Sample records for leg ulcer caused

  1. [Leg ulcers].

    PubMed

    Wollina, U; Unger, L; Stelzner, C; Machetanz, J; Schellong, S

    2013-11-01

    The lower leg is in particular prone to the development of ulceration. Many different causes may lead to ulceration. Thus, a thorough diagnosis is mandatory, and a biopsy is often required. By far the most common type is the classical venous ulcer due to chronic venous insufficiency, located at the medial ankle. A more complicated-and more difficult to treat-type of venous ulcer is arthrogenic congestion syndrome with its extreme variant of a "legging" ulcer. In cases with severe peripheral arterial disease, an arterial ulcer may develop. The hypertensive ulcer Martorell is associated with arterial hypertension and diabetes; the underlying pathology is occlusion of arteriolar vessels. A typical diabetic ulceration is the necrobiosis lipoidica. Important differential diagnoses of leg ulceration include pyoderma gangrenosum and the calciphylactic ulcer. Due to a long-standing course, an ulceration may turn malignant. Vice versa, ulceration may occur as sign of a primary malignant lesion. PMID:24005788

  2. Management of leg ulcers

    Microsoft Academic Search

    P K Sarkar; S Ballantyne

    2000-01-01

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

  3. Management of leg ulcers

    PubMed Central

    Sarkar, P; Ballantyne, S

    2000-01-01

    Leg ulcer is a leading cause of morbidity among older subjects, especially women in the Western world. About 400 years BC, Hippocrates wrote, "In case of an ulcer, it is not expedient to stand, especially if the ulcer be situated on the leg". Hippocrates himself had a leg ulcer. The best treatment of any leg ulcer depends upon the accurate diagnosis and the underlying aetiology. The majority of leg ulcers are due to venous disease and/or arterial disease, but the treatment of the underlying cause is far more important than the choice of dressing. The aetiology, pathogenesis, treatment, and the future trends in the management of the leg ulcers are discussed in this review.? PMID:11060140

  4. Clinical Examination and Treatment of a Leg Ulcer Caused by a Stingray Puncture.

    PubMed

    Fino, Pasquale; Onesti, Maria Giuseppina; Felli, Antonina; Scuderi, Nicolò

    2014-05-30

    The most frequent causes of leg ulcers include venous incompetency (superficial and deep), arterial insufficiency, trauma, vasculitis, and neoplasm. Leg ulcers from injury by stingrays are quite rare. In this case report, we describe a leg ulcer caused by a stingray sting complicated by infection, which healed completely without surgery. In addition, since there few cases in the literature describing such traumas, we performed a comprehensive review of the literature. Important is the fact that the wound healing was complete without resorting to surgery, but only with a correct targeted antibiotic therapy and the use of a collagenase, which has the particularity of having hyaluronic acid as a component. PMID:24879461

  5. [Prevention of leg ulcer].

    PubMed

    Marinovi? Kulisi?, Sandra

    2013-10-01

    Lower leg ulcers is the most common form of ulceration of the lower extremities. The prevalence of leg ulcer varies among studies from 0.1% to 0.6%. In the majority of studies, 1% of the population develop leg ulcer at least once in lifetime. The prevalence is higher in elderly people. There are several hypotheses used to explain the pathophysiological steps leading from the popliteal venous hypertension in value. Currently, the treatment of leg ulcer relies on due knowledge of ulcer pathophysiology and making an accurate diagnosis. Venous disease has a significant impact on quality of life and work productivity. In addition, costs associated with the prevention and treatment of lower leg ulcers are significant. PMID:24371975

  6. Multidimensional leg ulcer assessment.

    PubMed

    Anderson, Irene

    Assessing patients presenting with a leg ulcer is like doing a multidimensional jigsaw puzzle, in which all the pieces need to fit together to make a whole picture that has depth and meaning. This enables rational clinical decisions to be made with patients, according to their capability and agreement to be involved. This article highlights some of the key features of leg ulcer assessment, drawing on recommendations in national guidelines. PMID:22536723

  7. Ehlers-Danlos Syndrome Type VIII: A Rare Cause of Leg Ulcers in Young Patients

    PubMed Central

    Lucas, Antoine; Piérard, Gérald E.; Hermanns-Lê, Trinh; De Paepe, Anne; Dupuy, Alain

    2013-01-01

    Ehlers-Danlos syndrome type VIII (EDS-VIII) is a very rare autosomal dominant disease characterized by early-onset periodontitis associated with features of Ehlers-Danlos syndrome. We report a 32-year-old man whose chronic leg ulcer led to the diagnosis of EDS-VIII. He had severe periodontitis with complete loss of permanent teeth and skin fragility with thin skin, atrophic scars, and brownish atrophic pretibial plaques. Leg ulcer is not a prominent feature of EDS-VIII. We suggest adding EDS-VIII to the list of rare diseases accounting for chronic leg ulcers, if this case report prompts others to report leg ulcers associated with EDS-VIII. PMID:24198978

  8. [Diagnostic and treatment of leg ulcers].

    PubMed

    Velasco, M

    2011-12-01

    Ulcers are a frequent cause of dermatologic consultation, and most correspond to leg ulcers. Major advances in the treatment of ulcers have occurred in recent years as a result of research that has led to new concepts such as the consideration of the chronic ulcer as an inflammatory process involving proinflammatory cytokines and deficits of growth factors. Furthermore, studies into the use of the wet dressing have led to the appearance of a wide variety of new dressings. The aim of this review is to update the reader's knowledge of the treatment of ulcers in general and of leg ulcers in particular, with a detailed description of the new dressings available and of the new therapies for use in refractory cases. PMID:21890074

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

    Microsoft Academic Search

    Philip Coleridge Smith

    2006-01-01

    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

  10. [Differential diagnosis and work up of chronic leg ulcers].

    PubMed

    Spoljar, Sanja

    2014-10-01

    Many factors contribute to the pathogenesis of leg ulcers. The main causes are chronic venous insufficiency, peripheral arterial occlusive disease (PAOD) and diabetes. Some leg ulcers are caused by combinations of these well-known etiologic factors. The most common cause of PAOD is arteriosclerosis. In diabetic patients, distal symmetric neuropathy and peripheral vascular disease are probably the most important etiologic factors in the development of leg ulcers. Less frequent causes of chronic leg ulcers are hematologic diseases, autoimmune diseases, genetic defects, infections, primary skin disease, cutaneous malignant diseases, use of some medications and therapeutic procedures, and numerous exogenous factors. Diagnosis of leg ulcer is made upon medical history, clinical picture, palpation of arteries, functional testing and serologic testing. Device-based diagnostic testing should be performed for additional clarification. Also, lesion biopsy should be taken for histopathology, direct immunofluorescence, bacteriology and mycology. The knowledge of differential diagnosis is essential for ensuring treatment success in a patient with leg ulcer. PMID:25326987

  11. [Martorell Hypertensive Ischaemic Leg Ulcer.

