment. Thirty sessions of double filtration plasmapheresis were performed, over a period of 6 months, with no other associated treatment. Before and after each session an assessment of immunoglobulins, complement, cryocrit, and fibrinogen was made. HCV RNA levels were determined in serum cryoprecipitate, supernatant before and after each session, and in the collection bag. No differences in pre and postapheresis values were observed in the serum concentrations and the supernatant, whereas the postapheresis cryoprecipitate showed a significantly reduced viral load (P < 0.02) as compared with the preapheresis values. There was improvement in the condition of ulcers in the leg during apheresis and had completely regressed by the end of the cycle. PMID:18484642

Ramunni, A; Lauletta, G; Brescia, P; Saliani, M T; Montrone, M; Chironna, M; Sansonno, D; Dammacco, F; Coratelli, P



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

Microsoft Academic Search

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

Oliver R Herber; Wilfried Schnepp; Monika A Rieger



Risk Factors Associated With the Failure of a Venous Leg Ulcer to Heal  

Microsoft Academic Search

Background: Venous leg ulcers afflict a significant por- tion of the population. The most popular form of therapy for venous leg ulcers is a compression bandage (eg, Unna boot), a therapy that is frequently unsuccessful. Objective: To describe risk factors associated with the failure of a wound to heal when treated with a limb- compression bandage for 24 weeks. Design:

David J. Margolis; Jesse A. Berlin; Brian L. Strom



Laser irradiation effect on Staphylococcus aureus and Pseudomonas aeruginosa biofilms isolated from venous leg ulcer.  


Chronic wounds, including diabetic foot ulcers, pressure ulcers and venous leg ulcers, represent a significant cause of morbidity in developed countries, predominantly in older patients. The aetiology of these wounds is probably multifactorial, but the role of bacteria in their pathogenesis is still unclear. Moreover, the presence of bacterial biofilms has been considered an important factor responsible for wounds chronicity. We aimed to investigate the laser action as a possible biofilm eradicating strategy, in order to attempt an additional treatment to antibiotic therapy to improve wound healing. In this work, the effect of near-infrared (NIR) laser was evaluated on mono and polymicrobial biofilms produced by two pathogenic bacterial strains, Staphylococcus aureus PECHA10 and Pseudomonas aeruginosa PECHA9, both isolated from a chronic venous leg ulcer. Laser effect was assessed by biomass measurement, colony forming unit count and cell viability assay. It was shown that the laser treatment has not affected the biofilms biomass neither the cell viability, although a small disruptive action was observed in the structure of all biofilms tested. A reduction on cell growth was observed in S. aureus and in polymicrobial biofilms. This work represents an initial in vitro approach to study the influence of NIR laser treatment on bacterial biofilms in order to explain its potentially advantageous effects in the healing process of chronic infected wounds. PMID:22182280

Baffoni, Marina; Bessa, Lucinda J; Grande, Rossella; Di Giulio, Mara; Mongelli, Matteo; Ciarelli, Antonio; Cellini, Luigina



Evaluation of healing and antimicrobiological effects of herbal therapy on venous leg ulcer: pilot study.  


Venous leg ulcers represent a significant public health problem that will increase as the population ages. Numerous herbs and their extracts are potentially conducive to wound healing, including the ability to serve as an antimicrobial, antifungal, astringent, etc. A total of 32 patients with venous leg ulcers were randomized into two groups: a group with herbal therapy treatment (PT) (17 patients) and a control group (C) (15 patients). The investigation focused on five controls of parameter changes important for ulcer healing and the control of microbiological flora. Within-treatment analysis of the PT group showed that, following herbal therapy treatment, there was a significant decrease in the scores of surface leg ulcer and venous leg ulcer after week 7 of treatment (p < 0.05). In group C following topical antibiotic treatment there was no significant decrease in the surface leg ulcer. Comparing the results of decreased venous leg ulcer surface of the) PT group with the C group showed a significant difference at p < 0.05 after week 7 of treatment. The number of different types of isolated bacterial species decreased significantly (p < 0.05) after the use of herbal preparations. The results of this pilot study demonstrate the healing and antimicrobiological effects of herbal therapy on non-infected venous leg ulcer. PMID:19610037

Bini?, Ivana; Jankovi?, Aleksandar; Jankovi?, Dimitrije; Jankovi?, Irena; Vrucini?, Zoran





An ulcer is a crater-like sore on the skin or mucous membrane . Ulcers form when the top layers of skin or ... Ulcers can be caused by inflammation or infection. Some ulcers may be caused by a cancer.


Reducing avoidable harm caused by pressure ulcers.  


This article reports on the successful work undertaken within one NHS trust to reduce the incidence of pressure ulcers. The tissue viability nursing team at Medway NHS Foundation Trust devised, implemented and evaluated a strategy to reduce the incidence of pressure ulcers. This involved devising a comprehensive database, intensive monitoring using root cause analysis, writing action plans using high-impact actions (HIAs) and innovative thinking to address and reduce the incidence of pressure ulcers and staff training in the use of the SKIN acronym. This work identified pressure ulcers on the ears of patients receiving oxygen therapy as a particular problem. An evidence-based and multiprofessional strategy was devised to deal with this particular problem, which resulted in no further incidence of pressure ulcers on the ears of patients receiving oxygen therapy. The entire pressure ulcer reduction strategy was positively evaluated and proved to be sustainable. PMID:23587976

Harrison, Tarnia; Kindred, Jane; Marks-Maran, Di


Chronic leg ulceration with livedoid vasculitis, and response to oral ketanserin.  


We report a patient with a 6-year history of recalcitrant painful ulceration of both lower legs, diagnosed as being due to livedoid vasculitis. The lesions healed rapidly and remained healed on treatment with oral ketanserin. PMID:2638912

Rustin, M H; Bunker, C B; Dowd, P M



Management of non healing leg ulcers in Unani system of medicine.  


Non healing leg ulcers are becoming a major public health problem. The high prevalence of leg ulcer directly affects patients' quality of life because it produces psychological (anxiety, depression), social and physical (amputation) handicap. Most leg ulcers become unsightly and they hardly if ever, yield to conventional treatment. Healing of an amputated part may pose a problem, hence amputation cannot be recommended without extensive pre-operative investigations. Prevalence is high among the poor, for whom expenses of surgery are not affordable. Few surgeons try skin graft but unfavourable local condition of the ulcer leads to rejection and all efforts prove futile. Keeping all these factors in mind, we have tested a Unani formulation for its ulcer healing properties; early results were surprising and in some cases unbelievable. PMID:23116214

Zulkifle, Mohd; Ansari, Abdul H; Shakir, Mohd; Kamal, Zahid; Alam, Md Tanwir



Clinician's perspectives on the treatment of venous leg ulceration.  


Treatment of venous leg ulcers (VLU) represents a considerable challenge to the health care professional and to the patient alike. Much of the current literature regarding VLU focuses on either wound pathophysiology and treatment of chronic venous insufficiency or the patients' experience of the condition. We present two studies that examine more closely the clinicians' experience of treating VLU and reflect upon how that understanding may further enhance better outcomes for patients in the future. The first of these studies is a qualitative investigation of 49 clinicians treating VLU in the UK and USA. The second is a quantitative, online survey of 304 clinicians' beliefs, attitudes and practices in the UK, Germany and USA. Findings show that the clinicians' experience of treating VLU is often accompanied by frustration and dissatisfaction with treatment challenges and uncertain outcomes. Practices and treatment choices were found to vary widely and differ by countries. We conclude that a key aspect in improving VLU treatment is in listening to the frustrations of the clinician when considering new approaches to therapy. PMID:19912394

Cullen, George H; Phillips, Tania J



Chronic leg ulcers: an underestimated problem in primary health care among elderly patients  

Microsoft Academic Search

STUDY OBJECTIVE--The aim was to establish leg ulcer point prevalence, basal patient characteristics, and level of caretaking. DESIGN--The study was a postal cross sectional survey. The validity was ensured by examining a randomly selected sample of reported patients. Responding health care officials were asked to report all patients with an open wound below knee (including foot ulcer) which did not

O Nelzén; D Bergqvist; A Lindhagen; T Hallböök



Health-related quality of life and chronic venous leg ulceration: Part 2.  


Leg ulceration is a debilitating condition which compromises the quality of life of the sufferer, owing to factors such as pain, exudate, odour and social isolation. As nurses, much of the daily care provided for such patients focuses on the provision of wound care; often failing to fully address the wide ranging effects that the ulceration is having on the life of the sufferer. This article reviews the quantitative studies that have explored the health-related quality of life of patients with chronic venous leg ulceration and presents a synthesis of their findings. PMID:20220639

Green, Julie; Jester, Rebecca



[Primary antiphospholipid syndrome: newly developed leg ulcer and history of stroke].  


Antiphospholipid syndrome features not only deep vessel thrombosis but also may have cutaneous manifestations such as Raynaud phenomenon, acral necrosis, livedo reticularis, subcutaneous nodules, and leg ulcers. A 72-year-old man presented with a rapidly progressing leg ulcer. He was already on anticoagulation with warfarin due to atrial fibrillation and disclosed a history of stroke with temporary paresis of the left leg. Histopathology of a biopsy of the edge of the ulcer revealed occlusive arteriosclerosis of medium-sized arteries. Serology showed autoantibodies against cardiolipin, ?2- glycoprotein I, and phosphatidylserine which led to the diagnosis of antiphospholipid syndrome. Therapy with low molecular weight heparin, dexamethasone, and azathioprine in combination with stage-adjusted wound care led to complete healing of the ulcer within 5 months. PMID:23744031

Van Beek, N; Schumacher, N; Haase, O; Zillikens, D; Kahle, B; Schmidt, E



Eutectic mixture of local anaesthetics (EMLA) 5% cream as a primary dressing on a painful lower leg ulcer.  


Patients living with chronic leg ulceration may frequently experience moderate to severe wound-related pain, which may not be alleviated by oral analgesics alone. Poorly controlled leg ulcer pain can prevent timely and effective wound management strategies being implemented, and increase wound healing times. Furthermore, patients with poorly controlled leg ulcer pain can experience continuous pain, which significantly affects quality of life. This case report introduces an innovative way of using the eutectic mixture of local anaesthetics (EMLA) 5% cream to reduce wound-related pain, reduce oral analgesic intake, and improve health-related quality of life for a patient with a painful, chronic lower leg ulcer. PMID:22886329

Purcell, A; Marshall, A; King, J; Buckley, T



Tuberculosis: an unusual cause of genital ulcer.  


Tuberculosis can cause genital ulcers, although this clinical manifestation was more frequent at the beginning of the 20th century as it was related to the rite of circumcision. We report the case of a patient with this disease, presumably acquired through sexual intercourse. PMID:22801347

Toledo-Pastrana, Tomás; Ferrándiz, Lara; Pichardo, Antonio Rodríguez; Muniaín Ezcurra, Miguel Angel; Camacho Martínez, Francisco M



[Comparative analysis of horizontal venous reflux surgical correction by large trophic lower leg ulcers].  


Subfascial perforant veins dissection (SPVD) of the lower leg was performed in patients with chronic venous insufficiency CEAP class 5 and 6. 252 operations were performed in 236 patients. All patients had trophic lesions (skin hyperpigmentation and lipodermatosclerosis) 218 (92,4%) patients had trophic lower leg ulcer to the time of operation. 30 patients had earlier performed phlebectomy. Open SPVD was performed in 122 cases, endoscopic technique was used in 114 patients. Comparative analysis of these two methods was performed. Long-term results were accessed with the use of SF-36 questionnaire. Efficacy, pathogenetic validity and economic expedience of SPVD by large trophic lower leg ulcers are confirmed by the decrease of postoperative complications and recurrence rate. The horizontal venous reflux elimination and trophic ulcer dissection with intraoperative skin plasty allow a significant improvement of treatment results. PMID:20032933

Askerov, N G; Zhukov, A O; Malinina, V N



Venous leg ulcers: a prognostic index to predict time to healing.  

PubMed Central

OBJECTIVE--To evaluate the prognostic factors in uncomplicated venous leg ulcer healing. DESIGN--Randomised parallel group controlled trial with subjects stratified by initial ulcer diameter and four months' maximum duration of follow up. SETTING--Assessment at Northwick Park Hospital vascular unit with community based treatment. PATIENTS--200 patients with clinical and objective evidence of uncomplicated venous leg ulceration and an initial ulcer diameter > 2 cm. MAIN OUTCOME MEASURE--Time to complete healing of the ulcer. RESULTS--In the presence of graduated compression healing occurred more rapidly in patients with a smaller initial ulcer area (relative risk of healing 1.92 associated with halving of ulcer area (95% confidence interval 1.58 to 2.33)), shorter duration of ulceration (relative risk 1.35 associated with halving duration (1.17 to 1.56)), younger age (relative risk 1.34 associated with 10 year decrease (1.12 to 1.59)), and no deep vein involvement (relative risk 1.8 (1.19 to 2.78)). CONCLUSION--These prognostic factors used in a simple scoring system predict time to healing.

Skene, A. I.; Smith, J. M.; Dore, C. J.; Charlett, A.; Lewis, J. D.



Management of leg ulcers in patients with rheumatoid arthritis or systemic sclerosis: The importance of concomitant arterial and venous disease  

Microsoft Academic Search

Purpose: We assessed the etiology and the prevalence of peripheral arterial and venous disease in leg ulcers in patients with rheumatoid arthritis and systemic sclerosis and analyzed the outcome after treatment of macrovascular disease. Methods: A clinical study on 15 consecutive patients with chronic leg ulcers in collagen vascular disease (nine patients with rheumatoid arthritis, six patients with systemic sclerosis)

Jürg Hafner; Ernst Schneider; Günter Burg; Paolo C. Cassina



Phase I Study of H5.020CMV.PDGF-? to Treat Venous Leg Ulcer Disease  

PubMed Central

Venous leg ulcers are a prevalent nonhealing wound of the lower extremity. Although topically applied growth factors successfully improve wound repair in animal studies, similar studies on humans with venous leg ulcers have not been successful. This study was designed to evaluate the acute safety and biologic feasibility of peri-ulcer injection of a replication-incompetent adenoviral construct expressing platelet-derived growth factor-? (PDGF-?). In this phase I study, we demonstrate the initial safety, feasibility, and biologic plausibility of using H5.020CMV.PDGF-? to treat venous leg ulcer disease.

Margolis, David J; Morris, Lee M; Papadopoulos, Maryte; Weinberg, Linda; Filip, Jennifer C; Lang, Stephanie A; Vaikunth, Sachin S; Crombleholme, Timothy M



Eosinophilic fasciitis in association with chronic vasculitic-like leg ulcerations.  


Vasculitic lesions are not generally associated with eosinophilic fasciitis. Eosinophilic fasciitis is reported to be a syndrome distinct from progressive systemic sclerosis (PSS). More recent studies, however, note overlapping features in the clinical, pathologic, and laboratory findings of eosinophilic fasciitis and scleroderma. We report a typical presentation of eosinophilic fasciitis that developed vasculitic-like leg ulcerations as seen in scleroderma. PMID:8467618

Wong, A L; Anderson-Wilms, N; Mortensen, S E; Colburn, K K



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

PubMed Central

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.

Nafil, Hatim; Tazi, Illias; Mahmal, Lahoucine



Wound Fluid from Chronic Leg Ulcers Contains Elevated Levels of Metalloproteinases MMP-2 and MMP-9  

Microsoft Academic Search

The purpose of the present research was to determine if metalloproteinase levels were elevated in human chronic wound fluid. Samples of blood and wound fluid from acute (mastectomy) and chronic (leg ulcer) wounds were collected, and metalloproteinase profiles of the samples were determined by gelatin zymography. Compared to serum, acute wound fluid (mastectomy fluid) contained markedly increased levels (five- to

Annette B. Wysocki; Lisa Staiano-Coico; Frederick Grinnell



Chronic ulceration of the leg: extent of the problem and provision of care  

Microsoft Academic Search

A postal survey in two health board areas in Scotland, encompassing a population of about one million, identified 1477 patients with chronic ulcers of the leg. Women outnumbered men by a ratio of 2.8:1. The median age of the women was 74 and of the men 67. Seventy two (5%) were hospital inpatients, 174 (12%) were managed jointly by the

M J Callam; C V Ruckley; D R Harper; J J Dale



Therapeutic effectiveness of a Mimosa tenuiflora cortex extract in venous leg ulceration treatment  

Microsoft Academic Search

The cortex of Mimosa tenuiflora is a popular remedy utilized in Mexico for the treatment of skin lesions. Modern studies support the existence in this cortex of compounds with cicatrizing properties. In the present study the therapeutic effectiveness of an extract elaborated with this bark in the treatment of venous leg ulceration disease was explored. A randomized, double-blind, placebo-controlled clinical

Erika Rivera-Arce; Marco Antonio Chávez-Soto; Armando Herrera-Arellano; Silvia Arzate; Juan Agüero; Iris Angélica Feria-Romero; Angélica Cruz-Guzmán; Xavier Lozoya



Travel-related chronic hemorrhagic leg ulcer infection by Shewanella algae.  


Shewanella algae is an emerging seawater-associated bacterium. In immunocompromised patients, infections may result in bacteremia, osteomyelitis, and necrotizing fasciitis. Our patient, suffering from autoimmune vasculitis and myasthenia gravis, developed typical hemorrhagic bullae and leg ulcers because of S algae. She was treated efficiently with a combination of ciprofloxacin and piperacillin. PMID:23809079

Wagner, Nicola; Otto, Lisa; Podda, Maurizio; Schmitt, York; Tappe, Dennis



Skin Iron Deposition Characterises Lipodermatosclerosis and Leg Ulcer  

Microsoft Academic Search

BackgroundIt is commonly reported that chronic venous disease (CVD) increases the skin iron content in which the excess is stored as haemosiderin. Despite increasing interest in the role of haemosiderin in venous ulceration, no study has systematically evaluated the occurrence of iron overload in the limbs of patients with CVD.

A. Caggiati; C. Rosi; A. Casini; M. Cirenza; V. Petrozza; M. C. Acconcia; P. Zamboni



Health service pathways for patients with chronic leg ulcers: identifying effective pathways for facilitation of evidence based wound care  

PubMed Central

Background Chronic leg ulcers cause long term ill-health for older adults and the condition places a significant burden on health service resources. Although evidence on effective management of the condition is available, a significant evidence-practice gap is known to exist, with many suggested reasons e.g. multiple care providers, costs of care and treatments. This study aimed to identify effective health service pathways of care which facilitated evidence-based management of chronic leg ulcers. Methods A sample of 70 patients presenting with a lower limb leg or foot ulcer at specialist wound clinics in Queensland, Australia were recruited for an observational study and survey. Retrospective data were collected on demographics, health, medical history, treatments, costs and health service pathways in the previous 12 months. Prospective data were collected on health service pathways, pain, functional ability, quality of life, treatments, wound healing and recurrence outcomes for 24 weeks from admission. Results Retrospective data indicated that evidence based guidelines were poorly implemented prior to admission to the study, e.g. only 31% of participants with a lower limb ulcer had an ABPI or duplex assessment in the previous 12 months. On average, participants accessed care 2–3 times/week for 17 weeks from multiple health service providers in the twelve months before admission to the study clinics. Following admission to specialist wound clinics, participants accessed care on average once per week for 12 weeks from a smaller range of providers. The median ulcer duration on admission to the study was 22 weeks (range 2–728 weeks). Following admission to wound clinics, implementation of key indicators of evidence based care increased (p?leg or foot ulcers. Results demonstrate that access to wound management expertise can promote streamlined health services and evidence based wound care, leading to efficient use of health resources and improved health.



Diffuse large B-cell lymphoma presenting as a chronic leg ulcer: the importance of repeat tissue biopsy.  


Ulceration of the leg is often associated with significant consequences for both the individual and society. The diagnosis of chronic leg ulcer is not appropriate. Primary cutaneous diffuse large B-cell lymphoma (PCLBCL), leg type, is a distinct clinicopathological entity. Chemotherapy in the form of R-CHOP (rituximab, cyclophosphamide, hydroxydaunorubicin, Oncovin and prednisolone) is considered to be the first line of treatment for these lymphomas. We report a 69-year-old man who presented with chronic leg ulcer with a first negative biopsy and a diagnosis of PCLBCL, leg type, verified on the subsequent biopsy. This case report emphasises the importance of differential diagnosis of lymphoma in non-healing ulcers and also the value of repeat tissue biopsy in cases with a negative initial result but strong clinical suspicion. PMID:21944785

Khan, Junaid Alam; Usman, Farooq; Abbasi, Shaista; Shoab, Syed Sulaiman



Grafting of Venous Leg Ulcers: An Ultra-Individual Comparison between Cultured Skin Equivalents and Full Thickness Skin Punches.  

National Technical Information Service (NTIS)

Skin equivalents, consisting of a non-contracted collagen gel populated with allogeneic fibroblasts and covered with autologous cultured keratinocytes were used for grafting of venous leg ulcers. The results were compared in the same patient with those ob...

M. A. E. Mol B. P. Nanninga J. P. van Eendenburg W. Westerhof C. J. W. van Ginkel



Topical PDGF-BB results in limited healing in a patient with Werner's syndrome and chronic leg ulcers.  


Impaired wound healing is a feature of Werner's syndrome. Treatment of one such patient with painful chronic leg ulcers included topical application of PDGF-BB. Granulation increased slightly, enabling full-thickness skin grafting to take place. PMID:15575568

Wollina, U; Gruner, M; Koch, A; Köstler, E; Hubl, W; Hanson, N B; Oshima, J



The Use of Biatain Ag in Hard-to-Heal Venous Leg Ulcers: Meta-Analysis of Randomised Controlled Trials  

PubMed Central

Background 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 controlled trials (RCTs). Aim To evaluate ulcer healing through a meta-analytic approach after treatment with either Biatain Ag or a non-active dressing. Patients and Methods 685 subjects with pure or mixed hard-to-heal venous leg ulcers were included in the meta-analysis. Results Biatain Ag showed a significant treatment effect (p<0.0001), responder rate (p<0.001), and healing rate (p?=?0.002). Conclusion The meta-analysis of the 4 RCTs provided statistical significant evidence to support the use of Biatain Ag dressing in treatment of hard-to-heal venous leg ulcers.

Leaper, David; Munter, Christian; Meaume, Sylvie; Scalise, Alessandro; Mompo, Nacho Blanes; Jakobsen, Birte Petersen; Gottrup, Finn



Issues affecting concordance with leg ulcer care and quality of life.  


This article examines the issues that influence patients' concordance with leg ulcer treatment regimens and the effect this may have on quality of life. Nurses need to have a good understanding of the physical and psychosocial factors that affect patients' concordance with treatment and how any issues can be resolved to enable successful patient-professional partnership, effective care planning and delivery, and better patient outcomes. PMID:20701054

Williams, Anne Margaret


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

PubMed Central

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.

Bonilla-Abadia, Fabio; Echeverri, Andres F.; Izquierdo, Jorge H.; Canas, Felipe; Canas, Carlos A.



Efficacy of subfascial endoscopy in eradicating perforating veins of the lower leg and its relation with venous ulcer healing  

Microsoft Academic Search

Purpose: The purpose of this study was to investigate the efficacy of subfascial endoscopy by use of a mediastinoscope in the identification and ligation of incompetent perforating veins in patients with venous ulceration of the lower leg.Methods: All patients who underwent subfascial endoscopy for venous ulceration between Jan. 1, 1994, and Mar. 1, 1995, at the Sint Franciscus Gasthuis in

E. G. J. M. Pierik; H. van Urk; C. H. A. Wittens



Cutaneous large B-cell lymphoma of the leg masquerading as a chronic venous ulcer.  


We report on a 74-year-old female patient with a primary cutaneous CD20+, diffuse large cell B-cell lymphoma of the lower leg resembling a chronic non-healing leg ulcer. There was no evidence of systemic involvement on computed tomography (CT) scans of the chest, abdomen and pelvis; a slightly enlarged lymph node in the right groin showed dermatopathic lymphadenopathy on histology and immunohistochemistry. Involvement of the bone marrow and peripheral blood was ruled out by punch biopsy and fluorescent activated cell sorter (FACS) analysis of the blood, respectively. Therapeutic anti-CD20 monoclonal antibody rituximab was given at 375 mg m(-2) i.v. once weekly for 7 weeks, without adverse effects, resulting in a minor improvement in the centre of the ulcerated tumour. Unfortunately, the response was not maintained, and after 7 weeks of treatment the patient started to develop new tumour lesions at the border of the ulcer. Local radiotherapy was started and combined photon and electron beam irradiation induced complete remission of the B-cell lymphoma. PMID:11841383

Garbea, A; Dippel, E; Hildenbrand, R; Bleyl, U; Schadendorf, D; Goerdt, S



Prognostic implications of leg ulcers from hydroxycarbamide therapy in patients with essential thrombocythaemia.  


Essential thrombocythemia (ET) is a clonal stem-cell disorder characterized by persistent thrombocytosis. Patients with ET and risk factors for thrombotic complications have been shown to benefit from cytoreductive therapy, the most common agent used being, hydroxycarbamide. Although this agent is usually well-tolerated, one of the recognized adverse effects is the development of leg ulcers. We undertook retrospective analysis of consecutive ET patients treated with hydroxcarbamide and identified several specific features for this complication including advanced age, female preponderance, reduced overall survival, tendency to develop future vascular events and intolerance to the second line agent, anagrelide. PMID:22196956

Francis, Sebastian; Bareford, David; Baggott, Christina; Baginott, Christina; Thachil, Jecko




PubMed Central

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, Gie?en, Germany) for calculation of blood flow velocity, hemoglobin oxygen saturation (SCO2) 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 SO2 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 hemoglobin. Conclusions: The major findings are that continuous-wave low-frequency US of 34 kHz, but not, 53.5 kHz or 75 kHz, has a temporary stimulatory effect on microcirculation mainly due to an improved oxygenation. Further studies with treatment series are necessary.

Wollina, Uwe; Heinig, Birgit; Naumann, Gunther; Scheibe, Armin; Schmidt, Wolf-Dieter; Neugebauer, Reimund



Fatigue bone injuries causing anterior lower leg pain.  


Shin splints, or stress-related anterior lower leg pain, seem to arise from numerous causes, including stress fractures. We retrospectively reviewed 154 consecutive military patients who had magnetic resonance imaging during a 5-year period for stress-related anterior lower leg pain. Using magnetic resonance imaging, 143 bone stress injuries were diagnosed in 86 of the 154 (56%) patients. The incidence of bone stress injury requiring orthopaedic consultation and magnetic resonance imaging among recruits during the 5 years was 117 per 100,000 person years in military service. The bone stress injury was located in the tibia in 141 (99%) patients. Of these injuries, 80 (57%) were located in the distal (1/3) of the tibial shaft, 42 (30%) in the middle (1/3), 14 (10%) in the proximal (1/3), and five (3%) in the medial condyle. The locations of tibial stress injuries related to the magnetic resonance imaging grades. Almost all lower leg fatigue bone stress injuries were located in the tibia, and the distal lateral shaft was affected most often. When used early after onset of symptoms, magnetic resonance imaging provides accurate diagnosis to ensure appropriate treatment, especially when dealing with exercise-induced lower leg pain in physically active patients. Level of Evidence: Diagnostic study, Level II (development of diagnostic criteria on consecutive patients [with universally applied reference "gold" standard]). See the Guidelines for Authors for a complete description of levels of evidence. PMID:16523142

Ruohola, Juha-Petri S; Kiuru, Martti J; Pihlajamäki, Harri K



Nurse clinic versus home delivery of evidence-based community leg ulcer care: A randomized health services trial  

Microsoft Academic Search

BACKGROUND: International studies report that nurse clinics improve healing rates for the leg ulcer population. However, these studies did not necessarily deliver similar standards of care based on evidence in the treatment venues (home and clinic). A rigorous evaluation of home versus clinic care is required to determine healing rates with equivalent care and establish the acceptability of clinic-delivered care.

Margaret B Harrison; Ian D Graham; Karen Lorimer; Elizabeth VandenKerkhof; Maureen Buchanan; Phil S Wells; Tim Brandys; Tadeusz Pierscianowski



Chronic leg ulceration associated with polycythemia vera responding to ruxolitinib (jakafi(®)).  


We present the case of a 63-year-old white male with bilateral chronic leg ulcers due to polycythemia vera and hydroxyurea therapy who demonstrated dramatic healing of his wounds in response to ruxolitinib (Jakafi(®), Novartis), a novel Janus kinase-1 and -2 inhibitor. This patient's wound had previously been refractory to multiple surgical interventions and immunosuppression. After the initiation of ruxolitinib, the patient underwent successful split-thickness skin grafting, with resultant healing of his wounds. He was stable without prednisone and other immunosuppressant therapy and had healed at 6 months. Ruxolitinib therapy could represent a novel option for patients who develop persistent inflammatory wounds in the setting of polycythemia vera and hydroxyurea therapy. PMID:23953278

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



Proteolytic activity by multiple bacterial species isolated from chronic venous leg ulcers degrades matrix substrates.  


Background:A major feature of chronic wounds is the loss of tissue, with the exposure of dermal components preventing primary closure and leading to bacterial colonization. Bacterial colonization has been proposed as one of the common underlying pathologies present in chronic wounds. The objective of this exploratory study was to identify bacteria cultured from chronic venous leg ulcers and test for proteolytic activity that degrades matrix substrates.Method:Bacteria were isolated, cultured, and identified from six subjects (average age = 62.8 years) over 2-10 months under an approved protocol using swabs and microbiological culture media. Proteolytic activity against (a) gelatin, (b) an elastin substrate, and (c) a serine/trypsin-sensitive substrate was determined using a colorimetric plate assay with an ELISA plate reader and zymography.Results:We identified 13 bacteria that expressed proteolytic activity against one or more of the tested substrates. Of these, six were Gram-positive (Staphylococcus aureus, Enterococcus faecalis, Staphylococcus epidermidis, Streptococcus agalactiae, Corynebacterium, and Streptococcus bovis) and seven were Gram-negative (Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis, Morganella morganii, Klebsiella pneumoniae, Bacteroides fragilis, and Serratia marcescens) organisms. Two of these, S. aureus and P. aeruginosa, are recognized wound pathogens.Conclusions:Multiple bacteria species isolated from colonized venous leg ulcers have the capacity to secrete proteases capable of degrading components of the extracellular matrix important for wound healing. Matrix degradation by bacteria may contribute to delays in tissue deposition and repair, suggesting that treatment of chronic wounds should include appropriate management of colonizing bacteria. PMID:23118301

Wysocki, Annette B; Bhalla-Regev, Sandhya K; Tierno, Philip M; Stevens-Riley, Marla; Wiygul, Ryan-Claire



Other Causes of Leg Pain | NIH MedlinePlus the Magazine  


... turn Javascript on. Feature: Peripheral Artery Disease Other Causes of Leg Pain Past Issues / Fall 2011 Table of ... A.D. Other non-P.A.D. common causes of leg pain may include: A muscle cramp (also ...


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

PubMed Central

Introduction The aim of the study was to assess the influence of a supervised programme of exercises on ankle joint mobility in patients with venous leg ulcerations. Material and methods The study was carried out between 2008 and 2009 at the Venous Ulcer Treatment Outpatient Clinic and Clinic of General and Vascular Surgery of the Dr Jan Biziel University Hospital no. 2 in Bydgoszcz. It was a randomized control study in which 32 patients with venous leg ulcerations were qualified. Patients with ulcerations were randomized to 2 groups – 16 patients were included in the group with a supervised programme of exercises and the other 16 patients were included in the control group performing physical exercises by themselves, without supervision. The ranges of ankle joint mobility were assessed before, during and after the end of the 9-week exercise programme. A 32 cm goniometer with a scale from 0° to 180° with accuracy to 1° was used for measurements. Results In both groups a substantial increase of ankle joint mobility (p < 0.05) was observed. The total ankle joint mobility after completion of the exercises was significantly higher in the group performing exercises under the supervision of a nurse. Having a significant effect on the mobility of the ankle were the ulceration area, the extent of lipodermatosclerosis, and the intensity of symptoms and signs of CVI (p < 0.05). Conclusions Supervised physical exercises broaden the range of ankle joint mobility. They should constitute an integral part of a holistic model of care for patients with venous leg ulcerations.

Jawien, Arkadiusz; Cwajda-Bialasik, Justyna; Cierzniakowska, Katarzyna; Moscicka, Paulina; Hancke, Elzbieta



Treatment of recalcitrant venous leg ulcers with autologous keratinocytes in fibrin sealant: a multinational randomized controlled clinical trial.  


In a multicenter trial, the effect of a commercially available combination of autologous keratinocytes (3-6 x 10(6)/mL) with fibrin sealant (Tissucol Duo S Immuno, Baxter Hyland Immuno) on the healing of recalcitrant venous leg ulcers (duration >3 months) was compared with standard care. The primary endpoint was time to healing, and the secondary endpoint was number of healed ulcers in both groups. Both groups received compression therapy with short-stretch bandages. Forty-four (38.3%) of the 116 patients who had BioSeed-S treatment achieved complete healing of the target ulcer compared with 24 (22.4%) of 109 patients who received standard treatment. The advantage for treatment with BioSeed-S over standard treatment was statistically significant (chi-square test: p=0.0106). Time to complete healing of ulcers: the log-rank test for equality over strata revealed a superiority of treatment with BioSeed-S+compression (median: 176 days) over compression+standard care (median >201 days) (p<0.0001). This study, to date the largest multicenter study with autologous keratinocytes, provides evidence for its efficacy in the treatment of patients with therapy-resistant chronic venous leg ulcers. PMID:17537117

Vanscheidt, W; Ukat, A; Horak, V; Brüning, H; Hunyadi, J; Pavlicek, R; Emter, M; Hartmann, A; Bende, J; Zwingers, Th; Ermuth, T; Eberhardt, R


Mouth ulcers  


Oral ulcer; Stomatitis - ulcerative; Ulcer - mouth ... Mouth ulcers are caused by many disorders. These include: Canker sores Gingivostomatitis Herpes simplex ( fever blister ) Leukoplakia Oral cancer ...


Non-healing leg ulcers in a patient with dystrophic calcification and crest syndrome: a challenging clinical case.  


The management of non-healing leg ulcers in patients with CREST syndrome and subdermal calcification is rarely reported in medical literature. Only one similar case was found in the literature (1). Dealing with such patients can be a challenge for wound specialists. In this article, we discuss the clinical progress of an interesting case of extensive non-healing leg ulcers in a CREST patient with dystrophic calcification. The combination of systemic physiological deficits and immune compromise, along with the local physical abnormalities associated with the wound pose a complex multifactorial aetiological mix. There is no conclusive data on the optimal management of these wounds in CREST patients. It seems that ablation of the calcific deposits may offer some hope. PMID:21827631

Al-Najjar, Mahmoud; Jackson, Mark J



Developing a nurse-led education program to enhance self-care agency in leg ulcer patients.  


Patients with leg ulceration face changing self-care demands associated with the consequences of the disease and treatment. Often patients can manage their self-care for some time, but new therapeutic self-care demands may emerge that require more complex self-care actions. The purpose of this article is to describe the development of a nurse-led education program in North-Rhine Westphalia, Germany, that aims to help patients with leg ulcers to meet their therapeutic self-care demands. Orem's self-care deficit nursing theory is used as a framework to provide the conceptual context for this supportive-educative nursing system that is being tested in a multi-site clinical trial. PMID:18378825

Herber, Oliver R; Schnepp, Wilfried; Rieger, Monika A



Stasis Ulcer  


newsletter | contact Share | Stasis Ulcer Information for adults A A A This image displays a patient with chronic leg swelling with stasis dermatitis and a stasis ulcer. Overview A stasis ulcer is a breakdown of ...


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

PubMed Central

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.

Zaulyanov, Larissa; Kirsner, Robert S



Cameron's Ulcer: An Unusual Cause of Upper Gastrointestinal Bleeding  

PubMed Central

Introduction Upper gastrointestinal bleeding is common in the adult population. Peptic ulcer disease is a common cause of gastrointestinal bleeding and is usually related to Helicobacter pylori (H. pylori) infection or nonsteroidal anti-inflammatory drugs. Patients with a large hiatal hernia are at risk for a Cameron ulcer, which has a different physiology and treatment options. Case Report A 64-year-old woman presented with multiple episodes of melena followed by a syncopal episode and coffee-ground emesis. Her past medical history was notable for GERD and a hiatal hernia diagnosed on esophagogastroduodenoscopy (EGD) in 2008; she denied any NSAID use. Her GERD had been well-controlled on esomeprazole, but she stopped taking this medication two months before her presentation due to a concern over long-term side effects. On presentation, her blood hemoglobin level was 9.8 g/dL, decreased from a baseline of 14 g/dL. She underwent EGD which confirmed a large hiatal hernia and showed a 1 cm ulcer with a visible vessel located along the diaphragmatic impression, consistent with a Cameron ulcer. The ulcer was treated with epinephrine injection and bipolar cautery. Gastric biopsies were obtained, which later retuned negative for H. pylori. A proton pump inhibitor was restarted and she recovered uneventfully. Repeat upper endoscopy two months later showed complete resolution of her Cameron's ulcer. After a discussion of therapeutic options, she was referred for fundoplication and surgical repair of her hiatal hernia. Discussion Cameron ulcers are a mechanical phenomenon, related to extrinsic compression of the diaphragm on the stomach in patients with large hiatal hernias. These lesions should be suspected during upper endoscopy in patients with large hiatal hernias as Cameron ulcers may be overlooked due to their location along the diaphragmatic impression. Although our patient's ulcer resolved after she was restarted on a proton pump inhibitor, surgical repair of the hiatal hernia (often performed in combination with a fundoplication) is a consideration in patients who fail to respond to standard therapy.

Stratton, Amy; Laczek, Jeffrey



Autologous cultured keratinocytes on porcine gelatin microbeads effectively heal chronic venous leg ulcers.  


We have established a specific bioreactor microcarrier cell culture system using porcine gelatin microbeads as carriers to produce autologous keratinocytes on a large scale. Moreover, we have shown that autologous keratinocytes can be cultured on porcine collagen pads, thereby forming a single cell layer. The objective of this study was to compare efficacy and safety of autologous cultured keratinocytes on microbeads and collagen pads in the treatment of chronic wounds. Fifteen patients with recalcitrant venous leg ulcers were assigned to three groups in a single-center, prospective, uncontrolled study: five underwent a single treatment with keratinocyte monolayers on collagen pads (group 1); another five received a single grafting with keratinocyte-microbeads (group 2); and the last five received multiple, consecutive applications of keratinocyte-microbeads 3 days apart (group 3). All patients were followed for up to 12 weeks. By 12 weeks, there was a mean reduction in the initial wound area of 50, 83, and 97 percent in the three groups, respectively. The changes in wound size were statistically significant between the first and third groups (p= 0.0003). Keratinocyte-microbeads proved to be more effective than keratinocyte monolayers on collagen pads when the former were applied every 3 days. Rapid availability within 10-13 days after skin biopsy and easy handling represent particular advantages. PMID:15086765

Liu, Jin Yu; Hafner, Jürg; Dragieva, Galya; Seifert, Burkhardt; Burg, Günter


Neutrophil activity in chronic venous leg ulcers--A target for therapy?  

PubMed Central

Chronic venous leg ulcers (CVLUs) affect approximately 600,000 people annually in the United States and accrue yearly treatment costs of US$2.5–5 billion. As the population ages, demands on health care resources for CVLU treatments are predicted to drastically increase because the incidence of CVLUs is highest in those ?65 years of age. Furthermore, regardless of current standards of care, healing complications and high recurrence rates prevail. Thus, it is critical that factors leading to or exacerbating CVLUs be discerned and more effective, adjuvant, evidence-based treatment strategies be utilized. Previous studies have suggested that CVLUs’ pathogenesis is related to the prolonged presence of high numbers of activated neutrophils secreting proteases in the wound bed that destroy growth factors, receptors, and the extracellular matrix that are essential for healing. These events are believed to contribute to a chronically inflamed wound that fails to heal. Therefore, the purpose of this project was to review studies from the past 15 years (1996–2011) that characterized neutrophil activity in the microenvironment of human CVLUs for new evidence that could explicate the proposed relationship between excessive, sustained neutrophil activity and CVLUs. We also appraised the strength of evidence for current and potential therapeutics that target excessive neutrophil activity.

McDaniel, Jodi C.; Roy, Sashwati; Wilgus, Traci A.



EMLA cream as a topical anesthetic for the repeated mechanical debridement of venous leg ulcers: A double-blind, placebo-controlled study  

Microsoft Academic Search

Background: A granulating surface is important for skin grafting and healing of leg ulcers. Mechanical debridement to remove necrotic tissue often must be stopped before completion because of pain. Objective: Our purpose was to assess the effect of EMLA cream on the number of debridements required to obtain a clean ulcer and on pain during debridement and to determine its

Catherine Lok; Carle Paul; Pierre Amblard; Didier Bessis; Clélia Debure; Brigitte Faivre; Bernard Guillot; Jean Paul Ortonne; Gunilla Huledal; Bernard Kalis



Effect of sharp debridement using curette on recalcitrant nonhealing venous leg ulcers: a concurrently controlled, prospective cohort study.  


The objective of this study was to evaluate the effect of sharp debridement on the progression of recalcitrant chronic venous leg ulcers (CVLU) and to assess the feasibility of performing this procedure in an outpatient setting. We performed a prospective study of 55 CVLU (53 patients) over a 12-month period. The study group, which underwent debridement, contained 28 CVLU whose wound beds had slough, nonviable tissue, and no granulation tissue. The control group was 27 CVLU with minimal (15-20%) granulation tissue, but no slough or nonviable tissue. Treatments were otherwise similar. Age, body mass index, mean ulcer surface area (MSA) and mean ulcer duration were comparable in both groups. Ulcer measurements were taken at 4 weeks before debridement, at the time of debridement, and 4 and 20 weeks post-debridement. There was no change in the MSA from 4 weeks before to the time of debridement in either group. At 4 weeks post-debridement, the study ulcers showed a 6 cm(2) reduction in the MSA vs. a 1 cm(2) reduction in controls (P = 0.02). By week 20 post-debridement, the study ulcers achieved a 7.4 cm(2) reduction in the MSA vs. an increase of 1.3 cm(2) in controls (P = 0.008). Between weeks 8 and 20 post-debridement, 16% of study ulcers vs. 4.3% of control ulcers achieved complete healing. Infection rates and antimicrobial usage were similar. We conclude that sharp debridement is effective in stimulating healing of recalcitrant CVLU. It is safe, well tolerated, and can be performed in an outpatient setting. PMID:15828937

Williams, Dean; Enoch, Stuart; Miller, David; Harris, Karen; Price, Patricia; Harding, Keith G


Nurse clinic versus home delivery of evidence-based community leg ulcer care: A randomized health services trial  

PubMed Central

Background International studies report that nurse clinics improve healing rates for the leg ulcer population. However, these studies did not necessarily deliver similar standards of care based on evidence in the treatment venues (home and clinic). A rigorous evaluation of home versus clinic care is required to determine healing rates with equivalent care and establish the acceptability of clinic-delivered care. Methods Health Services RCT was conducted where mobile individuals were allocated to either home or nurse clinic for leg ulcer management. In both arms, care was delivered by specially trained nurses, following an evidence protocol. Primary outcome: 3-month healing rates. Secondary outcomes: durability of healing (recurrence), time free of ulcers, HRQL, satisfaction, resource use. Data were collected at base-line, every 3 months until healing occurred, with 1 year follow-up. Analysis was by intention to treat. Results 126 participants, 65 randomized to receive care in their homes, 61 to nurse-run clinics. No differences found between groups at baseline on socio-demographic, HRQL or clinical characteristics. mean age 69 years, 68% females, 84% English-speaking, half with previous episode of ulceration, 60% ulcers at inclusion < 5 cm2 for < 6 months. No differences in 3-month healing rates: clinic 58.3% compared to home care at 56.7% (p = 0.5) or in secondary outcomes. Conclusion Our findings indicate that organization of care not the setting where care is delivered influences healing rates. Key factors are a system that supports delivery of evidence-based recommendations with care being provided by a trained nursing team resulting in equivalent healing rates, HRQL whether care is delivered in the home or in a community nurse-led clinic. Trial registration Protocol Registration System: NCT00656383

Harrison, Margaret B; Graham, Ian D; Lorimer, Karen; VandenKerkhof, Elizabeth; Buchanan, Maureen; Wells, Phil S; Brandys, Tim; Pierscianowski, Tadeusz



Use of weekly, low dose, high frequency ultrasound for hard to heal venous leg ulcers: the VenUS III randomised controlled trial  

PubMed Central

Objective To assess the clinical effectiveness of weekly delivery of low dose, high frequency therapeutic ultrasound in conjunction with standard care for hard to heal venous leg ulcers. Design Multicentre, pragmatic, two arm randomised controlled trial. Setting Community and district nurse led services, community leg ulcer clinics, and hospital outpatient leg ulcer clinics in 12 urban and rural settings (11 in the United Kingdom and one in the Republic of Ireland). Participants 337 patients with at least one venous leg ulcer of >6 months’ duration or >5 cm2 area and an ankle brachial pressure index of ?0.8. Interventions Weekly administration of low dose, high frequency ultrasound therapy (0.5 W/cm2, 1 MHz, pulsed pattern of 1:4) for up to 12 weeks plus standard care compared with standard care alone. Main outcome measures Primary outcome was time to healing of the largest eligible leg ulcer. Secondary outcomes were proportion of patients healed by 12 months, percentage and absolute change in ulcer size, proportion of time participants were ulcer-free, health related quality of life, and adverse events. Results The two groups showed no significant difference in the time to healing of the reference leg ulcer (log rank test, P=0.61). After adjustment for baseline ulcer area, baseline ulcer duration, use of compression bandaging, and study centre, there was still no evidence of a difference in time to healing (hazard ratio 0.99 (95% confidence interval 0.70 to 1.40), P=0.97). The median time to healing of the reference leg ulcer was inestimable. There was no significant difference between groups in the proportion of participants with all ulcers healed by 12 months (72/168 in ultrasound group v 78/169 in standard care group, P=0.39 for Fisher’s exact test) nor in the change in ulcer size at four weeks by treatment group (model estimate 0.05 (95% CI –0.09 to 0.19)). There was no difference in time to complete healing of all ulcers (log rank test, P=0.61), with median time to healing of 328 days (95% CI 235 to inestimable) with standard care and 365 days (224 days to inestimable) with ultrasound. There was no evidence of a difference in rates of recurrence of healed ulcers (17/31 with ultrasound v 14/31 with standard care, P=0.68 for Fisher’s exact test). There was no difference between the two groups in health related quality of life, both for the physical component score (model estimate 0.69 (–1.79 to 3.08)) and the mental component score (model estimate –0.93 (–3.30 to 1.44)), but there were significantly more adverse events in the ultrasound group (model estimate 0.30 (0.01 to 0.60)). There was a significant relation between time to ulcer healing and baseline ulcer area (hazard ratio 0.64 (0.55 to 0.75)) and baseline ulcer duration (hazard ratio 0.59 (0.50 to 0.71)), with larger and older ulcers taking longer to heal. In addition, those centres with high recruitment rates had the highest healing rates. Conclusions Low dose, high frequency ultrasound administered weekly for 12 weeks during dressing changes in addition to standard care did not increase ulcer healing rates, affect quality of life, or reduce ulcer recurrence. Trial registration ISRCTN21175670 and National Research Register N0484162339



Ugh! Ulcers  


... real story? Let's find out. What Is an Ulcer? An ulcer (say: ul -sur) is a sore, ... people will eventually get an ulcer. What Causes Ulcers? For almost 100 years, doctors believed that ulcers ...


Motor Strokes Sparing the Leg: Different Lesions and Causes  

Microsoft Academic Search

rebral artery territory, with 276 (30.8%) in the anterior (superior) and 138 (15.4%) in the posterior (inferior) middle cerebral artery. More than half of the infarcts had a presumed embolic source from large-artery disease or from the heart. In comparison with patients with pare- sis involving the leg, patients without leg involvement had a lower prevalence of small-artery disease (P,.001),

Gabriel R. de Freitas; Gerald Devuyst; Guy van Melle; Julien Bogousslavsky



An object-oriented Bayesian network modeling the causes of leg disorders in finisher herds  

Microsoft Academic Search

The implementation of an effective control strategy against disease in a finisher herd requires knowledge regarding the disease level in the herd. A Bayesian network was constructed that can estimate risk indexes for three cause-categories of leg disorders in a finisher herd. The cause-categories of leg disorders were divided into infectious causes (arthritis caused by infectious pathogens), physical causes (e.g.

Tina Birk Jensen; Anders Ringgaard Kristensen; Nils Toft; Niels Peter Baadsgaard; Søren Østergaard; Hans Houe



/sup 201/Tl perfusion study of ''ischemic'' ulcers of the leg: prognostic ability compared with Doppler ultrasound  

SciTech Connect

Thallium 201 perfusion analysis was compared with Doppler ultrasound as a means of determining the healing potential of an ischemic ulcer of the leg in 27 patients. The degree of hyperemia was determined by comparative point counting of the 201Tl distribution in and about the ulcer. Using established Doppler criteria and a hyperemia ratio greater than 1.5:1, ultrasound alone correctly predicted healing in 15 out of 23 cases and 201Tl in 20 out of 23. Ultrasound correctly predicted non-healing in 3 out of 6 cases, compared with 5 out of 6 for 201Tl. The positive predictive value of the 201Tl study was 63%, versus 27% for ultrasound, and the negative predictive value was 95% for 201Tl and 83% for ultrasound. The accuracy of 201Tl and ultrasound was 86% and 62%, respectively. This limited study suggests that 201Tl perfusion scanning is a useful noninvasive test of ulcer healing potential and may be more sensitive than Doppler ultrasound.

Siegel, M.E.; Stewart, C.A.; Kwong, P.; Sakimura, I.



Strategies and approaches towards evidence-based practice in the management of chronic leg ulcers by nurses working in the community in Kronoberg County, Sweden and the East Riding & Hull, UK  

Microsoft Academic Search

Aim: This paper reports one aspect of a study concerning management of chronic leg ulcers by nurses working in the community in Kronoberg County, Sweden (KC) and the East Riding & Hull, UK (ER). Our study focus was to describe reported evidence-based practice in leg ulcer care in two samples of nurses from two countries. The paper describes the overall

Britt-Lousie Anderson



Pyoderma gangrenosum-like ulcer caused by Helicobacter cinaedi in a patient with x-linked agammaglobulinaemia.  


Cutaneous lesions of the legs have been linked to Helicobacter species in a number of patients with X-linked agammaglobulinaemia (XLA), a primary immunodeficiency. We describe a 26-year-old patient with XLA, who was referred with an extensive skin ulcer that enlarged gradually over the course of 7 years. The ulcer resembled pyoderma gangrenosum (PG), and extended from below the knee to the ankle. The man (who has sex with men) was negative for human immunodeficiency virus. Helicobacter cinaedi was identified by 16S ribosomal (r)DNA PCR analysis from a biopsy of the lesion. This fastidious organism has been implicated previously in causing unexplained skin macules in one other patient with XLA. We suggest that early consideration of infection with Helicobacter species in immunocompromised patients who present with unexplained cutaneous lesions is important, as a prolonged antibiotic course can lead to clinical improvement. PMID:22439627

Dua, J; Elliot, E; Bright, P; Grigoriadou, S; Bull, R; Millar, M; Wijesuriya, N; Longhurst, H J



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

Microsoft Academic Search

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

Astrid Langer; Wolf Rogowski



Targeting Cx43 and N-Cadherin, Which Are Abnormally Upregulated in Venous Leg Ulcers, Influences Migration, Adhesion and Activation of Rho GTPases  

PubMed Central

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

Mendoza-Naranjo, Ariadna; Cormie, Peter; Serrano, Antonio E.; Hu, Rebecca; O'Neill, Shay; Wang, Chiuhui Mary; Thrasivoulou, Christopher; Power, Kieran T.; White, Alexis; Serena, Thomas; Phillips, Anthony R. J.; Becker, David L.



Pyoderma Gangrenosum: A Rare Cause of Breast Ulceration  

PubMed Central

Breast ulceration is an alarming sign for clinicians and places a significant physical and psychological burden on the patient. We report a rare presentation of pyoderma gangrenosum of the breast in a patient known to have ulcerative colitis but no active underlying disease process and no history of breast tissue trauma. This case report with literature review highlights the importance of considering pyoderma gangrenosum as a differential diagnosis in breast ulcers.

Duke, Georgina; Samaraee, Ahmad Al; Husain, Akhtar; Meggitt, Simon; Fasih, Tarannum



Recruitment rates and reasons for community physicians' non-participation in an interdisciplinary intervention study on leg ulceration  

PubMed Central

Background This article describes the challenges a research team experienced recruiting physicians within a randomised controlled trial about leg ulcer care that seeks to foster the cooperation between the medical and nursing professions. Community-based physicians in North Rhine-Westphalia, Germany, were recruited for an interdisciplinary intervention designed to enhance leg ulcer patients' self-care agency. The aim of this article is to investigate the success of different recruitment strategies employed and reasons for physicians' non-participation. Methods The first recruitment phase stressed the recruitment of GPs, the second the recruitment of specialists. Throughout the recruitment process data were collected through phone conversations with GP practices who indicated reasons for non-participation. Results Despite great efforts to recruit physicians, the recruitment rate reached only 26 out of 1549 contacted practices (1.7%) and 12 out of 273 (4.4%) practices during the first and second recruitment phase respectively. The overall recruitment rate over the 16-month recruitment period was 2%. With a target recruitment rate of n = 300, only 45 patients were enrolled in the study, not meeting study projections. Various reasons for community physicians' non-participation are presented as stated spontaneously during phone conversations that might explain low recruitment rates. The recruitment strategy utilised is discussed against the background of factors associated with high participation rates from the international literature. Conclusion Time, money, and effort needed during the planning and recruitment phase of a study must not be underestimated to avoid higher than usual rates of refusal and lack of initial contact. Pilot studies prior to a study start-up may provide some evidence on whether the target recruitment rate is feasible. Trial registration Current Controlled Trials ISRCTN42122226.



Peptic Ulcers  


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


A home-based progressive resistance exercise programme for patients with venous leg ulcers: a feasibility study.  


This study aimed to assess the feasibility of a home-based exercise programme and examine the effects on the healing rates of venous leg ulcers. A 12-week randomised controlled trial was conducted investigating the effects of an exercise intervention compared to a usual care group. Participants in both groups (n = 13) had active venous ulceration and were treated in a metropolitan hospital outpatients clinic in Australia. Data were collected on recruitment from medical records, clinical assessment and questionnaires. Follow-up data on progress in healing and treatments were collected fortnightly for 12 weeks. Calf muscle pump function data were collected at baseline and 12 weeks from recruitment. Range of ankle motion data were collected at baseline, 6 and 12 weeks from recruitment. This pilot study indicated that the intervention was feasible. Clinical significance was observed in the intervention group with a 32% greater decrease in ulcer size (P = 0·34) than the usual care group, and a 10% (P = 0·74) improvement in the number of participants healed in the intervention group compared to the usual care group. Significant differences between groups over time were observed in calf muscle pump function parameters [ejection fraction (P = 0·05), residual volume fraction (P = 0·04)] and range of ankle motion (P = 0·01). This pilot study is one of the first to examine and measure clinical healing rates for participants involved in a home-based progressive resistance exercise programme. Further research is warranted with a larger multi-site study. PMID:22697811

O'Brien, Jane; Edwards, Helen; Stewart, Ian; Gibbs, Harry



Routine Diagnostic Venous Ultrasound and LAS for Leg Edema of Unknown Cause  

PubMed Central

Objective: To verify the diagnostic efficiency of venous duplex ultrasound and lymphangioscintigraphy (LAS) in establishing the cause of leg edema and to clarify the pathology of these leg edemas. Materials and Methods: Between April 2009, and March 2010, 62 patients with leg edema of unknown origin were referred to the Edema Clinic of the Yamaguchi University Graduate School of Medicine. All patients underwent a venous duplex ultrasound scan and LAS. Results: Of 62 patients, lymphatic insufficiency, venous insufficiency or both was diagnosed in 42 (68%), and lymphedema, in 29 (47%). Venous duplex ultrasound detected obvious venous disorders in only 13 (21%), and for 20 patients, the ultrasound and LAS did not reveal any abnormalities; however, for 15 of the 20 (24% of all patients), venous edema was attributed to functional causes. Conclusion: Venous duplex ultrasound and LAS assisted in the diagnosis of leg edema of unknown origin and also proved useful in establishing treatment strategies.



Fibroblast Dysfunction Is a Key Factor in the Non-Healing of Chronic Venous Leg Ulcers  

Microsoft Academic Search

Chronic age-related degenerative disorders, including the formation of chronic leg wounds, may occur due to aging of the stromal tissues and ensuing dysfunctional cellular responses. This study investigated the impact of environmental-driven cellular aging on wound healing by conducting a comprehensive analysis of chronic wound fibroblast (CWF) behavior in comparison with patient-matched healthy skin normal fibroblasts (NF). The dysfunctional wound

Ivan B Wall; Ryan Moseley; Duncan M Baird; David Kipling; Peter Giles; Iraj Laffafian; Patricia E Price; David W Thomas; Phil Stephens



Electrical stimulation as adjuvant treatment for chronic leg ulcers of different aetiology: an RCT.  


Objective: To investigate the effectiveness of an innovative electrical stimulation (ES) therapy as adjuvant treatment for chronic wounds of various aetiology, in terms of pain and ulcer healing. Method: Patients with chronic limb ulcers were enrolled for the study and randomised into the intervention or control group. The intervention group received conventional treatment plus ES therapy (FREMS; Lorenz Lifetech) while the control group received only conventional treatment. Each ES treatment cycle consisted of 12 sessions performed in 4 weeks (three sessions/week). All patients were treated until full wound healing occurred, or for a maximum of 9 ES cycles, with a 2-week rest between each cycle. Results: A total of 60 patients were enrolled in the study and randomised into the two groups: the intervention group (n=30) and the control group (n=30). During follow-up, some patients terminated the protocol because they reached the ulcer closure before the maximum of 9 cycles. The analysis of the effect of ES on pain and ulcer healing was performed on all patients who underwent at least two consecutive clinical evaluations (two cycles), in order to reach a compatible sample size with the primary objective (one patient withdrew). In both groups, there was a significant reduction of pain compared with baseline (p < 0.05), starting from T6 visit in the first cycle. In particular, there was a significant reduction of pain in the intervention group compared with the control group after 14 days, and this reduction continued until the end of the second cycle. Similarly, there was a significant reduction of PUSH tool score in the intervention group compared with the control group after 14 days, and this reduction continued until the end of the second cycle. Conclusion: Data collected in this study support data in the literature. Analysis of longitudinal data analysed by simple models and complex models suggest that the ES therapy had a positive and significant effect on pain reduction (VAS) and on the improvement of ulcer healing process in terms of the PUSH tool total index compared with conventional treatment, and may have induced a significant acceleration of the wound-healing process. Declaration of interest: There were no external sources of funding for this trial. The authors have no financial, commercial or social conflicts of interest to declare regarding the article or its content. PMID:24142074

Magnoni, C; Rossi, E; Fiorentini, C; Baggio, A; Ferrari, B; Alberto, G



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

PubMed Central

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 ?2 = 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 Component Score: 4LB, 39.0; SSB, 39.6; p = 0.675). The most common adverse events experienced by both groups included infection, skin breakdown and ulcer deterioration. Conclusions The Canadian Bandaging Trial revealed that in the practice context of trained RNs using an evidence-informed protocol, the choice of bandage system (4LB and SSB) does not materially affect healing times, recurrence rates, HRQL, or pain. From a community practice perspective, this is positive news for patient-centred care allowing individual/family and practitioner choice in selecting compression technologies based on circumstances and context. Trial registration Identifier: NCT00202267



Efficacy and safety of a gauze pad containing hyaluronic acid in treatment of leg ulcers of venous or mixed origin: a double-blind, randomised, controlled trial.  


Topical hyaluronic acid (HA) is routinely used in the local treatment of chronic wounds, but few data have been reported to date. A 60-day double-blind, randomised, controlled superiority trial was designed to investigate the efficacy and safety of a gauze pad containing HA in local treatment of venous leg ulcers, compared with its neutral vehicle. The primary endpoint was the percentage of wound size reduction after 45 days. Totally 89 patients were included. At day 45, the percentage of ulcer surface reduction was significantly greater in the HA group (73 ± 4·6%) versus neutral vehicle group (46 ± 9·6%) (P = 0·011). The number of healed ulcers was significantly higher in the HA group at day 45 (31·1% versus 9·3% respectively) and day 60 (37·8% versus 16·3% respectively; P < 0·05). At day 30, pain intensity based on visual analogue scale was significantly lower in the HA group (12·4 mm ± 2·6 versus 22·8 mm ± 3·8; P = 0·026). Tolerance of both treatments was comparable in the two groups. HA gauze pad, in local treatment of venous leg ulcers, was significantly more effective than the neutral vehicle on wound size reduction, healed ulcers rate and pain management with a good safety profile. PMID:22405094

Humbert, Philippe; Mikosinki, Jacek; Benchikhi, Hakima; Allaert, François-André



Acute Stress Causes Skin Ulceration in Striped Bass and Hybrid Bass (Morone)  

Microsoft Academic Search

Exposure of striped bass (Morone saxatilis) and hybrid bass (M. saxatilis female X Morone chrysops male) to an acute (2-hour) confinement stress caused skin ulceration on the fins but not on the body of all confined fish. Striped bass displayed more severe lesions than did hybrid bass. Histologically, lesions had varying degrees of epithelial erosion and ulceration, which was most

E. J. Noga; S. Botts; M.-S. Yang; R. Avtalion



Success Rate of Split-Thickness Skin Grafting of Chronic Venous Leg Ulcers Depends on the Presence of Pseudomonas aeruginosa: A Retrospective Study  

PubMed Central

The last years of research have proposed that bacteria might be involved in and contribute to the lack of healing of chronic wounds. Especially it seems that Pseudomonas aeruginosa play a crucial role in the healing. At Copenhagen Wound Healing Centre it was for many years clinical suspected 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 leg ulcers on 91 extremities, from the 1st of March 2005 until the 31st of August 2006. This was achieved by analysing the microbiology, demographic data, smoking and drinking habits, diabetes, renal impairment, co-morbidities, approximated size and age of the wounds, immunosuppressive treatment and complicating factors on the clinical outcome of each patient. The results were evaluated using a Student T-test for continuous parameters, chi-square test for categorical parameters and a logistic regression analysis to predict healing after 12 weeks. The analysis revealed that only 33,3% of ulcers with P. aeruginosa, isolated at least once from 12 weeks prior, to or during surgery, were healed (98% or more) by week 12 follow-up, while 73,1% of ulcers without P. aeruginosa were so by the same time (p?=?0,001). Smoking also significantly suppressed the outcome at the 12-week follow-up. Subsequently, a logistic 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.

H?gsberg, Trine; Bjarnsholt, Thomas; Thomsen, Jens Schiersing; Kirketerp-M?ller, Klaus



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

PubMed Central

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.

Romanelli, Marco; Dini, Valentina; Vowden, Peter; Agren, Magnus S



["And there are always enough 'promo leaflets'". A qualitative study on the situation of leg ulcer patients and their needs in regard to patient education].  


Chronic leg ulcers influence the daily lives of patients. Besides the burden of therapy, research results in the field of quality of life indicate constraints in the psychological, physiological, occupational and social parts of life. In order to take an active role in coping with the chronic disease, patients need knowledge and information that account for individual needs. Therefore our study had the objective to describe the lived experience of patients with leg ulcer and their corresponding needs for patient education. We used a qualitative study design. In a first step we made five narrative interviews. In a second step we made seven interviews using an interview guide that was based on results of the narrative interviews. Participants were recruited in two regions in Germany via two specialist practices and a hospital. We used a purposeful sampling strategy in order to account for the heterogenity of the patient group. Data was analysed using the content analysis approach by Mayring. Our analysis identified 4 interconnected main categories: living with the illness, experiences of wound care, being an expert, and educational needs. Patients are trying to integrate their illness into daily life and maximize their independence. They prefer individual counselling during regulartreatment to group counselling or meetings with other leg ulcer patients. Overall the described problems and solutions illustrate the complexities of the disease and its care. PMID:23951685

Schneider, Iris; Keller, Anita; Fleischer, Steffen; Berg, Almuth



Ovarian Mass Causing Paradoxical MI and Leg Ischaemia  

PubMed Central

Paradoxical embolus through a patent foramen ovale is a well-reported phenomenon. Clinical consequences include stroke, intestinal infarction, lower limb ischaemia, and even acute myocardial infarction (MI), via embolisation to the coronary arteries. We present a case of acute MI, cardiogenic shock, and cardiac arrest caused not by this mechanism, but by embolisation of thrombotic material to the aortic root with transient complete occlusion of the left main stem (LMS) coronary artery. During percutaneous coronary intervention to treat this occlusion the thrombus became lodged at the aortic bifurcation causing lower limb ischaemia. Despite successful treatment of this via bilateral groin exploration and thromboembolectomy the patient became increasingly acidotic and an abdominal and pelvic CT scan was performed. This revealed the source of the thrombus to be the patient's congested and compressed pelvic veins which were the result of a large, previously undiagnosed ovarian malignancy with metastatic spread. Although very unusual we feel this case highlights an important differential in the diagnosis of anterolateral MI and images similar to those presented here are previously unreported in the literature.

Griffin, K. J.; Bailey, M. A.; Greenwood, J. P.; Barker, L.; Nicholson, T.; Scott, D. J. A.



Recruitment Strategy Effectiveness for a Cryotherapy Intervention for a Venous Leg Ulcer Prevention Study  

PubMed Central

PURPOSE To describe the strategies and costs associated with recruiting African American and white adults into a randomized controlled pilot trial. DESIGN “Cryotherapy for Venous Disorders: A Pilot Study” is a randomized controlled trial designed to determine the effects of a cool gel wrap and leg elevation intervention versus a leg elevation alone intervention on skin temperature, skin microcirculation, quality of life, and pain in adults with stages 4 and 5 chronic venous disorders. We sought to recruit 60 participants (21 African Americans, 37 whites, and 2 Hispanic or Latino) to complete the study. These enrollment targets reflect the demographic distribution of the community in which the study was conducted (33% African American, 66% white, and 2% Latino). Proactive and reactive recruitment strategies were implemented to recruit subjects. RESULTS Seventy-three individuals (9 African American men, 29 African American women, 11 white men, 22 white women, 1 Asian woman, and 1 Hispanic woman) were screened, and of those, 67 were randomized (9 African American men, 25 African American women, 9 white men, 22 white women, 1 Asian woman, and 1 Hispanic women). Fifty-eight completed the study, yielding an overall 11% attrition rate. An additional 8 subjects canceled or did not show up for a first appointment. Reactive recruitment strategies were most successful for recruiting men, women, African American, and white participants. The 3 most successful reactive strategies were referrals from providers/clinics (34%), flyers posted in the hospital elevators (22%), and targeted mailings from a business (16%). Of the healthcare provider referrals (19), wound care nurses referred 12 completed participants. The amount budgeted for advertisement was $5,000 (2% of the total grant award). The amount spent on recruitment including labor was $5,978, which averaged $103 per participant who completed the study (N = 58). Reactive strategies per participant completer proved more cost-efficient than proactive strategies ($83 vs $215). However, the time spent by the principal investigator (approximately 100 hours or 2.5 hours per week × 40 weeks) on recruitment, particularly maintaining frequent face-to-face contact with providers, increased success in the area of healthcare provider referrals. CONCLUSION A variety of recruitment strategies are needed to ensure a diverse participant response to clinical research studies. As nurses become more involved in research activities, and particularly in recruitment, it is important to understand the most effective types of strategies and costs associated with these activities.

Kelechi, Teresa J.; Watts, Ashlee; Wiseman, Jan



An under-diagnosed cause of leg swelling.  


A grossly obese woman was wrongly diagnosed throughout her adult life of having lymphoedema. Her condition was subsequently confirmed as lipoedema, an entirely different condition, which is noted in medical text books but is seldom taught to medical students or to general practitioners. The condition is caused by abnormal deposition of adipose tissue in the extremities (usually the lower limbs) and almost exclusively affects women. It often starts at puberty or may occur after pregnancy. The exact aetiology is not yet understood but genetic and hormonal factors may be implicated. The problem is that misdiagnosis leads to inappropriate tests and improper treatment to the patient. When recognised it is often too late to do anything for the patient and they become highly dependent on social care. This case describes how the diagnosis can be confirmed through an ultrasound image and illustrates the need for early recognition to facilitate specialist care. PMID:23709549

Goodliffe, James M; Ormerod, Julian O M; Beale, Andrew; Ramcharitar, Steve



Surgical Treatment of the Ulcerated Foot  

Microsoft Academic Search

Foot ulceration with infection is one of the leading causes of hospitalization for patients with diabetes mellitus. Although\\u000a solid data on the true incidence and prevalence of diabetic foot ulcerations do not exist, it is believed that approx 15%\\u000a of patients with diabetes will develop a foot or leg ulceration in their lifetime (1). The rate of recidivism is also

John M. Giurini


Injectable silicone: Cause of facial nodules, cellulitis, ulceration, and migration  

Microsoft Academic Search

Fifty-four patients with problems following “medical grade” silicone injections into the face and legs were seen from 1974\\u000a until 1995. Complications consisted of chronic cellulitis, nodules, foreign body reactions, and movement of material to near\\u000a and distant parts of the body. These difficulties usually demonstrated themselves many years after injection. It is suggested\\u000a that problems occur despite good technique, good

Marvin J. Rapaport; Charles Vinnik; Harvey Zarem





... kissing may be one way. They also may be spread through food, water, or contact with vomit (puke) that has been infected with the bacteria. The best advice in ulcer prevention is to always wash your hands after you use the bathroom and before ...


Foot ulcer caused by multidrug-resistant Mycobacterium tuberculosis in a diabetic patient.  


Osteoarticular tuberculosis is the fourth leading type of extrapulmonary tuberculosis. The disease has a progressive course and the diagnosis is often made in the later stages of bone destruction. We describe a case of a foot ulcer caused by drug-resistant Mycobacterium tuberculosis in a patient with known diabetes where the diagnosis was not suspected initially. Although tuberculous foot ulcers are rare, they should be included in the differential diagnosis of unknown foot ulcers. A greater awareness of this rare clinical entity may help in commencing specific evidence-based therapy quickly and preventing undue morbidity and mortality. PMID:20576746

Baveja, C P; Gumma, Vidya Nidhi; Jain, Manisha; Jha, Himanshu



Diagnosis and treatment of venous ulcers.  


Venous ulcer, also known as stasis ulcer, is the most common etiology of lower extremity ulceration, affecting approximately 1 percent of the U.S. population. Possible causes of venous ulcers include inflammatory processes resulting in leukocyte activation, endothelial damage, platelet aggregation, and intracellular edema. The primary risk factors for venous ulcer development are older age, obesity, previous leg injuries, deep venous thrombosis, and phlebitis. On physical examination, venous ulcers are generally irregular, shallow, and located over bony prominences. Granulation tissue and fibrin are typically present in the ulcer base. Associated findings include lower extremity varicosities, edema, venous dermatitis, and lipodermatosclerosis. Venous ulcers are usually recurrent, and an open ulcer can persist for weeks to many years. Severe complications include cellulitis, osteomyelitis, and malignant change. Poor prognostic factors include large ulcer size and prolonged duration. Evidence-based treatment options for venous ulcers include leg elevation, compression therapy, dressings, pentoxifylline, and aspirin therapy. Surgical management may be considered for ulcers that are large in size, of prolonged duration, or refractory to conservative measures. PMID:20387775

Collins, Lauren; Seraj, Samina



Cricket ball injury: a cause of symptomatic muscle hernia of the leg.  


A case of symptomatic muscle hernia of the leg in a provincial cricketer caused by a cricket ball injury is presented. It was diagnosed clinically and treated with a limited fasciotomy. However, delay in the diagnosis and treatment ended the professional career of the player. An awareness of the condition and a high index of suspicion are required to treat this condition in time. PMID:19096020

Gupta, R K; Singh, D; Kansay, R; Singh, H



Effectiveness and tissue compatibility of a 12-week treatment of chronic venous leg ulcers with an octenidine based antiseptic--a randomized, double-blind controlled study.  


The aim of this study was to evaluate the cytotoxic effect of octenidine dihydrochloride/phenoxyethanol (OHP) found in vitro by conducting a randomized, double-blind controlled clinical study focusing on its safe and effective use in chronic venous leg ulcers. In total, 126 male and female patients were treated with either OHP (n = 60) or Ringer solution (n = 66). The treatment lasted over a period of maximum 12 weeks. For the assessment of the wound-healing process, clinical outcome parameters were employed, that is, time span until 100% epithelization, wound status and the wound surface area were analysed. Side effects were recorded during the study period. The median time to complete ulcer healing was comparable between the OHP and Ringer solution groups (92 versus 87 days; P = 0·952), without being influenced by wound size or duration of the target ulcer (P-values: 0·947/0·978). In patients treated with OHP, fewer adverse events (AEs) were observed compared with the Ringer group (17% versus 29% of patients reported 20 versus 38 AEs). OHP is well suitable for the treatment of chronic wounds without cytotoxic effects. Furthermore, OHP does not impair the wound healing in chronic venous ulcers. PMID:22074592

Vanscheidt, Wolfgang; Harding, Keith; Téot, Luc; Siebert, Jörg



Flaccid Leg Paralysis Caused by a Thoracic Epidural Catheterization: A Case Report  

PubMed Central

We report a case of a 44-year-old patient with paralysis of the left leg who had a thoracic epidural catheterization after general anesthesia for abdominal surgery. Sensory losses below T10 and motor weakness of the left leg occurred after the surgery. Magnetic resonance image study demonstrated a well-defined intramedullary linear high signal intensity lesion on T2-weighted image and low-signal intensity on T1-weighted image in the spinal cord between T9 and L1 vertebral level, and enhancements of the spinal cord below T8 vertebra and in the cauda equina. Electrodiagnostic examination revealed lumbosacral polyradiculopathy affecting nerve roots below L4 level on left side. We suggest that the intrinsic spinal cord lesion and nerve root lesion can be caused by an epidural catheterization with subsequent local anesthetic injection.

Jeon, Byoung Hyun; Bang, Heui Je; Lee, Gyung Moo; Kwon, Oh Pum



Venous leg ulcers  

Microsoft Academic Search

In 1837, Piorry, a French professor of medicine stated, “It is rather difficult to understand why the investigation of veins has been passed over almost in silence, while such a great diagnostic value has been attached to the investigation of arteries.” Even today, our understanding of venous disease pales in comparison to our understanding of arterial disease. This is despite

Carin F. Gonsalves



Proximal small bowel obstruction caused by a massive intraluminal thrombus from a stress ulcer  

PubMed Central

We describe a case of proximal small bowel obstruction caused by an occlusive thrombus as a result of bleeding from a duodenal ulcer, which is likely to be stress induced. Initial presentation was confused as a bleeding duodenal ulcer and resultant ileus. Such reports are incredibly rare in the literature and never has one been reported as a result of a stress ulcer. Obstructive symptoms in the acute postoperative patient may be confused for an ileus but mechanical causes must be excluded. The presence of upper gastrointestinal bleeding must not detract from that possibility. Future identification of an occlusive clot on endoscopy that is impossible to circumnavigate may benefit from intraluminal injection of thrombolytic agents to prevent obstruction but this must be weighed with the risk of exacerbating any bleeding. Clearly a risk versus benefit analysis will be necessary on an individual basis.

Siddiky, AH; Gupta, P



Role of neutrophils in a rat model of gastric ulcer recurrence caused by interleukin-1 beta.  

PubMed Central

The production of several cytokines such as interleukin (IL)-1 in gastric mucosa is increased in subjects infected with Helicobacter pylori, a bacterium associated with ulcer recurrence. This study was performed to determine whether the administration of IL-1 beta can cause recurrence of gastric ulcers in rats. Rats with healed ulcers received an injection of IL-1 beta (0.01 to 1 microgram/kg) or vehicle alone. Some rats received an injection of antiserum to rat neutrophils at the same time as 1 microgram/kg IL-1 beta or an injection of monoclonal antibodies against adhesion molecules (anti-intercellular adhesion molecule-1, anti-CD11a, and anti-CD11b) at 0, 12, and 24 hours after the initial injection. At this dose of IL-1 beta, the numbers of neutrophils and monocytes/macrophages infiltrating the scarred mucosa were higher at 12 and 24 hours than without injection of IL-1 beta. By 48 hours, seven of the eight bealed ulcers in the group treated with 1 microgram/kg IL-1 beta had recurred, as had one of the seven healed ulcers in the group given 0.1 microgram/kg IL-1 beta. No recurrence was found in the rats treated with 0.01 microgram/kg IL-1 beta or vehicle alone. Treatment with antiserum to neutrophils or antibodies to adhesion molecules inhibited both neutrophil infiltration into the scarred mucosa and the ulcer recurrence caused by IL-1 beta. These findings suggest possible mechanisms of recurrence of human peptic ulcers. Images Figure 1 Figure 2 Figure 3 Figure 4

Watanabe, T.; Arakawa, T.; Fukuda, T.; Higuchi, K.; Kobayashi, K.



Osteomyelitis and skin ulcers caused by Mycobacterium szulgai in an AIDS patient.  


Mycobacterium szulgai is a ubiquitious non-tuberculous mycobacterium causing infection in immunocompetent and immunocompromized patients. Clinically mimicking pulmonary tuberculosis in most cases described, rarely other manifestations occur. Here we report the case of an AIDS patient with osteomyelitis of the hand and toe, accompanied by multiple cutaneous ulcers of the chest and forearm. The case highlights the unusual combination of osteomyelitis and skin ulcers without pulmonary infection and describes the likely cutaneous route of infection in a patient who keeps tropical fish. PMID:15764180

Tappe, Dennis; Langmann, Peter; Zilly, Michael; Klinker, Hartwig; Schmausser, Bernd; Frosch, Matthias



Trigeminal trophic syndrome: an unusual cause of a non-healing cheek ulcer.  


Trigeminal trophic syndrome (TTS) is an uncommon condition characterised by anaesthesia, paraesthesias and ala nasi ulceration, following peripheral or central damage to the trigeminal nerve. Only about 100 cases have been described in the literature to date. We report a 74-year-old woman who presented with a right cheek ulcer accompanied by pruritus and paraesthesia for three months. An old right cerebellar infarct was demonstrated on magnetic resonance imaging of the brain. Vertebrobasilar insufficiency leading to the cerebellar infarct is likely to have predisposed her to developing TTS. An underlying infectious, malignant and vasculitic cause for the ulcer was excluded by a skin biopsy. An increased awareness of the predisposing factors and clinical presentations of this important disfiguring condition is necessary to ensure prompt diagnosis and treatment. PMID:17245500

Neoh, C Y; Tan, A W H



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

Microsoft Academic Search

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 ?-defensin-2 (hBD2), GM-CSF, VEGF growth factors

Hanna Galkowska; Waldemar L. Olszewski; Urszula Wojewodzka



What is causing the corneal ulcer? Management strategies for unresponsive corneal ulceration  

PubMed Central

Infectious keratitis represents a significant cause of ocular morbidity in the United States. The work-up and treatment of presumed infectious keratitis (PIK) has changed in the past two decades. The development of newer topical antibiotics has enabled broad-spectrum antibiotic coverage with good tissue penetration. The majority of PIK cases respond well to this strategy. The small numbers of cases that do not respond to the treatment are the cases that offer a diagnostic and therapeutic challenge. This review will describe different algorithms that can be followed for the successful management of patients with difficult or progressive PIK. These algorithms are based on scientific work and on our empirical clinical experience. The review will also present three different clinical cases of PIK that were managed according to the algorithms presented in this review.

Amescua, G; Miller, D; Alfonso, E C



Interleukin-8 production by polymorphonuclear leukocytes from patients with chronic infected leg ulcers treated with Lactobacillus plantarum.  


Bacterial infection impairs the healing process, promoting the chronicity of inflammation and wounds. Because antibiotics fail to eradicate bacteria, especially in biofilm form, new therapeutic modalities may be required. In the present study, the effectiveness of bacteriotherapy with Lactobacillus plantarum on infected chronic venous ulcers was investigated and its effects on interleukin (IL)-8 production by cells from the ulcer bed and neutrophils isolated from peripheral blood that were previously challenged in vitro with Pseudomonas aeruginosa and L. plantarum were studied. Topical application of L. plantarum culture to lesions (25-60 cm(2)) of 14 diabetic and 20 non-diabetic patients induced debridement, granulation tissue formation and total healing after 30 days in 43% diabetics and in 50% non-diabetics. No significant differences between the groups were observed. The cells from ulcer beds collected after treatment with L. plantarum for 10 days showed a decrease in the percentage of polymorphonuclear, apoptotic and necrotic cells and an enhancement of IL-8 production. IL-8 production by isolated neutrophils from these patients was compared with that in diabetics without ulcers, as well as normal subjects under basal conditions, and after infection of polymorphonuclear cells with P. aeruginosa preincubated either with or without L. plantarum. The basal values in diabetic and ulcer patients were higher than normal (p <0.001) and were increased by P. aeruginosa infection in normal, diabetics (p <0.001) and non-diabetics with ulcers (p <0.01). Preincubation with L. plantarum decreased IL-8 production in patients with ulcers non-diabetic and diabetic (p <0.001). Lactobacillus plantarum treatment reduced wound bacterial load, neutrophils, apoptotic and necrotic cells, modified IL-8 production and induced wound healing. PMID:19519855

Peral, M C; Rachid, M M; Gobbato, N M; Huaman Martinez, M A; Valdez, J C



Restless legs syndrome and all-cause mortality in four prospective cohort studies  

PubMed Central

Objectives To evaluate the association between restless legs syndrome (RLS) and all-cause mortality. Design Four prospective cohort studies. Setting The Dortmund Health Study (DHS) and the Study of Health in Pomerania (SHIP) from Germany. The Women's Health Study (WHS) and the Physicians’ Health Study (PHS) from the USA. Participants In DHS: a random sample (n=1?299) from the population of Dortmund; in SHIP: a sample (n=4?291) from residents living in West Pomerania were drawn by multistage random sampling design; in WHS: female healthcare professionals (n=31?370); in PHS: male physicians (n=22?926) Main outcome measures All-cause mortality. Results The prevalence of RLS ranged between 7.4% and 11.9% at baseline. During follow-up (ranging between 6 and 11?years) RLS was not associated with increased risk of all-cause mortality in any of the four cohorts. The multivariable-adjusted HRs (95% CI) for all-cause mortality ranged from 0.21 (0.03 to 1.53) to 1.07 (0.93 to 1.23) across the four studies. The HRs for all-cause mortality did not differ according to gender. Conclusions In these four independently conducted large prospective cohort studies from Germany and the USA, RLS did not increase the risk of all-cause mortality. These findings do not support the hypothesis that RLS is a risk factor for mortality of any cause.