    PubMed

    Nobbe, S; Hafner, J

    2014-10-21

    Martorell hypertensive ischaemic leg ulcer (HYTILU) represents an important differential diagnosis of painful leg ulcerations. Stenotic subcutaneous arteriolosclerosis in patients with long-standing arterial hypertension finally leads to skin infarction. The typical histological changes are very similar in Martorell HYTILU and calciphylaxis. This raises the hypothesis that the two entities may have a common pathogenesis. Martorell HYTILU presents as an extremely painful ulcer that is regularly located at the laterodorsal lower leg or at the Achilles tendon. Because of its inflammatory and violaceous wound edges and its tendency to progression, clinicians unaware of the diagnosis Martorell HYTILU might misdiagnose pyoderma gangrenosum or necrotising cutaneous vasculitis start an immunosuppressive treatment and avoid surgical diagnostic and therapeutic procedures. Instead, necrosectomy and split skin grafting are the treatment of choice for Martorell HYTILU. PMID:25333521

  12. [Contemporary management of leg ulcer].

    PubMed

    Huljev, Dubravko

    2012-12-01

    Chronic wounds are becoming an increasing health, economic and social problem worldwide, including Croatia. Most common chronic wounds are the results of venous insufficiency of lower legs, and their incidence is about 75% of all chronic wounds. Costs of treating patients with leg ulcer are not trivial. According to available data from different countries, they range from 1% to 3% of total fund allocated for health care. Expensive, time-consuming, difficult, and often uncertain treatment is still great health, social and economic problem. The paper describes current approach to the treatment of venous leg ulcers, with emphasis on the cost-benefit of this approach. Before hospitalization, the patient was treated without compression therapy, just with local application of various types of coatings for 4 years. There are no precise data on the types of dressings that were used, and no data on the microbiological status of the wound during this period. After admission to the hospital, the first step was approach to preparation and conditioning the bed of leg ulcer. After achieving satisfactory local status, the ulcer was covered by free skin graft. Upon discharge from the hospital, minor residual skin defects were treated with alginate dressings and fully healed within 3 weeks. Total cost of 3-month treatment (one-month preoperative period, hospitalization and time elapsed from discharge from the hospital to complete recovery) was 17,085.95 HRK. An approximate cost estimate of 4-year unsuccessful treatment is more than 100,000.00 HRK. Contemporary and active approach that is consistent with current state-of-the-art can achieve significant cost saving in the treatment of patients with chronic leg ulcer. PMID:23814968

  13. Ulcerated necrobiosis lipoidica as a rare cause for chronic leg ulcers: case report series of ten patients.

    PubMed

    Franklin, Cindy; Stoffels-Weindorf, Maren; Hillen, Uwe; Dissemond, Joachim

    2013-10-01

    Necrobiosis lipoidica is a rare granulomatous disorder of the skin. In up to 30% of the affected patients it can lead to ulcerations, which can impair the quality of life and are also very difficult to treat. Its pathogenesis is not fully understood. Only few studies focussing on necrobiosis lipoidica can be found, but none of them focus on ulcerated necrobiosis lipoidica. Therefore, we collected demographic data and comorbidities and assessed treatment options for patients with ulcerated necrobiosis lipoidica. Data of patients who were treated in the wound care centre of the University Hospital of Essen for ulcerated necrobiosis lipoidica over the past 10 years were retrospectively analysed. Hence, data of altogether ten patients (nine women and one man) with ulcerated necrobiosis lipoidica were collected. Of these, 70% of the patients had diabetes mellitus of which 30% had type I diabetes and 40% had type II diabetes; 60% of the patients suffered from arterial hypertension, obesity and hypercholesterolaemia; 40% of the patients suffered from psychiatric disorders such as depression and borderline disorder. Our clinical data demonstrate an association of ulcerated necrobiosis lipoidica and aspects of metabolic syndrome. This leads to a conclusion that ulcerating necrobiosis lipoidica can be seen as part of a generalised inflammatory reaction similar to the inflammatory reaction already known in the pathophysiology of rheumatoid diseases or psoriasis. In patients with clinical atypical painful ulcerations, necrobiosis lipoidica should be considered as a possible differential diagnosis. Therapists should be aware of associated aspects in patients with ulcerated necrobiosis lipoidica who besides diabetes often suffer from other aspects of a metabolic syndrome with increased cardiovascular risk factors. Therefore, these related comorbidities should also be diagnosed and treated. PMID:24119190

  14. Chronic ulcer of the leg: clinical history

    Microsoft Academic Search

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

    1987-01-01

    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

  15. [List of diagnostic tests and procedures in leg ulcer].

    PubMed

    Spoljar, Sanja

    2013-10-01

    Many factors contribute to the pathogenesis of leg ulcer. Most patients have venous leg ulcer due to chronic venous insufficiency. Less often, patients have arterial leg ulcer resulting from peripheral arterial occlusive disease, the most common cause of which is arteriosclerosis. Leg ulcer may be of a mixed arteriovenous origin. In diabetic patients, distal symmetric neuropathy and peripheral vascular disease are probably the most important etiologic factors in the development of diabetic leg ulcer. Other causes of chronic leg ulcers are hematologic diseases, autoimmune diseases, genetic defects, infectious diseases, primary skin diseases, cutaneous malignant diseases, use of some medications and therapeutic procedures, and numerous exogenous factors. Diagnosis of leg ulcer is based on medical history, inspection, palpation of skin temperature, palpation of arteries, fascia holes, presence and degree of edema, firm painful cords, and functional testing to assess peripheral occlusive arterial disease or identify superficial and deep venous reflux of the legs. Knowledge of differential diagnosis is essential for ensuring treatment success in patients with leg ulcer. There are many possible etiologic factors of leg ulcers and sometimes, clinical findings are similar. Additional testing should be performed, e.g., serologic testing such as blood count, C-reactive protein, HBA1c, erythrocyte sedimentation rate, differential blood count, total proteins, electrolytes, coagulation parameters, circulating immune complex, cryoglobulins, homocysteins, AT, PAI-1, APC resistance, proteins C and S, paraproteins, ANA, ENA, ANCA, dsDNA, antiphospholipid antibodies, urea, creatinine, blood lipids, vitamins and trace elements. Also, biopsy of the lesion for histopathology, direct immunofluorescence, bacteriology and mycology should be included. Other tests are Raynaud (cold stimulation) test and pathergy test. Device-based diagnostic testing should be performed for future clarification. Ankle brachial pressure index, color duplex sonography, plethysmography, MSCT and MR angiography, digital subtraction angiography, phlebography, angiography, x-ray, and capillaroscopy in lupus erythematosus are indicated. Except for bacteriologic analyses of wound biopsies, there is no test to provide specific information on the wound condition. PMID:24371972

  16. Compression therapy in leg ulcer management.

    PubMed

    Brown, V; Marshall, D

    Leg ulcer management is an important consideration for all nurses involved in the care of older people. Non-specialists in tissue viability might not always be aware of the evidence base for best practice. The authors examine the effectiveness of multilayer and single-layer long- or short-stretch bandage systems in leg ulcer management. PMID:12211949

  17. Leg ulcer management with topical medical honey.

    PubMed

    Sare, Janice Leigh

    2008-09-01

    Three case studies of patients with leg ulceration are used to illustrate the effectiveness of Medihoney antibacterial wound gel (Medical honey) in wound healing via wound bed preparation. The aim was to improve the patient's quality of life, during the healing process, through provision of comfort, reduction in pain and protection from infection. Three patients with chronic leg ulceration were assessed as potentially benefiting from the action of medical honey to achieve wound healing. Patient selection was based on structured leg ulcer assessment. The aetiology of ulceration in patient 1 was mixed arterial and venous, and in patient 2 and 3, venous. All had several years' history of reoccurrence. Promotion of healing occurred in all instances with a reduction in the incidence of infection, reduction in pain and the provision of comfort. Antibacterial medical honey should therefore be considered as a dressing option when assessing and managing chronic wounds. PMID:19024040