Szentkiralyi, Andras; Winter, Anke C; Schurks, Markus; Volzke, Henry; Hoffmann, Wolfgang; E Buring, Julie; Gaziano, J Michael; Kurth, Tobias; Berger, Klaus



[Restless-leg syndrome--possible unrecognized cause for insomnia and irritability in children].  


Restless legs syndrome (RLS) has gradually been recognized as a cause for insomnia in adults, but there have been few reports about children with RLS in Japan. Here we described seven pediatric RLS patients. All of the parents of our patients had difficult times to make their children sleep due to irritability, restlessness, and demanding bedtime routines. All patients had asked their parents to rub their feet in bed, and it took more than half an hour to soothe them until they fell asleep. Their mothers had been exhausted from this night-time routine. However, they did not consider the routine abnormal, as it had been their habitual behavior since infancy. Some parents were too distressed or embarrassed to describe the symptoms of their child properly. Five patients had clear family history and none had obvious periodic leg movements during sleep. All patients showed low levels of ferritin and iron supplementation was effective in five cases. In the severest two cases, pramipexole, but not iron, was dramatically effective. Both patients started to show RLS symptoms in the early days of infancy, which may suggest more severe hereditary dopaminergic dysfunction. RLS does occur in childhood and pediatricians should bear it in mind as one of the differential diagnoses when seeing children who are irritated and/or having difficulty in initiating their sleep. PMID:19039990

Mohri, Ikuko; Kato-Nishimura, Kumi; Kagitani-Shimono, Kuriko; Tachibana, Naoko; Ozone, Keiichi; Taniike, Masako



A Mycobacterium ulcerans Toxin, Mycolactone, Causes Apoptosis in Guinea Pig Ulcers and Tissue Culture Cells  

PubMed Central

Mycobacterium ulcerans is the causative agent of Buruli ulcer, a tropical ulcerative skin disease. One of the most intriguing aspects of this disease is the presence of extensive tissue damage in the absence of an acute inflammatory response. We recently purified and characterized a macrolide toxin, mycolactone, from M. ulcerans. Injection of this molecule into guinea pig skin reproduced cell death and lack of acute inflammatory response similar to that seen following the injection of viable bacteria. We also showed that mycolactone causes a cytopathic effect on mouse fibroblast L929 cells that is characterized by cytoskeletal rearrangements and growth arrest within 48 h. However, these results could not account for the extensive cell death which occurs in Buruli ulcer. The results presented here demonstrate that L929 and J774 mouse macrophage cells die via apoptosis after 3 to 5 days of exposure to mycolactone. Treatment of cells with a pan-caspase inhibitor can inhibit mycolactone-induced apoptosis. We demonstrate that injection of mycolactone into guinea pig skin results in cell death via apoptosis and that the extent of apoptosis increases as the lesion progresses. These results may help to explain why tissue damage in Buruli ulcer is not accompanied by an acute inflammatory response.

George, Kathleen M.; Pascopella, Lisa; Welty, Diane M.; Small, P. L. C.



Histoplasmosis as cause of penile ulcer in acquired immune deficiency syndrome (AIDS): three case reports  

Microsoft Academic Search

Background  \\u000a Histoplasma capsulatum is the causative agent of American histoplasmosis. The relationship between disseminated histoplasmosis and AIDS has been\\u000a well established. Widespread hematogenous dissemination of Histoplasma capsulatum in HIV positive patients can cause a plethora of clinical manifestations; virtually any organic system can be affected. However,\\u000a genital ulceration by H. capsulatum in patients with AIDS is a real challenge during investigation

Ederson Valei Lopes de Oliveira; Fernanda Belluci Miduati; João Roberto Antonio; Rafael de Negreiros Moraes; Margarete Teresa Gottardo de Almeida; Solange Corrêa Garcia Pires D’Ávilla; Eurides Maria de Oliveira Pozetti



Leukocyte activity in the microcirculation of the leg in patients with chronic venous disease  

Microsoft Academic Search

Purpose: It has been suggested that leukocyte trapping and activation in the microcirculation of the leg skin causes lipodermatosclerosis and ulceration in patients with chronic venous disease. Ambulatory venous hypertension is accepted as the physiologic factor that leads to ulceration. We investigated leukocyte endothelial adhesion in patients who were subjected to short-term venous hypertension.Methods: Two groups of patients with venous

Mrinal Saharay; David A. Shields; John B. Porter; John H. Scurr; Philip D. Coleridge Smith



Evaluation of the bacterial diversity among and within individual venous leg ulcers using bacterial tag-encoded FLX and Titanium amplicon pyrosequencing and metagenomic approaches  

PubMed Central

Background Approximately 1 out of every 100 individuals has some form of venous insufficiency, which can lead to chronic venous disease and Venous Leg Ulcer (VLU). There are known underlying pathologies which contribute to the chronic nature of VLU including biofilm phenotype infections. Results Using pyrosequencing based approaches we evaluated VLU to characterize their microbial ecology. Results show that VLU infections are polymicrobial with no single bacterium colonizing the wounds. The most ubiquitous and predominant organisms include a previously uncharacterized bacteroidales, various anaerobes, Staphylococcus, Corynebacterium, and Serratia. Topological analysis of VLU show some notable differences in bacterial populations across the surface of the wounds highlighting the importance of sampling techniques during diagnostics. Metagenomics provide a preliminary indication that there may be protozoa, fungi and possibly an undescribed virus associated with these wounds. Conclusion The polymicrobial nature of VLU and previous research on diabetic foot ulcers and surgical site infections suggest that the future of therapy for such wounds lies in the core of the logical and proven multiple concurrent strategy approach, which has been termed "biofilm-based wound care" and the use of individualized therapeutics rather than in a single treatment modality.



Effects of silver-based wound dressings on the bacterial flora in chronic leg ulcers and its susceptibility in vitro to silver.  


Silver-based dressings have been used extensively in wound management in recent years, but data on their antimicrobial activity in the clinical setting are limited. In order to explore their effects on chronic leg ulcer flora, 14 ulcers were cultured after at least 3 weeks treatment with Aquacel Ag(®) or Acticoat(®). Phenotypic and genetic silver resistance were investigated in a total of 56 isolates. Silver-based dressings had a limited effect on primary wound pathogens, which were present in 79% of the cultures before, and 71% after, treatment. One silver-resistant Enterobacter cloacae strain was identified (silver nitrate minimal inhibitory concentration (MIC)?>?512 mg/l, positive for silE, silS and silP). Further studies in vitro showed that inducible silver-resistance was more frequent in Enterobacteriaceae with cephalosporin-resistance and that silver nitrate had mainly a bacteriostatic effect on Staphylococcus aureus. Monitoring of silver resistance should be considered in areas where silver is used extensively. PMID:22215013

Sütterlin, Susanne; Tano, Eva; Bergsten, Agneta; Tallberg, Anna-Britta; Melhus, Asa



Mutations in DARS Cause Hypomyelination with Brain Stem and Spinal Cord Involvement and Leg Spasticity  

PubMed Central

Inherited white-matter disorders are a broad class of diseases for which treatment and classification are both challenging. Indeed, nearly half of the children presenting with a leukoencephalopathy remain without a specific diagnosis. Here, we report on the application of high-throughput genome and exome sequencing to a cohort of ten individuals with a leukoencephalopathy of unknown etiology and clinically characterized by hypomyelination with brain stem and spinal cord involvement and leg spasticity (HBSL), as well as the identification of compound-heterozygous and homozygous mutations in cytoplasmic aspartyl-tRNA synthetase (DARS). These mutations cause nonsynonymous changes to seven highly conserved amino acids, five of which are unchanged between yeast and man, in the DARS C-terminal lobe adjacent to, or within, the active-site pocket. Intriguingly, HBSL bears a striking resemblance to leukoencephalopathy with brain stem and spinal cord involvement and elevated lactate (LBSL), which is caused by mutations in the mitochondria-specific DARS2, suggesting that these two diseases might share a common underlying molecular pathology. These findings add to the growing body of evidence that mutations in tRNA synthetases can cause a broad range of neurologic disorders.

Taft, Ryan J.; Vanderver, Adeline; Leventer, Richard J.; Damiani, Stephen A.; Simons, Cas; Grimmond, Sean M.; Miller, David; Schmidt, Johanna; Lockhart, Paul J.; Pope, Kate; Ru, Kelin; Crawford, Joanna; Rosser, Tena; de Coo, Irenaeus F.M.; Juneja, Monica; Verma, Ishwar C.; Prabhakar, Prab; Blaser, Susan; Raiman, Julian; Pouwels, Petra J.W.; Bevova, Marianna R.; Abbink, Truus E.M.; van der Knaap, Marjo S.; Wolf, Nicole I.



Mutations in DARS cause hypomyelination with brain stem and spinal cord involvement and leg spasticity.  


Inherited white-matter disorders are a broad class of diseases for which treatment and classification are both challenging. Indeed, nearly half of the children presenting with a leukoencephalopathy remain without a specific diagnosis. Here, we report on the application of high-throughput genome and exome sequencing to a cohort of ten individuals with a leukoencephalopathy of unknown etiology and clinically characterized by hypomyelination with brain stem and spinal cord involvement and leg spasticity (HBSL), as well as the identification of compound-heterozygous and homozygous mutations in cytoplasmic aspartyl-tRNA synthetase (DARS). These mutations cause nonsynonymous changes to seven highly conserved amino acids, five of which are unchanged between yeast and man, in the DARS C-terminal lobe adjacent to, or within, the active-site pocket. Intriguingly, HBSL bears a striking resemblance to leukoencephalopathy with brain stem and spinal cord involvement and elevated lactate (LBSL), which is caused by mutations in the mitochondria-specific DARS2, suggesting that these two diseases might share a common underlying molecular pathology. These findings add to the growing body of evidence that mutations in tRNA synthetases can cause a broad range of neurologic disorders. PMID:23643384

Taft, Ryan J; Vanderver, Adeline; Leventer, Richard J; Damiani, Stephen A; Simons, Cas; Grimmond, Sean M; Miller, David; Schmidt, Johanna; Lockhart, Paul J; Pope, Kate; Ru, Kelin; Crawford, Joanna; Rosser, Tena; de Coo, Irenaeus F M; Juneja, Monica; Verma, Ishwar C; Prabhakar, Prab; Blaser, Susan; Raiman, Julian; Pouwels, Petra J W; Bevova, Marianna R; Abbink, Truus E M; van der Knaap, Marjo S; Wolf, Nicole I



Disruption of FADS2 gene in mice impairs male reproduction and causes dermal and intestinal ulceration  

PubMed Central

Delta-6 desaturase (D6D) catalyzes the first step in the synthesis of highly unsaturated fatty acids (HUFA) such as arachidonic (AA), docosapentaenoic (DPAn-6), and docosahexaenoic (DHA) acids, as well as the last desaturation of DPAn-6 and DHA. We created D6D-null mice (?/?), which enabled us to study HUFA deficiency without depleting their precursors. In ?/?, no in vivo AA synthesis was detected after administration of [U-13C]linoleic acid (LA), indicating absence of D6D isozyme. Unexpectedly, all of the ?/? developed ulcerative dermatitis when fed a purified diet lacking D6D products but containing ample LA. The ?/? also exhibited splenomegaly and ulceration in duodenum and ileocecal junction. Male ?/? lacked normal spermatozoa with a severe impairment of spermiogenesis. Tissue HUFAs in ?/? declined differentially: liver AA and DHA by 95%, and a smaller decrease in brain and testes. Dietary AA completely prevented dermatitis and intestinal ulcers in ?/?. DPAn-6 was absent in ?/? brain under AA supplementation, indicating absence of D6D isozyme for DPAn-6 synthesis from AA. This study demonstrated a distinct advantage of the D6D-null mice (?/?) to elucidate (1) AA function without complication of LA deprivation and (2) DHA function in the nervous system without AA depletion or DPAn-6 replacement seen in traditional models.—Stroud, C. K., T. Y. Nara, M. Roqueta-Rivera, E. C. Radlowski, P. Lawrence, Y. Zhang, B. H. Cho, M. Segre, R. A. Hess, J. T. Brenna, W. M. Haschek, and M. T. Nakamura. Disruption of FADS2 gene in mice impairs male reproduction and causes dermal and intestinal ulceration.

Stroud, Chad K.; Nara, Takayuki Y.; Roqueta-Rivera, Manuel; Radlowski, Emily C.; Lawrence, Peter; Zhang, Ying; Cho, Byung H.; Segre, Mariangela; Hess, Rex A.; Brenna, J. Thomas; Haschek, Wanda M.; Nakamura, Manabu T.



Restless legs syndrome in patients with systemic sclerosis. Prevalence and possible causes.  


This study aims to assess the prevalence and possible causes of restless legs syndrome (RLS) in patients with systemic sclerosis (SSc). The prevalence of RLS was assessed in 27 patients with SSc and 60 healthy controls. We evaluated the impact of age, disease duration, disease form, antibodies, and metoclopramide on the development of RLS in SSc patients. In order to reveal peripheral neuropathy or iron deficiency as possible causes of the syndrome, patients with RLS underwent electromyoneurography (EMNG) and ferritin level testing. RLS was diagnosed in 40.7% of SSc patients (11 out of 27), compared to 4.9% of healthy controls (pcauses include sensitive polyneuropathy, lumbosacral radiculopathy, and iron deficiency. A strong relationship was observed between RLS and metoclopramide, which is sometimes used to treat SSc-related gastrointestinal motility disturbances. PMID:23456369

Ostojic, P; Jovic, T; Stojic, B



Heart rate changes caused by varying the oxygen supply to isolated hind legs of rats  

Microsoft Academic Search

Summary  In a rat with an isolated hind leg circulation perfused with varying tyrode solutions, heart rate (HR) changes were studied\\u000a in dependence of\\u000a $$\\\\dot V_{O_{_2 } } $$\\u000a in the isolated hind leg and of\\u000a $$P_{CO_2 } $$\\u000a , [K+], pH and lactic acid concentration ([Lac]) measured in the venous outflow of the isolated hind leg. In experimental series\\u000a I

Franz Thimm; Ellen Dienstel; Elisabeth Meier zu Verl



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

Microsoft Academic Search

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

Ryan Saylor; Debra Miller; Mark Vandersea; Mark S Bevelhimer; Pamela Schofield; Wayne Bennett



Pain and quality of life for patients with venous leg ulcers: proof of concept of the efficacy of Biatain-Ibu, a new pain reducing wound dressing.  


Wound pain is a serious problem for elderly patients suffering from chronic leg ulcers, and it may lead to reduced wound healing rates and reduced quality of life. Biatain-Ibu Non-adhesive (Coloplast A/S), a new pain-reducing moist wound healing dressing containing ibuprofen was tested for pain reduction, safety, and efficacy on 10+2 patients in a single-blinded crossover study against Biatain Non-adhesive (Coloplast A/S). Pain was measured with a Numeric Box Scale before, during, and after dressing change. Quality of life was measured using the World Health Organization-5 Well-Being Index. Dressing moist wound healing properties such as absorption capacity and leakage were tested together with assessment of wound exudate and blood plasma content of ibuprofen. Use of the Biatain-Ibu foam dressing correlated with a decrease in pain intensity scores from 7 in the run-in period to approximately 2.5 in the Biatain-Ibu treatment phase. Quality of life measures were improved which together with the reduced pain could contribute to faster wound healing. The moist wound healing properties of Biatain-Ibu were similar to that of the Biatain Non-adhesive and ulcer size was reduced by 24% during the treatment period. Neither side effects nor systemic plasma concentrations of ibuprofen were observed. These data indicate that Biatain-Ibu could reduce persistent and temporary wound pain, increase Quality of life, was found safe to use, and had excellent moist wound healing properties. PMID:16808800

Jørgensen, Bo; Friis, Gitte Juel; Gottrup, Finn


Ulcerative keratitis caused by Serratia marcescens after laser in situ keratomileusis.  


We report 2 cases of severe corneal infections caused by Serratia marcescens after laser in situ keratomileusis (LASIK). Twenty-four hours after LASIK, 2 patients developed infectious keratitis, 1 bilaterally. In each eye, the corneal flap was edematous, ulcerated, and detached from the stromal bed. Treatment included removal of the necrotic flap and aggressive antibiotic therapy. Cultures from corneal exudates were positive for S marcescens. After 1 year, both patients had a loss of best corrected visual acuity (BCVA) ranging from 20/40 to 20/22 because of irregular astigmatism. Overrefraction with a hard contact lens resulted in a BCVA of 20/20 in the 3 affected eyes. Slitlamp examination showed trace subepithelial haze without severe corneal scarring. Videokeratography disclosed areas of paracentral inferior steepening resembling keratoconus. Refraction and videokeratography remained stable after 6 months of follow-up. Ulcerative keratitis caused by S marcescens is a potential complication of LASIK. Bilateral involvement may occur if bilateral simultaneous surgery is performed. PMID:15030851

Muñoz, Gonzalo; Alió, Jorge L; Pérez-Santonja, Juan-José; Artola, Alberto; Abad, José Luis



Fatiguing inspiratory muscle work causes reflex reduction in resting leg blood flow in humans.  


1. We recently showed that fatigue of the inspiratory muscles via voluntary efforts caused a time-dependent increase in limb muscle sympathetic nerve activity (MSNA) (St Croix et al. 2000). We now asked whether limb muscle vasoconstriction and reduction in limb blood flow also accompany inspiratory muscle fatigue. 2. In six healthy human subjects at rest, we measured leg blood flow (.Q(L)) in the femoral artery with Doppler ultrasound techniques and calculated limb vascular resistance (LVR) while subjects performed two types of fatiguing inspiratory work to the point of task failure (3-10 min). Subjects inspired primarily with their diaphragm through a resistor, generating (i) 60 % maximal inspiratory mouth pressure (P(M)) and a prolonged duty cycle (T(I)/T(TOT) = 0.7); and (ii) 60 % maximal P(M) and a T(I)/T(TOT) of 0.4. The first type of exercise caused prolonged ischaemia of the diaphragm during each inspiration. The second type fatigued the diaphragm with briefer periods of ischaemia using a shorter duty cycle and a higher frequency of contraction. End-tidal P(CO2) was maintained by increasing the inspired CO(2) fraction (F(I,CO2)) as needed. Both trials caused a 25-40 % reduction in diaphragm force production in response to bilateral phrenic nerve stimulation. 3. .Q(L) and LVR were unchanged during the first minute of the fatigue trials in most subjects; however, .Q(L) subsequently decreased (-30 %) and LVR increased (50-60 %) relative to control in a time-dependent manner. This effect was present by 2 min in all subjects. During recovery, the observed changes dissipated quickly (< 30 s). Mean arterial pressure (MAP; +4-13 mmHg) and heart rate (+16-20 beats min(-1)) increased during fatiguing diaphragm contractions. 4. When central inspiratory motor output was increased for 2 min without diaphragm fatigue by increasing either inspiratory force output (95 % of maximal inspiratory pressure (MIP)) or inspiratory flow rate (5 x eupnoea), .Q(L), MAP and LVR were unchanged; although continuing the high force output trials for 3 min did cause a relatively small but significant increase in LVR and a reduction in .Q(L). 5. When the breathing pattern of the fatiguing trials was mimicked with no added resistance, LVR was reduced and .Q(L) increased significantly; these changes were attributed to the negative feedback effects on MSNA from augmented tidal volume. 6. Voluntary increases in inspiratory effort, in the absence of diaphragm fatigue, had no effect on .Q(L) and LVR, whereas the two types of diaphragm-fatiguing trials elicited decreases in .Q(L) and increases in LVR. We attribute these changes to a metaboreflex originating in the diaphragm. Diaphragm and forearm muscle fatigue showed very similar time-dependent effects on LVR and .Q(L). PMID:11711580

Sheel, A W; Derchak, P A; Morgan, B J; Pegelow, D F; Jacques, A J; Dempsey, J A



A randomised comparative trial on the use of a hydrogel with tepescohuite extract (Mimosa tenuiflora cortex extract-2G) in the treatment of venous leg ulcers.  


Tepescohuite is an extract obtained from the bark of the Mimosa tenuiflora tree and is used as an empirical treatment in wounds for its healing and antiseptic properties. Venous leg ulcers (VLUs) are a common health care problem in most countries with a high rate of morbidity. The standard of care is moist interactive healing and compression; however, the ideal topical treatment is yet to be established. This study is designed to evaluate the effectiveness and safety of M. tenuiflora cortex extract (MTC-2G) in the treatment of VLUs in an Interdisciplinary Wound and Ostomy Care Center (IWOCC). A randomised, placebo-controlled, double blind clinical trial was conducted to compare the use of a hydrogel containing MTC-2G with the hydrogel alone in VLUs. The study included all patients with venous ulcers referred to the IWOCC. Laboratory tests and tissue biopsies were performed at the beginning and at the end of the study. The patients were instructed to daily cleansing followed by topical application of the hydrogel and compression. Forty-one patients were included, 22 patients received the MTC-2G and 19 patients received the hydrogel only. Of the 41 patients, 32 completed the study, 18 in the experimental arm and 14 in the control group, 19 were women and 13 men. The mean age of the subjects was 60 years. The mean time from presentation was 38 months. The mean surface reduction was 6·29 cm(2) [confidence interval (IC) 95%: 3·28-9·29] (P = 0·0001) in the MTC-2G group and 5·85 cm(2) (95% CI: 3·58-8·12) (P = 0·001) in the hydrogel group. There was no significant difference between the groups (P = 0·815). No changes in the laboratory parameters were noted. In the histology, there were not any differences between groups either. A hydrogel containing MTC-2G was not superior to a hydrogel alone in the treatment of VLUs. PMID:22128789

Lammoglia-Ordiales, Lorena; Vega-Memije, Maria Elisa; Herrera-Arellano, Armando; Rivera-Arce, Erika; Agüero, Juan; Vargas-Martinez, Felipe; Contreras-Ruiz, José



Ulcers caused by bullous morphea treated with tissue-engineered skin.  


Bullous morphea is an uncommon form of localized scleroderma. The exact pathogenesis is unknown and treatment of the accompanying ulcers is problematic. We report a patient with bullous morphea with long-standing ulcers whom we successfully treated with the tissue-engineered skin Apligraf (Organogenesis Inc., Canton, MA). The patient experienced rapid improvement in granulation tissue and the ulcers healed 4 months after a single application. The rationale for the use of Apligraf is based on experience with patients with venous ulcers who have surrounding peri-ulcer fibrosis. This condition, termed lipodermatosclerosis, has been reported as a poor prognostic factor for healing, yet many ulcers associated with lipodermatosclerosis may respond to treatment with tissue-engineered skin. Taken in concert, these results suggest a role for tissue- engineered skin in the treatment of chronic wounds with surrounding fibrosis. PMID:12755984

Martin, Lucy K; Kirsner, Robert S



Cost-effective faster wound healing with a sustained silver-releasing foam dressing in delayed healing leg ulcers--a health-economic analysis.  


The aim of this analysis was to examine the cost-effectiveness of Contreet Foam (A) in comparison with three other commonly used venous leg ulcer treatment protocols: Aquacel Ag (B), Actisorb Silver (C) and Iodoflex (D). A health-economic analysis reflecting the UK treatment practice and cost structure was performed. The analysis was set up to assess the cost of relative wound area reduction over a 4-week treatment period. The model was validated by a UK expert panel consisting of four wound care specialists. To assure that the 4-week model had a realistic link to cost-effectiveness of complete wound healing, a Markov analysis was also performed. Sensitivity analyses were carried out to ensure validity. Protocol A and C proved to be the most effective treatments. The mean relative reduction in wound area after 4 weeks of treatment was 50.2% (protocol A), 23.9% (protocol B), 44.6% (protocol C) and 36.0% (protocol D). Cost-effectiveness ratios showed that protocol A proved to be the most cost-effective treatment, and protocol B the least. The cost per percentage reduction in wound area was 9.50 UK pounds for protocol A, compared to 16.50-17.60 UK pounds for the other treatment options. The cost-effectiveness of complete healing (Markov analysis) and sensitivity analyses confirmed these results. Using Contreet Foam instead of the other dressing alternatives may imply savings of 2.2-4.4 million UK pounds per year to the National Health Service. PMID:16722864

Scanlon, Elizabeth; Karlsmark, Tonny; Leaper, David J; Carter, Kate; Poulsen, Peter B; Hart-Hansen, Kristian; Hahn, Tina W



Ulcerative Mycosis Caused by Aphanomyces invadans in Channel Catfish, Black Bullhead, and Bluegill from Southeastern Louisiana  

Microsoft Academic Search

Eight cases of chronic ulcerative mycosis affecting populations of channel catfish Ictalurus punctatus, black bullhead Ameiurus melas, and bluegill Lepomis macrochirus cultured in recreational fishing ponds were submitted to the Louisiana Aquatic Diagnostic Laboratory between April 2000 and January 2002. Diseased clinical specimens presented with multiple foci of skin ulceration, typically overlying more extensive areas of granulomatous myositis that extended

John P. Hawke; Amy M. Grooters; Alvin C. Camus



A Mycobacterium ulcerans Toxin, Mycolactone, Causes Apoptosis in Guinea Pig Ulcers and Tissue Culture Cells  

Microsoft Academic Search

Mycobacterium ulcerans is the causative agent of Buruli ulcer, a tropical ulcerative skin disease. One of the most intriguing aspects of this disease is the presence of extensive tissue damage in the absence of an acute inflammatory response. We recently purified and characterized a macrolide toxin, mycolactone, from M. ulcerans. Injection of this molecule into guinea pig skin reproduced cell




A Case of Double Pylorus Caused by Recurrent Gastric Ulcers: A Long-Term Endoscopic Observation  

Microsoft Academic Search

tient had no symptom of diarrhea, and abdomen CT showed no evidence of any abdominal mass or inflammation. Endoscopic examination revealed a small ulcer on the antrum and deformity of the duodenal bulb, with marked shortening of the lesser curvature of the stomach. Forceps biopsies taken from the ulcer revealed histologically the colonization of Helicobacter pylori, with no evidence of

Yuko Akazawa; Yohei Mizuta; Masayuki Osabe; Tsuguto Nakamura; Shunichi Morikawa; Hajime Isomoto; Fuminao Takeshima; Shigeru Kohno; Ikuo Murata



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

PubMed Central

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.

Favier, Anne-Laure; Flusin, Olivier; Lepreux, Sebastien; Fleury, Herve; Labreze, Christine; Georges, Aurelie; Crance, Jean-Marc; Boralevi, Franck



Leg lengthening - series (image)  


... the leg, the tibia and the femur. Surgical treatment may be recommended for severe unequal leg lengths caused by: poliomyelitis and cerebral palsy small, weak (atrophied) muscles or short, tight (spastic) ...


Overall and Cause-Specific Mortality in Ulcerative Colitis: Meta-analysis of Population-Based Inception Cohort Studies  

Microsoft Academic Search

OBJECTIVES:It remains debated whether patients with ulcerative colitis (UC) are at greater risk of dying and whether a possible alteration in mortality can be attributed to specific causes of death. We aimed to clarify this issue by conducting a meta-analysis of population-based inception cohort studies on overall and cause-specific mortality in patients with UC.METHODS:The MEDLINE search engine and abstracts from

Tine Jess; Michael Gamborg; Pia Munkholm; Thorkild I. A. Sørensen



Persistence of secondary restless legs syndrome in a phantom limb caused by end-stage renal disease.  


Our patient had secondary restless legs syndrome (RLS) in the left lower limb caused by end-stage renal disease (ESRD). Severe RLS symptoms persisted even after amputation of the affected limb. Considering that oral administration of a dopamine receptor agonist was effective in treating the RLS in the phantom limb in this case, dysfunction of the central dopaminergic system was thought to be involved in the phantom limb-RLS mechanism. The persistence of RLS symptoms even after amputation of the affected limb suggests that the area responsible for ESRD-related RLS symptoms exists at the spinal level or in the higher central nervous system. PMID:23545682

Nishida, Shingo; Hitsumoto, Akiko; Namba, Kazuyoshi; Usui, Akira; Inoue, Yuichi



Restless Legs Syndrome  


... page from the NHLBI on Twitter. What Is Restless Legs Syndrome? Restless legs syndrome (RLS) is a disorder that causes a strong ... and to find better treatments. Rate This Content: Restless Legs Syndrome Clinical Trials Clinical trials are research studies that ...


Managing venous stasis disease and ulcers.  


Venous leg ulcers are arguably the most common type of venous ulcers seen in clinical practice. Compression therapy is the essential intervention in venous leg ulcer treatment, but coexisting arterial vascular insufficiency must be excluded before compression is initiated. No single topical dressing has been shown to be superior for all wounds. Venous leg ulcers are chronic and often difficult to heal, with only 40% to 70% healing after 6 months of treatment. Surgical procedures to reduce venous hypertension do not accelerate healing of a chronic ulcer, but trials suggest a decreased rate of future recurrence after surgery. PMID:23571036

Thomas, David R



[Ulcerative colitis caused by Histoplasma capsulatum in a patient with the acquired immunodeficiency syndrome].  


The authors report a case of ulcerative colitis due to Histoplasma capsulatum in a previously healthy 35 year-old french geologist with acquired immune deficiency syndrome (AIDS). Gomori-Grocott and PAS stains and indirect immunofluorescence revealed Histoplasma capsulatum in colonic biopsies. The search for LAV antibody was positive. T-lymphocyte analysis revealed 10/mm3 OKT4 with OKT4/OKT8 ratio of 0.16. Histoplasmosis should be considered in subjects with ulcerative colitis according to the epidemiological context. In patients with AIDS relapses after discontinuation of treatment are to be expected and suppressive therapy with an imidazole derivative should probably be continued indefinitely. PMID:3542685

Naveau, S; Roulot, D; Cartier, I; Blanchard, A; Poynard, T; Drouhet, E; Chaput, J C



Efficacy of a whey protein concentrate on the inhibition of stomach ulcerative lesions caused by ethanol ingestion.  


The purpose of this research was to test the ability of a whey protein concentrate (WPC) to inhibit gastric mucosal ulcerative lesions caused by oral administration to rats of absolute ethanol. Acute administration (single doses) of WPC resulted in 41% inhibition of the ulcerative lesion index (ULI), and 73% inhibition was obtained with repetitive doses. In a 10-days subchronic treatment study, the inhibition was 64%, all relative to a saline treatment (negative control). Alkylation of sulfhydryl compounds by subcutaneous injection of N-ethylmaleimide essentially eliminated the WPC protection. Treating the rats with an intraperitoneal injection of butathionine sulfoximine, which inhibits glutathione synthesis, reduced WPC protection to 35% and 52% for single and double doses, respectively. Taken as a whole, the results indicate that WPC does protect gastric mucosa from ethanol damage and that the protection depends on sulfhydryl compounds present in the WPC, including its capacity to stimulate glutathione synthesis. PMID:12639397

Rosaneli, C F; Bighetti, A E; Antônio, M A; Carvalho, J E; Sgarbieri, V C



Phytobezoars--an overlooked cause of small bowel obstruction following vagotomy and drainage operations for duodenal ulcer.  


Phytobezoar impaction is an important cause of small bowel obstruction in patients who have had previous vagotomy and drainage procedures for duodenal ulcer. Most cases present with typical symptoms and signs of small bowel obstruction, but in some there are no definite radiological signs of bowel obstruction on plain X-ray. In these the phytobezoar is often located by barium studies. Operation is required in the majority of cases and the phytobezoar milked into the large bowel or removed at enterotomy. Before laparotomy is performed, it is essential to endoscope these patients to avoid overlooking gastric phytobezoars which are easily removed via a gastrotomy at the time of the laparotomy. The incidence of phytobezoar obstruction will be reduced by the giving of simple dietary advice and by employing highly selective vagotomy whenever possible in the surgery of duodenal ulcer. PMID:3463292

Vellar, D J; Vellar, I D; Pucius, R; Steedman, P K



Antibiotic Resistance and Herbal Treatment of Bacterial Fish Pathogens Causing Epizootic Ulcerative Syndrome  

Microsoft Academic Search

In in vitro screenings of antibiotics against the two most commonly found opportunistic bacteria related to epizootic ulcerative syndrome of fishes—Aeromonas hydrophila (MTCC 646) and Pseudomonas fluorescens (MTCC 103)—gentamycin, ofloxacin, kanamycin, and tobramycin were effective. The antibacterial screening of plant extracts revealed that both aqueous and methanolic extract of Terminalia chebula, Polyalthia longifolia, Terminalia bellerica, and Phyllanthus emblica were sensitive

Anupam Ghosh; Bidus Kanti Das; Arup Roy; Goutam Chandra



Pneumoperitoneum caused by a perforated peptic ulcer in a peritoneal dialysis patient: Difficulty in diagnosis  

Microsoft Academic Search

Peritonitis due to viscus perforation in peritoneal dialysis (PD) patients can be catastrophic. We describe the first reported case of perforated peptic ulcer (PPU) in a PD patient. This 78-year-old man presented with a 1-day history of mild abdominal pain. He had been receiving nocturnal intermittent PD for 2 years and had ischemic heart disease and cirrhosis of the liver.

Jenq-Wen Huang; Yu-Sen Peng; Ming-Shiou Wu; Tun-Jun Tsai



Nocturnal leg cramps.  


Up to 60 percent of adults report that they have had nocturnal leg cramps. The recurrent, painful tightening usually occurs in the calf muscles and can cause severe insomnia. The exact mechanism is unknown, but the cramps are probably caused by muscle fatigue and nerve dysfunction rather than electrolyte or other abnormalities. Nocturnal leg cramps are associated with vascular disease, lumbar canal stenosis, cirrhosis, hemodialysis, pregnancy, and other medical conditions. Medications that are strongly associated with leg cramps include intravenous iron sucrose, conjugated estrogens, raloxifene, naproxen, and teriparatide. A history and physical examination are usually sufficient to differentiate nocturnal leg cramps from other conditions, such as restless legs syndrome, claudication, myositis, and peripheral neuropathy. Laboratory evaluation and specialized testing usually are unnecessary to confirm the diagnosis. Limited evidence supports treating nocturnal leg cramps with exercise and stretching, or with medications such as magnesium, calcium channel blockers, carisoprodol, or vitamin B(12). Quinine is no longer recommended to treat leg cramps. PMID:22963024

Allen, Richard E; Kirby, Karl A



Digital sucking induced trophic ulcers caused by nerve deficit from amniotic constriction band.  


Two infants presented with amniotic constriction bands (ACB) in the distal third of the forearm. After teeth eruption they developed recurrent skin ulcerations mainly in the distribution of the median nerve from digital sucking. Both patients underwent reconstruction with multiple Z-plasties, followed by neurolysis of the ulnar nerve and sural nerve grafting of the median nerve. This neurological complication presented late in ACB as ulcerative lesions and secondary infection from digital sucking on the insensate digits. Thorough physical examination of the extremities at an early stage in children with ACB is essential to exclude an occult neurological dysfunction. Exploration of peripheral nerves is warranted in cases of deep forearm ACB during their soft tissue reconstruction. PMID:20347623

Beidas, Omar; Rayan, Ghazi M; Al-Harthy, A



Colonization and population growth of Yellow-legged Gull Larus cachinnans in southeastern Poland: causes and influence on native species  

Microsoft Academic Search

The Yellow-legged Gull Larus cachinnans was first recorded in Poland in the 1980s. We analysed the probable factors responsible for its successful colonization of new areas. We also expected that such a large species should affect populations of other colonial waterbirds. We studied the breeding and feeding ecology in the largest inland colony of the Yellow- legged Gull in Poland,




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

USGS Publications Warehouse

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.

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



A prospective, multi-centre, randomised, open label, parallel, comparative study to evaluate effects of AQUACEL® Ag and Urgotul® Silver dressing on healing of chronic venous leg ulcers.  


This study compared wound healing efficacy of two silver dressings, AQUACEL(®) Ag and Urgotul(®) Silver, against venous ulcers at risk of infection, over 8 weeks of treatment. The primary objective was to show non inferiority of AQUACEL(®) Ag to Urgotul(®) Silver. Patients (281) were randomised into two groups. The AQUACEL(®) Ag group had 145 patients treated with AQUACEL(®) Ag for 4 weeks followed by AQUACEL for another 4 weeks. TheUrgotul(®) Silver group had 136 patients treated with Urgotul(®) Silver for 4 weeks followed by Urgotul(®) for another 4 weeks. In both groups, ulcer size and depth, safety events and ulcer healing were compared. After 8 weeks of treatment, the AQUACEL(®) Ag group had a relative wound size reduction (49·65% ± 52·53%) compared with the Urgotul(®) Silver group (42·81% ± 60·0%). The non inferiority of the AQUACEL(®) Ag group to the Urgotul(®) Silver group was established based on the difference between them (6·84% ± 56·3%, 95% confidence interval -6·56 to 20·2) and the pre-defined non inferiority margin (-15%). Composite wound healing analysis showed that the AQUACEL(®) Ag group had statistically higher percentage of subjects with better wound progression (66·9% versus 51·9%, P = 0·0108). In general, both dressings were effective at promoting healing of venous ulcers. PMID:22066961

Harding, Keith; Gottrup, Finn; Jawie?, Arkadiusz; Mikosi?ski, Jacek; Twardowska-Saucha, Krystyna; Kaczmarek, S?awomir; Sopata, Maciej; Shearman, Cliff; Pieronne, Alaine; Kommala, Dheerendra



Severe irritant contact dermatitis causing skin ulceration secondary to a testosterone patch.  


Testosterone replacement has undergone somewhat of a revolution in the past decade with the introduction of topical administration techniques, including patches and gels, as well as an increasing interest in the treatment of older men with low testosterone levels for what is now termed andropause. Increasingly, testosterone replacement therapy is being individually tailored. Side effects to skin patches have been reported with irritant contact dermatitis being the most common. However, ulceration has previously not been reported. Herein, we present a case that highlights testosterone transdermal therapies, their potential side effects and management strategies, and broadens our knowledge as we approach an era where these types of treatments are likely to be more common. PMID:19468653

Lawrentschuk, Nathan; Fleshner, Neil



Ulcerated Necrobiosis Lipoidica: A Combined Treatment Approach with Dermatosurgery and PUVA  

Microsoft Academic Search

Ulcerated necrobiosis lipoidica is one of the differential diagnoses in leg ulcers. The diagnosis is confirmed by histopathology. The authors report on a 68-year-old female patient with a history of chronic venous insufficiency who developed a chronic leg ulcer that did not respond to good ulcer care and compression bandaging. Skin biopsies revealed necrobiosis lipoidica. The patient was recently discovered

Erich Köstler; Uwe Wollina



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


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. PMID:23538597

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



Leg lymphedema caused by iliopectineal bursitis associated with destruction of a rheumatoid hip joint: A case report  

PubMed Central

The present study describes a case of leg lymphedema due to iliopectineal bursitis associated with rheumatoid arthritis (RA), which was satisfactorily controlled by surgery and combination therapy with methotrexate (MTX) and tacrolimus. A 68-year-old male, who had a six-year history of RA, developed an iliopectineal bursa associated with destruction of the hip joint. The mass gradually increased in size, and there was swelling in his right lower extremity. The patient was subsequently hospitalized with increasing right hip pain and leg edema. A colorless transparent lymph fluid leaked from his leg, and leg lymphedema was thus diagnosed. The patient also had a 20-year history of myelodysplastic syndrome. Therefore, the extensive or total resection of the bursa was considered to be too invasive, so a partial bursal excision was performed via an anterior approach. Following the partial bursal excision, total hip arthroplasty (THA) was performed using the Hardinge approach. The leg lymphedema disappeared following the surgery, and the iliopectineal bursa was no longer enlarged. MTX and tacrolimus were postoperatively administered to strictly control the RA. The RA was subsequently well controlled, without any increases in the levels of inflammatory markers, such as C-reactive protein and matrix metalloproteinase-3. This case demonstrated that iliopectineal bursitis was resolved following THA, without complete excision of the intrapelvic bursa, and that strict RA control led to a good clinical course without recurrent inflammation of the bursa. Similar procedures may be beneficial in other patients contraindicated for resection of the entire bursa.