  18. Causes of venous ulceration: a new hypothesis

    Microsoft Academic Search

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

    1988-01-01

    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

  19. Leg ulcer treatment by superficial vein surgery and saline-gauze dressing

    Microsoft Academic Search

    Rolandas Dagilaitis; Vytautas Triponis; Ingrida Gudgalytë; Dalia Triponienë

    Objective To determine the effectiveness of phlebectomy and topic saline in patients with leg ulcer caused by isolated superficial vein reflux. Materials and methods One hundred and thirty consecutive patients with 143 ulcers were operated for superficial varicose veins and venous ulcer. Patients with deep reflux, peripheral arterial disease (ankle\\/brachial index <0.9), diabetes, history of circular venous ulcer, malignancies, mental

  20. A case of prolidase deficiency accompanying leg ulcers.

    PubMed

    Solak, Berna; Kara, Rabia Oztas; Erdem, Teoman; Muftuoglu, Tuba

    2015-03-01

    Prolidase deficiency (PD) is a rare autosomal recessive disorder that has symptoms such as skin ulcers, characteristic facies, mental retardation, skeletal deformities, hematological anomalies, splenomegaly, and chronic infections. Deficiency of prolidase leads to the increased excretion of proline in urine, which causes impaired collagen synthesis and delay in wound healing. This case reports a 40-year-old female who has had cutaneous ulcers since the age of 7 years. We also recognized borderline intellectual functioning as well as hematologic abnormalities and splenomegaly. We present this rare case to draw attention to consider prolidase deficiency in the differential diagnosis of leg ulcers. PMID:25691319

  1. Leg ulcers in peripheral arterial disease (arterial leg ulcers): Impaired wound healing above the threshold of chronic critical limb ischemia

    Microsoft Academic Search

    Jürg Hafner; Iris Schaad; Ernst Schneider; Burkhardt Seifert; Günter Burg; Paolo Claudio Cassina

    2000-01-01

    Background: Peripheral arterial disease is the only identifiable etiology in approximately 10% of leg ulcers. Clinical data on the management of these chronic wounds are scarce. Objective: We attempted to outline the threshold of systolic ankle pressure and ankle-brachial-index (ABI) below which arterial leg ulcers can occur and to outline the indication for revascularization in arterial leg ulcers. Methods: Diagnostic

  2. Compression in leg ulcer treatment: inelastic compression.

    PubMed

    Mosti, Giovanni

    2014-05-19

    Compression therapy is extremely effective in promoting ulcer healing. Which material to use, if elastic or inelastic, is still a matter of debate. This paper will provide an overview on the recent findings in compression therapy mainly for venous or mixed ulcers which are the great majority of leg ulcers. In this paper it will be demonstrated that inelastic compression has been proved to be significantly more effective than elastic compression in reducing venous reflux, increasing venous pumping function and decreasing ambulatory venous hypertension. In addition it is comfortable, well accepted by patients and achieved an extremely high healing rate in venous ulcers. With reduced pressure inelastic compression is able to improve venous pumping function in patients with mixed ulcers without affecting but improving the arterial inflow. It will be also clearly shown that studies claiming a better effect of elastic compression compared to inelastic in favouring healing rate have significant methodological flaws making their conclusions at least doubtful. In conclusion inelastic- is significantly more effective than elastic compression in reducing ambulatory venous hypertension which is the main pathophysiological determinant of venous ulcers and demonstrated to be very effective in getting ulcer healing. New multicentric, randomized and controlled studies, without methodological flaws, will be necessary to prove that elastic- is at least as effective as inelastic compression or, maybe, more effective. PMID:24843101

  3. Venous Leg Ulcerations: A Treatment Update

    Microsoft Academic Search

    Ronda S. Farah; Mark D. P. Davis

    2010-01-01

    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

  4. Case study: psychosocial aspects of chronic bilateral venous leg ulcers.

    PubMed

    Mapplebeck, Lynda

    2008-03-01

    This case study gives an concise report on how venous leg ulceration can cause deep psychological problems for those suffering with this condition. As with all disease, you cannot separate the physical from the psychological. Suffering with clinical depression and not seeing a future, Emily's life has been turned around by the evidence-based application of a 2-layer bandaging system. Emily's ulcers are now almost healed showing that good clinical skills and collaboration with patients are the key to effective clinical outcomes in hard-to-heal wounds. PMID:18557572

  5. Oxpentifylline treatment of venous ulcers of the leg

    Microsoft Academic Search

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

    1990-01-01

    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

  6. Treatment of leg ulcers with split skin grafts: early and late results.

    PubMed

    Turczynski, R; Tarpila, E

    1999-09-01

    Sixty patients (mean age 73.5 years) with 88 leg ulcers that had not responded to conservative treatment had split skin grafts applied at the Department of Plastic Surgery, Linköping, Sweden. Of 51 venous leg ulcers 45 (88%) healed after a mean of 15 days (range 5-30); and 13 (62%) of the 21 arterial ulcers healed after a mean of 18 days (range 8-30). Additional skin grafting was done on nine of the venous and on three of the arterial ulcers. Twenty-two (49%) of the healed venous ulcers recurred after a mean of four months while only two (15%) of the healed arterial ulcers recurred after a mean of 10 months. At late follow up after a mean of four years 18 of the patients were dead and 10 had had the leg in question amputated. Of the 34 patients still alive who had not had amputations, 31 were investigated at open ward or interviewed by telephone and 23 patients were examined with colour duplex scan. Seven of these patients had open leg ulcers. At duplex scan six patients had no venous or arterial insufficiency that could cause a leg ulcer. Of 16 patients with venous insufficiency 10 patients had only an inadequate superficial system. The mean cost for treating one leg ulcer by skin grafting is estimated at SEK 89000 (US$11125). We conclude that leg ulcers often heal with skin grafting but that venous ulcers often recur. To reduce the recurrence rate we suggest a better preoperative aetiological evaluation and improved postoperative treatment with a compression bandage. PMID:10505443

  7. The Lindsay Leg Club: supporting the NHS to provide leg ulcer care.

    PubMed

    McKenzie, Morag

    2013-06-01

    Public health services will need to cope with additional demands due to an ageing society and the increasing prevalence of chronic conditions. Lower-limb ulceration is a long-term, life-changing condition and leg ulcer management can be challenging for nursing staff. The Lindsay Leg Club model is a unique partnership between community nurses, members and the local community, which provides quality of care and empowerment for patients with leg ulcers, while also supporting and educating nursing staff. The Leg Club model works in accord with core themes of Government and NHS policy. Patient feedback on the Leg Club model is positive and the Leg Clubs provide a service to members which is well accepted by patients, yet is more economically efficient than the traditional district nursing practice of home visits. Lindsay Leg Clubs provide a valuable support service to the NHS in delivering improved quality of care while improving efficiency. PMID:24156167