Pneumoperitoneum caused by a perforated peptic ulcer in a peritoneal dialysis patient: difficulty in diagnosis.  


Peritonitis due to viscus perforation in peritoneal dialysis (PD) patients can be catastrophic. We describe the first reported case of perforated peptic ulcer (PPU) in a PD patient. This 78-year-old man presented with a 1-day history of mild abdominal pain. He had been receiving nocturnal intermittent PD for 2 years and had ischemic heart disease and cirrhosis of the liver. Pneumoperitoneum and peritonitis were documented, but the symptoms were mild. The "board-like abdomen" sign was not noted. Air inflation and contrast radiography indicated a perforation in the upper gastrointestinal tract, and laparotomy disclosed a perforation in the prepyloric great curvature. Unfortunately, the patient died during surgery. This case illustrates that the "board-like abdomen" sign may be absent in PD patients with PPU because of dilution of gastric acid by the dialysate. Free air in the abdomen, although suggestive of PPU, is also not uncommon in PD patients without viscus perforation. Because PD has to be discontinued after laparotomy and exploratory laparotomy may be fatal in high-risk patients, other diagnostic methods should be used to confirm viscus perforation before surgery. PPU, which can be proved by air inflation and contrast radiography, should be suspected in PD patients with pneumoperitoneum and peritonitis. PMID:10196037

Huang, J W; Peng, Y S; Wu, M S; Tsai, T J



Low body stores of iron and restless legs syndrome: a correctable cause of insomnia in adolescents and teenagers  

Microsoft Academic Search

Background: It has been shown that restless legs syndrome (RLS) in adults may be linked to abnormalities in iron stores. Whether reduced iron stores play a role in children is not clear.Methods: We evaluated the status of iron stores and sleep in three teenagers who presented with severe sleep onset insomnia, subjective sleep latency exceeding 60 min and excessive daytime

Meir H Kryger; Kazuo Otake; John Foerster



Dietary restriction causes chronic elevation of corticosterone and enhances stress response in red-legged kittiwake chicks  

Microsoft Academic Search

Release of corticosterone in hungry kittiwake chicks facilitates begging and allows them to restore depleted energy reserves by increasing parental food provisioning. However, in order to avoid detrimental effects of chronic elevation of corticosterone, chicks might suppress adrenocortical activity in response to prolonged food shortages. In this study we examined temporal dynamics of corticosterone release in red-legged kittiwake (Rissa brevirostris)

Alexander S. Kitaysky; Evgenia V. Kitaiskaia; John C. Wingfield; John F. Piatt



Biochemical changes in tissue catecholamines and serotonin in duodenal ulceration caused by cysteamine or propionitrile in the rat  

SciTech Connect

Previous structure-activity and pharmacologic studies with duodenal ulcerogens cysteamine and propionitrile implicating catecholamines in the pathogenesis of duodenal ulceration have now been followed up by dose- and time-response biochemical investigations to assess the importance of monoamines in the development of duodenal ulcers. The concentrations of norepinephrine (noradrenaline), dopamine, serotonin and their metabolites were measured in total brain, brain regions, stomach, duodenum, pancreas and adrenals in the rat. Turnover of catecholamines was determined in rats pretreated with the inhibitor of tyrosine hydroxylase alpha-methyl-p-tyrosine. The duodenal ulcerogens caused a dose- and time-dependent depletion of norepinephrine in virtually all the tissues examined. The effect was maximal 4 or 7 hr after cysteamine or propionitrile, and norepinephrine levels returned to normal in 24 hr. Dopamine changes were selective and often biphasic, e.g., elevation in adrenals, biphasic in brain cortex, hippocampus and midbrain, but uniformly decreasing in glandular stomach and duodenum. In the median eminence dopamine levels decreased by 181 and 324% at 15 and 30 min, respectively, after cysteamine, but neither dopamine nor 3,4-dihydroxyphenylacetic acid was modified in the periventricular nucleus. Serotonin levels were relatively stable, revealing slight elevations or no changes in most of the tissues. The turnover of norepinephrine was accelerated by both chemicals in virtually all brain regions, but dopamine turnover was affected only in a few areas, e.g., in the corpus striatum and medulla oblongata cysteamine decreased dopamine turnover, whereas propionitrile first (at 1 hr) accelerated then (at 8 hr) significantly suppressed it.(ABSTRACT TRUNCATED AT 250 WORDS)

Szabo, S.; Horner, H.C.; Maull, H.; Schnoor, J.; Chiueh, C.C.; Palkovits, M.



A novel, non-invasive diagnostic clinical procedure for the determination of an oxygenation status of chronic lower leg ulcers using peri-ulceral transcutaneous oxygen partial pressure measurements: results of its application in chronic venous insufficiency (CVI).  


The basis for the new procedure is the simultaneous transcutaneous measurement of the peri-ulceral oxygen partial pressure (tcPO(2)), using a minimum of 4 electrodes which are placed as close to the wound margin as possible, additionally, as a challenge the patient inhales pure oxygen for approximately 15 minutes. In order to evaluate the measurement data and to characterise the wounds, two new oxygen parameters were defined: (1) the oxygen characteristic (K-PO(2)), and (2) the oxygen inhomogeneity (I-PO(2)) of a chronic wound. The first of these is the arithmetic mean of the two lowest tcPO(2) measurement values, and the second is the variation coefficient of the four measurement values. Using the K-PO(2) parameter, a grading of wound hypoxia can be obtained. To begin with, the physiologically regulated (and still compensated) hypoxia with K-PO(2) values of between 35 and 40 mmHg is distinguished from the pathological decompensated hypoxia with K-PO(2) values of between 0 and 35 mmHg; the first of these still stimulates self-healing (within the limits of the oxygen balance). The decompensated hypoxia can be (arbitrarily) divided into "simple" hypoxia (Grade I), intense hypoxia (Grade II) and extreme hypoxia (Grade III), with the possibility of intermediate grades (I/II and II/III).Measurements were carried out using the new procedure on the skin of the right inner ankle of 21 healthy volunteers of various ages, and in 17 CVI (chronic venous insufficiency) wounds. Sixteen of the 17 CVI wounds (i.e., 94%) were found to be pathologically hypoxic, a state which was not found in any of the healthy volunteers. The oxygen inhomogeneity (I-PO(2)) of the individual chronic wounds increased exponentially as a function of the hypoxia grading (K-PO(2)), with a 10-fold increase with extreme hypoxia in contrast to a constant value of approximately 14% in the healthy volunteers. This pronounced oxygen inhomogeneity explains inhomogeneous wound healing, resulting in the so-called mosaic wounds. The hypoxia grades found in all of the chronic wounds was seen to be evenly distributed with values ranging from 0 to 40 mmHg, and therefore extremely inhomogeneous. In terms of oxygenation, chronic wounds are therefore inhomogeneous in two respects: (1) within the wound itself (intra-individual wound inhomogeneity) and (2) between different wounds (inter-individual wound inhomogeneity). Due to the extreme oxygen inhomogeneity, single measurements are not diagnostically useful. In healthy individuals the oxygen inhalation challenge (see above) results in synchronised tcPO(2) oscillations occurring at minute rhythms, which are not seen in CVI wounds. These oscillations can be interpreted as a sign of a functioning arterial vasomotor system.The new procedure is suitable for the routine characterisation of chronic wounds in terms of their oxygen status, and correspondingly, their metabolically determining (and limiting) potential for healing and regeneration. The oxygen characteristic K-PO(2) can furthermore be used as a warning of impending ulceration, since the oxygen provision worsens over time prior to the demise of the ulcerated tissue, thus making a controlled prophylaxis possible. PMID:22737104

Barnikol, Wolfgang K R; Pötzschke, Harald



Rebamipide Prevents Delay of Acetic Acid-Induced Gastric Ulcer Healing Caused by Helicobacter pylori Infection in Mongolian Gerbils  

Microsoft Academic Search

In this study, we examined the effect of rebamipide, a mucoprotective drug, on gastric ulcer healing in Mongolian gerbils infected with H. pylori. Male Mongolian gerbils were inoculated with H. pylori or vehicle alone 12 hr after the production of an acetic acid-induced gastric ulcer. On day 5, the gerbils inoculated with H. pylori were divided into three groups and

Toshio Watanabe; Kazuhide Higuchi; Masaki Hamaguchi; Tetsuya Tanigawa; Rikimon Wada; Kazunari Tominaga; Yasuhiro Fujiwara; Tetsuo Arakawa



[Ulcerated plaques of the aorta as a cause of ischaemic stroke].  


Stroke is a second cause of mortality worldwide and a leading cause of acquired disability in adults. Approximately 20% of all ischaemic strokes are of cardioembolic origin. We present a case of a 60-year-old man with a history of stroke without changes in carotid and vertebral arteries. Echocardiography exam revealed patent foramen ovale (PFO) and abnormal echos in the aorta that were verified as advanced complex atheromas by computed tomography. Due to small size PFO was deemed insignificant and the source of embolism were most probably aortic atheromas. Patient was put on acenocumarol, aspirin and statin. PMID:22623252

Rybicka, Justyna; Kowalski, Miros?aw; Micha?owska, Ilona; Hoffman, Piotr



Mucormycosis Caused byRhizopus microsporusvar.microsporus: Cellulitis in the Leg of a Diabetic Patient Cured by Amputation  

Microsoft Academic Search

Mucormycosis accompanied the development of bacterial infection in the leg of a diabetic African-American man. Local injury, diabetic ketoacidosis, renal insufficiency, and antimicrobial therapy were factors that con- tributedtothepathogenesisofthemucormycosis.ThecellulitiswascausedinpartbyRhizopusmicrosporusvar. microsporusandwascuredbyamputation.Wereportthisunusualcaseofmucormycosistoemphasizethevalue of fungal identification, to illustrate a dramatic and successful clinical result, and to draw attention to an apparentroleforbacterialinfectionanditstreatmentinthepathogenesisofmucormycosis.Itisthethirdcase report of mucormycosis in a human in whichR. microsporusvar.microsporuswas definitively identified as




Pterygotus legs  

NSDL National Science Digital Library

Eurypterids have a pair of paddle-like swimming legs located at the back edge of the head. These legs are connected to the body by toothplates or "gnathobases." The toothplates border a slit-like mouth and are lined by teeth. The large slab pictured above (also from Passage Gulf, NY) contains a complete swimming leg (center) connected to a partial toothplate (upper right) and another partial toothplate (lower center) with a series of thorn-like teeth (left side).



Functional fatigue of the hip and ankle musculature cause similar alterations in single leg stance postural control.  


Isokinetic fatigue protocols have been used to determine the relative importance of lower extremity musculature to the maintenance of balance. However, these protocols are not representative of physical activity, thus the recommendations based on these findings may be inappropriate. Therefore, purpose of this investigation was to use a completely within subjects design to examine the effects of a functional ankle and hip fatigue protocol on postural control during single leg stance. All testing was completed in a health and wellness facility where 18 healthy recreationally active university students (nine female, nine male: 21.2+/-1.96 years, 72.2+/-17.8 kg, 170.4+/-10.12 cm) volunteered to participate. Testing consisted of functionally fatiguing the ankle plantar flexors and dorsiflexors as well as the hip flexors and extensors. Postural control was assessed with two pre- and post-fatigue 20s trials during single leg stance. Three measures of dynamic balance: the overall, medial/lateral, and anterior/posterior stability index were calculated using the Biodex Stability System at stability level 4. Three separate 2-way repeated measure ANOVAs indicated that fatigue of both the ankle (plantar flexors, dorsiflexors) and hip (flexors, extensors) musculature led to postural control impairments for the medial-lateral stability index (p<0.01), and anterior-posterior stability index (p<0.01). However, only ankle fatigue resulted in deficits in the overall stability index were (p<0.01). Furthermore, neither fatigue protocol impaired single leg stance postural control more than the other (p>0.05). Our results contradict previous isokinetic fatigue protocol findings, which indicate that proximal musculature fatigue results in greater postural control deficits. PMID:19342297

Reimer, Robert C; Wikstrom, Erik A



Hunner's Ulcers  


Hunner's Ulcers Hunner's ulcers, also called "Hunner’s lesions" or "Hunner's patches," are a subtype of interstitial cystitis (also called IC) and are not ulcers in the usual sense. They are distinctive areas ...


Benefit of a 2Month Treatment with a Micronized, Purified Flavonoidic Fraction on Venous Ulcer Healing  

Microsoft Academic Search

Objective: To assess the efficacy of a micronized purified flavonoid fraction (Daflon 500 mg = Dios) in venous leg ulcer healing, in addition to compression therapy and standardized local care. Design: Double-blind, multicentre, randomized, parallel groups, controlled versus placebo trial; stratification according to ulcer size. Subjects: 107 patients, with venous ulcer of the leg for at least 3 months, and

J.-J. Guilhou; F. Février; C. Debure; D. Dubeaux; M.-N. Gillet-Terver; B. Guillot; H. Levesque; L. Marzin; J. Mignot; P. Ouvry; G. Pillion; H. Van Landuyt; F. Zuccarelli; A. N. Nicolaïdes



Helicobacter pylori infection and peptic ulcers  

Microsoft Academic Search

Nearly all peptic ulcers are caused by either Helicobacter pylori infection or non-steroidal inflammatory drug (NSAID) use, including aspirin. As H. pylori infection is becoming less prevalent in developed countries, NSAIDs are an increasingly important cause of ulceration, particularly ulcers complicated by bleeding. Only about 15% of H. pylori-infected people develop an ulcer in their lifetime; virulence of the H.

Debabrata Majumdar; James Bebb; John Atherton



[Two wooden legs.  


The physical aids of a one-legged male farmhand, a cane, a crutch and two wooden legs, are preserved at the local history museum Hnjótur in the West Fjords of Iceland, along with a number of his everyday possessions. The older wooden leg was made by a farmer in the year 1910 and the younger by a machinist in 1935. There is no proof that either of the builders had any special knowledge or a model to follow but comparison with similar wooden legs in use on the Continent indicates some foreign influence on the construction of the Icelandic wooden legs. Each leg was used for at least 25 years, one after the other. The older leg shows signs of much wear but the younger one is in good shape. Most important for the life-time of an artificial leg is that the body weight should rest in balance over the centre of the wooden peg and that the weight does not fall outside the longitudinal axis of the peg. The medical history of the patient concerned was investigated, and compared with the tale which circulated locally, which claimed that wearing fisherman's boots which were too tight had caused the injury to his foot. The medical records of the hospital reveal, however, that the ankle was infected with tuberculosis. An attempt was made to treat this by resecting the ankle joint, which is likely to have been only the second time that such an operation was performed in Iceland. Gangrene developed in the surgical area and the leg had to be amputated. PMID:20065443

Olason, Atli Thor



Remote wound monitoring of chronic ulcers  

Microsoft Academic Search

Chronic wounds or ulcers are wounds that do not heal in the usual manner. This type of wound is most common in the elderly and in paraplegic patients with an estimated 1% of the population suffering from leg ulcers and the costs adding up to 4% of the annual National Health Service budget in the U.K. There is an identified

Sonja A. Weber; Niall Watermann; Jacques Jossinet; J. Anthony Byrne; Jonquille Chantrey; Shabana Alam; Karen So; Jim Bush; Sharon O'Kane; Eric T. McAdams



A rare cause of severe periorbital edema and dermonecrotic ulcer of the eyelid in a child: brown recluse spider bite.  


Spider bites are a worldwide problem. Brown recluse spider bites can lead to severe local or systemic clinical effects, such as edema, necrotic ulcer, rashes, fever, chills, nausea, vomiting, malaise, arthralgia, myalgia, hemolysis, leukocytosis, disseminated intravascular coagulation, renal failure, and death. Eyelid bites from brown recluse spiders are rare. We report a child with severe facial edema and a dermonecrotic ulcer on the eyelid. Upon laboratory examination, leukocytosis with a significant left shift was detected. The patient was treated with antibiotics, systemic corticosteroid and conservative therapy that included saline compresses and ocular lubrication. No surgical excision was required. Vision was not impaired. A dermonecrotic ulcer is a severe complication of brown recluse spider bites. Since the diagnosis is difficult, clinical and epidemiological findings and a detailed history are important for an accurate diagnosis. PMID:21534346

Ta?kesen, Mustafa; Akdeniz, Sedat; Ta?, Ta?kin; Keklikçi, U?ur; Ta?, Mehmet Ali


Venogram - leg  


... failure, especially in the elderly or persons with diabetes who take the medicines Glucophage or metformin Worsening of a clot in the leg vein There is low radiation exposure; however, most experts feel that the risk ...


Leg muscles  

NSDL National Science Digital Library

Like many areas of the body, the legs contain bones, muscles, tendons, and ligaments. All of these are needed for movement. Muscles contract and lengthen as movement occurs. Muscles become shorter when they contract.

Uwe Gille (None;)



Application of Brookhaven National Laboratory's hot particle methodology for determining the most effective beta particle energy in causing skin ulcers.  

National Technical Information Service (NTIS)

The purpose of this project was to compare the effectiveness of hot particles with different energy betas in producing ulcers on skin. The sources were man-made hot particles similar in size and activity to those found in the commercial nuclear power indu...

C. Schaefer



Wet litter as a cause of plantar pododermatitis, leading to foot ulceration and lameness in fattening turkeys  

Microsoft Academic Search

Spraying water to produce wet litter increased the severity and incidence of plantar pododermatitis in two commercial strains of fattening turkeys. A clinical syndrome resembling “shaky leg” was also produced. In one experiment breast blisters, scabby hocks and a depression of final body weight were seen.

M. F. Martland




PubMed Central

Foot and leg cramps are among the most frequent complaints presented by patients of both sexes, especially older persons. Similar cramping may occur in the thighs or in other skeletal muscles of the extremities and trunk. Foot and leg cramps usually occur after unusual exertion or during sleep. “Nocturnal leg cramps” may be of sufficient intensity to prevent sleep. “Pregnancy cramps” are particularly distressing. Effective treatment of foot and leg cramps requires an understanding of the etiology, pathophysiology and diagnostic techniques. Weight reduction and improved diet are essential. Among the useful supplementary medications are calcium lactate or gluconate, vitamin-mineral supplements, sympathetic blocking agents, vasodilators, ataraxics, muscle relaxants, quinine, hydrochloride, antihistamines, and nonmercurial diuretics. Improved foot care and correction of foot imbalance is usually required. Edema and venous insufficiency are improved by elastic support, by repeated foot elevation for massages, by manipulations and exercises and by the use of diuretics. There may be need for operations on the veins and for sclerotherapy. Patients with arterial insufficiency are often benefited by lumbar sympathetic blocks with long-acting anesthetics and intra-arterial injections with relaxants, vasodilators, thrombolytic enzymes and anticoagulants. Sympathectomy, angiography and reconstructive arterial operations are indicated in only a small proportion of patients with foot and leg cramps.

Fields, Albert



Canker Sore (Aphthous Ulcer)  


... or aphthae, are the most common cause of periodic (recurring) ulcers inside the mouth and genital linings ( ... Dec 2008 Information for other ages: Child Teen Table of Contents: Overview Who's At Risk Signs and ...


Peptic Ulcer  


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


Capsaicin and gastric ulcers.  


In recent years, infection of the stomach with the organism Helicobacter Pylori has been found to be the main cause of gastric ulcers, one of the common ailments afflicting humans. Excessive acid secretion in the stomach, reduction in gastric mucosal blood flow, constant intake of non-steroid anti-inflammatory drugs (NSAIDS), ethanol, smoking, stress etc. are also considered responsible for ulcer formation. The prevalent notion among sections of population in this country and perhaps in others is that "red pepper" popularly known as "Chilli," a common spice consumed in excessive amounts leads to "gastric ulcers" in view of its irritant and likely acid secreting nature. Persons with ulcers are advised either to limit or avoid its use. However, investigations carried out in recent years have revealed that chilli or its active principle "capsaicin" is not the cause for ulcer formation but a "benefactor." Capsaicin does not stimulate but inhibits acid secretion, stimulates alkali, mucus secretions and particularly gastric mucosal blood flow which help in prevention and healing of ulcers. Capsaicin acts by stimulating afferent neurons in the stomach and signals for protection against injury causing agents. Epidemiologic surveys in Singapore have shown that gastric ulcers are three times more common in the "Chinese" than among Malaysians and Indians who are in the habit of consuming more chillis. Ulcers are common among people who are in the habit of taking NSAIDS and are infected with the organism "Helicobacter Pylori," responsible for excessive acid secretion and erosion of the mucosal layer. Eradication of the bacteria by antibiotic treatment and avoiding the NSAIDS eliminates ulcers and restores normal acid secretion. PMID:16621751

Satyanarayana, M N



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

PubMed Central

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.

Oe, Keisuke; Miwa, Masahiko; Kurosaka, Masahiro



Capsaicin and Gastric Ulcers  

Microsoft Academic Search

In recent years, infection of the stomach with the organism Helicobacter Pylori has been found to be the main cause of gastric ulcers, one of the common ailments afflicting humans. Excessive acid secretion in the stomach, reduction in gastric mucosal blood flow, constant intake of non-steroid anti-inflammatory drugs (NSAIDS), ethanol, smoking, stress etc. are also considered responsible for ulcer formation.The

M. N. Satyanarayana



Helicobacter pylori infection and peptic ulcers  

Microsoft Academic Search

Nearly all peptic ulcers are caused by either Helicobacter pylori infection or non-steroidal inflammatory drug (NSAID) use, including aspirin. As H. pylori infection is becoming less prevalent in developed countries, NSAIDs are an increasingly important cause of ulceration, particularly ulcers complicated by bleeding. Only about 15% of H. pylori-infected people develop an ulcer in their lifetime; virulence of the H. pylori

Debabrata Majumdar; James Bebb; John Atherton



Ulcerative sarcoidosis.  


Sarcoidosis is a multi-system, granulomatous disease, which affects the skin in approximately 20 to 30 percent of cases. Recognition of cutaneous sarcoidosis can be challenging because of the wide range of skin lesion morphologies. Ulcerative sarcoidosis is uncommon. We present a 35-year-old woman with pretibial ulcerative sarcoidosis, indurated tattoos, and hilar lymphadenopathy. PMID:23286819

Hunt, Raegan D; Gonzalez, Mercedes E; Robinson, Maria; Meehan, Shane A; Franks, Andrew G



Novel posterior splinting technique to avoid heel ulcers.  


Heel ulcers are a costly and preventable complication of lower-extremity immobilization, but they still occur with some regularity. A technique using a short leg posterior splint that suspends the heel away from the splint is described. This modification completely removes pressure the heel to prevent decubitus ulcer formation. This technique is simple, inexpensive, and effective. PMID:23276331

Hsu, Raymond Y; Lareau, Craig R; Born, Christopher T



Operations Resumes, LEG 45 through LEG 54.  

National Technical Information Service (NTIS)

This Report tells about operational and engineering procedures used aboard D/V Glomar Challenger from Leg 45 through Leg 54. This Technical Report, the first covering some of the International Phase of Ocean Drilling (IPOD) cruises, gives performance achi...

T. Wiley




Microsoft Academic Search

We report a prospective study of the causes and treatment of 26 long-standing neuropathic ulcers of the foot in 21 patients. The most important causal factor, well illustrated by pressure studies, was the presence of a dynamic or static deformity leading to local areas of peak pressure on insensitive skin. All but one of the 26 ulcers had healed after



Preventing Decubitus Ulcers with Cotton Sheeting Systems  

Technology Transfer Automated Retrieval System (TEKTRAN)

Decubitus pressure ulcers are a worldwide health crisis and their prevention and treatment has become a national priority. The National Pressure Ulcer Advisory Board estimates that as many as three million people in the United States have pressure ulcers. The causes of the ailment include both extr...


Approach to skin ulcers in older patients  

Microsoft Academic Search

OBJECTIVE To provide family physicians with an approach to managing skin ulcers in older patients. SOURCES OF INFORMATION Clinical practice guidelines and best practice guidelines were summarized to describe an evidence-based approach. MAIN MESSAGE Preventing ulcers is important in frail older patients. Using guidelines can help prevent ulcers in institutions. Clarifying the cause and contributing factors is the fi rst

Christopher Frank



Practice Recommendations for Preventing Heel Pressure Ulcers  

Microsoft Academic Search

Heels are the second most common anatomical location for pressure ulcers. A combination of risk factors, including pressure, may cause ulceration. Heel pressure ulcers are a particular concern for surgical patients. A review of the literature, including poster presentations, shows that controlled clinical studies to assess the effectiveness and cost-effectiveness of available interventions are not available. Case series (with or

Evonne Fowler; Suzy Scott-Williams; James B. McGuire


Lipschütz [corrected] ulcers--four cases.  


A distinctive clinical entity of acute genital ulcers occurring in adolescents, with nonvenereal infectious etiology was described by Lipschütz in 1913. We describe four puberal virgin girls who developed fever and painful genital ulcers. The main causes infectious and noninfectious of ulceration were rejected. Although the etiology is unknown, recent cases related with Epstein-Barr virus acute infection have been reported. PMID:18577045

Hernández-Núñez, Almudena; Córdoba, Susana; Romero-Maté, Alberto; Miñano, Román; Sanz, Tatiana; Borbujo, Jesús


Management of Chronic Pressure Ulcers  

PubMed Central

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, 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 Objective The Medical Advisory Secretariat (MAS) conducted a systematic review on interventions used to treat pressure ulcers in order to answer the following questions: Do currently available interventions for the treatment of pressure ulcers increase the healing rate of pressure ulcers compared with standard care, a placebo, or other similar interventions? Within each category of intervention, which one is most effective in promoting the healing of existing pressure ulcers? Background A pressure ulcer is a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in conjunction with shear and/or friction. Many areas of the body, especially the sacrum and the heel, are prone to the development of pressure ulcers. People with impaired mobility (e.g., stroke or spinal cord injury patients) are most vulnerable to pressure ulcers. Other factors that predispose people to pressure ulcer formation are poor nutrition, poor sensation, urinary and fecal incontinence, and poor overall physical and mental health. The prevalence of pressure ulcers in Ontario has been estimated to range from a median of 22.1% in community settings to a median of 29.9% in nonacute care facilities. Pressure ulcers have been shown to increase the risk of mortality among geriatric patients by as much as 400%, to increase the frequency and duration of hospitalization, and to decrease the quality of life of affected patients. The cost of treating pressure ulcers has been estimated at approximately $9,000 (Cdn) per patient per month in the community setting. Considering the high prevalence of pressure ulcers in the Ontario health care system, the total cost of treating pressure ulcers is substantial. Technology Wounds normally heal in 3 phases (inflammatory phase, a proliferative phase of new tissue and matrix formation, and a remodelling phase). However, pressure ulcers often fail to progress past the inflammatory stage. Current practice for treating pressure ulcers includes treating the underlying causes, debridement to remove necrotic tissues and contaminated tissues, dressings to provide a moist wound environment and to manage exudates, devices and frequent turning of patients to provide pressure relief, topical applications of biologic agents, and nutritional support to correct nutritional deficiencies. A variety of adjunctive physical therapies are also in use. Method Health technology assessment databases and medical databases were searched from 1996 (Medline), 1980 (EMBASE), and 1982 (CINAHL) systematically up to March 2008 to identify randomized controlled trials (RCTs) on the following treatments of pressure ulcers: cleansing, debridement, dressings, biological therapies, pressure-relieving devices, physical therapies, nutritional therapies, and multidisciplinary wound care teams. Full literature search strategies are reported in appendix 1. English-language studies in previous systematic reviews and studies published since the last systematic review were included if they had more than 10 subjects, were randomized, and provided objective outcome measures on the healing of pressure ulcers. In the absence of RCTs, studies of the highest level of evidence available were included. Studies on wounds other than pressure ulcers and on surgical treatment of pressure ulcers were excluded. A total of 18 systematic reviews, 104 RCTs, and 4 observational



Peptic Ulcer.  

National Technical Information Service (NTIS)

Explains that the ulcer is a disease of modern man. Dr. Dennis McCarthy, Specialist with the National Institute of Arthritis, Metabolism, and Digestive Diseases, discusses the reasons for its prevalence. He analyzes the differences between gastric and duo...



Restless Legs Syndrome  


NINDS Restless Legs Syndrome Information Page Condensed from Restless Legs Syndrome Fact Sheet Table of Contents (click to jump to sections) ... Trials Organizations Additional resources from MedlinePlus What is Restless Legs Syndrome? Restless legs syndrome (RLS) is a neurological disorder ...


Giant duodenal ulcers  

Microsoft Academic Search

Giant duodenal ulcers (GDU) have been associated with a high incidence of morbidity and mortality unless early operative intervention is undertaken. There are few published reports of successful medical management of GDU. Therefore, we reviewed 14 consecutive patients with GDU at our institution. Excluding the following cases: Two patients who had elective surgery, two patients who died from unrelated causes,

Richard Jaszewski; Steven A. Crane; Arturo A. Cid



Modelling of oedemous limbs and venous ulcers using partial differential equations  

PubMed Central

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.

Ugail, Hassan; Wilson, Michael J



Leg Problems  


... the bone. These injuries are often caused by overuse during physical activity. Get plenty of rest and ... of the bone). Apply mild heat and an antibiotic ointment. Call your doctor if you have a ...


Restless Legs  


... pregnancy. Some medicines can also cause temporary RLS. Caffeine, tobacco, and alcohol may make symptoms worse. Lifestyle changes, such as regular sleep habits, relaxation techniques, and moderate exercise during the day can help. If those don't work, medicines may reduce the symptoms of RLS. Most ...


Aphthous ulcers (recurrent)  

PubMed Central

Introduction Most people with recurrent aphthous ulcers develop a few ulcers less than 1 cm in diameter, that heal after 5 to 14 days without scarring. The causes are unknown, but risks of recurrence may decrease if the person gives up smoking. Local physical trauma may trigger ulcers in susceptible people. In 10% of sufferers, lesions are more than 1 cm in diameter, and can cause scarring. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for recurrent aphthous ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2006 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 18 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: analgesics (local), carbenoxolone mouthwash, chlorhexidine (and similar agents), corticosteroids (topical), and tetracycline antibiotic mouthwash.



Dynamically Stable Legged Locomotion.  

National Technical Information Service (NTIS)

Though vehicles that use legs for locomotion promise superior mobility and versatility, very little is known about their design and control. Balance, resonance, and dynamic control are key issues underlying high performance legged systems, both man-made a...

M. H. Raibert H. B. Brown M. Chepponis E. Hastings S. E. Shreve



Dynamically Stable Legged Locomotion.  

National Technical Information Service (NTIS)

Humans and animals use their legs to locomote with great mobility, but we do not yet have a full understanding of how they do so. One sign of our ignorance is the lack man-made vehicles that use legs to obtain high mobility. A legged vehicle might someday...

M. H. Raibert H. B. Brown M. Chepponis E. Hastings S. S. Murthy



Discriminant value of dyspeptic symptoms: a study of the clinical presentation of 221 patients with dyspepsia of unknown cause, peptic ulceration, and cholelithiasis.  

PubMed Central

This study aims to determine whether the features of dyspepsia can discriminate a subgroup of patients who present with non-ulcer dyspepsia from other diagnostic categories. The following groups were studied: One hundred and thirteen patients with endoscopically confirmed non-ulcer dyspepsia in the absence of clinical, biochemical or radiological evidence of other gastrointestinal diseases or disorders, termed essential dyspepsia; Fifty five patients with symptomatic and endoscopically proven peptic ulceration (32 duodenal ulcers, 23 gastric ulcers); Fifty three patients admitted to hospital with biliary pain and cholelithiasis without other lesion at laparotomy. All patients completed a structured history questionnaire at personal interview. Stepwise logistic regression analysis was done on 19 predefined variables to determine if one or more of these could discriminate between the diagnostic categories. The results suggest that certain groups of symptoms may be of diagnostic value, but many are not. Upper abdominal pain aggravated by food or milk, pain severity, night pain, vomiting, weight loss, and age significantly discriminated essential dyspepsia from the other diagnostic categories. A scoring system was established based on these discriminating symptoms. Using the weighted score, at a sensitivity of 57%, the specificity for a diagnosis of essential dyspepsia was 94%, but only prospective studies will determine if this scoring system is of actual clinical value.

Talley, N J; McNeil, D; Piper, D W



Poison ivy on the leg (image)  


This is a typical early appearance of a poison ivy rash, located on the leg. These early lesions ... line where the skin has brushed against the poison ivy plant. The rash is caused by skin contact ...


Ulcerative colitis.  


Ulcerative colitis is an idiopathic, chronic inflammatory disorder of the colonic mucosa, which starts in the rectum and generally extends proximally in a continuous manner through part of, or the entire, colon; however, some patients with proctitis or left-sided colitis might have a caecal patch of inflammation. Bloody diarrhoea is the characteristic symptom of the disease. The clinical course is unpredictable, marked by alternating periods of exacerbation and remission. In this Seminar we discuss the epidemiology, pathophysiology, diagnostic approach, natural history, medical and surgical management, and main disease-related complications of ulcerative colitis, and briefly outline novel treatment options. Enhanced understanding of how the interaction between environmental factors, genetics, and the immune system results in mucosal inflammation has increased knowledge of disease pathophysiology. We provide practical therapeutic algorithms that are easily applicable in daily clinical practice, emphasising present controversies in treatment management and novel therapies. PMID:22914296

Ordás, Ingrid; Eckmann, Lars; Talamini, Mark; Baumgart, Daniel C; Sandborn, William J



[Restless-legs syndrome].  


Restless-legs syndrome (RLS) is a sensorimotor disorder, characterized by an irresistible urge to move the legs usually accompanied or caused by uncomfortable and unpleasant sensations. It begins or worsens during periods of rest or inactivity, is partially or totally relieved by movements and is exacerbated or occurs at night and in the evening. RLS sufferers represent 2 to 3% of the general population in Western countries. Supportive criteria include a family history, the presence of periodic-leg movements (PLM) when awake or asleep and a positive response to dopaminergic treatment. The RLS phenotypes include an early onset form, usually idiopathic with a familial history and a late onset form, usually secondary to peripheral neuropathy. Recently, an atypical RLS phenotype without PLM and l-DOPA resistant has been characterized. RLS can occur in childhood and should be distinguished from attention deficit/hyperactivity disorder, growing pains and sleep complaints in childhood. RLS should be included in the diagnosis of all patients consulting for sleep complaints or discomfort in the lower limbs. It should be differentiated from akathisia, that is, an urge to move the whole body without uncomfortable sensations. Polysomnographic studies and the suggested immobilization test can detect PLM. Furthermore, an l-DOPA challenge has recently been validated to support the diagnosis of RLS. RLS may cause severe-sleep disturbances, poor quality of life, depressive and anxious symptoms and may be a risk factor for cardiovascular disease. In most cases, RLS is idiopathic. It may also be secondary to iron deficiency, end-stage renal disease, pregnancy, peripheral neuropathy and drugs, such as antipsychotics and antidepressants. The small-fiber neuropathy can mimic RLS or even trigger it. RLS is associated with many neurological and sleep disorders including Parkinson's disease, but does not predispose to these diseases. The pathophysiology of RLS includes an altered brain-iron metabolism, a dopaminergic dysfunction, a probable role of pain control systems and a genetic susceptibility with nine loci and three polymorphisms in genes serving developmental functions. RLS treatment begins with the elimination of triggering factors and iron supplementation when deficient. Mild or intermittent RLS is usually treated with low doses of l-DOPA or codeine; the first-line treatment for moderate to severe RLS is dopaminergic agonists (pramipexole, ropinirole, rotigotine). In severe, refractory or neuropathy-associated RLS, antiepileptic (gabapentin, pregabalin) or opioid (oxycodone, tramadol) drugs can be used. PMID:18656214

Karroum, E; Konofal, E; Arnulf, I



Another 'Cushing ulcer'  

PubMed Central

The authors describe the case of a 39-year-old man who presented to our hospital with easy fatigability and malaise. On physical examination, hypertension was noted without any cushingoid appearance. Laboratory testing revealed normochromic-normocytic anaemia with positive results of occult blood in the stool, hyperglycaemia and hypokalemia. Upper endoscopy revealed active gastric ulcer with Helicobacter pylori infection, likely causing gastrointestinal bleeding. Endocrine examinations showed that both serum adrenocorticotropic hormone and cortisol were elevated with loss of diurnal variation. A diagnosis of Cushing’s disease secondary to pituitary adenoma was made as results of brain MRI and blood sampling from inferior petrosal sinus. In a patient with peptic ulcer disease, physician should be alert to the possible endocrine background.

Hoshino, Chisho; Satoh, Noriyuki; Narita, Masashi; Kikuchi, Akio; Inoue, Minoru



[Ulcerative colitis].  


Ulcerative colitis (UC) is a prevalent inflammatory bowel disease of the colonic mucosa affecting approximately 20,000-25,000 Danes. Apart from subgroups with early onset, extensive and long-standing inflammation, or primary sclerosing cholangitis the risk of developing colorectal cancer is of the same magnitude as in the background population. The symptoms are usually diarrhoea including bloody stools, rectal tenesmi, anaemia, and fatigue. This review is an update on diagnostics and treatment strategies of relevance for clinicians, and as UC often affects patients during their peak reproductive years, emphasis is additionally put on the management of pregnant patients with UC. PMID:23663396

Nielsen, Ole Haagen; Jess, Tine; Bjerrum, Jacob Tveiten; Seidelin, Jakob B



Distally based sural flap in treatment of chronic venous ulcers.  


The treatment of venous ulcers of the leg often fails to heal because venous ulcers are mostly associated with severe lipodermatosclerosis. These complicated ulcers may require correction of local hemodynamics, excision of ulcer with surrounding lipodermatosclerotic skin, and replacement of the defect with healthy tissue. We present our experience with the use of the distally based sural flaps for the reconstruction of soft-tissue defects of the distal region of the lower limb in patients with chronic venous ulcer. Between 2001 and 2003, 12 patients with venous ulceration were treated with distally based sural flaps. At operation, the ulcer and its surrounding lipodermatosclerotic skin were excised. The defects after excision ranged from 3 x 3 to 11 x 17 cm. The distally based sural artery flap was inset within the defect. In all patients, the flap survived completely, and in only 1 patient, distal venous congestion was seen and was treated successfully with leeches. There was donor site skin graft loss in 2 patients. Two flaps had minor local complications that healed with local wound care. No recurrent ulcers were identified after average 19.7 months. In conclusion, the distally based sural flaps can be used reliably for treatment of venous ulcers. Our approach in treatment of chronic venous ulcers improves venous hemodynamics and provides local flap alternative that should be considered prior to a free-flap transfer for closure of the defect. PMID:16034246

Top, Husamettin; Benlier, Erol; Aygit, A Cemal; Kiyak, Medeni



Approach to skin ulcers in older patients.  

PubMed Central

OBJECTIVE: To provide family physicians with an approach to managing skin ulcers in older patients. SOURCES OF INFORMATION: Clinical practice guidelines and best practice guidelines were summarized to describe an evidence-based approach. MAIN MESSAGE; Preventing ulcers is important in frail older patients. Using guidelines can help prevent ulcers in institutions. Clarifying the cause and contributing factors is the first step in management. Pressure and venous ulcers are common in elderly people. Poor nutrition, edema, arterial insufficiency, and anemia often impair wound healing. Adequate debridement is important to decrease risk of infection and to promote healing. There are guidelines for cleaning ulcers. Choice of dressings depends on the circumstances of each wound, but dressings should provide a moist environment. Options for dressings are summarized. CONCLUSION: Family physicians can manage skin ulcers effectively by applying basic principles and using readily available guidelines.

Frank, Christopher



Aphthous ulcers as a multifactorial problem.  


Recurrent aphthous stomatitis (RAS) is a disorder characterized by recurrent ulcerations limited to the oral mucosa. Many specialists and researchers in the domain of oral medicine and other fields do not recognize a single disease in RAS, but several pathologic states with similar clinical characteristics. Even though the real cause is unknown, there are some predisposing factors such as anemia caused by the lack of iron, folic acid and vitamin B, neutropenia, local trauma, emotional stress, metabolic disorders, hormonal disorders and chronic diseases, which cause immunodeficiency. This disease can appear in three clinical forms: small aphthous ulcers, large aphthous ulcers and herpetiform aphthous ulcers. The treatment of this type of disorder involves local or systemic use of corticosteroids, immunostimulants and vitamin therapy. Due to the association of aphthous ulcers with various other diseases, cooperation among multiple fields of medicine and a multidisciplinary approach are necessary. PMID:24053082

Ujevi?, Ana; Lugovi?-Mihi?, Liborija; Situm, Mirna; Ljubesi?, Luka; Mihi?, Josip; Troskot, Nina



A simplified method of total contact casting for diabetic foot ulcers.  