  8. Community clinics for leg ulcers and impact on healing

    Microsoft Academic Search

    C. J. Moffatt; P. J. Franks; M. Oldroyd; N. Bosanquet; P. Brown; R. M. Greenhalgh; C. N. McCollum

    1992-01-01

    OBJECTIVE--To evaluate the effectiveness of community clinics for leg ulcers. DESIGN--All patients with leg ulceration were invited to community clinics that offered treatment developed in a hospital research clinic. Patients without serious arterial disease (Doppler ankle\\/brachial index > 0.8) were treated with a high compression bandage of four layers. SETTING--Six community clinics held in health centres in Riverside District Health

  9. Managing leg and foot ulcers: the role of Kerraboot.

    PubMed

    Ashton, Jacqui

    2004-09-01

    Foot and leg ulcers are chronic wounds characterized by slow or non-healing breakdown of epidermal and dermal tissue on the foot or below the knee. The prevalence is high and ulcers are a significant drain on the NHS in terms of nursing time and cost of dressings, and are incredibly burdensome to the individual patient. This article reviews the evidence for a new wound management system, Kerraboot, designed for the management of leg and foot ulcers. It is a boot-shaped dressing that completely surrounds the ulcer, creating an optimum healing environment. In clinical investigations, Keraboot offered patients relief from pain, was comfortable, easy to use and effectively controlled embarrassing odour, while also saving nursing time. Currently Kerraboot is recommended for the management of diabetic foot ulcers and venous ulcers where the patient is unable to tolerate compression therapy. PMID:15389156

  10. Treatment of an atypical leg ulcer: pyoderma gangrenosum.

    PubMed

    Knock, Karen; Butcher, Martyn

    2003-06-01

    Mrs B was referred to the Skin and Woundcare Department at the start of January 2002 with a chronic non-healing ulcer to her lower right leg proximal to the medial aspect of her right knee. The ulcer was diagnosed as pyoderma gangrenosum, a condition which Mrs B had suffered from previously. Assessment and management of this atypical ulcer are discussed. Once the progression of the lesion was halted, conservative treatment could be undertaken, and led to a successful outcome. PMID:12819591

  11. Squamous cell carcinoma developed on chronic venous leg ulcer.

    PubMed

    Sîrbi, Adelina Gabriela; Florea, Marius; P?tra?cu, Virgil; Rotaru, Maria; Mogo?, Dan Gabriel; Georgescu, Claudia Valentina; M?rg?ritescu, Nicolae Drago?

    2015-01-01

    Chronic venous leg ulcers (VLU), especially long-lasting non-healing ulcers, are among the risk factors for squamous cell carcinoma (SCC). Malignant transformation of a VLU is a rare finding and the relative risk of carcinomatous transformation is quite low (about 5.8). SCC arising in the context of a VLU has a particularly aggressive behavior. A 76-year-old male patient with no relevant medical familial history, with chronic venous insufficiency CEAP C6 for 10 years [recurrent leg ulcers with favorable outcome (healing) after specific local and systemic treatment], showing for about three years one ulcerated lesion located on the anterior upper third of the right calf non-responsive to specific treatment, which subsequently increased their size and merged. Biopsy sample was taken. Histopathology showed epidermal acanthosis, papillomatosis, intense parakeratosis, pseudoepitheliomatous hyperplasia, dysplasia and moderately differentiated squamous cell carcinoma with areas of acantholysis. Immunohistochemistry (Ki67, EMA, cytokeratin 34?E12 and p63) was performed and all types of immunostaining were moderately to intense positive. Above-knee leg amputation and specific oncologic treatment were proposed as possible curative solutions but the patient refused. Ten months after diagnosis and discharge form the Department of Dermatology, the patient died. Patients with chronic venous leg ulcers and clinically suspicious lesions should be evaluated for malignant transformation of the venous lesion. When diagnosed, malignancy complicating a chronic venous leg ulcer requires a resolute treatment as it may be fatal. PMID:25826522

  12. The relevance of large-vessel vascular disease and restricted ankle movement to the aetiology of leg ulceration in rheumatoid arthritis

    Microsoft Academic Search

    E. R. MCRORIE; C. V. RUCKLEY; G. NUKI

    1998-01-01

    SUMMARY Leg ulceration in rheumatoid arthritis (RA) without systemic vasculitis is a diYcult clinical problem and a common cause of morbidity. We have assessed venous function, arterial pressures and range of ankle movement in 23 RA patients with a leg ulcer and compared the results with those in the non-ulcerated contralateral limb and in 25 RA patients matched for age

  13. Living with a venous leg ulcer: a descriptive study of patients' experiences.

    PubMed

    Walshe, C

    1995-12-01

    This study aimed to describe the experience of living with a venous leg ulcer from the patient's perspective, to answer the question 'What is it like to live with a venous leg ulcer?' Investigating the experience of illness is important in understanding how disease processes affect people, how they understand and cope with these processes, and how care may be given most effectively. Little research was identified which examined these areas with reference to people with leg ulceration. A qualitative approach was taken in the following study, using phenomenological methods to describe the experience of venous leg ulceration. Informal unstructured interviews were conducted with 13 informants, guided by their descriptive priorities. Tape recordings were then transcribed and analysed for recurrent themes and their meanings. It was found that certain symptoms of ulceration, principally pain, were the overwhelming feature of the experience. These symptoms caused significant restrictions in people's lives, particularly in their ability to walk and go out. Treatment was not described as being efficacious in ameliorating these symptoms, but nevertheless great confidence and trust was placed in the expertise of nurses. People coped with the experience mainly by a process of normalizing its components. It is concluded that if treatment is to meet the needs of those suffering venous leg ulceration, then symptom control must be the highest priority. PMID:8675863

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

    PubMed

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

    2014-12-01

    Vascular leg ulcers remain a challenge for the modern health care, and a systematic pathological study on this kind of lesions has not been reported so far. A total of 293 consecutive white patients with chronic leg ulcers (present for a minimum of 6 months and up to several years) referred to the Wound Care Unit (Dermatology, University of Bologna) between March 2008 and June 2011. Thirty-four patients affected by other than vascular ulcers, neoplastic or inflammatory conditions, were excluded. The remaining 259 patients affected by vascular leg ulcers were enrolled in this study. Assessment of the patients general health, skin biopsy, and vascular Doppler of the lower limbs were performed to determine the etiology and to formulate an appropriate management plan, whereas 2 punch biopsies of 3 mm were performed on the border and on the bed of each ulcer. Doppler evaluation showed the presence of vascular hemodynamic impairment in 259 patients. Of these, 181 (69.9%) patients were affected by venous insufficiency, 58 (22.4%) by venous and arterial insufficiency, and 20 (7.7%) by arterial insufficiency. Histopathologic features revealed significant differences, thus, reflecting the clinicopathologic correlation with the underlying hemodynamic impairments. In conclusion, histopathologic and hemodynamic data correlation could provide the basis for future analysis of leg ulcers pathogenesis and may improve treatment protocols. We should underline that this observational study represents a single-institute experience and that larger series are needed to confirm our observations. PMID:25072681

  15. Marjolin's Ulcer of the Leg Secondary to Nonhealing Chronic Venous Stasis Ulcer

    Microsoft Academic Search

    Royden Stanford; Danae Lowell; Shylaja Arya

    We report on a 79-year-old man with a chronic venous stasis ulceration of greater than 20 years' duration in the left medial leg presenting to our clinic after admission for bleeding and suspected infection of his ulceration. This lesion had been biopsied in 1999 and was found to be a benign, chronic venous insufficiency ulceration. Plain film radiographs as well as

  16. A Team Approach to the Management of Intractable Leg Ulcers

    PubMed Central

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

    2013-01-01

    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) PMID:23641282

  17. Traffic light system for healed venous leg ulcer monitoring.

    PubMed

    Hindley, Jenny

    2012-09-01

    The purpose of this paper is to introduce the conceptualisation and evolution of a trialed Doppler traffic light system for healed venous leg ulceration. This tool aims to facilitate clinical decision-making and provides a systematic approach to the ongoing assessment of arterial disease in patients with healed venous leg ulcers when used in conjunction with other purposely-designed assessment documentation to ensure the novice registered and unregistered nurse contributes safely and effectively to the care of patients. The validation and trial of this clinical decision tool is discussed in terms of the use of a recognised methodology determining its fitness for purpose and robustness. PMID:23638479

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

    PubMed

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

    2013-06-01

    A number of leg ulcer specialist/tissue viability specialists from across the UK were invited to evaluate PICO (Smith and Nephew, Hull) as a treatment for venous leg ulcers also in conjunction with a variety of compression bandages and garments. Patients across 5 sites had PICO applied in conjunction with compression therapy. This group of treating clinicians were then asked to give feedback on the outcome of the patients on whom they had used the new device. All feedback was recorded at a meeting and this was used to create a guideline for use. PMID:24156166

  19. Role of hyperbaric medicine for intractable leg ulcers: a case report.

    PubMed

    Skeik, N; Kia, F; Klosterman, D

    2014-10-01

    We present a case report of intractable multifactorial leg ulcer that was treated successfully with multiple approaches including hyperbaric oxygen treatment (HBOT) to prepare for skin grafting. A 66-year-old female with a history of rheumatoid arthritis and Felty's syndrome presented with a non-healing ulcer on her left leg that was caused by a trauma. She failed multiple treatment options including debridement, different wound dressings, antibiotics, anti-inflammatories and vein closure procedure. She finally healed with skin graft following HBOT that prepared the wound bed before the procedure. PMID:25289650

  20. Understanding venous leg ulcer pain: results of a longitudinal study.

    PubMed

    Nemeth, Kathleen A; Harrison, Margaret B; Graham, Ian D; Burke, Sharon

    2004-01-01

    Venous leg ulcer pain experienced during compression bandaging is poorly understood. A prospective, pilot cohort study was initiated to determine the feasibility of conducting a large-scale, repeated measures cohort study of venous leg ulcer pain and to document and describe the venous leg ulcer pain experience during the first 5 weeks of treatment with compression bandages. Eligible individuals admitted to a nurse-led community leg ulcer service in one Canadian community were recruited for the 5-week study. Pain assessment tools (ie, numerical rating scale and short form McGill Pain Questionnaire) were evaluated by 20 venous ulcer patients (mean age = 73.7 years) and their nurses for ease of use during one baseline and five weekly follow-up visits. Health-related quality of life (HRQL) information was obtained. Nurses reported on ease of integrating pain data collection into regular clinical care. Each pain assessment tool was audited for completion. Most participants found the pain assessment tools easy to use, but nurses reported lengthened visit times with some participants as a result of tool administration difficulties, particularly the visual analogue scale (VAS). Overall completeness of pain assessment tools ranged from 85.0% (visual analogue scale) to 96.3% (present pain intensity and word descriptor list). The vast majority of patients (18) reported ulcer pain at baseline. Total mean scores for all pain assessment tools used decreased over time, but most patients reported pain throughout the study. The most common pain descriptors used were "aching," "stabbing," "sharp," "tender," and "tiring." Health-related quality of life was low and did not change during the 5-week study. The results of this study suggest that the vast majority of venous ulcer patients experience pain and that it is feasible to examine this pain in individuals receiving care in the community over time. PMID:14712004

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

    Microsoft Academic Search

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

    2003-01-01

    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

  2. The Diagnosis and Management of 689 Chronic Leg Ulcers in a Single-visit Assessment Clinic

    Microsoft Academic Search

    D. J. Adam; J. Naik; T. Hartshorne; M. Bello; N. J. M. London

    2003-01-01

    Objectives: accurate diagnosis is essential if patients with chronic leg ulceration are to receive optimal treatment. This prospective study describes the findings of a standardised assessment protocol and the initial management of a consecutive series of patients with chronic leg ulceration presenting to a single-visit leg ulcer assessment clinic.Methods: between January 1993 and January 1999, a total of 555 patients

  3. Cost-of-illness of leg ulcers in the community.

    PubMed

    Augustin, Matthias; Brocatti, Leyla K; Rustenbach, Stephan J; Schäfer, Ines; Herberger, Katharina

    2014-06-01

    Leg ulcer management is complex, time-consuming and of high socio-economic importance. Data on cost-of-illness in leg ulcer care are sparse. The objective of this study was to evaluate the cost-of-illness in leg ulcer treatment in the metropolitan area of Hamburg. About 147 institutions involved in wound care participated in a cross-sectional study. Patients consecutively recruited underwent a standardised interview and clinical examination. Main economic outcomes were direct, indirect and intangible costs from a societal perspective. Five hundred and two patients with a mean age of 71 years and mean wound duration of 9 years were enrolled. Annual total costs summed up to a mean of 9060€ /patient/year (8288€ direct, 772€ indirect costs). Direct costs carried by statutory health insurances amounted to 7680€ , patients themselves paid on average 607€. Leg ulcer is associated with high costs for health insurances, patients and the society. Exploratory predictor analyses suggest that early, interprofessional disease-management could lower treatment costs. PMID:23020710

  4. Wound Teleconsultation in Patients with Chronic Leg Ulcers

    Microsoft Academic Search

    Wolfgang Salmhofer; Rainer Hofmann-Wellenhof; Gerald Gabler; Karin Rieger-Engelbogen; Dieter Gunegger; Barbara Binder; Thomas Kern; Helmut Kerl; H. Peter Soyer

    2005-01-01

    Background: The treatment of chronic leg ulcers requires frequent assessments of local wound status and adjustment of therapy. The availability of reasonably priced photographic equipment and quick electronic transfer of high-quality digital images should make it possible that the assessment of wound status can be made by remote experts. Objective: This study examines the feasibility of using teledermatology for wound

  5. Topical Treatment of Nonhealing Venous Leg Ulcer with Propolis Ointment

    PubMed Central

    Kucharzewski, M.; Kózka, M.; Urbanek, T.

    2013-01-01

    An investigation of effectiveness of topical treatment of nonhealing chronic venous leg ulcers with propolis ointment was conducted. 56 patients were included in the study and randomized into two groups. In group 1, there were 28 patients (ulceration area: 6.9–9.78?cm2) treated by means of topical propolis ointment application and short stretch bandage compression. In group 2, there were 29 patients (ulceration area: 7.2–9.4?cm2) treated by means of Unna boot leg compression without topical propolis treatment. In the study, the efficacy of both treatment methods in patients with resistive venous leg ulcers was compared. The ulceration of patients from group 1 healed completely after 6 weeks of therapy in all cases. In all patients from group 2, the process of healing was longer but successfully completed after 16 weeks of the therapy. We found that an adjunctive propolis ointment treatment increases the efficacy of the short stretch bandage compression stocking, and this combined treatment is more effective than Unna's boot compression alone. PMID:23662121

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

    PubMed

    Chia, Hui Y; Tang, Mark B Y

    2014-12-01

    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, such as, 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

  7. Leg ulcer plastic surgery descent by laser therapy

    NASA Astrophysics Data System (ADS)

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

    1994-02-01

    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.