A simplified method of total contact casting for diabetic plantar ulcerations is described in which a standard, well-molded short-leg walking cast is applied. Weekly cast changes are performed initially, followed by longer cast change intervals. Either fiberglass or plaster casting tape appears equally efficacious. Healing of all ulcers was demonstrated in 12 patients treated with this technique. PMID:10148327

Huband, M S; Carr, J B



Vesicular, ulcerative, and necrotic dermatitis of reptiles.  


Vesicular, ulcerative, and necrotic dermatologic conditions are common in captive reptiles. Although these conditions have distinct differences histologically, they are commonly sequelae to each other. This article examines the anatomy and physiology of reptile skin; discusses reported causes of vesicular, ulcerative, and necrotic dermatologic conditions; and reviews various management options. PMID:24018035

Maas, Adolf K



Management of radiation ulcers  

SciTech Connect

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.

Shack, R.B.



Evidence-based management of common chronic lower extremity ulcers.  


Chronic lower extremity ulcers are a significant burden on patients and health care systems worldwide. Although relatively common, these wounds can be difficult to treat and present a challenge to physicians. Treatment has often been based on anecdotal accounts; however, there is a growing emphasis on using evidence-based conclusions to guide clinical decisions. In this review article, the standard of care and adjuvant therapies of venous leg ulcers and diabetic foot ulcers are presented from an evidence-based perspective. PMID:23742279

Richmond, Nicholas A; Maderal, Andrea D; Vivas, Alejandra C


Dynamically Stable Legged Locomotion.  

National Technical Information Service (NTIS)

This report documents our progress over the past three years in exploring active balance for dynamic legged systems. The purpose of this research is to build a foundation of knowledge that can lead both to the construction of useful legged vehicles and to...

H. B. Brown J. Hodgins J. Koechling M. Chepponis M. H. Raibert



Dynamically Stable Legged Locomotion.  

National Technical Information Service (NTIS)

This report documents our study of active balance in dynamic legged systems. The purpose of this research is to build a foundation of knowledge that can lead both to the construction of useful legged vehicles and to a better understanding of animal locomo...

H. B. Brown J. Koechling J. K. Hodgins M. Chepponis M. H. Raibert



Nonhealing ulcer secondary to factor V Leiden mutation and cryofibrinogenemia.  


Factor V Leiden is the most common genetic thrombophilia in people of European descent, and is important to recognize as it can have significant implications in dermatology. We report a case of a 30-year-old man who presented for evaluation and treatment of a chronic ulceration on the site of his stump following a below the knee amputation which had been performed for non-healing ulcerations. Despite a variety of treatments, his ulcer persisted. He was referred to a dermatologist who performed a biopsy that was interpreted ass non-specific, and treatment was started for pyoderma gangrenosum. Further investigation revealed a homozygous factor V Leiden mutation and cryofibrinogenemia. He was tapered off of the methylprednisolone and was improving on stanozolol. He healed well after surgery and no new ulcerations have developed. This case highlights the importance of considering this mutation in a non-healing leg ulcer. PMID:15577768

Barrio, Victoria R; Sanfilippo, Angela M; Malone, Janine C; Callen, Jeffrey P



Successful treatment of two refractory venous stasis ulcers treated with a novel poly-N-acetyl glucosamine-derived membrane.  


Standard of care for venous leg ulcers (VLUs) consists of the application of compression bandages or stockings and of local moist wound care. While the majority of patients heal with the above mentioned treatments some ulcers become refractory to treatment causing significant disability and costs. The authors present the observation made on two patients with VLUs who had failed to respond to a comprehensive state of the art wound care approach for 11 and 3 years respectively. Both patients were treated with a poly-N-acetyl glucosamine-derived membrane (pGlcNAc) (Talymed, Marine Polymer Technologies, Danvers, Massachusetts, USA) in addition to compression bandaging. Both patients healed within 6 weeks of the first application of pG1cNAc. The authors present two cases of VLUs that had been considered non-healable that were successfully treated in a very short period of time with the application of a novel technology. PMID:22778460

Maus, Erik Alberto



A Foot Ulcer Caused by the Use of an Angio-Seal Arterial Closure Device after Percutaneous Transluminal Angioplasty: A Case Report  

PubMed Central

Although the Angio-Seal arterial closure device is widely used for preventing bleeding and facilitating early ambulation after arterial puncture, it is also associated with unique complications, such as stenosis, occlusion, or peripheral embolism. We report the first case of a foot ulcer that developed 70 days after an Angio-Seal application. The collagen sponge component accidently positioned itself in the arterial lumen and was not absorbed. A foreign body reaction was observed microscopically. In patients with arteriosclerosis, the Angio-Seal device should be used carefully; post procedural monitoring is necessary after implantation.

Chihara, Shingo; Matsuo, Hideki; Takagi, Katsuaki; Arai, Shoichirou; Morimatsu, Minoru



An application of Brookhaven National Laboratory`s hot particle methodology for determining the most effective beta particle energy in causing skin ulcers  

SciTech Connect

The purpose of this project was to compare the effectiveness of hot particles with different energy betas in producing ulcers on skin. The sources were man-made hot particles similar in size and activity to those found in the commercial nuclear power industry. Four different particle types were used. These were thulium (Tm-170) with a 0.97 MeV maximum energy beta, ytterbium (Yb-175) with a maximum beta energy of 0.47 MeV, scandium (Sc-46) with a 0.36 MeV beta, which was used as a surrogate for cobalt-60 (0.31 MeV beta) and uranium (in the carbide form) with an average maximum beta energy of about 2.5 MeV. Since higher energy beta particles penetrate further in skin, they will affect a higher number and different populations of target cells. The experiments were designed as threshold studies such that the dose needed to produce ulcers ten percent of the time (ED 10%) for each particle type could be compared against each other.

Schaefer, C.



The role of hemodynamic measurements in the management of venous and ischemic ulcers.  


There is a need for quantitative investigations in the vascular laboratory to manage lower extremity ulcers. The majority of leg ulcers are of venous (45%-60%) or arterial origin (10%-20%). Despite the increasing complexity of new devices used in vascular surgical practice, the anklebrachial pressure index (ABPI) remains the cornerstone for the differential diagnosis of ischemic ulcers. The toe-brachial pressure index and the pole test represent attractive alternative tests especially in patients with diabetes. Color flow Doppler imaging (CFDI) is advantageous over ABPI in cases in which wounds and ulcers prevent the use of a cuff by virtue of their size or location; additionally CFDI technology can detect nonflow limiting lesions, lesions to nonaxial arteries such as the deep femoral artery, or lesions limited to a single tibial artery. Continued improvements in the accuracy of CFDI have prompted some vascular surgeons to replace contrast arteriography in distal bypass procedures. Transcutaneous partial oxygen tension measurement (TcPO(2)) is another noninvasive method that is reliable to select the level of amputation and recommended to determine tissue viability in critically ischemic limbs and in the management of the diabetic foot. CFDI has revolutionized the diagnostic approach to venous disorders and it is considered the gold standard for the assessment of the venous system of the lower limb, causes minimal inconvenience to patients, and is easily repeatable, but it is considered highly operator dependent. Various plethysmography techniques are of limited application in ulcer investigations, because of their difficulty to calibrate signal, unless time measurements such as the postexercise refilling time are used. PMID:18048871

Lazarides, M K; Giannoukas, A D



Yellow Legged Frog  

USGS Multimedia Gallery

USGS scientists found this adult mountain yellow-legged frog on June 10 in Tahquitz Creek, a rediscovered population of the endangered frog in the San Jacinto Wilderness, San Bernardino National Forest, California....



Night Leg Cramps  


... leg cramps are likely to be related to muscle fatigue and nerve problems. The risk of having night ... lowering drugs (statins) Dialysis Other conditions Dehydration Diarrhea Muscle fatigue Nerve damage, as from cancer treatments Osteoarthritis Parkinson's ...


[Acute and chronic anal ulcers].  


Classic types of anal ulcers are acute and chronic anal fissure. Characteristic symptoms of chronic fissures are severe pain during defecation accompanied by the triad of ulceration, hypertrophic anal papilla and external skin tag. If the symptoms deviate other causes of ulceration must be considered. Primarily, malignancies should be excluded. The special setting in the anal fold, especially with concurrent immunosuppression, could lead to nonspecific manifestations of different proctological, dermatological and infectious diseases, which can only be clarified by further diagnostic workup and histopathology. Only the correct diagnosis will lead to causal and effective therapy. Successfully treated inflammatory dermatoses and precancerous lesions require regular follow-up because a recurrent or persistent course of the disease may result in malignant transformation. PMID:19997893

Weyandt, G H



Stable walking with asymmetric legs  

Microsoft Academic Search

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

Andreas Merker; Juergen Rummel; Andre Seyfarth



Endovenous Laser and Radiofrequency Treatment of Leg Veins  

Microsoft Academic Search

\\u000a Superficial varicosity is a common medical condition that is symptomatic in 20-30% of the US population. Classic symptoms\\u000a of venous insufficiency are ankle edema, leg fatigue, aching, discomfort, and muscle cramps. Some patients develop associated\\u000a complications, including stasis dermatitis, lipodermatosclerosis, skin atrophy, superficial thrombophlebitis, and venous ulcers.\\u000a The treatment of varicose veins reduces symptoms and complications of chronic venous insufficiency

Marisa Pongprutthipan; Jeffrey T. S. Hsu


Venous stasis ulcers due to primary, isolated deep venous insufficiency in a patient with systemic lupus erythematosus: report of a case.  


Primary, isolated deep venous incompetence is rare, difficult to diagnose, and can lead to the development of venous stasis ulcers. We herein report a case demonstrating chronic venous stasis ulcers due to primary, isolated deep venous incompetence, which was misdiagnosed as vasculitis ulcers associated with systemic lupus erythematosus (SLE). Although primary, isolated deep venous incompetence is rare, it is important to bear this possibility in mind when a patient presents with leg ulcers. PMID:12376799

Nishibe, Toshiya; Kudo, Fabio; Flores, Jorge; Imai, Takahiro; Miyazaki, Keiko; Yasuda, Keishu



Infections in diabetic foot ulcerations  

Microsoft Academic Search

Diabetic foot complications are the largest nontraumatic cause of lower extremity amputations, accounting for almost 90,000\\u000a amputations per year. Most of these amputations are the result of infections caused by ulcerations of the foot that are not\\u000a recognized or treated in an appropriate and timely fashion. Often, cultures are taken when not warranted and antibiotics are\\u000a administered when no infection

Warren S. Joseph; James S. Tan



SPECT imaging of striatal pre- and postsynaptic dopaminergic status in restless legs syndrome with periodic leg movements in sleep  

Microsoft Academic Search

Restless legs syndrome (RLS) is a common sleep-related disorder principally characterised by leg paresthesia associated with\\u000a an irresistible urge to move. A majority of RLS patients experience periodic leg movements during sleep (PLMS) and wakefulness.\\u000a Pharmacological evidence suggests that RLS-PLMS may be caused by a central nervous system dopaminergic (DA) dysfunction. The\\u000a aim of the present study was to evaluate

Martin Michaud; Jean-Paul Soucy; Allal Chabli; Gilles Lavigne; Jacques Montplaisir



Preventing pressure ulcers  


Decubitus ulcer prevention; Bedsore prevention; Pressure sores prevention ... care protocol: Skin safety protocol: Risk assessment and prevention of pressure ulcers . Institute for Clinical Systems Improvement. 2nd ed. 2007 ...


Solitary Rectal Ulcer Syndrome  


Solitary rectal ulcer syndrome Basics Multimedia Resources Reprints A single copy of this article may be reprinted for personal, noncommercial use only. Solitary rectal ulcer syndrome By Mayo Clinic staff Original Article: http:// ...


Surveillance and early detection of altered biomechanical parameters help keeping reconstructed ulcer healed  

Microsoft Academic Search

Diabetic ulcers in neuropathic feet are difficult to manage. In earlier studies, appropriate footwear helps healing but recurrent\\u000a ulceration, recalcitrant and difficult ulcers need surgical intervention. Keeping surgically reconstructed ulcers healed is\\u000a a great challenge in diabetes mellitus patients when the primary cause of ulceration, reduced sensibility of skin persists.\\u000a We have developed a system of keeping these surgically treated

V. B. Narayana Murthy; Richa Poddar; R. Periyasamy



Relevance of fatigue tests to cold leg piping. [PWR  

Microsoft Academic Search

The ''cold leg'' in a PWR is defined as that portion of the primary coolant loop that lays between the coolant pump and the reactor vessel. One of the conditions which may lead to failure in a cold leg consists of repeated cycles of stress. These repeated stress cycles may cause the growth of any small defect in the weld

M. E. Mayfield; E. C. Rodabaugh; R. J. Eiber




Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

20. DETAIL, TYPICAL LEG CONNECTION, CROSS BRACING AT LEG, WITH CROSSED BRACE BLOCK, GROUND WIRES AND GUIDE WIRE. - Hat Point Fire Lookout Tower, Forest Service Road #4340, 24 miles from Imnaha, Imnaha, Wallowa County, OR


Restoring Psychology's Role in Peptic Ulcer  

PubMed Central

This paper reviews the history of the transition from the belief that gastrointestinal ulcers are caused primarily by psychological factors to the current state of belief that they are caused primarily by infection and argues that neither is fully accurate. We argue that psychological factors play a significant role as predisposing to vulnerability, modulating of precipitation, and sustaining of gastric ulceration. We review data that challenge the assumption of a simple infectious disease model and adduce recent preclinical data that confirm the predisposing, modulatory, and sustaining roles for psychological factors. We note that others, too, are now challenging the adequacy of the contemporary simple bacterial infection model. We hope to replace the competition between psychology and medicine with cooperation in understanding and treating patients suffering gastric ulceration and ulcer.

Overmier, J Bruce; Murison, Robert



Learning adaptive leg cycles using fitness biasing  

Microsoft Academic Search

This paper discusses the use of fitness biasing to alter the control of a seven-microprocessor robot as it shifts from one environment to another. The robot was initially using a gait evolved to work on a smooth surface (tile). When tested on a rough surface (carpet) the learned gait was found to be inappropriate because the legs were causing drag

Gary B. Parker



Athletes' leg pains  

Microsoft Academic Search

The frequency and nature of exertion pains of the leg in athletes were studied in 2,750 cases of overuse injuries treated at the Sports Clinic of the Deaconess Institute of Oulu, Finland, during the years 1972-1977. 465 cases of exertion pain (18%) were located in the shin. The medial tibial syndrome was the most common overuse injury among these athletes,

S. Orava; J. Puranen



Restless legs syndrome.  


Restless legs syndrome (RLS) is a common neurological sensory-motor disorder that is characterized by intense restlessness and unpleasant creeping sensations deep inside the lower legs. Symptoms appear when the legs are at rest and are worst in the evening and at night. They force patients to keep moving their legs, and often to get out of bed and wander about. Periodic limb movements (PLMS) are also common during sleep amongst those suffering from RLS, and sleep efficiency is severely reduced. There are idiopathic as well as symptomatic forms of RLS, the latter being associated with e.g. pregnancy, iron deficiency and chronic renal failure. A family history of RLS is very common and pedigrees in these cases suggest an autosomal-dominant transmission with high penetrance. Genetic investigations have been performed in order to identify genes associated with RLS. Several loci have been found (on chromosomes 12q, 14q, 9p, 2q, 20p and 16p). Pathophysiology of RLS remains incompletely understood. However, advanced brain imaging studies and positive results of dopaminergic treatment suggest that RLS may be generated by dopamine dysfunction locally within the central nervous system. At present, there is a wide range of treatment options including levodopa, dopamine agonists, opioids, benzodiazepines, antiepileptic drugs and iron supplements. PMID:19817966

Ekbom, Karl; Ulfberg, J



Dynamically Stable Legged Locomotion.  

National Technical Information Service (NTIS)

This report documents recent progress in exploring active balance for dynamic legged systems. Balance in 3D can be achieved with a very simple control system. The control system has three separate parts, one that controls forward running velocity, one tha...

M. H. Raibert H. B. Brown M. Chepponis E. Hastings J. Koechling



Recurrent Peptic Ulcer due to Carcinoid Tumour of Jejunum.  


Carcinoid Tumours are classified as Neuro-endocrine tumours. Commonly known ulcerogenic neuro-endocrine tumour is Gastrinoma of the Pancreas and Duodenum.It secretes hormone Gastrin which causes hyperplasia of the gastric parietal cells with excessive secretion of hydrochloric acid resulting in multiple ulcerations in the stomach, duodenum and upper jejunum. Carcinoid tumours is not known to cause peptic ulceration. PMID:22851846

Bhattacharyya, Parimal



Diabetic foot ulcers. Pathophysiology, assessment, and therapy.  

PubMed Central

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 amputation unless a prompt, rational, multidisciplinary approach to therapy is taken. Factors that affect development and healing of diabetic patients' foot ulcers include the degree of metabolic control, the presence of ischemia or infection, and continuing trauma to feet from excessive plantar pressure or poorly fitting shoes. Appropriate wound care for diabetic patients addresses these issues and provides optimal local ulcer therapy with débridement of necrotic tissue and provision of a moist wound-healing environment. Therapies that have no known therapeutic value, such as foot soaking and topical antiseptics, can actually be harmful and should be avoided. CONCLUSION: Family physicians are often primary medical contacts for patients with diabetes. Patients should be screened regularly for diabetic foot complications, and preventive measures should be initiated for those at risk of ulceration.

Bowering, C. K.



Giant duodenal ulcer  

PubMed Central

Twenty-five cases of benign giant duodenal ulcer have been studied. In every case a barium meal examination showed an ulcer crater with a radiographic diameter of at least 2 centimetres. Abdominal pain was the commonest symptom but less than half of the patients had had pain characteristic of chronic peptic ulcer. Haemorrhage from the ulcer occurred in a large majority of them. The radiological appearances are described, and it has been shown that the giant ulcer may be missed through being mistaken for the duodenal cap or else misdiagnosed. It appears that the death rate in this condition has been falling but it is still high. The management of patients with giant ulcers is discussed. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5Fig. 6

Lumsden, K.; MacLarnon, J. C.; Dawson, J.



Leg symptoms in outpatient veterans.  

PubMed Central

In a survey of outpatients at the Denver Veterans Affairs Medical Center for common leg symptoms--515 questionnaires returned in a 3-week period--56% reported nocturnal leg cramps, 29% reported the restless leg syndrome, and 49% reported symptoms of peripheral neuropathy. Only 33% of patients had no symptoms relating to their legs. Patients often did not report these symptoms to their physician but were more likely to do so if the symptoms were frequent. Conditions especially related to leg symptoms were hypertension, peripheral vascular disease, coronary artery disease, cerebrovascular disease, kidney disease, and hypokalemia. Most patients did not receive effective therapy for these symptoms.

Oboler, S. K.; Prochazka, A. V.; Meyer, T. J.



Unilateral lower leg purpura.  


We present a case of an extensive, purpuric eruption on the lower leg with peculiar clinical findings in 55-year-old woman with rheumatoid arthritis. The purpuric lesions were present unilaterally on the left lower leg, where prominent varices and telangiectasia were noted. Histological examination revealed a perivascular infiltration of lymphocytic cells and eosinophils and extravasation of erythrocytes in the upper and middle dermis. There was no evidence of vasculitis. The eruption responded well to treatment with hemostatic agents and elastic stockings. Based on the clinical and histological findings, we concluded that the main pathophysiology of the purpuric eruption is an extravasation of erythrocytes related to increased venous pressure secondary to venous stasis. PMID:23374958

Ogawa, Satoshi; Oka, Masahiro; Kunisada, Makoto; Nishigori, Chikako



[Restless legs syndrome epidemiology].  


The restless legs syndrome (RLS) is a chronic sensori-motor disorder characterized by a complaint of an irresistible urge to move the legs. This urge can often be accompanied by pain or other unpleasant sensations, it either occurs or worsens with rest, particularly at night, and temporarily improves with activity. Prevalence estimates vary between 7.2% and 11.5% of the Caucasian adult population. RLS prevalence increases with age, and women are more frequently affected than men. In France, a prevalence rate of 8.5% was estimated. Although RLS is mainly idiopathic, several clinical conditions have been associated with it, mainly pregnancy, iron deficiency with or without anemia, end-stage renal disease and peripheral neuropathy. RLS is often underdiagnosed and there is a clear need for complementary education to improve the accurate diagnosis of RLS. Indeed, a better knowledge of this syndrome is a prerequisite to prompt an appropriate therapeutic management. PMID:20334990

Ghorayeb, Imad; Tison, François



Pairs of Legs  

NSDL National Science Digital Library

In this problem students practice counting by twos as they explore the natural phenomenon that legs on creatures always come in pairs, laying the foundation for doubling and halving. A set of cards can be downloaded (pdf) and matched. The Teachers' Notes page offers suggestions for implementation, discussion questions, ideas for extension and support, an expanded set of cards (pdf), and links to related activities (Noah and Number Tracks, both cataloged separately).



The mangled lower leg  

Microsoft Academic Search

A surgeon faced with a patient presenting with an open tibial\\/fibular fracture in combination with severe damage of the surrounding soft tissues, has to make the difficult decision whether to attempt salvage or to perform an immediate amputation of the leg.\\u000a\\u000aUntil late in the nineteenth century the mortality from open fractures was high - mainly due to sepsis after

Jochem Maarten Hoogendoorn



Adaptive leg coordination with a biologically inspired neurocontroller  

NASA Astrophysics Data System (ADS)

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.

Braught, Grant; Thomopoulos, Stelios C.



Diabetic foot ulcers  

Microsoft Academic Search

In this review, we describe the epidemiology, pathogenesis, and management of diabetic foot ulceration, and its effect on patients and society. The condition deserves more attention, both from those who provide care and those who fund research. Epidemiology Incidence and prevalence Although accurate figures are difficult to obtain for the prevalence or incidence of foot ulcers, the results of cross-

William J Jeffcoate; Keith G Harding



Approach to leg edema of unclear etiology.  


A common challenge for primary care physicians is to determine the cause and find an effective treatment for leg edema of unclear etiology. We were unable to find existing practice guidelines that address this problem in a comprehensive manner. This article provides clinically oriented recommendations for the management of leg edema in adults. We searched on-line resources, textbooks, and MEDLINE (using the MeSH term, "edema") to find clinically relevant articles on leg edema. We then expanded the search by reviewing articles cited in the initial sources. Our goal was to write a brief, focused review that would answer questions about the management of leg edema. We organized the information to make it rapidly accessible to busy clinicians. The most common cause of leg edema in older adults is venous insufficiency. The most common cause in women between menarche and menopause is idiopathic edema, formerly known as "cyclic" edema. A common but under-recognized cause of edema is pulmonary hypertension, which is often associated with sleep apnea. Venous insufficiency is treated with leg elevation, compressive stockings, and sometimes diuretics. The initial treatment of idiopathic edema is spironolactone. Patients who have findings consistent with sleep apnea, such as daytime somnolence, loud [corrected] snoring, or neck circumference >17 inches, should be evaluated for pulmonary hypertension with an echocardiogram. If time is limited, the physician must decide whether the evaluation can be delayed until a later appointment (eg, an asymptomatic patient with chronic bilateral edema) or must be completed at the current visit (eg, a patient with dyspnea or a patient with acute edema [<72 hours]). If the evaluation should be conducted at the current visit, the algorithm shown in Figure 1 could be used as a guide. If the full evaluation could wait for a subsequent visit, the patient should be examined briefly to rule out an obvious systemic cause and basic laboratory tests should be ordered for later review (complete blood count, urinalysis, electrolytes, creatinine, blood sugar, thyroid stimulating hormone, and albumin). PMID:16513903

Ely, John W; Osheroff, Jerome A; Chambliss, M Lee; Ebell, Mark H


Pericapillary fibrin deposits and skin hypoxia precede the changes of lipodermatosclerosis in limbs at increased risk of developing a venous ulcer  

Microsoft Academic Search

This study investigated the possibility that pericapillary fibrin deposition, found in the calf skin of patients with venous ulceration and lipodermatosclerosis, might already be present in the dermis of the gaiter area of apparently healthy limbs before any skin changes were visible. The apparently healthy limbs of 19 consecutive patients with a healed venous ulcer on one leg and no

M. C Stacey; K. G Burnand; B. S Bhogal; M. M Black



Illness meanings and experiences for pre-ulcer and ulcer conditions of Buruli ulcer in the Ga-West and Ga-South Municipalities of Ghana  

PubMed Central

Background Ghana is a Buruli ulcer (BU) endemic country yet there is paucity of socio-cultural research on BU. Examining distinctive experiences and meanings for pre-ulcers and ulcers of BU may clarify the disease burden, illness experience and local perceptions of causes and spread, and environmental features of BU, which are useful to guide public health programmes and future research. This study aimed to explain local meanings and experiences of BU for persons with pre-ulcers and ulcers in the Ga-West and Ga-South municipalities in Accra. Methods Semi-structured interviews based on the Explanatory Model Interview Catalogue framework were administered to 181 respondents comprising 15 respondents with pre-ulcers and 166 respondents with ulcers. The Wilcoxon rank-sum test was used to compare categories of illness experiences (PD) and perceived causes (PC) among respondents with pre-ulcer and ulcer conditions. The Fisher’s exact test was used to compare the most troubling PD and the most important PC variables. Qualitative phenomenological analysis of respondents’ narratives clarified illness experiences and meanings with reference to PC and PD variables. Results Families of respondents with pre-ulcers and the respondents themselves were often anxious about disease progression, while families of respondents with ulcers, who had to give care, worried about income loss and disruption of school attendance. Respondents with pre-ulcers frequently reported swimming in ponds and rivers as a perceived cause and considered it as the most important PC (53.3%). Respondents with ulcers frequently attributed their BU illness to witchcraft (64.5%) and respondents who claimed they had no water contact, questioned the credibility of health messages Conclusions Affected persons with pre-ulcers are likely to delay treatment because of social and financial constraints and the absence of pain. Scepticism on the role of water in disease contagion and prolonged healing is perceived to make ideas of witchcraft as a PC more credible, among respondents with ulcers. Health messages should address issues of locally perceived risk and vulnerability. Guided by study findings, further research on the role of environmental, socio-cultural and genetic factors in BU contagion, is also needed to clarify and formulate health messages and strengthen public health initiatives.



Textiloma in the leg  

PubMed Central

Textiloma is defined as a tumor formed due to retained gauze. It is rarely reported in the musculoskeletal system. We are presenting a case with a soft tissue swelling over the lateral aspect of the lower third of the leg, come for implant removal of the distal tibia and fibular fracture. We removed the soft tissue mass enbloc thinking it to be a benign tumor. On cutting the mass on the operation table, a gauze piece encased by fibrous tissue was found. Textiloma can present as tumoral forms and can mimic as a pseudo-tumor.

Patel, Amol C; Kulkarni, Govind S; Kulkarni, Sunil G



Laparoscopic Repair of Perforated peptic ulcers versus conventional open surgery  

Microsoft Academic Search

Perforated peptic ulcer is a common abdominal disease that is treated by surgery. The development of laparoscopic surgery causes great controversy regarding the choice of procedure for perforated duodenal ulcer. In this study the safety and efficacy of laparoscopic surgery was evaluated, different types of procedures were described and early outcomes in comparison with open surgery were assessed. In addition

Nita Zaji



Solitary ulcer of the rectum  

Microsoft Academic Search

Solitary ulcer of the rectum is usually a disease of young adults of either sex which has a characteristic appearance on sigmoidoscopy. Distinctive changes may also be seen in biopsies taken from mucosa adjacent to the ulcer.The name `solitary ulcer' is misleading because more than one ulcer may be present. Moreover, there is a preulcerative phase which is clinically and

M. R. Madigan; B. C. Morson



Treatment of Chronic Posttraumatic Leg Injury Using Autologous Fat Graft  

PubMed Central

We present the results obtained in a case of a 20-year-old Caucasian woman with a posttraumatic injury “hard-to-heal” of the left leg treated using autologous fat graft. Considering our experience in treatment of chronic posttraumatic ulcers by autologous fat graft, we decided to use this surgical technique to induce a regenerative effect in this young patient. We have had complete wound closure with only a single surgical procedure after 1 month; after the second intervention of autologous fat graft we observed an improvement in the quality of the scar tissue. The patient satisfaction was excellent. The results were long lasting and remained virtually unchanged after 1 year.

Caviggioli, Fabio; Klinger, Francesco Maria; Vinci, Valeriano; Cornegliani, Guido; Klinger, Marco



Pressure ulcer and mortality in frail elderly people living in community  

Microsoft Academic Search

Pressure ulcer is one of the most common, disruptive and often disabling conditions affecting frail older people. Purposes of the present study are to ascertain the prevalence of pressure ulcer and to explore the relationship between pressure ulcer and the risk of 1-year all-cause mortality in a large population of frail and very old people living in community. This was

F. Landi; G. Onder; A. Russo; R. Bernabei



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

Microsoft Academic Search

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 of nutrients and the development of ulcerative colitis in a cohort study. Methods: The study population was

Andrew R. Hart; Robert Luben; Anja Olsen; Anne Tjonneland; Jakob Linseisen; Gabriele Nagel; Göran Berglund; Stefan Lindgren; Olof Grip; Timothy Key; Paul Appleby; Manuela M. Bergmann; Heiner Boeing; Göran Hallmans; Åke Danielsson; Richard Palmqvist; Hubert Sjodin; Gun Hägglund; Kim Overvad; Domenico Palli; Giovanna Masala; Elio Riboli; Hugh Kennedy; Ailsa Welch; Kay-Tee Khaw; Nicholas Day; Sheila Bingham



Operations Resumes, LEG 34 through LEG 44A.  

National Technical Information Service (NTIS)

This book tells about the operational and engineering procedures used aboard D/V Glomar Challenger beginning with Leg 34 and continuing through Leg 44A. Other DSDP Technical Reports dealing with Operation Resumes were TR no. 1, published in October of 197...

T. Wiley



Measurement of body fat using leg to leg bioimpedance  

Microsoft Academic Search

AIMS(1) To validate a leg to leg bioimpedance analysis (BIA) device in the measurement of body composition in children by assessment of its agreement with dual energyx ray absorptiometry (DXA) and its repeatability. (2) To establish a reference range of percentage body fat in Hong Kong Chinese children.METHODSSequential BIA and DXA methods were used to determine body composition in 49

R Y T Sung; P Lau; C W Yu; P K W Lam; E A S Nelson



Vascular ulcers in scleroderma.  


Seven patients with scleroderma and either livedo reticularis or atrophie blanche lesions had ulcers of the lower extremity. Livedoid vasculitis, periarteritis nodosa, or endarteritis obliterans lesions were associated with the ulcers. Five patients had livedoid vasculitis, one patient had associated lupus panniculitis, and one patient had rheumatoid arthritis. Four patients had elevated ESRs, four had positive antinuclear antibody tests, and two had positive tests for rheumatoid factor. Patients with scleroderma and livedoid vasculitis or livedo reticularis and ulcers should be examined to rule out underlying vascular disease or endarteritis obliterans. PMID:6137196

Thomas, J R; Winkelmann, R K



Leg regeneration stunts wing growth and hinders flight performance in a stick insect (Sipyloidea sipylus)  

PubMed Central

Major morphological structures are sometimes produced not once, but twice. For example, stick insects routinely shed legs to escape a predator or tangled moult, and these legs are subsequently re-grown. Here, I show that in Sipyloidea sipylus, re-growth of a leg during development causes adults to have disproportionately smaller wings and increases wing loading. These morphological consequences of leg regeneration led to significant reductions in several biologically relevant measures of individual flight performance. This previously unrecognized tradeoff between legs and wings reveals the integrated nature of phasmid phenotypes, and I propose how this tradeoff may have shaped phasmid evolution.

Maginnis, Tara L



Biomechanical risk factors associated with neuropathic ulceration of the hallux in people with diabetes mellitus.  


In this study of people with diabetes mellitus and peripheral neuropathy, it was found that the feet of patients with a history of hallux ulceration were more pronated and less able to complete a single-leg heel rise compared with the feet of patients with a history of ulceration elsewhere on the foot. The range of active first metatarsophalangeal joint dorsiflexion was found to be significantly lower in the affected foot. Ankle dorsiflexion, subtalar joint range of motion, and angle of gait differed from normal values but were similar to those found in other studies involving diabetic subjects and were not important factors in the occurrence of hallux ulceration. These data indicate that a more pronated foot type is associated with hallux ulceration in diabetic feet. Further studies are required to evaluate the efficacy of footwear and orthoses in altering foot posture to manage hallux ulceration. PMID:16707629

Nubé, Vanessa L; Molyneaux, Lynda; Yue, Dennis K


Infantile ulcerative keratitis secondary to congenital entropion.  


Congenital entropion is a rare eyelid anomaly that can cause chronic corneal erosions or ulceration. The diagnosis may be easily overlooked by both the pediatrician and the ophthalmologist, particularly when the lids are tightly closed in the crying child. We present three cases of congenital entropion associated with corneal ulceration. Each patient underwent a complete ophthalmologic examination. Examination under anesthesia, including corneal scrapings for culture and photography, was performed before surgical repair of the entropion. There were two cases of lower lid entropion and one case of upper lid entropion. In all three cases symptoms were present since birth, and the diagnosis was overlooked by the treating pediatrician. Corneal ulceration ultimately developed in all three cases. Cultures revealed Staphylococcus aureus in one case, and coagulase negative Staphylococcus in another case. Cultures were negative in one case. In all three patients the ulcers healed rapidly after surgical entropion repair. Congenital upper or lower lid entropion is an uncommon condition that does not spontaneously improve and is an important cause of corneal ulceration in infants. Recognition of this condition is often difficult, and early surgical intervention to repair the lid deformity may help to avoid permanent corneal scarring and visual loss. PMID:8985631

Luchs, J I; Laibson, P R; Stefanyszyn, M A; Rapuano, C J; Cohen, E J; Schnall, B M; Raber, I M



Maneuvers during legged locomotion.  


Maneuverability is essential for locomotion. For animals in the environment, maneuverability is directly related to survival. For humans, maneuvers such as turning are associated with increased risk for injury, either directly through tissue loading or indirectly through destabilization. Consequently, understanding the mechanics and motor control of maneuverability is a critical part of locomotion research. We briefly review the literature on maneuvering during locomotion with a focus on turning in bipeds. Walking turns can use one of several different strategies. Anticipation can be important to adjust kinematics and dynamics for smooth and stable maneuvers. During running, turns may be substantially constrained by the requirement for body orientation to match movement direction at the end of a turn. A simple mathematical model based on the requirement for rotation to match direction can describe leg forces used by bipeds (humans and ostriches). During running turns, both humans and ostriches control body rotation by generating fore-aft forces. However, whereas humans must generate large braking forces to prevent body over-rotation, ostriches do not. For ostriches, generating the lateral forces necessary to change movement direction results in appropriate body rotation. Although ostriches required smaller braking forces due in part to increased rotational inertia relative to body mass, other movement parameters also played a role. Turning performance resulted from the coordinated behavior of an integrated biomechanical system. Results from preliminary experiments on horizontal-plane stabilization support the hypothesis that controlling body rotation is an important aspect of stable maneuvers. In humans, body orientation relative to movement direction is rapidly stabilized during running turns within the minimum of two steps theoretically required to complete analogous maneuvers. During straight running and cutting turns, humans exhibit spring-mass behavior in the horizontal plane. Changes in the horizontal projection of leg length were linearly related to changes in horizontal-plane leg forces. Consequently, the passive dynamic stabilization associated with spring-mass behavior may contribute to stability during maneuvers in bipeds. Understanding the mechanics of maneuverability will be important for understanding the motor control of maneuvers and also potentially be useful for understanding stability. PMID:19566265

Jindrich, Devin L; Qiao, Mu



Maneuvers during legged locomotion  

NASA Astrophysics Data System (ADS)

Maneuverability is essential for locomotion. For animals in the environment, maneuverability is directly related to survival. For humans, maneuvers such as turning are associated with increased risk for injury, either directly through tissue loading or indirectly through destabilization. Consequently, understanding the mechanics and motor control of maneuverability is a critical part of locomotion research. We briefly review the literature on maneuvering during locomotion with a focus on turning in bipeds. Walking turns can use one of several different strategies. Anticipation can be important to adjust kinematics and dynamics for smooth and stable maneuvers. During running, turns may be substantially constrained by the requirement for body orientation to match movement direction at the end of a turn. A simple mathematical model based on the requirement for rotation to match direction can describe leg forces used by bipeds (humans and ostriches). During running turns, both humans and ostriches control body rotation by generating fore-aft forces. However, whereas humans must generate large braking forces to prevent body over-rotation, ostriches do not. For ostriches, generating the lateral forces necessary to change movement direction results in appropriate body rotation. Although ostriches required smaller braking forces due in part to increased rotational inertia relative to body mass, other movement parameters also played a role. Turning performance resulted from the coordinated behavior of an integrated biomechanical system. Results from preliminary experiments on horizontal-plane stabilization support the hypothesis that controlling body rotation is an important aspect of stable maneuvers. In humans, body orientation relative to movement direction is rapidly stabilized during running turns within the minimum of two steps theoretically required to complete analogous maneuvers. During straight running and cutting turns, humans exhibit spring-mass behavior in the horizontal plane. Changes in the horizontal projection of leg length were linearly related to changes in horizontal-plane leg forces. Consequently, the passive dynamic stabilization associated with spring-mass behavior may contribute to stability during maneuvers in bipeds. Understanding the mechanics of maneuverability will be important for understanding the motor control of maneuvers and also potentially be useful for understanding stability.

Jindrich, Devin L.; Qiao, Mu



Peptic Ulcer Disease  


... therapy will use acid suppression therapy with a proton pump inhibitor (PPI) along with antibiotic therapy and ... all peptic ulcers will be treated with a proton pump inhibitor (PPI). PPIs are powerful acid blocking ...


[Preventing pressure ulcers].  


Preventing the occurrence of pressure ulcers requires multi-disciplinary care of the patient. Firstly, it is necessary to identify patients predisposed to developing pressure ulcers thanks to awareness of the risk factors and using where necessary adapted assessment scales. Preventative measures then comprise the suitable positioning of the patient, regularly changing their position, the use of special support equipment, nursing care and the treatment of undernutrition. PMID:23785858

Néouze, Angèle


Sustaining pressure ulcer prevention in practice.  


This article describes a campaign to eliminate avoidable grade 2-4 pressure ulcers at University Hospitals Coventry and Warwickshire Trust. The 100 Days Free strategy used traditional educational approaches along with ward-based power training and social media to engage staff and update practice. Root cause analysis has been vital in providing feedback to staff and identifying training needs. PMID:23696992

McDonagh, Vanessa


Modern Endoscopic Therapy of Peptic Ulcer Bleeding  

Microsoft Academic Search

Acute upper gastrointestinal bleed (UGIB) remains a challenging clinical problem owing to significant patient morbidity and costs involved with management. Peptic ulcer bleeding (PUB) contributes to the majority of causes of UGIB with a growing concern of its impact on the elderly and the increasing use of non-steroidal anti-inflammatory drugs as precipitating bleeding episodes. Apart from initial critical care, endoscopy

Shajan Peter; C. Mel Wilcox




Microsoft Academic Search

Background Pyoderma gangrenosum is a diagno- sis of exclusion, and the misdiagnosis of pyoderma gangrenosum can result in substantial complications in patients who have other causes of severe cutane- ous ulceration. Methods We reviewed the charts of 240 patients with a diagnosis of pyoderma gangrenosum who were eval- uated at our institution from 1975 through 2000, in- cluding 157 consecutive




Complications of ascending phlebography of the leg.  

PubMed Central

Forty patients were studied prospectively for complications of ascending phlebography. The commonest immediate complication was pain at the site of injection and the commonest delayed complication pain in the foot or calf. Out of 30 patients with pain in the foot and calf, 15 had venous thrombosis. Review of 200 case notes disclosed only one recorded complication--namely, necrosis of the dorsal skin of the foot. Complications of the procedure reported by referring clinicians over 10 years comprised four cases of necrosis of the dorsum of the foot and two of gangrene of the foot, in one of which the gangrene spread to the leg. Major complications of ascending phlebography are rare, though when they occur may cause serious morbidity. If a scrupulous technique is used contrast phlebography remains the most accurate method of diagnosing venous disease of the leg.

Thomas, M L; MacDonald, L M



Prevention and treatment of pressure ulcers.  


Pressure ulcer prevention and treatment remains a challenge for interprofessional teams in all health care sectors. Evidencebased pressure ulcer guidelines can be simplified with a bedside enabler utilizing the wound bed preparation paradigm. Key steps involve treatment of the cause, addressing patient-centered concerns, and administering local wound care (debridement, infection/ inflammation control, and moisture balance before considering advanced therapies with the edge effect). Optimal outcomes are achievable with a multi-disciplinary approach that supports patients and their circle of care, which is central to every evaluation and course of treatment decisions. PMID:22949132

Sibbald, R G; Goodman, L; Norton, L; Krasner, D L; Ayello, E A



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

PubMed Central

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.