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

    PubMed Central

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

    2007-01-01

    Background A systematic review was conducted to analyse journal articles that describe or measure the impact of leg ulceration on patients' quality of life (QoL) in order to improve the content of an educational programme that aims to enhance self-care agency in leg ulcer patients. Method Original articles published in English and German between 1990 and 2006 were included if the findings were analysed at the level of patients. Articles were excluded if (1) they investigated the impact of specific treatments or settings on QoL or (2) focused mainly on arterial ulcers or diabetic foot ulcers. Results Twenty-four original research articles met the inclusion criteria; 11 studies used a quantitative, 11 studies a qualitative, and 2 used a mixed method approach. The findings were collapsed into 5 core domains. Quantitative studies commonly investigated the parameters of pain, sleep, social isolation, and physical mobility. Patients had significantly more pain, more restrictions regarding social functioning, less vitality, and limitations with respect to emotional roles compared to the respective controls. Other problem areas identified were restrictions in work capacity, recreation, social interaction, psychological well-being, as well as problems caused by treatment regimes. Inconclusive results were obtained regarding pain intensity, physical restrictions, and gender effects. Limitations Numerous original studies neither undertook a differentiation of participants by ulcer aetiology nor did they analyse the results according to gender differences. Conclusion As leg ulceration has an impact on QoL, national guidelines on the treatment of leg ulceration need to more specifically address these far-ranging effects identified in this review. PMID:17651490

  9. UNUSUAL CAUSES OF CUTANEOUS ULCERATION

    PubMed Central

    Panuncialman, Jaymie; Falanga, Vincent

    2010-01-01

    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. PMID:21074034

  10. Leg ulcers and the Urgocell Non-Adhesive wound dressing.

    PubMed

    Fays, S; Schmutz, J L; Vin, F; Thirion, V; Sigal-Grinberg, M; Ingen-Housz-Oro, S; Esteve, E; Sauvadet, A; Bohbot, S

    The objectives of this clinical trial were to evaluate the efficacy and tolerance of the Urgocell Non-Adhesive (NA) dressing in the local management of venous or mixed leg ulcers. The study was a non-comparative, prospective, multicentre (15 centres) phase III, clinical trial. The studied population was composed of non-immunodepressed adults presenting a venous or mixed leg ulcer, uninfected, non-cancerous, present for less than 18 months. Patients were followed up for 6 weeks with a weekly visit, including a clinical examination, area tracings and photographs. Evaluation by nursing staff and patients was performed at each dressing changed. Forty-three patients were included, presenting a leg ulcer with a mean surface area of 10.7 cm2. The surface area was reduced by a mean of 38% after 6 weeks of treatment. Four local adverse events were deemed to be related to the tested treatment and acceptability was noted very good for patients and nursing staff. The Urgocell NA dressing, combined with compression therapy, promoted the healing of the chronic wounds under study. The good tolerance and acceptability of the tested dressing were greatly appreciated. PMID:15976606

  11. 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

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

    2010-01-01

    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

  12. Cost effectiveness analysis of larval therapy for leg ulcers

    PubMed Central

    2009-01-01

    Objective To assess the cost effectiveness of larval therapy compared with hydrogel in the management of leg ulcers. Design Cost effectiveness and cost utility analyses carried out alongside a pragmatic multicentre, randomised, open trial with equal randomisation. Population Intention to treat population comprising 267 patients with a venous or mixed venous and arterial ulcers with at least 25% coverage of slough or necrotic tissue. Interventions Patients were randomly allocated to debridement with bagged larvae, loose larvae, or hydrogel. Main outcome measure The time horizon was 12 months and costs were estimated from the UK National Health Service perspective. Cost effectiveness outcomes are expressed in terms of incremental costs per ulcer-free day (cost effectiveness analysis) and incremental costs per quality adjusted life years (cost utility analysis). Results The larvae arms were pooled for the main analysis. Treatment with larval therapy cost, on average, £96.70 (€109.61; $140.57) more per participant per year (95% confidence interval ?£491.9 to £685.8) than treatment with hydrogel. Participants treated with larval therapy healed, on average, 2.42 days before those in the hydrogel arm (95% confidence interval ?0.95 to 31.91 days) and had a slightly better health related quality of life, as the annual difference in QALYs was 0.011 (95% confidence interval ?0.067 to 0.071). However, none of these differences was statistically significant. The incremental cost effectiveness ratio for the base case analysis was estimated at £8826 per QALY gained and £40 per ulcer-free day. Considerable uncertainty surrounds the outcome estimates. Conclusions Debridement of sloughy or necrotic leg ulcers with larval therapy is likely to produce similar health benefits and have similar costs to treatment with hydrogel. Trial registration Current Controlled Trials ISRCTN55114812 and National Research Register N0484123692. PMID:19304578

  13. Ulcers

    MedlinePLUS

    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.

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-01-01

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

  16. EMLA anaesthetic cream for sharp leg ulcer debridement: a review of the clinical evidence for analgesic efficacy and tolerability.

    PubMed

    Vanscheidt, W; Sadjadi, Z; Lillieborg, S

    2001-01-01

    Sharp debridement is a fast method of achieving a clean leg ulcer, which promotes healing and enables skin grafting. EMLA cream is the only topical anaesthetic for which there is clinical evidence of analgesic efficacy for debridement. Thirteen clinical investigations of EMLA are reviewed. Four double-blind studies and one open randomised controlled study show that EMLA applied to the ulcer for 30-45 min under occlusion significantly reduces the pain from sharp debridement, decreases the incidence of post-debridement pain and reduces the time needed to achieve a clean ulcer, giving potential savings in healthcare costs. Doses of up to 10 g EMLA result in plasma levels of lidocaine and prilocaine well below toxic levels. Repeated treatment does not change the bacterial flora of the ulcer and rarely causes sensitisation. The treatment of pain in leg ulcer patients is important for patient satisfaction and for patient-perceived quality of life. PMID:11275800

  17. Behaviour of the plasma concentration of gelatinases and their tissue inhibitors in subjects with venous leg ulcers.

    PubMed

    Caimi, G; Ferrara, F; Montana, M; Muratori, I; Amato, C; Canino, B; Lo Presti, R; Hopps, E

    2014-08-26

    Venous leg ulcers are common in subjects with chronic venous insufficiency. The increased intraluminal pressure causes alteration of the skin microcirculation, leukocyte activation and release of proteolytic enzymes leading to ulceration. An impaired expression and activity of matrix metalloproteases (MMPs) and their tissue inhibitors (TIMPs) might influence extracellular matrix degradation and deposition in chronic venous ulcers with the failure of the healing process. Our aim was to evaluate plasma concentration of gelatinases (MMP-2 and MMP-9) and their inhibitors (TIMP-1 and TIMP-2) in subjects with venous leg ulcers before and after the compression therapy. We enrolled 36 subjects (12 men and 24 women, mean age 67.38 ± 12.7 yrs) with non-infected venous leg ulcers (CEAP C6), which underwent a color Duplex scan examination of the veins and arteries of the inferior limbs and were treated with a multi-layer bandaging system. The ulcer healing was obtained in 23 subjects only (9 men and 14 women). We evaluated, on fasting venous blood, the plasma levels of MMP-2, MMP-9, TIMP-1 and TIMP-2 using ELISA kit, before and after the treatment. We observed a significant increase in plasma concentration of gelatinases and their inhibitors and in MMP-2/TIMP-2 ratio in subjects with leg ulcers in comparison with normal controls. In subjects with healed ulcers we found a decrease in MMP-9 and TIMP-1 levels and in MMP-2/TIMP-2 ratio compared to the baseline values, although higher levels of all the examined parameters in comparison with normal controls. In conclusion, plasma MMPs profile is impaired in subjects with venous leg ulcers and it improves after the healing, persisting anyway altered in respect to healthy controls. PMID:25159491

  18. Evaluating a superabsorbent hydropolymer dressing for exuding venous leg ulcers.

    PubMed

    Schulze, H J; Lane, C; Charles, H; Ballard, K; Hampton, S; Moll, I

    2001-01-01

    A new hydropolymer dressing was compared with an alginate dressing in a multicentre, prospective, controlled, randomised, stratified, open label trial of 113 patients with exuding venous leg ulcers. The study aimed to evaluate the performance of the dressings in terms of their ability to handle exudate, patient and user acceptability and cost-effectiveness. Patients were stratified according to volume of wound exudate (moderate/heavy) and randomised to the hydropolymer dressing or the alginate plus a secondary dressing. A statistically significant difference between treatment groups was observed in mean wear time, with a longer wear time observed in the hydropolymer group (3.91 days) compared with the alginate group (3.09 days, p = 0.001). In terms of patient and user acceptability, all 10 overall evaluations made by both patient and investigator were markedly in favour of the hydropolymer dressing (p < 0.001 to p = 0.020). The use of the hydropolymer dressing for patients with moderate to heavily exuding venous leg ulcers has statistically significant advantages over the alginate dressing in terms of wear time and investigator and patient acceptability. It is anticipated that this reduction in dressing frequency will translate into a cost-effective wound treatment. PMID:12964233

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

    Microsoft Academic Search

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

    1999-01-01

    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:

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

    Microsoft Academic Search

    Oliver R Herber; Wilfried Schnepp; Monika A Rieger

    2007-01-01

    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

  1. Quality of Life in Different Stages of Chronic Venous Insufficiency and Leg Ulcer

    Microsoft Academic Search

    I. Zschocke; F. Bross; K. Maier; W. Vanscheidt; M. Augustin

    2002-01-01

    Summary Background: Chronic venous insufficiency (CVI) is a frequent disease, reaching from mild ankle edema to severe venous leg ulcer. Previous studies have focused on the quality of life (QoL) in patients with leg ulcer, but not in patients with early forms of CVI nor stagerelated differences. Objective: To assess the quality of life in patients with CVI stages I,

  2. Larval therapy for leg ulcers (VenUS II): randomised controlled trial

    Microsoft Academic Search

    Jo C Dumville; Gill Worthy; J Martin Bland; Nicky Cullum; Christopher Dowson; Cynthia Iglesias; Joanne L Mitchell; E Andrea Nelson; Marta O Soares; David J Torgerson

    2009-01-01

    Objective To compare the clinical effectiveness of larval therapy with a standard debridement technique (hydrogel) for sloughy or necrotic leg ulcers.Design Pragmatic, three armed randomised controlled trial.Setting Community nurse led services, hospital wards, and hospital outpatient leg ulcer clinics in urban and rural settings, United Kingdom.Participants 267 patients with at least one venous or mixed venous and arterial ulcer with

  3. Leg amputation for an extensive, severe and intractable sickle cell anemia ulcer in a Brazilian patient.

    PubMed

    Queiroz, Ana Maria Mach; Campos, Jessica; Lobo, Clarisse; Bonini-Domingos, Claudia Regina; Cardoso, Gilberto; Ballas, Samir K

    2014-01-01

    A 35-year-old African Brazilian patient had sickle cell anemia complicated with recurrent vasoocclusive (VOC) crises and refractory painful leg ulcers for 16 years. The ulcers started over both medial malleoli and expanded gradually. The ulcer on the left leg spread from the foot to the knee circumferentially and was refractory to all forms of therapy within the frame work of multi-disciplinary care. The patient agreed to a below the knee amputation of the left leg. He felt much better after the amputation but developed severe neuropathic phantom pain that was well controlled medically. He could differentiate the sickle cell anemia and ulcer pain from the neuropathic pain. About 6 months after the amputation he had dengue fever with fatal outcome. This is the first report of treatment of refractory sickle cell anemia leg ulcer with amputation and probably the first report of a Brazilian patient with sickle cell anemia and dengue fever. PMID:24471701

  4. Living with venous leg ulceration: issues concerning adherence.

    PubMed

    Mudge, Elizabeth; Holloway, Samantha; Simmonds, Wendy; Price, Patricia

    Compression therapy is advocated for the treatment of chronic venous leg ulceration and the proportion of patients whose ulcers heal appears to be directly related to adherence (Moffatt, 2004). The aim of this study was to examine patients' understanding of adherence, in terms of their own experiences of compression bandage systems. Following full ethical approval, a purposeful sample of 6 participants was recruited to take part in a focus group. Free-flowing conversation was encouraged so that the participants could discuss issues that were important to them, although a series of prompts were available to stimulate the conversation when necessary. Four major themes were identified using a phenomenological approach: frustration with the healthcare system leading to a feeling of complacency with primary healthcare teams; functional limitations leading to adaptation of everyday life situations (e.g. bathing and coping with pain); emotional reactions affecting well-being and body image, and perception of others; and avoidance of transport, shopping and holidays. PMID:17170690

  5. Ischemic ulcers - self-care

    MedlinePLUS

    Ischemic ulcers (wounds) can occur when there is poor blood flow in your legs . Poor blood flow causes cells to die and damages tissue. Most ischemic ulcers occur on the feet and legs. These types ...

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

    PubMed Central

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

    2011-01-01

    Background: In Germany, cost calculations on the financial burden of wound treatment are scarce. Studies for attributable costs in hospitalized patients estimate for pressure ulcer additional costs of € 6,135.50 per patient, a calculation based on the assumption that pressure ulcers will lead to prolonged hospitalization averaging 2 months. The scant data available in this field prompted us to conduct a prospective economical study assessing the direct costs of treatment of chronic ulcers in hospitalized patients. Study design: The study was designed and conducted as an observational, prospective, multi-centre economical study over a period of 8 months in three community hospitals in Germany. Patients: Direct treatment costs for leg ulcer (n=77) and pressure ulcer (n=35) were determined observing 67 patients (average age: 75±12 years). 109 treatments representing 111 in-ward admissions and 62 outpatient visits were observed. During a total of 3,331 hospitalized and 867 outpatient wound therapies, 4,198 wound dressing changes were documented. Main outcome measure: Costs of material were calculated on a per item base. Direct costs of care and treatment, including materials used, surgical interventions, and personnel costs were determined. Results: An average of € 1,342 per patient (€ 48/d) was spent for treatment of leg ulcer (staff costs € 581, consumables € 458, surgical procedures € 189, and diagnostic procedures € 114). On average, each wound dressing change caused additional costs of € 15. For pressure ulcer, € 991 per patient (€ 52/d) was spent on average (staff costs € 313, consumables € 618, and for surgical procedures € 60). Each wound dressing change resulted in additional costs of € 20 on average. Conclusion: When direct costs of chronic wounds are calculated on a prospective case-by-case basis for a treatment period over 3 months, these costs are lower than estimated to date. While reduction in prevalence of chronic wounds along with optimised patient care will result in substantial cost saving, this saving might be lower than expected. Our results, however, do not serve as basis for making any conclusions on cost-benefit analysis for both, the affected individual, as well as for the society. PMID:22242088