Chatterjee, Sasanka S.



Patient education for preventing diabetic foot ulceration.  


Treatment of diabetic foot ulceration is very challenging, costly and often needs to be of long duration. This leads to substantial economic burden. Population-based research suggests that a meaningful reduction of the incidence of amputations caused by diabetes mellitus has already been achieved since the St. Vincent resolution in 1989. Still, it cannot be inferred from these studies that the current preventive efforts are (cost-)effective because reduction of amputation incidence can also be the result of improvements in ulcer treatment. Nevertheless, education of people with diabetes is widely advocated and implemented in standard practice. Despite the fact that preventive interventions are often combined in daily practice, there is little scientific evidence demonstrating the effect of those efforts. In systematically reviewing the evidence, there is insufficient evidence that limited patient education alone is effective in achieving clinically relevant reductions in ulcer and amputation incidence. To date, high quality evidence that more complex interventions including patient education can prevent diabetic foot ulceration is not available either. This, however, should be interpreted as lack of evidence rather than evidence of no effect. Future directions for research and practice may be to concentrate preventive effort on those patients who appear to be at highest risk of foot ulceration after careful screening and selection. PMID:22271733

Dorresteijn, Johannes A N; Valk, Gerlof D



Recurrent Peptic Ulcer due to Carcinoid Tumour of Jejunum  

Microsoft Academic Search

Carcinoid Tumours are classified as Neuro-endocrine tumours. Commonly known ulcerogenic neuro-endocrine tumour is Gastrinoma\\u000a of the Pancreas and Duodenum.It secretes hormone Gastrin which causes hyperplasia of the gastric parietal cells with excessive\\u000a secretion of hydrochloric acid resulting in multiple ulcerations in the stomach, duodenum and upper jejunum. Carcinoid tumours\\u000a is not known to cause peptic ulceration.

Parimal Bhattacharyya


Getting Your Sea Legs  

PubMed Central

Sea travel mandates changes in the control of the body. The process by which we adapt bodily control to life at sea is known as getting one's sea legs. We conducted the first experimental study of bodily control as maritime novices adapted to motion of a ship at sea. We evaluated postural activity (stance width, stance angle, and the kinematics of body sway) before and during a sea voyage. In addition, we evaluated the role of the visible horizon in the control of body sway. Finally, we related data on postural activity to two subjective experiences that are associated with sea travel; seasickness, and mal de debarquement. Our results revealed rapid changes in postural activity among novices at sea. Before the beginning of the voyage, the temporal dynamics of body sway differed among participants as a function of their (subsequent) severity of seasickness. Body sway measured at sea differed among participants as a function of their (subsequent) experience of mal de debarquement. We discuss implications of these results for general theories of the perception and control of bodily orientation, for the etiology of motion sickness, and for general phenomena of perceptual-motor adaptation and learning.

Stoffregen, Thomas A.; Chen, Fu-Chen; Varlet, Manuel; Alcantara, Cristina; Bardy, Benoit G.



Functional Long Leg Brace Research.  

National Technical Information Service (NTIS)

The research (February 1969-January 1970) indicated the practical use of the functional long leg brace with patients requiring external support for a flaccid knee. A biomechanical analysis of the brace demonstrated that the brace is mechanically stable du...

C. M. Scott



Ulcer disease of trout  

USGS Publications Warehouse

During the summer of 1933, lesions of a disease were noted among some fingerling brook, rainbow, blackspotted, and lake trout at the Cortland (New York) trout hatchery. Although these lesions bore a marked superficial resemblance to those of furunculosis, they were sufficiently atypical to warrant further investigation. A more detailed examination of the lesions proved them to be of a distinct disease, which for lack of a better name is herein called "ulcer disease," for the lesions closely resemble those described by Calkins (1899) under this name. Because of the marked resemblance to furunculosis, ulcer disease has not been generally recognized by trout culturists, and any ulcer appearing on fish has been ascribed by them to furunculosis without further question.

Fish, F. F.



Necrolytic migratory ulceration  

PubMed Central

Endocrine tumors of the gastroenteropancreatic system associated with specific skin manifestations are rare. We report a 53-year-old female who presented with migratory annular and arcuate ulcers on her limbs. Histopathology was similar to necrolytic erythema family which includes necrolytic migratory erythema (NME). Though initial CT scans were normal, follow up scans revealed multiple mass lesions in the tail of pancreas. Her skin lesions responded to oral zinc sulphate and monthly injections of octreotide. Prior to planned FNAC from the mass lesion, patient developed altered sensorium and succumbed to the disease. This case report seems to differ from NME clinically, due to unique finding of deep migrating ulcers which heal with scarring. ‘Necrolytic migratory ulceration’ thus appears to be a new paraneoplastic manifestation, secondary to pancreatic malignancy.

Pakran, Jaheersha; Riyaz, Najeeba



Prognostic indicators in venous ulcers  

Microsoft Academic Search

Background: Venous ulcers can be difficult to heal, and prognostic factors for healing have not been fully elucidated. Objective: The objective of this study was to analyze the results of a large multicenter venous ulcer trial to retrospectively establish prognostic factors for venous ulcer healing. Methods: This study examined data from a previously published prospective randomized placebo-controlled trial of an

Tania J. Phillips; Fidelis Machado; Richard Trout; John Porter; Jeffrey Olin; Vincent Falanga



Restless legs syndrome: diagnostic time-savers, Tx tips.  


To diagnose restless legs syndrome (RLS), start with the 4 "essential criteria": (1) a powerful urge to move the legs that is (2) rest-induced, (3) improves with activity, and (4) worsens in the evening. Carefully screen for secondary causes of RLS, including renal failure, pregnancy, iron deficiency, and medications that can cause or exacerbate symptoms. Carbidopa/levodopa is the first-line treatment for patients with intermittent symptoms of RLS; dopamine agonists are recommended for those with daily or refractory symptoms. PMID:19679021

Moyer, Darlene E; Zayas-Bazan, Javier; Reese, Gary



Biomechanics of human bipedal gallop: asymmetry dictates leg function.  


Unilateral skipping or bipedal galloping is one of the gait types that humans are able to perform. In contrast to many animals, where gallop is the preferred gait at higher speeds, human bipedal gallop only occurs spontaneously in very specific conditions (e.g. fast downhill locomotion). This study examines the lower limb mechanics and explores the possible reasons why humans do not spontaneously opt for gallop for steady-state locomotion on level ground. In 12 subjects, who were required to run and gallop overground at their preferred speed, kinematic and kinetic data were collected and mechanical work at the main lower limb joints (hip, knee, ankle) was calculated. In a separate treadmill experiment, metabolic costs were measured. Analysis revealed that the principal differences between running and galloping are located at the hip. The asymmetrical configuration of gallop involves distinct hip actions and foot placing, giving galloping legs different functions compared with running legs: the trailing leg decelerates the body in the vertical direction but propels it forward while the leading leg acts in the opposite way. Although both legs conserve mechanical energy by interchanging external mechanical energy with potential elastic energy, the specific orientation of the legs causes more energy dissipation and generation compared with running. This makes gallop metabolically more expensive and involves high muscular stress at the hips, which may be why humans do not use gallop for steady-state locomotion. PMID:23239890

Fiers, Pieter; De Clercq, Dirk; Segers, Veerle; Aerts, Peter



Herpes simplex virus and intraoral ulcers in immunocompromised patients with haematologic malignancies.  


Possible factors predisposing to the development of intraoral ulcers in immunocompromised patients with haematologic malignancies were investigated. Among 46 patients undergoing antineoplastic treatment, 18 developed an intraoral ulcer during the prospective study. Patients with or without ulcers were comparable with respect to underlying disease, presence of teeth, the qualitative composition of the aerobic and facultatively anaerobic oral microflora, herpes simplex virus (HSV) titer positivity, a past history of herpes labialis, leukocyte and thrombocyte counts, and duration of fever. Viral cultures from saliva revealed an association between the presence of HSV in saliva and the presence of intraoral ulcers. HSV was not isolated from the saliva of any patient without ulcers. Viral cultures from the ulcers revealed growth of HSV in 11 (61%) of the 18 patients with ulcers. HSV-positive ulcers were located more often on the alveolar process than elsewhere in the oral cavity. Ulcers on the lateral borders of the tongue and on the buccal mucosa were found only in dentate patients. Development of intraoral ulcers was not associated with an increase of the HSV titer in serum in any patient. It is concluded that some intraoral ulcers, especially when located on the alveolar process, are associated with and probably caused by HSV, while mechanical trauma during mastication seems likely to be involved in the pathogenesis of ulcers elsewhere in the oral cavity. PMID:2338087

Bergmann, O J; Mogensen, S C; Ellegaard, J



Leg recirculation in horizontal plane locomotion  

Microsoft Academic Search

A protocol prescribing leg motion during the swing phase is developed for the planar lateral leg spring model of locomotion.\\u000a Inspired by experimental observations regarding insect leg function when running over rough terrain, the protocol prescribes\\u000a the angular velocity of the swing-leg relative to the body in a feedforward manner, yielding natural variations in the leg\\u000a touch-down angle in response

A. Wickramasuriya; J. Schmitt



Endocrinology of duodenal ulcer  

Microsoft Academic Search

Several gastrointestinal peptides with proven or suggested endocrine or paracrine functions influence gastric acid secretion, gastrointestinal motility, and mucosal blood flow. Increased or decreased release of such factors could participate in the pathogenesis of duodenal ulcer disease by inducing increased gastric acid concentration in the duodenal bulb. To date, increased stimulation of parietal cells by gastrin has been demonstrated only

W. Creutzfeldt; R. Arnold



[Managing perilesional pressure ulcers].  


The skin of elderly patients is very fragile and dry which impairs its function as a barrier and renders it more exposed to external attacks, perilesional complications around pressure ulcers are often linked to several interrelated mechanisms. These complications require, from the teams, in-depth knowledge of the care protocols. PMID:23785860

Perceau, Géraldine


Necrotizing Ulcerative Gingivitis (NUG)  


... swollen gums that are painful even if no pressure is placed on them Gums that bleed easily Bad breath or a bad taste in the mouth A gray film on the gums Sores (ulcers) on the gums Sore throat Fever (not often) ...


Chronic idiopathic ulcerative colitis  

Microsoft Academic Search

Many frequently cited studies of the interaction of chronic idiopathic ulcerative colitis (CIUC) and pregnancy were performed in the 1950s before pharmacotherapy for this disease was common. We retrospectively reviewed obstetrical records at a large maternity facility to determine the effects of CIUC on pregnancy and on fetal outcome. We observed that the prevalence of CIUC in pregnant women was

Robert R. Schade; David H. Van Thiel; Judith S. Gavaler



Factor V Leiden mutation-related chronic skin ulcers.  


Chronic skin ulcers require extensive, systemic differential diagnosis; thus, they are difficult to diagnose and treat. Transient or persistent hypercoagulable states are among the rare causes of skin ulcers. Here, we present the case of a 27-year-old woman patient with recurrent, nonhealing skin ulcers of 8 years' duration, who had been treated unsuccessfully with various medications under different diagnoses at different clinics. On admission, a skin biopsy demonstrated occlusive vasculopathy, and the search for an inherited hypercoagulable state revealed a heterozygous factor V Leiden mutation. The patient was treated with anticoagulants and hyperbaric oxygen. On treatment, the skin lesions healed and did not recur. PMID:23446370

Kayatas, Kadir; Cebeci, Filiz; Karatoprak, Cumali; Benzer, Muhammet; Demirtunç, Refik; Demirkesen, Cuyan



[A case of groove pancreatitis associated with duodenal ulcer].  


We describe a 69-year-old man with a history of multiple gastroduodenal ulcers, presenting with the onset of obstructive jaundice. Abdominal CT, MRI and EUS demonstrated a sheet-like mass in the pancreaticoduodenal groove. EUS-FNA did not reveal malignancy. Conservative treatment did not improve his clinical condition and repeated acute pancreatitis occurred during his treatment. Thus, pancreaticoduodenectomy was performed. Histopathological findings showed a duodenal ulcer penetrating the pancreas and infiltration of inflammatory cells and fibrosis in the pancreaticoduodenal groove. The spread of inflammation associated with the duodenal ulcer may have been one of the causes of groove pancreatitis. PMID:23303234

Iemoto, Takao; Shiomi, Hideyuki; Masuda, Atsuhiro; Sanuki, Tsuyoshi; Kutsumi, Hiromu; Hayakumo, Takanobu; Shinzeki, Makoto; Matsumoto, Ippei; Ku, Yonson; Kanzawa, Maki; Hara, Shigeo; Azuma, Takeshi



Genetic parameters for claw health and feet and leg conformation traits in Finnish Ayrshire cows.  


Genetic parameters for different claw disorders, overall claw health and feet and leg conformation traits were estimated for Finnish Ayrshire cows. The merged data set with records of claw health and feet and leg conformation traits consisted of 105,000 observations from 52,598 Finnish Ayrshire cows between 2000 and 2010. The binary claw health data and the linearly scored conformation data were analysed using an animal model and restricted maximum likelihood method by applying the statistical package ASReml. Binomial logistic models with mixed effects were used to estimate genetic parameters for sole haemorrhages, chronic laminitis, white-line separation, sole ulcer, interdigital dermatitis, heel horn erosion, digital dermatitis, corkscrew claw and overall claw health. Estimated heritabilities for different claw disorders using a binomial logistic model ranged from 0.01 to 0.20. Estimated heritability for overall claw health using a binomial logistic model was 0.08. Estimated heritabilities for feet and leg conformation traits ranged from 0.07 to 0.39. The genetic correlations between claw health and feet and leg conformation traits ranged from -0.40 to 0.42. All phenotypic correlations were close to zero. The moderate genetic correlation, together with higher heritability of feet and leg conformation traits, showed that RLSV (rear leg side view) is a useful indicator trait to be used together with claw trimming information to increase the accuracy of breeding values for claw health in genetic evaluation. PMID:23496009

Häggman, J; Juga, J; Sillanpää, M J; Thompson, R



New and experimental approaches to treatment of diabetic foot ulcers: a comprehensive review of emerging treatment strategies  

Microsoft Academic Search

Diabetic foot ulcers occur in up to 15% of all diabetic patients and are a leading cause of nontraumatic amputation worldwide. Neuropathy, abnormal foot biomechanics, peripheral vascular disease and external trauma are the major contributors to the development of a foot ulcer in the diabetic patient. Therapy today includes repeated debridement, offloading, and dressings, for lower grade ulcers, and broad

R. Eldor; I. Raz; A. Ben Yehuda; A. J. M. Boulton



CROSSED LEG PALSY with Report of a Recurrent Case  

PubMed Central

A form of peroneal palsy may be caused by crossing the legs. Two physical factors—pressure and tension — are the basic causes, although other factors may be contributory. Direct pressure is applied by the bones of the two legs, compressing the peroneal nerve between them at its superficial part near the head and neck of the fibula. The palsy may be overlooked as an integral part of a widespread disorder so that careful evaluation and observation of the patient's habits are required. Detection becomes especially difficult when the palsy is bilateral, for then the lesion by virtue of its symmetry blends more readily with associated polyneuritis. A case of recurrent peroneal palsy due to crossing the legs in a prolonged postoperative convalescence is reported in detail.

Weiss, Isidore I.



Pipe crawler with extendable legs  


A pipe crawler for moving through a pipe in inchworm fashion having front and rear leg assemblies separated by air cylinders to increase and decrease the spacing between assemblies. Each leg of the four legs of an assembly is moved between a wall-engaging, extended position and a retracted position by a separate air cylinder. The air cylinders of the leg assemblies are preferably arranged in pairs of oppositely directed cylinders with no pair lying in the same axial plane as another pair. Therefore, the cylinders can be as long as a leg assembly is wide and the crawler can crawl through sections of pipes where the diameter is twice that of other sections. The crawler carries a valving system, a manifold to distribute air supplied by a single umbilical air hose to the various air cylinders in a sequence controlled electrically by a controller. The crawler also utilizes a rolling mechanism, casters in this case, to reduce friction between the crawler and pipe wall thereby further extending the range of the pipe crawler. 8 figs.

Zollinger, W.T.



The odd-skipped family of zinc finger genes promotes Drosophila leg segmentation.  


Notch signaling controls formation of joints at leg segment borders and growth of the developing Drosophila leg. Here, we identify the odd-skipped gene family as a key group of genes that function downstream of the Notch receptor to promote morphological changes associated with joint formation during leg development. odd, sob, drm, and bowl are expressed in a segmental pattern in the developing leg, and their expression is regulated by Notch signaling. Ectopic expression of odd, sob, or drm can induce invaginations in the leg disc epithelium and morphological changes in the adult leg that are characteristic of endogenous invaginating joint cells. These effects are not due to an alteration in the expression of other genes of the developing joint. While odd or drm mutant clones do not affect leg segmentation, and thus appear to act redundantly, bowl mutant clones do perturb leg development. Specifically, bowl mutant clones result in a failure of joint formation from the distal tibia to tarsal segment 5, while more proximal clones cause melanotic protrusions from the leg cuticle. Together, these results indicate that the odd-skipped family of genes mediates Notch function during leg development by promoting a specific aspect of joint formation, an epithelial invagination. As the odd-skipped family genes are involved in regulating cellular morphogenesis during both embryonic segmentation and hindgut development, we suggest that they may be required in multiple developmental contexts to induce epithelial cellular changes. PMID:14597202

Hao, Irene; Green, Ryan B; Dunaevsky, Olga; Lengyel, Judith A; Rauskolb, Cordelia



Restless legs syndrome and periodic leg movements of sleep.  


Women are more commonly affected than men by restless legs syndrome, and prevalence is highest amongst those of northern European heritage. The motor manifestations include nonvolitional myoclonus (periodic leg movements). Disinhibition of spinal sensorimotor circuits may underlie these primary features and can be affected by peripheral as well as supraspinal networks. Insufficient mobilizable iron stores increase expressivity in some individuals. The sensorimotor features are relieved by dopamine, especially dopamine agonists, gabapentin and its derivatives, and opioids. A diagnosis relies on recognition of key primary and supportive features, and treatments are generally well tolerated, efficacious, and life-changing. PMID:23099132

Rye, David B; Trotti, Lynn Marie



Promethus Hot Leg Piping Concept  

SciTech Connect

The Naval Reactors Prime Contractor Team (NRPCT) recommended the development of a gas cooled reactor directly coupled to a Brayton energy conversion system as the Space Nuclear Power Plant (SNPP) for NASA's Project Prometheus. The section of piping between the reactor outlet and turbine inlet, designated as the hot leg piping, required unique design features to allow the use of a nickel superalloy rather than a refractory metal as the pressure boundary. The NRPCT evaluated a variety of hot leg piping concepts for performance relative to SNPP system parameters, manufacturability, material considerations, and comparison to past high temperature gas reactor (HTGR) practice. Manufacturability challenges and the impact of pressure drop and turbine entrance temperature reduction on cycle efficiency were discriminators between the piping concepts. This paper summarizes the NRPCT hot leg piping evaluation, presents the concept recommended, and summarizes developmental issues for the recommended concept.

AM Girbik; PA Dilorenzo



Prometheus Hot Leg Piping Concept  

NASA Astrophysics Data System (ADS)

The Naval Reactors Prime Contractor Team (NRPCT) recommended the development of a gas cooled reactor directly coupled to a Brayton energy conversion system as the Space Nuclear Power Plant (SNPP) for NASA's Project Prometheus. The section of piping between the reactor outlet and turbine inlet, designated as the hot leg piping, required unique design features to allow the use of a nickel superalloy rather than a refractory metal as the pressure boundary. The NRPCT evaluated a variety of hot leg piping concepts for performance relative to SNPP system parameters, manufacturability, material considerations, and comparison to past high temperature gas reactor (HTGR) practice. Manufacturability challenges and the impact of pressure drop and turbine entrance temperature reduction on cycle efficiency were discriminators between the piping concepts. This paper summarizes the NRPCT hot leg piping evaluation, presents the concept recommended, and summarizes developmental issues for the recommended concept.

Gribik, Anastasia M.; Dilorenzo, Peter A.



Gastric Mucosal Energy Metabolism and "Stress Ulceration,"  

PubMed Central

Acute gastric erosions following hemorrhagic shock (stress ulceration) have been attributed to gastric hyperacidity, altered gastric secretion of mucus and an abnormal permeability of the gastric mucosa to H+. This report aims at presenting evidence supporting an alternate hypothesis: the event linking shock-induced gastric mucosal ischemia to mucosal necrosis is a deficit in gastric mucosal energy metabolism. Our experimental procedure consisted of harvesting the stomachs of rats and rabbits by “stop-freeze” (liquid N2) at different intervals after the induction of hemorrhagic shock. Levels of adenosine-phosphates and of glycolytic intermediates in gastric mucosa were measured. We studied the changes in the levels of these substrates produced by shock as well as by factors capable, when combined with shock, of rendering the gastric mucosa more vulnerable to stress ulceration. The influence of shock and of these modifying factors were evaluated by comparison with data from appropriately designed control experiments. In parallel experiments we examined the frequency of stress ulceration (gross and microscopic) under these same standard conditions. There have emerged from these studies a number of observations all based upon data with the highest statistical significance. The data are consonant with the hypothesis stated above: an energy deficit severe enough to cause cellular necrosis is the event linking shock-induced gastric mucosal ischemia and stress ulceration. ImagesFig. 1.Fig. 2.

Menguy, Rene; Masters, Y. F.



Sleep complaints and restless legs syndrome in adult type 2 diabetics  

Microsoft Academic Search

Objective: To determine the prevalence and characteristics of sleep complaints and restless legs syndrome (RLS) in type 2 adult diabetics. To test the hypothesis that sleep complaints are more common among adult diabetics.Background: Restless legs syndrome is a common disorder and is a cause of insomnia and daytime somnolence. An association between RLS and diabetes mellitus has been hypothesized but

R. P Skomro; S Ludwig; E Salamon; M. H Kryger



Restless legs syndrome and periodic limb movement disorder in the elderly  

Microsoft Academic Search

Restless legs syndrome (RLS) is a sensorimotor neurological disorder characterized by an urge to move the extremities, mostly the legs, caused or accompanied by unpleasant sensations in the affected limbs. Symptoms appear or increase in the evening or during the night and at rest. Sleep disturbances are the most frequent reason why patients seek medical aid. The diagnosis of periodic

Magdolna Hornyak; Claudia Trenkwalder



Relevance of fatigue tests to cold leg piping. Final report. [PWR  

Microsoft Academic Search

The cold leg in a PWR, for the purpose of this report, is defined as that portion of the primary coolant loop that lays between the coolant pump and the reactor vessel. One of the conditions which may lead to failure in a cold leg consists of repeated cycles of stress. These repeated stress cycles may cause the growth of

M. E. Mayfield; E. C. Rodabaugh; R. J. Eiber



Use of magnetic variation and station declination for heading (VX) and course (CX) leg types  

Microsoft Academic Search

Leg types, also known as path terminators, are used in aircraft navigation to define paths as routes for RNAV equipped aircraft. Many leg types are specifically defined to cause the Area Navigation (RNAV) system to emulate the actions that an aircrew would take when flying the route manually based on the text and other depictions on the chart. Some emulate

Michael Cramer; Albert Herndon; Sam Miller



Rotigotine for restless legs syndrome.  


Restless legs syndrome (RLS) is a neurological disorder related to abnormal and unpleasant sensations and movements in the legs. It usually occurs at nighttime and thus has a detrimental impact on the ability to sleep, leading to poor patient quality of life. UCB has been developing rotigotine transdermal patch system (Neupro; SPM-962) as a treatment for RLS. This system is designed to replace levels of dopamine in the body via once-daily application of the patch, in a bid to restore proper motor functioning. The rotigotine patch has been authorized for the treatment of RLS since August 2008. PMID:19956807

Davies, Shelley



[A case of aseptic osteomyelitis with heel ulcer improved by steroid application].  


A 43-year-old male patient was admitted to our hospital because of left heel pain and fever. He had had swelling of the left ankle joint and pain 4 years prior to this, and 4 years later, he was admitted to another hospital when left heel ulcer and fever developed. The ulcer was diagnosed and treated as a diabetic ulcer because of hyperglycemia. In spite of good control of blood sugar, the ulcer became enlarged and the pain deteriorated, so he was transferred to orthopedics. Antibiotics produced no response, and culture from a specimen of the ulcer was negative. However, severe inflammatory response was seen in blood examination. MRI and scintigram of his left foot showed disseminated low intensity areas and accumulation in the tarsal bone area, so osteomyelitis was suspected. A biopsy of the ulcer showed infiltration of inflammatory cells into the dermis. We considered amputation of the left lower leg at first. However the biopsy result suggested an autoimmune mechanism, so prednisolone was administered. As a result, the ulcer and pain both diminished. This case was similar to pyoderma gangenosum, however this diagnosis cannot explain osteomyelitis or all its symptoms. We expect that there must be other case report with the same symptoms. PMID:10917019

Idogawa, M; Takahashi, H; Soma, T; Mihara, M; Mizukoshi, T; Murakami, R; Sugaya, T; Makiguchi, Y; Imai, K



The role of gastrin in ulcer pathogenesis  

Microsoft Academic Search

Duodenal ulcer patients are characterized by an antrum-predominant, body-sparing, non-atrophicHelicobacter pylori (H. pylori) gastritis, which results in increased gastrin release and increased acid secretion. The increased gastrin release is caused by the infection impairing the acid-mediated inhibitory control of gastrin release. The elevated levels of the gastrin stimulate the healthy uninflamed, non-atrophic acid-secreting region of the stomach to secrete excess

Kenneth E. L. McColl; Derek Gillen; Emad El-Omar



Buruli ulcer disease: prospects for a vaccine  

Microsoft Academic Search

Buruli ulcer disease (BUD), caused by Mycobacterium ulcerans, is a neglected bacterial infection of the poor in remote rural areas, mostly affecting children. BUD is a mutilating disease\\u000a leading to severe disability; it is the third most common mycobacterial infection in immunocompetent people after tuberculosis\\u000a and leprosy. It is most endemic in West Africa, but cases have been reported from

Kris Huygen; Ohene Adjei; Dissou Affolabi; Gisela Bretzel; Caroline Demangel; Bernhard Fleischer; Roch Christian Johnson; Jorge Pedrosa; Delphin M. Phanzu; Richard O. Phillips; Gerd Pluschke; Vera Siegmund; Mahavir Singh; Tjip S. van der Werf; Mark Wansbrough-Jones; Françoise Portaels



Budesonide for ulcerative colitis.  


In this review, we examined studies published on oral and topical formulations of budesonide (Entocort and Budenofalk, in Spain: Entocord and Intestifalk) for the treatment of ulcerative colitis. This glycocorticosteroid has a potent local action and an important first-pass liver metabolism. It has proven successful over the last years as a controlled-release formulation. It obtained results similar to prednisolone, without the latter s significant suppression of plasma cortisol. Many publications exist on the effects of oral budesonide for the treatment of Crohn s disease (CD). These have led to the registration of this drug for the treatment of CD. Studies on oral formulations of budesonide for the treatment of ulcerative colitis (UC) are scarce. After reviewing published evidence, we suggest the conduction of controlled trials for the treatment of UC to obtain evidence-based efficacy and safety results in order to benefit patients with this form of inflammatory bowel disease (IBD). PMID:16944997

Marín-Jiménez, I; Peña, A S



Low long-term risk of foot ulcer recurrence after nerve decompression in a diabetes neuropathy cohort.  


Background: Use of nerve decompression in diabetic sensorimotor polyneuropathy is a controversial treatment characterized as being of unknown scientific effectiveness owing to lack of level I scientific studies. Methods: Herein, long-term follow-up data have been assembled on 65 diabetic patients with 75 legs having previous neuropathic foot ulcer and subsequent operative decompression of the common peroneal and tibial nerve branches in the anatomical fibro-osseous tunnels. Results: The cohort's previously reported low recurrence risk of less than 5% annually at a mean of 2.49 years of follow-up has persisted for an additional 3 years, and cumulative risk is now 2.6% per patient-year. Nine of 75 operated legs (12%) have developed an ulcer in 4,218 months (351 patient-years) of follow-up. Of the 53 contralateral legs without decompression, 16 (30%) have ulcerated, of which three have undergone an amputation. Fifty-nine percent of patients are known to be alive with intact feet a mean of 60 months after decompression. Conclusions: The prospective, objective, statistically significant finding of a large, long-term diminution of diabetic foot ulcer recurrence risk after operative nerve decompression compares very favorably with the historical literature and the contralateral legs of this cohort, which had no decompression. This finding invites prospective randomized controlled studies for validation testing and reconsideration of the frequency and contribution of unrecognized nerve entrapments in diabetic sensorimotor polyneuropathy and diabetic foot complications. PMID:24072366

Nickerson, D Scott; Rader, Andrew J


Recommendations for research in geotechnical engineering for Tension Leg Platforms  

Microsoft Academic Search

The Tension Leg Platform (TLP) is a buoyant, compliant structural system designed for drilling and producing oil and gas in deep water. The unique vertical mooring system of the TLP imposes a sustained uplift load on the platform's foundations; cyclic loads caused by environmental forces can be as large as the static uplift load. Deep water and the unusual type




Restless legs syndrome as side effect of second generation antidepressants  

Microsoft Academic Search

Although of clinical interest, the question is still not fully answered whether antidepressants (AD) can cause or exacerbate restless legs syndrome (RLS). The literature provides contradictory information. This study addresses this problem for the class of second generation AD.In four neurological offices, all patients treated for the first time with an AD were prospectively observed with regard to the question

Klaus G. Rottach; Bernhard M. Schaner; Michael H. Kirch; Ari Z. Zivotofsky; Lydia M. Teufel; Thorsten Gallwitz; Thomas Messer



Diabetic Foot Ulcers  

Microsoft Academic Search

The Wagner system describes the diabetic foot ulcer as a full thickness wound extending to tendons or deeper subcutaneous\\u000a tissue but without bony involvement or osteomyelitis [1]. The university of Texas system refers to levels of ischemia [2]\\u000a and infection while the SAD system [3] attends to size, area, depth, arteriopathy and any neuropathic involvement. The breadth\\u000a of classification system

Andrew Boulton; Frank Bowling


Stress ulcer bleeding  

Microsoft Academic Search

Opinion statement  Although upper gastrointestinal (GI) bleeding from stress-related mucosal disease (SRMD) in critically ill patients is common,\\u000a significant bleeding with hemodynamic instability is not. Risk factor assessment can assist in identifying patients with a\\u000a greater likelihood of developing significant SRMD. Prophylaxis against stress ulcer bleeding with luminal agents (eg, antacids\\u000a and sucralfate) or drugs that inhibit acid secretion (eg, histamine

Richard F. Harty; Hari B. Ancha



Solitary rectal ulcer syndrome  

Microsoft Academic Search

Background  Although the clinicopathologic features of solitary rectal ulcer syndrome (SRUS) are well documented, the heterogeneous endoscopic appearance of lesions that the syndrome produces and its rare incidence may make for clinical confusion.Methods  Together with a literature review, we describe the variety of lesions experienced in our hospital with a series of endoscopic and histological illustrations and emphasize the diagnostic dilemma both

Jy-Ming Chiang; Chung-Rong Changchien; Jim-Ray Chen



Persistent nicorandil induced oral ulceration  

PubMed Central

Four patients with nicorandil induced ulceration are described, and the literature on the subject is reviewed. Nicorandil induced ulcers are very painful and distressing for patients. Clinically they appear as large, deep, persistent ulcers that have punched out edges. They are poorly responsive to topical steroids and usually require alteration of nicorandil treatment. The ulceration tends to occur at high doses of nicorandil and all four cases reported here were on doses of 40 mg per day or greater. In these situations reduction of nicorandil dose may be sufficient to promote ulcer healing and prevent further recurrence. However, nicorandil induced ulcers have been reported at doses as low as 10 mg daily and complete cessation of nicorandil may be required.

Healy, C M; Smyth, Y; Flint, S R



Acute lower leg compartment syndrome  

Microsoft Academic Search

Acute compartment syndromes in the lower leg are well recognized following major trauma. However, although rare, they may occur following seemingly minor sporting injury. A case of acute compartment syndrome, following a football game and affecting the peroneal or lateral compartment, is described, in which prompt diagnosis and treatment led to a satisfactory outcome. The diagnosis and surgical management of

R A Power; P Greengross



Investigating the relationship between abomasal hairballs and perforating abomasal ulcers in unweaned beef calves.  

PubMed Central

This study investigated the relationship between abomasal hairballs (trichobezoars) and perforating abomasal ulcers in unweaned beef calves <4 mo of age. The calves enrolled in the study represented routine necropsy submissions to veterinary practitioners in western Canada and to the Western College of Veterinary Medicine. Regardless of the cause of death, each calf was examined for evidence of abomasal ulcers and hairballs. Thirty-two practitioners and the Western College of Veterinary Medicine provided 166 cases for the study; 56 died of perforating ulcers (ulcer calves), and 110 died of causes unrelated to abomasum (non-ulcer calves). The calves ranged in age from 1-90 d; 154 (92.8%) were <61 d of age. Overall, ulcer calves were 2.74 (P = 0.003) times more likely to die with an abomasal hairball than were the nonulcer calves. However, stratifying the calves into 2 age groups, young (<31 d) and old (>30 d), yielded conflicting results. While the young ulcer calves were 3.81 (P = 0.003) times more likely to have a hairball than were the young nonulcer calves, there was no statistically significant relationship (OR = 0.76, P = 0.65) between ulcer and hairballs in the older calves. The authors concluded that the relationship between hairballs and ulcers in the young calves was probably spurious, created by a Berkson's bias. It is unlikely that abomasal hairballs have a significant role in the development of fatal perforating ulcers in beef calves.

Jelinski, M D; Ribble, C S; Campbell, J R; Janzen, E D



Treatment of chronic posttraumatic leg injury using autologous fat graft.  


We present the results obtained in a case of a 20-year-old Caucasian woman with a posttraumatic injury "hard-to-heal" of the left leg treated using autologous fat graft. Considering our experience in treatment of chronic posttraumatic ulcers by autologous fat graft, we decided to use this surgical technique to induce a regenerative effect in this young patient. We have had complete wound closure with only a single surgical procedure after 1 month; after the second intervention of autologous fat graft we observed an improvement in the quality of the scar tissue. The patient satisfaction was excellent. The results were long lasting and remained virtually unchanged after 1 year. PMID:23319957

Caviggioli, Fabio; Klinger, Francesco Maria; Vinci, Valeriano; Cornegliani, Guido; Klinger, Marco



[Guidelines of treatment for non-bleeding peptic ulcer disease].  


Over the past century, since the introduction of non steroidal anti-inflammatory drugs (NSAID), antacid, histamine H2-receptor antagonists (H2RA), proton pump inhibitors (PPI), and discovery of Helicobacter pylori infection, the paradigm of peptic ulcer disease has changed with marked decrease in morbidity and mortality. However, peptic ulcer disease still occupies a position as a major health problem with increase of aged population and NSAIDs usage. In daily general practice, the management of peptic ulcer disease is directed according to the presence of bleeding or not. For non-bleeding peptic ulcer disease, proper acid suppression and the correction of underlying causes such as Helicobacter pylori infection and NSAID use is the main stay of treatment. Though a complete understanding of pathophysiology and a perfect treatment strategy are still a challenge, this guideline aims to provide practical recommendations based on evidences or consensus of experts through in-depth literature review and expert meeting. PMID:19934610

Cheung, Dae Young; Jung, Hwoon Yong; Song, Ho June; Jung, Sung Woo; Jung, Hyun Chae



Pressure ulcer prevention: An efficient turning schedule for bed-bound patients  

Microsoft Academic Search

Pressure ulcer is a critical problem for bed-ridden and wheelchair-bound patients, diabetics, and the elderly. Pa- tients need to be regularly repositioned to prevent excessive pressure on a single area of body, which can lead to ulcers. Pressure ulcers are costly to treat and cause many other health problems, including death. The current standard for prevention is to reposition at-risk

Sarah Ostadabbas; Rasoul Yousefi; Miad Faezipour; Mehrdad Nourani; Matthew Pompeo



Celecoxib compared with lansoprazole and naproxen to prevent gastrointestinal ulcer complications  

Microsoft Academic Search

PurposeSelective cyclooxygenase-2 (COX-2) inhibitors cause significantly fewer peptic ulcers than conventional nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) in patients at low risk or high risk for peptic ulcers. On the other hand, proton pump inhibitor co-therapy has also been shown to be effective in preventing relapse of peptic ulcers in high-risk patients using nonselective NSAIDs. We compared the efficacy of a

Kam-Chuen Lai; Kent-Man Chu; Wai-Mo Hui; Benjamin Chun-Yu Wong; Wayne Hsing-Ching Hu; Wai-Man Wong; Annie On-On Chan; John Wong; Shiu-Kum Lam



Resolution of an oral ulcer secondary to acetaminophen/hydrocodone withdrawal.  


Acetaminophen/hydrocodone is a common non-opioid/opioid analgesic indicated for the treatment of moderate to severe pain. The following report depicts a unique case involving a 57-year-old woman with a persistent, painful oral ulcer that was unresponsive to standard treatments. The ulcer was resolved when the patient discontinued acetaminophen/hydrocodone use. The cause of the ulcer is unclear but it was speculated to result from a systemic hypersensitivity reaction to acetaminophen/hydrocodone. PMID:17899723

Balasubramaniam, Ramesh; Lin, Po-Ching; White, Dean K; Yepes, Juan F


Restless Legs Syndrome: scoring criteria for leg movements recorded during the suggested immobilization test  

Microsoft Academic Search

Objective: To evaluate the characteristics of leg movements experienced by patients with the restless legs syndrome (RLS) during wakefulness using the suggested immobilization test (SIT).Methods: Forty patients with primary RLS who showed an index of leg movements greater than 40 during the SIT were selected for these analyses.Results: In general, Coleman's criteria for scoring PLMS were appropriate for scoring leg

Martin Michaud; Gaétan Poirier; Gilles Lavigne; Jacques Montplaisir



How Is Restless Legs Syndrome Treated?  


... page from the NHLBI on Twitter. How Is Restless Legs Syndrome Treated? Restless legs syndrome (RLS) has no cure. If a condition or ... to prevent these side effects. Rate This Content: Restless Legs Syndrome Clinical Trials Clinical trials are research studies that ...


Leg Stiffness and Expertise in Men Jumping  

Microsoft Academic Search

LAFFAYE, G., B. G. BARDY, and A. DUREY. Leg Stiffness and Expertise in Men Jumping. Med. Sci. Sports Exerc., Vol. 37, No. 4, pp. 536-543, 2005. Purpose: The aim of the present study is to investigate: a) the leg spring behavior in the one-leg vertical jump, b) the contribution of impulse parameters to this behavior, and c) the effect of




Integrated system for single leg walking  

Microsoft Academic Search

The Carnegie Mellon University Planetary Rover project is developing a six-legged walking robot capable of autonomously navigating, exploring, and acquiring samples in rugged, unknown environments. This report describes an integrated software system capable of navigating a single leg of the robot over rugged terrain. The leg, based on an early design of the Ambler Planetary Rover, is suspended below a

Reid Simmons; Eric Krotkov; Gerry Roston



The decubitus ulcer: facts and controversies.  


Defining the decubitus ulcer proves as difficult as agreeing on a name for the condition. Causes include pressure over bony prominences, shearing force, destruction of skin, and compromised blood flow. Evidence is emerging of the importance of ischemia as a primary causative agent, rather than pressure, which needs further investigation. Scales, staging, and treatment and prevention guidelines should be used with caution due to their arbitrary implementation and lack of evidence-based support. Unfortunately, much of the research and expert opinion developed by the government and touted as regulation lacks appropriate strength-of-evidence. Although decubitus ulcers should be prevented and treated to the best of our abilities, recognizing the possibility that the skin, like any other organ in the body, may fail is crucial. PMID:20797513

Campbell, Caren; Parish, Lawrence Charles


Pressure Ulcers and Nutritional Implications. (Video).  

National Technical Information Service (NTIS)

This satellite broadcast will define pressure ulcers, describe the etiology of pressure ulcers, identify the effective prevention measures, and explain the rational for comprehensive nutrition intervention.



Prophylactic antibiotics for the prevention of cellulitis (erysipelas) of the leg: results of the U.K. Dermatology Clinical Trials Network's PATCH II trial  

PubMed Central

Summary Background Cellulitis (erysipelas) of the leg is a common, painful infection of the skin and underlying tissue. Repeat episodes are frequent, cause significant morbidity and result in high health service costs. Objectives To assess whether prophylactic antibiotics prescribed after an episode of cellulitis of the leg can prevent further episodes. Methods Double-blind, randomized controlled trial including patients recently treated for an episode of leg cellulitis. Recruitment took place in 20 hospitals. Randomization was by computer-generated code, and treatments allocated by post from a central pharmacy. Participants were enrolled for a maximum of 3 years and received their randomized treatment for the first 6 months of this period. Results Participants (n = 123) were randomized (31% of target due to slow recruitment). The majority (79%) had suffered one episode of cellulitis on entry into the study. The primary outcome of time to recurrence of cellulitis included all randomized participants and was blinded to treatment allocation. The hazard ratio (HR) showed that treatment with penicillin reduced the risk of recurrence by 47% [HR 0·53, 95% confidence interval (CI) 0·26–1·07, P = 0·08]. In the penicillin V group 12/60 (20%) had a repeat episode compared with 21/63 (33%) in the placebo group. This equates to a number needed to treat (NNT) of eight participants in order to prevent one repeat episode of cellulitis [95% CI NNT(harm) 48 to ? to NNT(benefit) 3]. We found no difference between the two groups in the number of participants with oedema, ulceration or related adverse events. Conclusions Although this trial was limited by slow recruitment, and the result failed to achieve statistical significance, it provides the best evidence available to date for the prevention of recurrence of this debilitating condition.



Progressive leg pain and weakness.  


A 54-year-old man presented with progressive asymmetric leg pain and weakness. He had a history of invasive squamous cell carcinoma that was fully treated 2 years earlier. His leg symptoms progressed relentlessly during several months. Imaging studies demonstrated enhancement of the cauda equina and leptomeninges of the lower spinal cord. Initial cerebrospinal fluid examination showed an elevated protein concentration and lymphocytic pleocytosis with no malignant cells on cytological analysis. There was short-term improvement in symptoms and cerebrospinal fluid abnormalities with intravenous steroids. Two additional cerebrospinal fluid studies showed normal cytological findings, elevated IgG synthesis, and elevated antibody titers to varicella-zoster virus. Over time, the patient worsened, developed cranial neuropathies, and ultimately died. The pathological diagnosis and the approach to the clinical data are discussed. PMID:23440264

Navalkele, Digvijaya D; Georgescu, Maria-Magdalena; Burns, Dennis K; Greenberg, Tasha; Vernino, Steven



Fibromyxoid sarcoma of the leg  

PubMed Central

A 48-year-old female with an atypical plaque-like lesion of the lower leg is presented in this article. Histologic investigation revealed a rare low-grade fibromyxoid sarcoma (pT1a cN0 cM0; stage Ia) of suprafascial localization. Staging of the patient did not reveal metastatic spread. The tumor was surgically removed with wide safety margins. The defect was closed using a mesh graft transplant and vacuum-assisted closure. Healing was complete. Regular follow-up for at least 5 years is recommended. Besides the rareness of this tumor, this case is also remarkable because of the localization on the lower leg and the suprafascial soft tissue.

Wollina, Uwe; Runge, Juliane; Schonlebe, Jaqueline



Assessing Children's Legs and Feet  

PubMed Central

Shoes are necessary for protection and warmth. Normal children do not require shoes for support. There is no scientific evidence that shoes—‘orthopedic’ or otherwise—influence or alter the growth or shape of the normal child's foot except, perhaps, adversely if they fit poorly. Family physicians must understand common variations of normal foot and leg development if they are to effectively advise and reassure parents about appropriate footwear. Flat feet, knock knees, bow legs, in-toeing, and out-toeing in otherwise normal children can easily be distinguished from similar but more serious deformities associated with disease or congenital anomaly. ImagesFig. 1AFig. 1BFig. 2AFig. 2B

Wedge, John H.



Persistent ulcer of the knee.  


A 15-year-old female suffered from a persistent ulcer which developed in her knee. At the ninth operation, intraarticular knee arthrodesis was performed but the ulcer recurred. The most effective treatment was neither thorough debridement nor a free musculocutaneous flap covering, but the application of a plaster cast. The condition is thought to have been Munchausen syndrome. PMID:8012256

Nishijima, N; Yamamuro, T; Seto, Y



Current concepts of peptic ulceration  

Microsoft Academic Search

These observations support the theory that peptic ulceration results from failure of adequate local repair to mucosal injury. The resultant ulcer may be acute or chronic depending upon the duration of the stress or the mucosal contact of the irritative substance and on the ability of the local tissue to achieve cellular homeostasis. The role of acid and pepsin secretion

S. P. Bralow



Surgical Management of Ulcer Disease  

Microsoft Academic Search

The history of management of ulcer disease is one of the great stories in the history of general surgery. The surgeons who have helped elucidate the anatomy, physiology, biochemistry, and operative management of patients who have ulcers have earned their place in the historical ranks of our discipline. One is hard-pressed to find a vein of surgical thought with such

Ronald F. Martin


Acute lower leg compartment syndrome.  

PubMed Central

Acute compartment syndromes in the lower leg are well recognized following major trauma. However, although rare, they may occur following seemingly minor sporting injury. A case of acute compartment syndrome, following a football game and affecting the peroneal or lateral compartment, is described, in which prompt diagnosis and treatment led to a satisfactory outcome. The diagnosis and surgical management of acute compartment syndromes are discussed. Early recognition and treatment are important in the prevention of long-term disability. Images Figure 1

Power, R A; Greengross, P



Acute lower leg compartment syndrome.  


Acute compartment syndromes in the lower leg are well recognized following major trauma. However, although rare, they may occur following seemingly minor sporting injury. A case of acute compartment syndrome, following a football game and affecting the peroneal or lateral compartment, is described, in which prompt diagnosis and treatment led to a satisfactory outcome. The diagnosis and surgical management of acute compartment syndromes are discussed. Early recognition and treatment are important in the prevention of long-term disability. PMID:1810617

Power, R A; Greengross, P



Propeller flaps for leg reconstruction.  


Leg soft tissue defects with bone or tendon exposure need to be covered with a flap. Various local and free flaps with more or less consistent donor site defects have been described in the past. After the introduction of the perforator-based flap concept, new flaps have also been described for the leg. An evolution and simplification of the perforator flap concept, together with the 'free style' flap harvesting method, are the propeller flaps, i.e. local flaps, based on a perforator vessel, which becomes the pivot point for the skin island that can, therefore, be rotated up to 180 degrees . In this prospective study, six consecutive patients, having post-traumatic soft tissue defects of the leg or knee prosthesis infection, with bone or tendon exposure, were treated with propeller flaps. Complete and stable coverage of the soft tissue losses was obtained in all cases with an inconspicuous, only cosmetic, donor site defect. No flap necrosis was observed, with the exception of a small superficial necrosis of the tip of one flap, due to the inclusion in the design of scarred tissue. In two cases, transient venous congestion was observed and resolved spontaneously. Mean operative time was 2 h (ranging from 60 min to 6 h when an orthopaedic procedure was also needed) and mean hospital stay after surgery was 10 days. Propeller flaps allow the coverage of wide defects, can be raised with a relatively simple surgical technique, have a high success rate and good cosmetic results without functional impairment. In the light of this they can be considered among the first surgical choices to resurface complex soft tissue defects of the leg. PMID:18450531

Pignatti, Marco; Pasqualini, Monica; Governa, Maurizio; Bruti, Massimiliano; Rigotti, Gino



Aetiopathogenesis of restless legs syndrome  

Microsoft Academic Search

The pathogenesis of restless legs syndrome (RLS) is not yet completely understood. However, recent research addressed the\\u000a hypothesis that dopaminergic pathways are involved in the mechanisms responsible for the syndrome both for sensory and motor\\u000a symptoms. Different aspects of RLS physiopathogenesis are discussed: the genetic components indicating different chromosomes\\u000a are responsible for the heterogeneity in the phenotypic expression of the

M. Zucconi; M. Manconi; L. Ferini Strambi



Malignant Degeneration of Gastric Ulcer  

PubMed Central

Malignant degeneration is the most serious complication of gastric ulcer. Its recognition is difficult both in the early stage and in advanced cases in which only the evidence of a previous ulcer-cavity, and the radiating folds of the mucous membrane indicate progressive development of carcinoma from an original ulcer. It is impossible to say how often gastric ulcer becomes malignant; one can only state the frequency of ulcer-carcinoma, found in gastric resections. One hundred and forty-one personal cases of ulcer-carcinoma are recorded, and are divided into three groups. Group I: 41 which were diagnosed clinically and at operation as cases of ulcer, but in which histological examination showed incipient cancer. Group II: 55 diagnosed clinically as cases of ulcer, but in which a diagnosis of ulcer-carcinoma was made during operation and afterwards histologically confirmed. Group III: 45 diagnosed both clinically and macroscopically (from the typical folding of the mucous membrane) as cases of ulcer-cancer, in which the cancer had entirely overgrown the ulcer. Therefore in the series of 532 resections for gastric ulcer the frequency of ulcer-carcinoma was 20.9%, or 15.2% if the third group is omitted. In a series of 718 resections for gastric cancer, the frequency of ulcer-carcinoma was 19.6% (or 14.2% if the third group is omitted). The mortality in simple two-third resection of the stomach is low (four deaths in 99 cases = 4%). When the pancreas, liver, colon, or œsophagus, is involved, the resection mortality is high (14 deaths in 42 cases = 33.3%), but even in these cases the operation is justifiable because permanent cures were achieved in a number of cases. The prognosis in cases of ulcer-cancer is very grave. In many cases, judging from the author's own experience, patients suffering from incipient ulcer-cancer—only histologically diagnosed as cancer—die from liver metastases, in spite of radical resection. It will thus be seen that the end-results of resection for ulcer-carcinoma are actually worse than those of resection for primary carcinoma. A. Ulcer-cancer: In Group I, 35 cases were operated on before 1933, and in 18 of these (51.4%) the patients have been free from symptoms for more than five years; in Group II, 27 cases were operated on before 1933, and in four of these (14.8%) the patients are still symptom-free. In Group III, out of 37 cases operated on, only two patients (5.4%) have been symptom-free for the same period. B. Primary cancer: Out of 260 cases of resection for primary cancer before 1933, 77 patients (29.6%) are permanently cured. If the ulcer-cancer is so far advanced that the diagnosis can be made clinically, or during operation, the prognosis is extremely bad (permanent cures having been only 9.3% in the series). In cases of gastric ulcer the best plan is to carry out resection before malignant degeneration begins. The result would then be that not merely 51% but at least 90% of the patients would be alive and well after five years. ImagesFig. 1Fig. 2

Finsterer, H.



Thick legs - not always lipedema.  


Due to its increased presence in the press and on television, the diagnosis of lipedema is on the way to becoming a trendy diagnosis for those with thick legs. Despite this, one must recognize that lipedema is a very rare disease. It is characterized by disproportional obesity of the extremities, especially in the region of the hip and the legs, hematoma development after minimal trauma, and increased pressure-induced or spontaneous pain. Aids for making the correct diagnosis are (duplex) sonography, the waist-hip index or the waist-height index and lymphoscintigraphy. Important differential diagnoses are constitutional variability of the legs, lipohypertrophy in obesity, edema in immobility, edema in chronic venous insufficiency and rheumatic diseases. The symptom-based therapy of lipedema consists of conservative (compression, manual lymphatic drainage, exercise) and surgical treatments (liposuction). Until now there is no curative therapy. Obesity is an important risk factor for the severity and prognosis of lipedema. Further studies for a better understanding of the pathogenesis of lipedema and in the end possible curative treatments are urgently needed. PMID:23231593

Reich-Schupke, Stefanie; Altmeyer, Peter; Stücker, Markus



Stress-induced hemorrhagic gastric ulcer after successful Helicobacter pylori eradication: two case reports  

PubMed Central

Introduction Helicobacter pylori infection is a major cause of gastric ulcers, and Helicobacter pylori eradication drastically reduces ulcer recurrence. It has been reported, however, that severe physical stress is closely associated with gastric ulceration even in Helicobacter pylori -negative patients. Case presentation We report the cases of a 47-year-old Japanese man and a 69-year-old Japanese man who developed psychological stress-induced hemorrhagic gastric ulcers, in both of whom Helicobacter pylori had been successfully eradicated. Conclusion Our cases strongly suggest that not only physical but also psychological stress is still an important pathogenic factor for peptic ulceration and accordingly that physicians should pay attention to the possible presence of psychological stress in the management of patients with peptic ulcers.



The pre-ulcerative phase of carrageenan-induced colonic ulceration in the guinea-pig.  

PubMed Central

The pre-ulcerative phase of carrageenan-induced colonic ulceration was investigated in guinea-pigs supplied 3% degraded carrageenan as an aqueous solution as drinking fluid for 2 or 3 days during which no ulceration of the bowel was observed with the naked eye or dissecting microscope. Mucosal microscopic changes, from caecum to rectum, were multifocal and included cellular infiltrates, dilatation of glands, crypt abscesses, micro-ulcers and sulphated polysaccharide in the lamina propria. Sulphated polysaccharide was also demonstrated histologically for the first time within the surface epithelium and showed ultrastructural features similar to carrageenan. The results indicate that colonic epithelium in the guinea-pig is capable of macromolecular absorption. Carrageenan, a highly active polyanionic electrolyte, within the surface epithelial cells is most likely a primary factor in the breakdown of mucosal integrity. Macromolecular absorption causing enteropathy of the large bowel is a new pathophysiological concept which may have implications in man, particularly in the pathology of large bowel disease. Images Fig. 7 Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6

Marcus, S. N.; Marcus, A. J.; Marcus, R.; Ewen, S. W.; Watt, J.



Gabapentin Enacarbil: Pharmacotherapy of Restless Legs Syndrome  

PubMed Central

Restless Legs Syndrome (RLS) is a prevalent sleep-associated movement disorder greatly affecting patients’ quality of life (QoL). Several drugs can be used to control this condition although the first-line dopamine agents often cause adverse effects. Non-dopaminergic drugs such as oral gabapentin (GBP) have been more recently advocated. Despite ameliorating RLS symptoms, GBP’s pharmacokinetic limitations restrict its overall effectiveness. A novel specifically designed prodrug, gabapentin enacarbil (GE), has demonstrated successful RLS alleviation with a superior pharmacokinetic profile. This review aims to examine the efficacy and tolerability of both GBP and GE as pharmacotherapy for RLS. Despite some heterogeneity and limitations across research methodologies, GE appears to be a potential RLS therapy superior to GBP and other dopaminergic agents.

Jones, Ruth; Rickards, Hugh; Cavanna, Andrea Eugenio



Gastric Acid Secretion and Fasting Serum Gastrin in Patients with Duodenal Ulcer, Prepyloric Ulcer or Gastric Ulcer  

Microsoft Academic Search

In order to evaluate whether prepyloric ulcer (PPU) could be classified as an intermediate ulcer type between duodenal ulcer (DU) and gastric ulcer (GU), fasting serum gastrin as well as basal and pentagastrin-stimulated acid secretion were studied. The fasting serum gastrin values in the three groups were not significantly different. Patients with PPU and DU showed a higher basal acid

H. Stødkilde-Jørgensen; N. A. Løvgreen; J. Ørnsholt; E. Amdrup



Static one-legged balance in soccer players during use of a lifted leg.  


The goal was to describe static one-legged balance during use of a lifted leg and to compare balance between the dominant and nondominant legs of soccer players. Participants were 17 male soccer players and 17 untrained male students (control). Balance ability was evaluated with four sway measures: sway velocity, anterior-posterior sway, medial-lateral sway, and high-frequency sway. Soccer players had smaller magnitude mean anterior-posterior and medial-lateral sway than untrained students. Although mean sway velocity and anterior-posterior sway were higher with the dominant leg than in the nondominant leg of the control group, there was no significant difference on any sway factor between the two legs of the soccer group. In conclusion, the soccer players were observed to have superior static one-legged balance during use of a lifted leg, and there is no difference in balance for the two legs in the soccer group. PMID:21058597

Matsuda, Shigeki; Demura, Shinichi; Nagasawa, Yoshinori



Pressure induced cellular senescence-a possible mechanism linking venous hypertension to venous ulcers  

Microsoft Academic Search

Introduction: Slowed healing and venous ulcers are the soft tissue effects of chronic venous insufficiency (CVI). Chronic venous hypertension has long been thought to be the root cause of these soft tissue effects, but mechanisms linking venous hypertension to delayed wound healing have been elusive. Dermal fibroblasts isolated from venous ulcers have morphologies and protein production suggestive of premature aging.

N. Fernandez; K. M. Lounsbury; T. Osler; K. A. Corrow; C. Healey; P. Forgione; A. C. Stanley



Pressure Ulcers Among Nursing Home Residents: United States, 2004. NCHS Data Brief, No. 14, Feburary 2009.  

National Technical Information Service (NTIS)

Pressure ulcers, also known as bed sores, pressure sores, or decubitus ulcers, are wounds caused by unrelieved pressure on the skin. They usually develop over bony prominences, such as the elbow, heel, hip, shoulder, back, and back of the head. Pressure u...

C. Caffrey E. P. Lee



Transaxillary thoracoscopically assisted sympathectomy for nonhealing ulcers in scleroderma: a case report of successful treatment.  


We describe the successful treatment of a patient with chronic nonhealing ulcers caused by scleroderma refractory to medical therapy. This patient underwent a successful, transaxillary, thoracoscopically assisted, limited sympathectomy that resulted in healing of her ulcers and resolution of pain in the affected hand. PMID:15890223

Volchok, Japa; Santamarina, Rodrigo; Sadighi, Parvis


Development of Highly Organized Lymphoid Structures in Buruli Ulcer Lesions after Treatment with Rifampicin and Streptomycin  

Microsoft Academic Search

BackgroundBuruli ulcer caused by Mycobacterium ulcerans is an infection of the subcutaneous tissue leading to chronic necrotising skin ulcers. The pathogenesis is associated with the cytocidal and immunosuppressive activities of a macrolide toxin. Histopathological hallmark of progressing disease is a poor inflammatory response despite of clusters of extracellular bacilli. While traditionally wide excision of the infected tissue was the standard

Daniela Schütte; Alphonse Um-Boock; Ernestina Mensah-Quainoo; Peter Itin; Peter Schmid; Gerd Pluschke



Bacteriological study on corneal ulcers in the eye outpatient clinics, Great River Eye Hospital, Benghazi  

Microsoft Academic Search

Objectives: The aim of the present study was to investigate the types of organisms causing bacterial corneal ulcer and their sensitivity to various antibiotics. Patients and Methods: During the study period of September 2006 to January 2007, a total of 22 patients with corneal ulcers (6 males and 16 females) were recruited prospectively from the eye outpatient clinics of Great

Abdelsalam A. Geilani


Molecular Assays for Detecting Aphanomyces invadans in Ulcerative Mycotic Fish Lesions  

Microsoft Academic Search

The pathogenic oomycete Aphanomyces invadans is the primary etiological agent in ulcerative mycosis, an ulcerative skin disease caused by a fungus-like agent of wild and cultured fish. We developed sensitive PCR and fluorescent peptide nucleic acid in situ hybridization (FISH) assays to detect A. invadans. Laboratory-chal- lenged killifish (Fundulus heteroclitus) were first tested to optimize and validate the assays. Skin

Mark W. Vandersea; R. Wayne Litaker; Bryan Yonnish; Emilio Sosa; Jan H. Landsberg; Chris Pullinger; Paula Moon-Butzin; Jason Green; James A. Morris; Howard Kator; Edward J. Noga; Patricia A. Tester



[Therapeutic complex in therapy of patients with complicated course of pylorobulbar ulcers].  


Combined treatment of pylorobulbar ulcers associated with duodenogastric reflux incorporated surgery, antiinflammatory and antisecretory therapy. The treatment provides preventing ulcer recurrence, gastric mucosa affection caused by duodenogastric reflux and infection Helicobacter pylori. Finally, this led to improved quality of life. PMID:10723148

Beloborodova, E I; Zherlov, G K; Gibadulina, I O; Gibadulin, N V



Effect of Lower Body Positive Pressure on Fluid Turnover in Human Legs  

NASA Astrophysics Data System (ADS)

We have developed a device for walking rehabilitation which has a treadmill in a lower body positive pressure (LBPP) chamber to unload the lower extremities. In this review, we summarize the present knowledge of effects of gravity, LBPP, and walking on leg fluid turnover in standing human. Prolonged standing caused swelling in the legs due to an effect of hydrostatic pressure. Circumferences of leg gradually increased during standing still and reached a plateau level after 30-40 minutes. Exposure to LBPP significantly improved the swelling in the thigh, suggesting that the LBPP possibly reduces fluid filtration by decreasing transmural pressure gradient in the capillaries and/or increases lymphatic outflow from the tissue. Walking also decreased the leg swelling by muscle pump activity, and this effect was further enhanced by applying LBPP. These results suggest that applying LBPP can change the body fluid turnover, resulting in a decrease in the tissue fluid of the legs in standing and walking human.

Matsuo, Satoshi; Onishi, Hiroshi; Kawai, Yasuaki


Association Between Mechanical Axis of the Leg and Osteochondritis Dissecans of the KneeRadiographic Study on 103 Knees  

Microsoft Academic Search

Background: The cause of osteochondritis dissecans (OCD) is unknown, but mechanical factors seem to play a role.Purpose: To identify a relationship between localization of OCD and mechanical axis of the leg.Study Design: Case series; Level of evidence, 4.Methods: Using bilateral full-leg standing radiographs, we analyzed the position of the mechanical axis of the leg in a group of 93 adolescent

Matthias Jacobi; Peter Wahl; Samy Bouaicha; Roland P. Jakob; Emanuel Gautier




PubMed Central

The epidemics we have observed, were due to the presence and growth in the frogs of Bacillus hydrophilus fuscus. This was proved by recovering the bacillus in pure culture from the body fluids of frogs sick or dead of the disease, and the inoculation of healthy frogs with an emulsion of the pure culture, and by obtaining the same clinical picture and pathological findings as in the original diseased frogs; and, finally, by recovering the bacillus in pure culture from frogs inoculated and sick or dying as a result of the inoculation. The disease is widely distributed throughout North America and Europe, and in this country and Canada is known as "red-leg." It has been observed by us chiefly in the warm weather of September and October. The disease is characterized by congestion of the ventral surfaces of the body, with more or less ulceration in, and hæmorrhage beneath, the skin, bloating due to serous exudation into the lymph sacs, gradual failure to respond to stimuli, which symptoms are followed by coma and death, the last being occasionally preceded by tetanic seizures. After death hæmorrhages into the muscles and degenerative changes in the muscles, spleen, liver, and, to a slight degree, in the intestinal tract, are found. The blood shows an advanced degree of anæmia and leucocytosis. Predisposing causes of the disease are lesions of the skin, which seem to be the usual portal of entry of the infection, and lowered resistance from heat and from anæmia. By a series of controlled experiments with inoculated frogs we have shown that, while temperatures a little above freezing have no harmful effect upon the frogs, they completely control all manifestations of the disease in inoculated or diseased frogs, if the frogs are left in the cold for a period as long as seven days; and, further, that even short periods in the cold chamber will bring about a delay of the fatal results in diseased or inoculated frogs. The anæmia so often found in apparently healthy frogs seems in many cases to be due to the presence in the lungs of the frog of a parasite, the Distomum cylindraceum, which, occurring in sufficiently large numbers in an individual frog, is capable of materially diminishing the available supply of red corpuscles. Severe laking of the blood, the presence of numerous isolated red-cell nuclei, and great diminution in the number, or almost total absence of the red cells in the diseased frogs, are in proportion to the severity of the infection and due to bacterial action. The presence of the hæmatozoan parasite, the Drepanidium, does not play any part as a predisposing or exciting cause of the disease. The ascarid Rhabdomena nigrovenosum, although frequently present as a parasite in the lungs of the frogs, plays no part in causing or promoting the disease.

Emerson, Haven; Norris, Charles



Histiocytic sarcoma with fatal duodenal ulcers.  


Histiocytic sarcoma is an uncommon neoplasm of mature histiocytes with very poor outcome. We report an autopsy case of a true histiocytic sarcoma with characteristic symptoms of so-called "malignant histiocytosis of the intestine". The liver and spleen were enlarged, with remarkable tumor cell infiltration in the hepatic sinusoids and splenic sinuses. Tumor cells aggregated to form sporadic nodular lesions in the liver, which often showed coagulative necrosis. Infarcted lesions also occurred at the splenic subcapsular area. In addition, tumor cell infiltration was noted in the sinuses of bone marrow and lymph node. Tumor cells often demonstrated moderate pleomorphism with multinucleated giant cells. They were positive for CD68 and negative for T- and B-cell lineage markers, megakaryocytic markers, and CD30. Various examinations were done to rule out infection-associated hemophagocytic syndrome, and the absence of infectious diseases was revealed. Thus, the diagnosis of histiocytic sarcoma was made. Apart from these lesions, multiple ulcerations, some with fatal perforation, were found in the esophagus and duodenum. They showed only non-specific inflammatory changes without tumor cell involvement. The ulcers probably derived from ischemic condition through an embolic process caused by tumor cell infiltration elsewhere in the blood vessels at the periphery of the ulcers. PMID:15310151

Akishima, Yuri; Akasaka, Yoshikiyo; Yih-Chang, Ger; Ito, Kinji; Ishikawa, Yukio; Lijun, Zhang; Kiguchi, Hideko; Lipscomb, Gary; Strong, Jack P; Ishii, Toshiharu



The pathophysiology of stress ulcer disease  

Microsoft Academic Search

Stress ulcers are superficial mucosal lesions located predominantly in the fundus of the stomach. They occur mainly in the victims of severe trauma and sepsis and are to be clearly distinguished from Cushing's ulcers, ulcers induced by drugs and from activation of a preexistent ulcer. It is generally agreed that mucosal ischemia is the major inciting event in the pathogenesis

William Silen; Aryeh Merhav; Jay N. L. Simson



Comparison of passive leg raising and hyperemia on macrovascular and microvascular responses.  


Passive leg raising is a simple diagnostic maneuver that has been proposed as a measure of arterial vasodilator reserve and possibly endothelial function. While passive leg raising has previously been shown to lower blood pressure, increase flow velocity and cause brachial artery dilation, its effects on microvascular flow has not been well studied. Also, passive leg raising has been directly compared previously to upper arm but never to lower arm occlusion of blood flow induced hyperemia responses. We compared changes in macrovascular indices measured by brachial artery ultrasound and microvascular perfusion measured by Laser Doppler Flowmetry induced by passive leg raising to those provoked by upper arm and lower arm induced hyperemia in healthy subjects. Upper arm induced hyperemia increased mean flow velocity by 398%, induced brachial artery dilatation by 16.3%, and increased microvascular perfusion by 246% (p<.05 for all). Lower arm induced hyperemia increased flow velocity by 227%, induced brachial artery dilatation by 10.8%, and increased microvascular perfusion by 281%. Passive leg raising increased flow velocity by 29% and brachial artery dilatation by 5.6% (p<.05 for all), but did not change microvascular perfusion (-5%, p=ns). In conclusion, passive leg raising increases flow velocity orders of magnitude less than does upper arm or lower arm induced hyperemia. Passive leg raising-induced brachial artery dilatation is less robust than either of these hyperemic techniques. Finally, although upper arm and lower arm hyperemia elicits macrovascular and microvascular responses, passive leg raising elicits only macrovascular responses. PMID:23261755

Bapat, Manasi; Musikantow, Daniel; Khmara, Kseniya; Chokshi, Priya; Khanna, Neel; Galligan, Sean; Kamran, Haroon; Salciccioli, Louis; Barone, Frank C; Lazar, Jason M



Ulcerative Colitis: An Overview  

PubMed Central

Idiopathic ulcerative colitis primarily affects young adults. Colonic symptoms are the most annoying. In severe colitis, systemic and extraintestinal inflammatory manifestations can be disabling. Proximal extension of colitis is demonstrated by double-contrast barium enema and total colonoscopy. Bacterial and parasitic colitis must be excluded by appropriate microbiological studies. Colonoscopy is recommended to screen for high-grade dysplasia or neoplasia in cases of chronic diffuse colitis (after seven years). Severe colitis can benefit from hospitalization, parenteral nutritional support, and high doses of corticosteroids that are progressively tapered. Mild or moderate cases or severe cases in remission respond well to rest, low-irritant diets, mild symptomatic medication, oral sulfasalazine, or more recent 5-acetylsalicylic derivatives. Long-term maintenance with reduced dosages will control more than 80% of cases.

Archambault, Andre



Stress ulcer bleeding.  


Although upper gastrointestinal (GI) bleeding from stress-related mucosal disease (SRMD) in critically ill patients is common, significant bleeding with hemodynamic instability is not. Risk factor assessment can assist in identifying patients with a greater likelihood of developing significant SRMD. Prophylaxis against stress ulcer bleeding with luminal agents (eg, antacids and sucralfate) or drugs that inhibit acid secretion (eg, histamine 2-receptor antagonists and proton-pump inhibitors) can reduce major bleeding but has little or no effect on mortality. Currently, the mainstays of prophylactic therapy for SRMD are intravenously administered H2RAs and PPIs. Wider usage of PPIs reflects their enhanced efficacy in suppressing acid secretion as well as lack of tolerance for H2RAs. Guidelines for the prophylactic use of H2RAs or PPIs in treatment of SRMD will require large, randomized studies that also examine cost effectiveness of individual strategies. PMID:16539876

Harty, Richard F; Ancha, Hari B



Corneal cross-linking in 9 horses with ulcerative keratitis  

PubMed Central

Background Corneal ulcers are one of the most common eye problems in the horse and can cause varying degrees of visual impairment. Secondary infection and protease activity causing melting of the corneal stroma are always concerns in patients with corneal ulcers. Corneal collagen cross-linking (CXL), induced by illumination of the corneal stroma with ultraviolet light (UVA) after instillation of riboflavin (vitamin B2) eye drops, introduces crosslinks which stabilize melting corneas, and has been used to successfully treat infectious ulcerative keratitis in human patients. Therefore we decided to study if CXL can be performed in sedated, standing horses with ulcerative keratitis with or without stromal melting. Results Nine horses, aged 1 month to 16 years (median 5 years) were treated with a combination of CXL and medical therapy. Two horses were diagnosed with mycotic, 5 with bacterial and 2 with aseptic ulcerative keratitis. A modified Dresden-protocol for CXL could readily be performed in all 9 horses after sedation. Stromal melting, diagnosed in 4 horses, stopped within 24 h. Eight of nine eyes became fluorescein negative in 13.5 days (median time; range 4–26 days) days after CXL. One horse developed a bacterial conjunctivitis the day after CXL, which was successfully treated with topical antibiotics. One horse with fungal ulcerative keratitis and severe uveitis was enucleated 4 days after treatment due to panophthalmitis. Conclusions CXL can be performed in standing, sedated horses. We did not observe any deleterious effects attributed to riboflavin or UVA irradiation per se during the follow-up, neither in horses with infectious nor aseptic ulcerative keratitis. These data support that CXL can be performed in the standing horse, but further studies are required to compare CXL to conventional medical treatment in equine keratitis and to optimize the CXL protocol in this species.



[Gastroduodenal peptic ulcer and height].  


763 patients from the "Honorio Delgado" Regional Hospital of Arequipa city (2300 mts ht) are studied, all suffering of gastroduodenal peptic ulcer disease. A comparison between the principal clinical feactures of patients coming from the Coast and the Hights, is done. It is concluded that in patients from the Hights ulcer disease has an earlier beginning (third decade), clinical features are atypical; the incidence of complications are higher (59%) mainly hemorrhagic ones (53%); the occurrence of gastric ulcer is also higher (DU/GU = 2.5/1 against 5/1 seen in patients from the Coast) and mortality rate is greater (2.0%). PMID:2131004

Estremadoyro, O; Portugal, A; Estremadoyro, L



Clinical management of pressure ulcers.  


Pressure ulcers are chronic and difficult to heal. Pressure-reducing devices are clearly superior to a standard hospital mattress in preventing pressure ulcers, but only limited evidence and clinical intuition supports pressure-reducing devices in improving the healing rate of pressure ulcers. Local wound treatment should aim at maintaining a moist wound environment. The choice of a particular dressing depends on wound characteristics, such as the amount of exudate, dead space, or wound location. Nutritional status should be addressed as a process of good care. Debridement may improve time to a clean wound bed, but no clearly superior approach has been demonstrated. PMID:23571035

Thomas, David R



Treatment of refractory venous stasis ulcers with autologous platelet-rich plasma and light-emitting diodes: a pilot study.  


Background: Stasis dermatitis with secondary ulcer formation is not only therapeutically challenging but also significantly decreases the quality of life for affected individuals. Recently, autologous platelet-rich plasma (PRP) has entered the therapeutic regimen for leg ulcers, while light-emitting diodes (LEDs) are now used to accelerate wound healing. Objective: To assess the efficacy and safety of autologous PRP with concomitant LED therapy for the treatment of venous stasis dermatitis with secondary ulceration. Methods and materials: In total, 16 Korean patients with ulcers secondary to venous stasis dermatitis were enrolled in this study. Each lesion was treated with autologous PRP weakly, and LED therapy three times per week. Treatments continued for 6 weeks or until the ulcer completely reepithelialized without evidence of drainage. Not only were subjects objectively evaluated by a study investigator, their own subjective satisfaction was also assessed. Results: The combined autologous PRP and LED therapy was well tolerated and safe. A statistically significant improvement was observed post-therapeutically in the clinical parameters of pain, itching, heaviness, paresthesia, cramps, and leg swelling. There was also a significant decrease in ulcer size. None of the patients showed worsening of their venous stasis ulcer. Regarding subject satisfaction with the regimen, 75.0% of participants reported being 'satisfied or very satisfied' with their overall improvement after treatment. No significant adverse effects were observed. Conclusion: Combined autologous PRP and LED therapy is a promising conservative combination regimen for treating recalcitrant ulcerating stasis dermatitis. Additional studies comparing combined autologous PRP and LED therapy directly with autologous PRP or LED monotherapies are needed to confirm the results reported here. PMID:23738854

Park, Kui Young; Kim, In Su; Yeo, In Kwon; Kim, Beom Joon; Kim, Myeung Nam



A fundamental mechanism of legged locomotion with hip torque and leg damping.  


New models and theories of legged locomotion are needed to better explain and predict the robustly stable legged locomotion of animals and some bio-inspired robots. In this paper we observe that a hip-torque and leg-damping mechanism is fundamental to many legged robots and some animals and determine its affect on locomotion dynamics. We discuss why this hip-torque-and-leg-damping mechanism is not so easily understood. We investigate how hip-torque and leg-damping affect the stability and robustness of locomotion using a mathematical model: First, we extend the canonical spring-loaded-inverted-pendulum model to include constant hip torque and leg damping proportional to leg length speed. Then, we calculate the stability and robustness of locomotion as a function of increasing levels of torque and damping, starting from zero-the energy conserving and marginally stable special case-to high levels of torque and damping. We find that the stabilizing effects of hip-torque and leg-damping occur in the context of the piecewise-continuous dynamics of legged locomotion, and so linear intuition does not apply. We discover that adding hip torque and leg damping changes the stability of legged locomotion in an unexpected way. When a small amount of torque and damping are added, legged locomotion is initially destabilized. As more torque and damping are added, legged locomotion turns stable and becomes increasingly more stable and more robust the more torque and damping are added. Also, stable locomotion becomes more probable over the biologically-relevant region of the parameter space, indicating greater prediction and explanatory capabilities of the model. These results provide a more clear understanding of the hip-torque-and-leg-damping mechanism of legged locomotion, and extend existing theory of legged locomotion towards a greater understanding of robustly stable locomotion. PMID:22989956

Shen, Z H; Seipel, J E



Total colectomy, mucosal proctectomy, and an ileal reservoir to an anal anastomosis. A comparison of short and long efferent legs.  


In a consecutive series of 46 possible candidates for total colectomy, mucosal proctectomy, and ileal reservoir to an anal anastomosis, we have compared the clinical outcome of group I, with a long efferent leg (12 cm), and group II, with a short efferent leg (3-5 cm). The surgical procedure was done in three steps: first, a total colectomy; second, mucosal proctectomy and construction of an 'S-shaped' ileal reservoir with a temporary loop ileostomy; and, third, closing of the ileostomy. Nine patients with a long efferent leg and eight patients with a short leg were observed for 2-51 months with a functioning ileal reservoir. The overall mortality was zero. The results showed that the short efferent leg was important for low fecal urgency, spontaneous evacuation of stools, minimal soiling, independence of reservoir catheterization, and use of antidiarrheal drugs. The length of the efferent leg did not influence the function of the anal sphincter itself. The postoperative sexual life was unchanged, and all patients in group II had a better resocialization than those in group I. The selection of candidates for ileal reservoir operations from among patients with ulcerative colitis or familiar polyposis is most important because of a relatively long postoperative course and high incidence of surgical complications. PMID:4089520

Hansen, L K; Olsen, P R; Simonsen, L



Effect of exogenous administration of transforming growth factor-beta and famotidine on the healing of duodenal ulcer under the impact of indomethacin  

Microsoft Academic Search

Background. Non-steroidal anti-inflammatory drugs delay ulcer healing and cause refractory peptic ulcers in humans.Objective. To study the effects of growth factors on experimental duodenal ulcer healing in indomethacin-treated rats.Methods. Duodenal ulcers were induced in male Wistar rats by the serosal application of 75% acetic acid for 10 s. Rats were then treated with indomethacin (2 mg\\/kg\\/day; s.c.), transforming growth factor

A Pérez-Aisa; F Sopeña; E Arceiz; J Ortego; R Sainz; A Lanas



Spike: A Six Legged Cube Style Robot  

Microsoft Academic Search

This paper describes a six legged cube based robot named ‘Spike’, which uses three axes of symmetry with a collinear pair\\u000a of legs mounted on each axis. Spike is designed to implement a novel form of locomotion which uses a tilting and falling motion\\u000a as a result of leg movements to form its gait. Due to the triangular symmetry inherent

Christopher Coyte; Mark Beckerleg; John Collins



Characteristics and Clinical Managements of Chronic Skin Ulcers Based on Traditional Chinese Medicine  

PubMed Central

Chronic skin ulcer (CSU), including diabetic ulcers, venous ulcers, radiation ulcers, and pressure ulcers, remains a great challenge in the clinic. CSU seriously affects the quality of life of patients and requires long-term dedicated care, causing immense socioeconomic costs. CSU can cause the loss of the integrity of large portions of the skin, even leading to morbidity and mortality. Chinese doctors have used traditional Chinese medicine (TCM) for the treatment of CSU for many years and have accumulated much experience in clinical practice by combining systemic regulation and tropical treatment of CSU. Here, we discuss the classification and pathogenic process of CSU and strategies of TCM for the intervention of CSU, according to the theories of TCM. Particularly, we describe the potential intervenient strategies of the “qing-hua-bu” protocol with dynamic and combinational TCM therapies for different syndromes of CSU.

Li, Fu-Lun; Wang, Yi-Fei; Li, Xin; Li, Feng; Xu, Rong; Chen, Jie; Geng, Lin; Li, Bin



Uvular ulceration following transoesophageal echocardiography  

PubMed Central

This report describes two episodes of significant uvular and oropharyngeal ulceration occurring during routine transoesophageal echocardiographic examination of the heart while intubated under general anaesthesia. Both patients were young and healthy and underwent anaesthesia without compromise, but experienced significant morbidity as a result of the ulceration. Uvular and oropharyngeal ulceration has been described following endoscopy and intubation, but there are few reports of ulceration following transoesophageal echocardiography. Operator skill is often a factor. Physical trauma and local ischaemia may play a role in aetiology. Patients experiencing sore throat following the procedure should be examined and observed in case of potentially fatal complications of airway compromise or uvular necrosis and infection. Particular care is required in patients undergoing day case procedures, as early discharge may lead to complications while the patient is at home.

Nijjer, Sukhjinder; Crean, Andrew; Li, Wei; Swan, Lorna



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


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 in the skin and the underlying tissue. This paper reviews existing knowledge about decubital shoulder ulcers in sows, focusing on the pathogenesis, classification and consequences in terms of pain and animal welfare. On the basis of available human as well as animal literature, we describe the primary causal factors, underlying mechanisms, suggested direction of progression as well as temporal development. We review suggested scales for the classification of decubital shoulder ulcers, and argue that none of these are useful for the classification of decubital shoulder ulcers in live sows. The knowledge of the welfare consequences of decubital shoulder ulcers is limited. On the basis of the tissue structures that are involved, we assume that the development and presence of decubital shoulder ulcers in sows are a painful and prolonged condition. It is concluded that the extent of the welfare problem related to decubital shoulder ulcers cannot be fully determined until a valid ante-mortem classification system is available, and knowledge about the duration of the condition (including the various stages), as well as the possible consequences in terms of pain or discomfort have been established. PMID:22439998

Herskin, M S; Bonde, M K; Jørgensen, E; Jensen, K H



[Nursing care of pressure ulcers].  


The definition of a pressure ulcer remains very academic. It results from tissue necrosis following ischemia through prolonged arteriolar constriction between two hard surfaces progressing in stages. The nursing care and the use of dressings are therefore adapted to each stage. Today, the treatment of pressure ulcers is complex due to the large number of categories of dressings available. Moreover, the choice of the dressing must take into account the specificities of elderly patients. However, certain basic principles remain essential. PMID:23785859

Hautin, Pascale


Comparison of Ground Reaction Force Asymmetry in One- and Two-legged Countermovement Jumps.  


Benjanuvatra, N, Lay, BS, Alderson, JA, and Blanksby, BA. Comparison of ground reaction force asymmetry in one- and two-legged countermovement jumps. J Strength Cond Res 27(10): 2700-2707, 2013-This study examined whether ground reaction force (GRF) asymmetry of 2-legged countermovement jumps (CMJ) is related to 1-legged CMJ asymmetry. The GRF asymmetry of a 2-legged CMJ has been suggested as a preferred test to the 1-legged CMJ for functional strength and power deficit assessment. Twenty-eight men and 30 women performed 5 trials each of a 1-legged CMJ with the right limband the left limb, and a 2-legged CMJ. Vertical GRFs were collected from each lower limb using 2 force platforms. Although several GRF variables were calculated, vertical impulse correlated most strongly with jump height in all conditions (p < 0.05), and they were used in subsequent analyses. A moderate correlation was found for impulse asymmetry between the 1- and 2-legged CMJs for women (r = 0.45, p < 0.05), but not for men (r = 0.06, p = 0.76). In contrast, cross-tabulation analyses of subjects presented with the same dominant characteristics in the 1- and 2-legged CMJs revealed poor associations for both men (Freeman-Halton exact p = 0.61) and women (Freeman-Halton exact p = 0.19). Only 11 women recorded the same dominant limb for both 1- and 2-legged CMJs. This suggests that impulse asymmetries found in the 1- and 2-legged CMJ were unrelated. As the 1-legged CMJ relies on the extension forces generated entirely from 1 limb, variations in jump heights and GRF impulses by left and right limbs separately were more indicative of functional strength differences between sides. Hence, it is recommended that the 1-legged CMJ is used when examining functional strength asymmetry in the lower limbs. In contrast, factors causing asymmetry in GRF impulses during 2-legged CMJs are more complicated and require further investigation. PMID:23287834

Benjanuvatra, Nat; Lay, Brendan S; Alderson, Jacqueline A; Blanksby, Brian A



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

ERIC Educational Resources Information Center

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…

Gettman, Larry R.; Huckel, Jack R.


Prediction of lamb carcass leg and loin weights using leg score and width measures.  

Technology Transfer Automated Retrieval System (TEKTRAN)

Lamb carcass leg score (LS; 1 = low cull to 15 = high prime) is a subjective indicator of carcass muscling. Our objective for this study was to compare LS, live leg width (LL), and carcass leg width (LW) as single predictors, and in combination with live (LWT) or carcass weight (CWT), of harvested ...


Common Leg Injuries of Long-Distance Runners  

PubMed Central

Context Long-distance running (greater than 3000 m) is often recommended to maintain a healthy lifestyle. Running injury rates increase significantly when weekly mileage extends beyond 40 miles cumulatively. With the development of running analysis and other diagnostic tests, injuries to the leg secondary to bone, musculotendinous, and vascular causes can be diagnosed and successfully managed. Evidence Acquisition Searches used the terms running, injuries, lower extremity, leg, medial tibial stress syndrome, compartment syndrome, stress fractures, popliteal artery entrapment, gastrocnemius soleus tears, and Achilles tendinopathy. Sources included Medline, Google Scholar, and Ovid from 1970 through January 2012. Results Tibial stress fractures and medial tibial stress syndrome can sometimes be prevented and/or treated by correcting biomechanical abnormalities. Exertional compartment syndrome and popliteal artery entrapment syndrome are caused by anatomic abnormalities and are difficult to treat without surgical correction. Conclusion Leg pain due to bone, musculotendinous, and vascular causes is common among long-distance runners. Knowledge of the underlying biomechanical and/or anatomic abnormality is necessary to successfully treat these conditions.

Gallo, Robert A.; Plakke, Michael; Silvis, Matthew L.



Time course of arousal response during periodic leg movements in patients with periodic leg movements and restless legs syndrome  

Microsoft Academic Search

Objective: The temporal evolution of periodic leg movements (PLM) and the relationship of their arousing effect on sleep episode has not been extensively investigated. We studied the nocturnal evolution of PLM associated or not with microarousal (MA) and associated with slow wave activity (PLM with slow wave activity) in 23 patients with PLM and\\/or restless legs syndrome (RLS).Methods: All subjects

Emilia Sforza; Christophe Jouny; Vincent Ibanez



Running on four legs as though they were one  

Microsoft Academic Search

Simple locomotion algorithms provide balance for machines that run on one leg. The generalization of these one-leg algorithms for control of machines with several legs is explored. The generalization is quite simple when muitilegged systems run with gaits that use the support legs one at a time. For these gaits the one-leg algorithms can be used to control multilegged running.

M. H. Raibert; M. Chepponis



Pasteurella multocida corneal ulcer following a baseball injury.  

PubMed Central

Pasteurella multocida is an ubiquitous organism that can be isolated from a variety of animals and birds. It is an infrequent ocular pathogen but can cause infection as a result of injury or animal exposure. This article reports a case of P multocida corneal ulcer following a baseball injury.

Robinson, J. D.; Kosoko, O.; Mason, R. P.; Cowan, C. L.



Major life event stress and dyspepsia of unknown cause: a case control study  

Microsoft Academic Search

Stress is purported to be a major cause of non-ulcer dyspepsia, defined here as dyspepsia where peptic ulcer, oesophagitis, and cancer are excluded by endoscopy. There is a subgroup of non-ulcer dyspepsia patients who have no definite cause for their dyspepsia, provisionally termed essential dyspepsia. The aim of the present study was to determine if stress, as measured by major

N J Talley; D W Piper



[A case of esophageal cancer required jejunal reconstruction because of a gastric ulcer scar].  


Recently, with increase of number of esophagectomy for esophageal cancer, the cases having the lesion in the organs for esophageal substitute have been increasing. The case of esophageal cancer, required reconstruction using the pedicled jejunum, because of impaired submucosal blood perfusion of the stomach caused by a ulcer scar, was reported. The patient was a 72-year-old female, with the ulcerative and infiltrative cancer lesion in the anterior wall of the mid-thoracic esophagus. Barium swallow revealed shortening of the lesser curvature and indentation of the greater curvature of the stomach. Endoscopy showed the lesion occupying anterior two thirds of the esophageal wall circumferentialy from 30 to 34 cm from the incisor tooth. The lineal scar of ulcer on the lesser curvature of the body of the stomach was also found. Following esophagectomy through right thoracotomy, the stomach was mobilized for reconstruction by dividing left gastric artery and short gastric artery, but the stomach oral to the ulcer scar became ischemic and bleeding was not found at the tip of the stomach. Therefore, reconstruction was performed using the pedicled jejunum through antesternal route. The gastric cardia is rich in the vascular network in the submucosal layer. The ulcer or ulcer scar of this region can cause ischemia in the tip of the gastric tube for esophageal substitute. Care should be taken to detect the ulcer lesion at the stomach preoperatively. In the case with the ulcer lesion blood supply to the tip of the gastric tube should be critically evaluated. PMID:8551077

Fujiwara, K; Higashino, M; Osugi, H; Tokuhara, T; Kaseno, S; Kinoshita, H



Recurrence of Diabetic Pedal Ulcerations Following Tendo-Achilles Lengthening  

PubMed Central

Foot and ankle surgeons are frequently challenged by the devastating systemic consequences of diabetes mellitus manifested through neuropathy, integumentary and joint breakdown, delayed healing, decreased ability to fight infection, and fragile tendon/ligaments. Diabetic neuropathic pedal ulcerations lead to amputations at an alarming rate and also carry a high mortality rate. This article will discuss causes of diabetic pedal ulcerations that persist or recur after tendo-Achilles lengthening and will highlight areas that need to be addressed by the practitioner such as infection, vascular and nutritional status, glucose control, off-loading, biomechanics, and patient compliance.

Weiner, Richard D.; Hlad, Lee M.; McKenna, Danielle R.



Fulminant ulcerative colitis  

Microsoft Academic Search

Opinion statement  \\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a Fulminant ulcerative colitis necessitates immediate hospitalization.\\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a Supportive therapy such as aggressive rehydration, restriction of oral intake, and consideration of parenteral nutrition should\\u000a be initiated.\\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a High-dose intravenous steroids should be started in almost all cases.\\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a Antibiotics and cyclosporine should be considered, especially in disease refractory to steroid therapy.\\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a Indications for surgery should always be

Clarence K. W. Wong; B. R. Yacyshyn



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

PubMed Central

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.

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.



Effects of Audio-Visual Stimulation on the Incidence of Restraint Ulcers on the Wistar Rat.  

National Technical Information Service (NTIS)

The role of sensory simulation in restrained rats was investigated. Both mixed audio-visual and pure sound stimuli, ineffective in themselves, were found to cause a significant increase in the incidence of restraint ulcers in the Wistar Rat.

M. S. Martin F. Martin R. Lambert



Dynamic legged robots for rough terrain  

Microsoft Academic Search

Summary form only given. Only about half the Earth's landmass is accessible to wheeled and tracked vehicles, yet people and animals can go almost everywhere on foot. Our goal is to harness the power of legs to create robot vehicles that can go where legged animals and people can go. These systems combine dynamic control systems, actuated mechanisms and a

M. Raibert



A new articulated leg for mobile robots  

Microsoft Academic Search

Purpose – The paper aims to present a new mechanical scheme for a leg to be included in legged vehicles that simplifies the control actuations along the stride. Design\\/methodology\\/approach – The scheme includes three four-bar links grouped in two mechanisms. The first one decouples the vertical and horizontal foot movements. The second one produces a constant horizontal foot velocity when

Antonio Gonzalez Rodriguez; Angel Gonzalez Rodriguez; Pierluigi Rea



Understanding Possible "Mimics" of Restless Legs Syndrome  


... diagnostic test to ensure a patient truly has restless legs syndrome (RLS). Primarily, diagnosis is based on patient reports. ... and Manage Your RLS Understanding Possible “Mimics” of Restless Legs Syndrome 16 NightWalkers Akathisia Akathisia is ...


Sleep Laboratory Diagnosis of Restless Legs Syndrome  

Microsoft Academic Search

Polysomnographic recordings and the Suggested Immobilization Test (SIT) are frequently used to support the clinical diagnosis of restless legs syndrome (RLS). The present study evaluated the discriminant power of 5 different parameters: (1) index of periodic leg movements during sleep (PLMS), (2) index of PLMS with an associated microarousal (PLMS-arousal), (3) index of PLM during nocturnal wakefulness (PLMW), (4) SIT

Martin Michaud; Jean Paquet; Gilles Lavigne; Alex Desautels; Jacques Montplaisir



Dynamic Legged Locomotion in Robots and Animals.  

National Technical Information Service (NTIS)

This report documents our study of active legged systems that balance actively and move dynamically. The purpose of this research is to build a foundation of knowledge that can lead both to the construction of useful legged vehicles and to a better unders...

M. Raibert R. Playter R. Ringrose D. Bailey K. Leeser



The Reflex Mechanism of the Insect Leg  

Microsoft Academic Search

1. Variations in the frequency of the motor discharges to the leg muscles of Periplaneta americana are followed in the intact animal under different types of sensory stimulation by electrical recording from the muscles.2. Two main reflexes are described: the depressor reflex, evoked by stimulation of the campaniform sensilla on the legs, and a levator response to touch on the

J. W. S. Pringle



Posture Control of 6Leg Walking Robot  

Microsoft Academic Search

This paper describes a walking method and inclination control experiments of the new omni-directional walking robot, which has six legs and can move in any direction. The mechanism consists of a parallel link mechanism connecting the two frames with three linear actuators. Legs are attached to each frame. The relative position and angle of the two frames are selected arbitrarily

Toshio Fukuda; Yuji Adachi; Haruo Hoshino; Kazuhiro Kosuge; Isao Matsunaga; Fumihito Arai



Diagnosis and management of long-standing benign oral ulceration.  


The authors formed a Mouth Clinic at Sunnybrook Hospital in 1973 since when there have been 3025 patient visits. Those patients with chronic ulceration present a challenge, the diagnosis sometimes being difficult and therapy not rapidly effective. The differential diagnosis includes lichen planus, pemphigus vulgaris, benign mucous membrane pemphigoid, discoid lupus erythematosus, erythema multiforme, aphthous ulcers, Behcets disease, periadenitis mucosa necrotica recurrens, specific infections and iatrogenic causes. It is possible to reach a definite diagnosis in virtually every case by means of a good history and careful clinical examination supplemented by biopsies and in some cases direct and indirect immunofluorescent studies. Treatment emphasizes scrupulous attention to oral hygiene with baking soda mouthwashes and careful teeth cleaning to minimize the accumulation of dental plaque. Specific therapy includes topical steroids in lichen planus, intra muscular gold in benign mucous membrane pemphigoid, a previously unreported treatment which considerably improved seven out of ten patients, and tetracycline mouthwashes in aphthous ulcers. PMID:6990140

Birt, D; From, L; Main, J



A simple surveillance system for xerophthalmia and childhood corneal ulceration*  

PubMed Central

A simple cost-effective surveillance system is described for reporting cases of xerophthalmia and childhood corneal ulceration. The system is suitable for use by ophthalmic auxiliaries in developing countries. Presented are the results of a 2-year surveillance involving 15 hospitals in 11 areas of the United Republic of Tanzania. Cases of xerophthalmia in its early stages (characterized by night blindness or Bitot's spots) were found in all areas surveyed. Of almost 300 cases of unilateral and bilateral corneal ulceration, 46% and 79%, respectively, followed a recent infection with measles. The single most important cause of bilateral corneal ulceration was vitamin A deficiency. The surveillance system has proved to be particularly useful as a first step in defining the type and distribution of serious corneal disease in children.

Foster, Allen; Kavishe, Festo; Sommer, Alfred; Taylor, Hugh R.



Becaplermin gel in the treatment of diabetic neuropathic foot ulcers  

PubMed Central

Diabetic foot ulcers remain a major cause of morbidity. Significant progress has been accomplished in ulcer healing by improved management of both ischemia and neuropathy in the diabetic foot. Nevertheless, there is a vital need for further improvement. Becaplermin gel represents an important therapeutic advance for diabetic neuropathic foot ulcers with adequate blood supply. Randomized controlled trials have shown that it is effective in increasing healing rates. However, this efficacy has not translated to positive clinical experience, and the drug is not widely used. Moreover, becaplermin is an expensive medication. Even though it has repeatedly been estimated as cost-effective, its high cost may be prohibitive for some clinicians, especially in developing countries. Clearly, further work is needed to clarify whether use of becaplermin is justified in everyday clinical practice. Future research also needs to assess the potential room for improvement with becaplermin, for instance by combination with other growth factors or by exploring alternative modes of drug delivery.

Papanas, Nikolaos; Maltezos, Efstratios



Fatal peptic ulcer complications and the use of non-steroidal anti-inflammatory drugs, aspirin, and corticosteroids  

Microsoft Academic Search

Although non-steroidal anti-inflammatory drugs are known to cause peptic ulcer and its complications, controversy exists about the number of deaths from ulcer which are attributable to their use. A case-control study was therefore performed to determine whether prior use of non-steroidal and other anti-inflammatory compounds was associated with an increased case fatality rate from complications of peptic ulcer. Non-steroidal anti-inflammatory

D A Henry; A Johnston; A Dobson; J Duggan



Ketamine-Induced Stress Ulcers in the Rat.  

National Technical Information Service (NTIS)

Restraint of rats in wire mesh for four hours produces ulcers histologically similar to human stress ulcers. Ketamine, alone, was incapable of producing ulcers. However, when given to rats prior to restraint, ketamine increased the incidence of ulcers fro...

D. H. Cheney S. Stogoff G. W. Allen



Healing of ulcers due to cryofibrinogenemia with colchicine and high-dose pentoxifylline.  


Cryofibrinogenemia is due to the presence of reversibly cold-precipitating plasma proteins and material, consisting mostly of fibrinogen, fibronectin, and fibrin. This condition can be idiopathic or secondary to infection, thromboembolic states, neoplasm, or connective tissue disease. The characteristic lesions of cryofibrinogenemia include purpura and ulcerations. Histologically, the lesions of cryofibrinogenemia demonstrate fibrin thrombi within vessels, with no evidence of vasculitis. Treatment of cryofibrinogenemia should be directed at the underlying disease process, if one can be found. Other treatments have included the anabolic steroid stanozolol, which is presently unavailable, anticoagulants, immunosuppressive agents, plasmapheresis, and the combination of streptokinase and streptodornase. We report a case of a 61-year-old male smoker with a 10-year history of intermittent ulcerations of both legs and feet. Two separate biopsies showed epidermal ulceration and thrombi within superficial dermal vessels without evidence of vasculitis. These findings, together with the presence of elevated plasma cryofibrinogen, led to the diagnosis of cryofibrinogenemia. The patient continued to have ulcerations despite efforts to control his high blood pressure, cold avoidance, local wound care, and treatment with pentoxifylline 800 mg three times daily. However, when colchicine 0.6 mg twice daily was added to the patient's care, this led to rapid healing of his ulcerations. He has remained ulcer free for 2 years taking the combination of colchicine and high-dose pentoxifylline. Efforts to reduce the dose of these agents have repeatedly led to recurrences, and remission has promptly followed re-establishment of the combination. To our knowledge, this is the first report documenting use of the combination of colchicine and high-dose pentoxifylline to successfully treat ulcers due to cryofibrinogenemia. PMID:19170411

Chartier, Molly; Falanga, Vincent



Gait Planning Research for Biped Robot with Heterogeneous Legs  

Microsoft Academic Search

\\u000a Biped Robot with Heterogeneous Legs (BRHL) is a novel robot model, which consists of an artificial leg and an intelligent\\u000a bionic leg. The artificial leg is used to simulate the amputee’s healthy leg and the intelligent bionic leg works as the intelligent\\u000a artificial limb. This paper discusses how a BRHL robot imitates a person’s walking from the points of gait

Jun Xiao; Xing Song; Jie Su; Xinhe Xu



Genetics of ulcerative colitis.  


Ulcerative colitis (UC) and Crohn's disease (CD) are related polygenic inflammatory bowel diseases (IBDs), with distinct and overlapping susceptibility loci. Recently, hypothesis-free genome-wide association (GWA) studies have revolutionized the field of complex disease genetics. Substantial advances have been achieved in defining the genetic architecture of IBD. To date, over 60 published IBD susceptibility loci have been discovered and replicated, of which approximately a third are associated with both UC and CD, although 21 are specific to UC and 23 to CD. In CD, the breakthrough identification of NOD2 as a susceptibility gene was followed by a rapid phase of gene discovery from GWA studies between 2006 and 2008. Progress in UC was slower; however, by initially testing hits for CD in UC, and later scanning larger UC cohorts, significant new loci for UC have been discovered, with exciting novel insights into disease pathogenesis. Notably, genes implicated in mucosal barrier function (ECM1, CDH1, HNF4?, and laminin B1) confer risk of UC; furthermore, E-cadherin is the first genetic correlation between colorectal cancer and UC. Impaired IL10 signaling has reemerged as a key pathway in intestinal inflammation, and is perhaps the most amenable to therapeutic intervention in UC. Collaborative international efforts with large meta-analyses of GWA studies and replication will yield many new UC genes. Furthermore, a large effort is required to characterize the loci found. Fine-mapping, deep resequencing, and functional studies will be critical to translating these gene discoveries into pathogenic insights, and ultimately into clinical insights and novel therapeutics. PMID:21319274

Thompson, Alexandra I; Lees, Charlie W



Neutral endopeptidase activity is increased in the skin of subjects with diabetic ulcers.  


Cutaneous sensory nerves mediate inflammation and wound healing by releasing neuropeptides, such as substance P, which stimulates pro-inflammatory responses by keratinocytes, fibroblasts, and endothelial cells. The cell surface enzyme, neutral endopeptidase, degrades substance P, thereby regulating its biologic actions. We hypothesized that neutral endopeptidase enzymatic activity is increased in chronic wounds and skin from subjects with diabetes. We compared cutaneous neutral endopeptidase expression and enzymatic activity between normal controls and diabetic subjects with neuropathy and chronic wounds. Skin samples from subjects with diabetes were taken at the time of amputation for nonhealing ulcers. Skin taken from the ulcer margin, 1 cm from the ulcer (adjacent), and from the most proximal region of the amputated leg were studied. Skin biopsies from the leg of healthy control subjects were also studied. Neutral endopeptidase was localized by immunohistochemistry in all tissue sections. Neutral endopeptidase activity was measured using a fluorimetric assay. The median neutral endopeptidase activity of the ulcer margin was 1.21 x higher (p>0.2) than adjacent skin, 5.26 (p<0.001) than proximal skin, and 15.22 x higher (p<0.001) than control skin. Adjacent skin had a median neutral endopeptidase activity 4.34 x higher (p<0.001) than proximal skin and 12.58 x higher (p<0.001) than control skin. The median neutral endopeptidase activity of proximal skin was 2.90 x higher (p<0.001) than control skin. This elevated neutral endopeptidase activity in the skin and chronic ulcers of subjects with diabetes combined with peripheral neuropathy may contribute to deficient neuroinflammatory signaling and may impair wound healing in subjects with diabetes. PMID:12485446

Antezana, MarcosA; Sullivan, Stephen R; Usui, MarciaL; Gibran, NicoleS; Spenny, MichelleL; Larsen, JerrieA; Ansel, JohnC; Bunnett, NigelW; Olerud, JohnE



Bacteriological study of pus isolates from neuropathic plantar ulcers associated with acute inflammatory phase.  


In this retrospective study, sensitivity of organisms cultured from ulcers of leprosy patients without and with diabetes mellitus, diabetic patients without leprosy and patients with ulcers from other causes was examined. The profile of organisms grown from these groups of patients did not differ significantly. However, there was a high prevalence of organisms like Proteus, E. coli and Enterococcus in the ulcers of leprosy patients indicating faecal contamination of the ulcers. Co-trimaxazole and tetracycline were of little value in the treatment of these ulcers. We therefore recommend that in situations where there is no culture facility, the patients be started on a course of penicillin and gentamycin. If these antibiotics fail, it would be necessary to use more advanced antibiotics like norfloxacin, amikacin and ciprofloxacin. PMID:11212478

Ebenezer, G; Daniel, S; Suneetha, S; Reuben, E; Partheebarajan, S; Solomon, S


Early diagnosis is vital in the management of squamous cell carcinomas associated with chronic non healing ulcers: a case series and review of the literature.  


The association between chronic ulcers and squamous cell carcinomas (SCCs) is well established. Their clinical presentations, however, are varied, ranging from innocously appearing lesions to overtly exophytic growths. We present a series of cases with heterogeneous clinical presentations and different treatment outcomes. Case series - patient 1 was a 69-year-old man with an 18-month history of static non healing venous leg ulcer, but no sinister features, biopsy was performed to rule out Marjolin's transformation, histology revealed SCC and treatment was simple excision and skin grafting; patient 2 was a 73-year-old lady with an 18-month history of non healing ulcer (innocuous appearance) over distal interphalangeal joint of index finger, histology revealed SCC with deeper extension and treatment was amputation of distal half of finger; patient 3 was a 73-year-old lady with a 12-month history of non healing fungating leg ulcer with irregular borders and everted edges, histology revealed SCC (tumour eroding tibia and distant metastasis) and treatment was above-knee amputation, radiotherapy and palliation. Whilst SCC is amenable to simple excision in the early stages, delay in diagnosis could result in loss of the affected digit or limb; an SCC which has metastasised is also life threatening. Therefore, a low threshold to biopsy static non healing ulcers or ulcers in unusual sites should be adopted even in those not manifesting any evidence of malignancy. PMID:16722875

Enoch, Stuart; Miller, David R; Price, Patricia E; Harding, Keith G



Review of Duodenal and Gastric Ulcer.  

National Technical Information Service (NTIS)

Duodenal and gastric ulcer are chronic often recurring conditions that in the past were grouped together as peptic ulcer. Many diverse environmental and genetic factors, which create an imbalance between secretion of acid and pepsin by by the stomach and ...

F. C. Garland E. D. Gorham



Pressure ulcers - what to ask your doctor  


Pressure ulcers are also called bedsores, or pressure sores. They can form when your skin and soft tissue press ... damaged or die. When this happens, a pressure ulcer may form. Below are some questions you may ...


Ulcer disease after gastric bypass surgery  

Microsoft Academic Search

BackgroundThe mechanism of marginal ulceration after laparoscopic gastric bypass surgery is poorly understood. We reviewed the incidence, presentation, and outcome of ulcer disease in consecutive patients undergoing laparoscopic gastric bypass surgery.

Ramsey M. Dallal; Linda A. Bailey



Nonhealing Ulcer: Acroangiodermatitis of Mali  

PubMed Central

An 18-year-old male presented with a nonhealing wound on left lower limb, pain and swelling over multiple joints, weight loss, and yellowish discoloration of eyes and urine for the past 4 years. On examination, the patient had pallor, icterus, and generalized lymphadenopathy with a nonhealing unhealthy ulcer over left medial malleolus. He had deformed joints with hepatomegaly and splenomegaly. His laboratory investigations were positive for antinuclear antibody (ANA) and anticardiolipin antibody (ACLA). Synovial fluid analysis showed inflammatory findings. Biopsy of margin of the ulcer showed findings consistent with Acroangiodermatitis of Mali. The patient was treated with disease-modifying antirheumatic drugs (DMARDs) and aspirin for juvenile idiopathic arthritis and secondary antiphospholipid antibody syndrome (APS), respectively. The ulcer was managed conservatively with systemic antibiotics and topical steroids along with limb elevation and compression elastic stockings. The patient's symptoms improved significantly, and he is in our followup.

Varyani, Neeraj; Thukral, Anubhav; Kumar, Nilesh; Gupta, Kailash Kumar; Tandon, Ravi; Tripathi, Kamlakar



Inhibition of angiogenesis in lipodermatosclerosis: implication for venous ulcer formation.  


Lipodermatosclerosis refers to skin induration of the lower extremities characterized by tortuous, hyperpermeable vessels preceding venous leg ulcerations. Protein ligands and receptor tyrosine kinases that specifically regulate endothelial cell function are mainly involved in physiological as well as in disease-related angiogenesis. These ligand/receptor systems include the vascular endothelial growth factor (VEGF) and the angiopoietin (Ang) families and their receptor the tyrosine kinase with immunoglobulin-like domains (Tie-2) as well as the VEGF receptor family (VEGF-R1 and VEGF-R2). In the present study, the contribution of these endothelium-specific ligand/receptor systems in tissue samples of lipodermatosclerosis was evaluated. Our results provide evidence, that the mRNA-transcripts of VEGF (p<0.01), Ang-1 (p<0.1), Ang-2 (p<0.1) and VEGF-R1 (p<0.01) were significantly upregulated in all samples of lipodermatosclerosis in comparison with healthy skin by using reverse transcriptase-polymerase chain reaction. On protein level VEGF (p<0.01), Ang-1 (p<0.1), Ang-2 (p<0.1) and VEGF-R1 (p<0.01) were significantly elevated as well. Solely for Tie-2 and for VEGF-R2 no statistical difference could be detected on mRNA and protein level in patients with lipodermatosclerosis in comparison with healthy skin. By immunohistochemistry we confirmed upregulated protein expression for VEGF, Ang-1, Ang-2 and VEGF-R1 compared with healthy skin. Our findings strongly suggest that an imbalance between these ligand/receptor systems might contribute to the pathophysiology of advanced stages of chronic venous insufficiency. Inhibition of angiogenesis could significantly impact the tissue breakdown in lipodermatosclerosis and could hereby enable the formation of venous leg ulcerations. PMID:19787198

Herouy, Yared; Kreis, Sebastian; Mueller, Tobias; Duerk, Thorsten; Martiny-Baron, Georg; Reusch, Petra; May, Florian; Idzko, Marco; Norgauer, Yohannes



Prevention and treatment of pressure ulcers.  


The prevention and treatment of pressure ulcers continues to present a challenge across acute and long-term care settings, and costs the NHS up to pound2.64 billion annually. As well as causing a reduced quality of life for sufferers, they can prove to be fatal. The complexity of the exact causes of skin breakdown and accurate risk assessment has proved problematic to fully understanding this common nursing problem, yet despite limited evidence clear guidelines on best practice exist, suggesting that prevention strategies should encompass interventions in three areas: risk assessment; relief of pressure, and education. Evidence exists that where these strategies are adopted at an organizational level, and strong leadership provided, the outcomes can be remarkable. This article outlines effective prevention and risk-reduction strategies, together with interventions that can promote healing. PMID:20081668

Riordan, Jennifer; Voegeli, David


Larval therapy applied to a large arterial ulcer: an effective outcome.  


This article is a review of larval therapy and includes a case study that uses larval therapy in the treatment of complex leg ulcer wounds. Complex wounds require careful management from the multidisciplinary team and present clinicians with intricate challenges to save the limb. Wound-bed preparation and debridement needs to be as effective and non-traumatic as possible for the patient. Larval therapy removes the devitalised tissue effectively with minimal tissue trauma. This case study reports on a patient with a non-progressing, full-thickness wound with exposed tendon following reconstructive surgery at a local vascular unit. The patient was left with very limited treatment options, as traditional dressings for the arterial ulcer nearly resulted in amputation due to the deterioration in the wound. As part of the patient's management, she was treated with larval therapy in an attempt to salvage her limb. This article follows the progress of complex leg ulcer wounds employing BioFoam® dressing (BioMonde, Bridgend) for larvae debridement therapy over a 4-week period and incorporating five applications of three BioFoam dressing bags. This care pathway ensured the patient's safety by promoting effective wound healing with the larval therapy leading to excellent clinical patient outcomes. PMID:23587971

Rafter, Linda


[Development of the "Whittener Activity Catalog of Self-Care in Venous Ulcer"].  


Poor rates of healing and high rates of re-ulceration are characteristic of venous leg ulcer. The performing of special health-deviation self-care is important for the successful treatment and prevention of this chronic disease. This study aimed to validate a newly designed instrument for the measurement of specific self-care. The "Wittener Aktivitätenkatalog der Selbstpflege bei venös bedingten offenen Beinen" (WAS-VOB) (a catalogue containing self-care activities for venous leg ulcer) was conceptualized on the basis of Orem's theory and on pathophysiological processes. The items were created by using patient interviews (n = 20) and a literature review. An analysis of the reliability was used to reduce the raw scale. The quality of the WAS-VOB was assessed for face-validity (n = 6), feasibility (n = 8), test-retest-reliability (n = 60) and the internal consistency (n = 234). The involvement of patients was based on an informed consent. The WAS-VOB is a self-describing instrument, includes 59 self-care activities and describes those in eight scales which deal with "general compression", "wearing compression bandages", "wearing compression hosiery", "mobility", "temperature", "overload of the venous system", "prevention of skin damage" and "wound healing". The WAS-VOB is practicable and has good psycho-metric characteristics. The test-retest-coefficient (Kendall's tau b) is 0.58, Cronbach's alpha 0.72. The instrument WAS-VOB is suitable for the assessment of self-care deficits. PMID:15040244

Panfil, Eva-Maria; Mayer, Herbert; Evers, Georges C



Computed tomographic findings in penetrating peptic ulcer  

SciTech Connect

Four cases of peptic ulcer penetrating the head of the pancreas were diagnosed by computed tomography (CT). Findings common to 3 cases included (a) an ulcer crater, (b) a sinus tract, and (c) enlargement of the head of the pancreas. Unlike other modalities, the inherent spatial resolution of CT allows a convenient diagnosis of this important complication of peptic ulcer disease.

Madrazo, B.L.; Halpert, R.D.; Sandler, M.A.; Pearlberg, J.L.



How effective is pressure ulcer prevention?  

Microsoft Academic Search

Background: How do we know when an intervention has altered the natural history of a developing pressure ulcer? Objectives: To determine the fate of 2574 pressure-ulcer free subjects admitted to hospitals in the UK and US. Method: Prospective observation of a cohort of hospital patients. Results: 108 subjects developed pressure ulcers. The incidence (among the high to very-high risk group),

Michael Clark


Gastric ulceration in an equine neonate.  


A 24-hour-old colt presented with clinical signs consistent with gastric ulceration. Treatment was initiated with a histamine type-2 receptor antagonist and clinical signs resolved. Gastroscopy at 16 d confirmed the presence of a gastric ulcer. Although gastric ulceration is common in foals, it is rarely reported in foals this young. PMID:12757136

Lewis, Susan



Evaluation of Pressure Ulcer Risk Variables.  

National Technical Information Service (NTIS)

The purpose of this study was to explore characteristics of patients admitted to an acute care facility with a pressure ulcer and to determine whether the Braden Scale accurately identifies patients with pressure ulcers as at-risk for ulcer development. T...

D. F. Williams



Peripheral Ulcerative Keratitis  


... probably caused by an autoimmune reaction (see Allergic Reactions and Other Hypersensitivity Disorders: Autoimmune Disorders ). People develop blurred vision, increased sensitivity to bright light, and a sensation of a foreign object trapped ...


Peptic ulcer disease - discharge  


... you will take two different antibiotics and a proton pump inhibitor (PPI). These medicines may cause nausea, ... or NSAIDs, your doctor will likely prescribe a proton pump inhibitor for 8 weeks. Taking antacids as ...


Hot Leg Piping Materials Issues  

SciTech Connect

With Naval Reactors (NR) approval of the Naval Reactors Prime Contractor Team (NRPCT) recommendation to develop a gas cooled reactor directly coupled to a Brayton power conversion system as the space nuclear power plant (SNPP) for Project Prometheus (References a and b) the reactor outlet piping was recognized to require a design that utilizes internal insulation (Reference c). The initial pipe design suggested ceramic fiber blanket as the insulation material based on requirements associated with service temperature capability within the expected range, very low thermal conductivity, and low density. Nevertheless, it was not considered to be well suited for internal insulation use because its very high surface area and proclivity for holding adsorbed gases, especially water, would make outgassing a source of contaminant gases in the He-Xe working fluid. Additionally, ceramic fiber blanket insulating materials become very friable after relatively short service periods at working temperatures and small pieces of fiber could be dislodged and contaminate the system. Consequently, alternative insulation materials were sought that would have comparable thermal properties and density but superior structural integrity and greatly reduced outgassing. This letter provides technical information regarding insulation and materials issues for the Hot Leg Piping preconceptual design developed for the Project Prometheus space nuclear power plant (SNPP).

V. Munne



Cohort study of atypical pressure ulcers development.  


Atypical pressure ulcers (APU) are distinguished from common pressure ulcers (PU) with both unusual location and different aetiology. The occurrence and attempts to characterise APU remain unrecognised. The purpose of this cohort study was to analyse the occurrence of atypical location and the circumstances of the causation, and draw attention to the prevention and treatment by a multidisciplinary team. The cohort study spanned three and a half years totalling 174 patients. The unit incorporates two weekly combined staff meetings. One concentrates on wound assessment with treatment decisions made by the physician and nurse, and the other, a multidisciplinary team reviewing all patients and coordinating treatment. The main finding of this study identified APU occurrence rate of 21% within acquired PU over a three and a half year period. Severe spasticity constituted the largest group in this study and the most difficult to cure wounds, located in medial aspects of knees, elbows and palms. Medical devices caused the second largest occurrence of atypical wounds, located in the nape of the neck, penis and nostrils. Bony deformities were the third recognisable atypical wound group located in shoulder blades and upper spine. These three categories are definable and time observable. APU are important to be recognisable, and can be healed as well as being prevented. The prominent role of the multidisciplinary team is primary in identification, prevention and treatment. PMID:23374746

Jaul, Efraim



Postural stability during one-leg stance on an unstable moving platform and its relationship with each leg.  


This study examined the laterality of the supporting leg in postural stability during a one-leg stance test on an unstable moving platform and its practice effect. 30 male university students were evaluated using the omnidirection stability index (OSI) during a one-leg stance test on an unstable moving platform (three trials). The leg used when kicking a ball was defined as the manipulation leg (ML) and the supporting leg was defined as the non-manipulation leg (NML). According to the two-way repeated measures analysis of variance (ANOVA; trials x legs), a statistically significant difference was observed only on the leg factor, and OSI values of the second and third trials were less for the ML than the NML. The correlation between both legs was statistically significant but not high. The ML was superior to NML with regard to stability, and no practice effect with trials was evident in either leg. PMID:24032330

Noguchi, Takanori; Demura, Shin-Ichi; Nakagawa, Tomoharu



Autonomous Legged Hill and Stairwell Ascent.  

National Technical Information Service (NTIS)

This paper documents near-autonomous negotiation of synthetic and natural climbing terrain by a rugged legged robot,achieved through sequential composition of appropriate perceptually triggered locomotion primitives. The first, simple composition achieves...

A. M. Johnson D. E. Koditschek G. C. Haynes M. T. Hale



Treating restless legs syndrome with rotigotine.  


Restless legs syndrome has attracted increasing interest as a clinically significant, common and treatable disorder. Good evidence suggests that dopaminergic drugs are the most effective first-line agents when symptoms are severe. PMID:20393432

Reading, Paul




PubMed Central

Forward propulsion is a central task of walking that depends on the generation of appropriate anterior-posterior ground reaction forces (AP GRFs). The AP impulse (i.e., time integral of the AP GRF) generated by the paretic relative to non-paretic leg is a quantitative measure of the paretic leg’s contribution to forward propulsion and is variable across hemiparetic subjects. The purpose of this study was to investigate the underlying mechanisms of propulsion generation in hemiparetic walking by identifying the biomechanical predictors of AP impulses. Three-dimensional kinematics and GRFs were recorded from 51 hemiparetic and 21 age-matched control subjects walking at similar speeds on an instrumented treadmill. Hierarchical regression models were generated for each leg to predict the AP impulse from independent biomechanical variables. Leg extension was a significant predictor and positively related to the propulsive impulse in the paretic, non-paretic and control legs. Secondarily, the hip flexor impulse was negatively related to the propulsive impulse. Also, the relationship of paretic and non-paretic ankle moments with the propulsive impulse depended on the paretic step ratio, suggesting the plantar flexor contribution to the propulsive impulse depends on leg angle. These results suggest that increasing paretic leg extension will increase propulsion. Increasing paretic leg plantar flexor output and decreasing paretic leg hip flexor output could also increase paretic leg propulsion. While increased pre-swing hip flexor output has been suggested to compensate for decreased plantar flexor output, such output may further impair propulsion by the paretic leg if it occurs too soon in the gait cycle.

Peterson, Carrie L.; Cheng, Jing; Kautz, Steven A.; Neptune, Richard R.



Treatment by athermal laser of the diabetic leg  

NASA Astrophysics Data System (ADS)

This work shows the result obtained in the medical clinic of the `Dr. I. Cantacuzino Hospital' on a lot of 43 diabetic patients using the `LASSIS' devices composed of a He-Ne laser and 4 semiconductor lasers. The 43 patients showed various clinic pictures of a diabetic leg (diabetic arteriopathy and neuropathy) 16 of the lot showed an arteriopathy with claudication and a decrease of pulses oscillometrically measurements, 15 had ulceration and a beginning of gangrene and the other 12 showed a plantary boring ill. There has been achieved an amelioration of the oscillometric index of the claudication while walking the amelioration of local circulation, together with the limitation of the necrosis. For the boring ill, there has been achieved the acceleration of the granulating and epithelization process avoiding surgeries, suppuration and cutaneous plasties. The response to the laser treatment was compared to the response to the classic treatment (vasodilatation surgery unstrapping, antibiotherapy) on a proving lot. We appreciated that the cicatrization and local vasodilatation with athermal laser treatment should be a hope for the treatment of patients suffering of diabetic arteriopathy and neuropathy.

Ignat, P.; Suteanu, S.; Brojbeanu, Gabriela; Vasiliu, Virgil



Standard Treatment of Ulcerative Colitis  

Microsoft Academic Search

Ulcerative colitis (UC) is an idiopathic, chronic inflammation of the colon which may present with a range of mild to severe symptoms. The disease may be localized to the rectum or can be more extensive and involve the left side of the colon or the whole colon. Treatment in UC is directed towards inducing and maintaining remission of symptoms and

Paolo Gionchetti; Fernando Rizzello; Flavio Habal; Claudia Morselli; Cristina Amadini; Rossella Romagnoli; Massimo Campieri



Reaginic hypersensitivity in ulcerative colitis  

Microsoft Academic Search

Reaginic hypersensitivity in ulcerative colitis has been investigated in respect of a hypersensitivity to the cow's milk proteins and the frequency of atopic asthma, hay fever, and eczema. Intradermal tests were frequently positive, especially to casein, but the results did not differ from those found in healthy individuals and in groups of patients with Crohn's disease, hypolactasia, and the irritable