  7. Low-frequency ultrasound to manage chronic venous leg ulcers.

    PubMed

    Johnson, Sue

    2003-10-01

    Chronic leg ulceration costs the NHS around pound 500 million per year (Moffatt and Dorman, 1995) so it is not surprising that the condition attracts attention from manufacturers of medical devices. However, the evidence available for many novel technologies is scant and a systematic approach to product evaluation is essential to avoid the adoption of ineffective and therefore costly measures. A low-frequency ultrasound device was presented in clinic as an aid to stimulate and accelerate healing in otherwise recalcitrant wounds. There followed a systematic evaluation of the product including a literature review of the mode of action, safety and efficacy, followed finally by a product evaluation with case studies used as outcome measures. In this case, the product proved to be a useful tool in the management of chronic wounds, not only for healing but also for pain, pigmentation and odour reduction. The importance of understanding fully a novel technology and how it fits with clinical practice cannot be underestimated. PMID:14593268

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

    Microsoft Academic Search

    O Nelzén; D Bergqvist; A Lindhagen; T Hallböök

    1991-01-01

    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

  9. Healing rates and cost efficacy of outpatient compression treatment for leg ulcers associated with venous insufficiency

    Microsoft Academic Search

    William A. Marston; Robert E. Carlin; Marc A. Passman; Mark A. Farber; Blair A. Keagy

    1999-01-01

    Objective: Although newer techniques to promote the healing of leg ulcers associated with chronic venous insufficiency are promising, improved healing rates and cost effectiveness are unproven. We prospectively followed a series of patients who underwent treatment with outpatient compression for venous stasis ulcers without adjuvant techniques to determine healing rates and costs of treatment. Methods: Two hundred fifty-two patients with

  10. Guts & Glory H. pylori: Cause of Peptic Ulcer

    Microsoft Academic Search

    Ashley Johnson; Bryan Kratz; Lorraine Scanlon; Alina Spivak

    Summary Due to the 1983 discovery of H. pylori bacteria as the leading cause of peptic ulcers, the understanding of the disease dramatically changed. We now know that stress and spicy foods are not the leading causes of peptic ulcers. Symptoms including acute abdominal pain, vomiting of blood, and weight loss are characteristic of peptic ulcers. Ulcers form because of

  11. Ultrasound-Guided Injection of Polidocanol Microfoam in the Management of Venous Leg Ulcers

    Microsoft Academic Search

    Juan Cabrera; Pedro Redondo; Antonio Becerra; Celia Garrido; Maria Antonia Garcia-Olmedo; Alejandro Sierra; Pedro Lloret; Miguel A. Martinez-Gonzalez

    Background: Venous leg ulceration is a frequent and severe complication of lower limb venous insufficiency. Compression therapy is associated with a protracted course of healing and multiple recurrences. Minimally invasive surgery (subfascial endoscopic perforating sur- gery) is only possible in a subset of patients with leg ul- cers. Low-cost and noninvasive therapeutic procedures are needed as alternative treatments. Objective: To

  12. Ultrasound-Guided Injection of Polidocanol Microfoam in the Management of Venous Leg Ulcers

    Microsoft Academic Search

    Juan Cabrera; Pedro Redondo; Antonio Becerra; Celia Garrido; Maria Antonia Garcia-Olmedo; Alejandro Sierra; Pedro Lloret; Miguel A. Martinez-Gonzalez; Iltefat Hamzavi; Hem Jain; David McLean; Jerry Shapiro; Haishan Zeng; Harvey Lui; Julie A. Byrd; Mark D. P. Davis; Roy S. Rogers III; Alice N. Lee; Victoria P. Werth; Michael E. Ming; Ross M. Levy; Ole J. Hoffstad; Jennifer Filip; Phyllis A. Gimotty; David J. Margolis

    2004-01-01

    Background: Venous leg ulceration is a frequent and severe complication of lower limb venous insufficiency. Compression therapy is associated with a protracted course of healing and multiple recurrences. Minimally invasive surgery (subfascial endoscopic perforating sur- gery) is only possible in a subset of patients with leg ul- cers. Low-cost and noninvasive therapeutic procedures are needed as alternative treatments. Objective: To

  13. Setting up a community nurse-led healed leg ulcer clinic.

    PubMed

    Flaherty, Elaine

    The success of compression therapy and emphasis on healing rates of venous ulcers in studies has shifted the emphasis from prevention to cure. Venous insufficiency is, in the majority of cases, a chronic condition. From a patient's perspective, unless they are suitable for corrective surgery, he/she will never be rewarded with a cure. Patients often need to make permanent life-style changes to reduce the risk of ulceration or re-ulceration and may require differing levels of support to achieve this. The implementation of a designated clinic for patients with healed leg ulcers in a primary care trust in the east end of London is the first step in promoting a collaborative approach to prevention of leg ulcer recurrence. PMID:16144072

  14. Cultured Allogeneic Skin Cells are E¡ective in the Treatment of Chronic Diabetic Leg and Foot Ulcers

    Microsoft Academic Search

    ILKKA T. HARVIMA; SUOMA VIRNES; LEENA KAUPPINEN; MARIA HUTTUNEN; PETRI KIVINEN; LEO NISKANEN; MAIJA HORSMANHEIMO

    Diabetic ulcers on the lower extremities present a di?cult treatment problem, and some ulcers respond poorly to conven- tional topical and cast treatment. The purpose of this study was to assess the e¡ect of cultured allogeneic keratinocyte epithelium and ¢broblast-gelatin sponge on the healing of chronic, refractory diabetic leg and foot ulcers. Non-diabetic chronic leg ulcers were treated for comparison.

  15. A Review of Technological Approaches to Venous Ulceration

    Microsoft Academic Search

    M. Clarke-Moloney; G. M. Lyons; P. E. Burke; D. O'Keeff; P. A. Grace

    Leg ulceration is a chronic condition aff ecting about 1-2% of the adult population. Th e main causes of leg ulceration are venous hypertension, arterial insuffi ciency, diabetes, or a combination of these aetiologies (causes) or malignancy. Venous ulcers ac- count for approximately 80% of all leg ulcers and are a result of venous hypertension. Th e current mainstay of

  16. Community-based leg ulcer clinics: organisation and cost-effectiveness.

    PubMed

    Morrell, C J; King, B; Brereton, L

    To establish the cost effectiveness of community leg ulcer clinics using four-layer compression bandaging and the care provided by district nurses, a randomised controlled trial was set up in eight community-based research clinics in four trusts, funded by Trent Regional Health Authority. The main outcomes monitored were the amount of time needed to complete ulcer healing, patient health status, and recurrence. Satisfaction with care, use of services and personal costs were also monitored. PMID:9735752

  17. Novel Wound Healing Powder Formulation for the Treatment of Venous Leg Ulcers

    PubMed Central

    Ghatnekar, Angela V.; Elstrom, Tuan; Ghatnekar, Gautam S.; Kelechi, Teresa

    2011-01-01

    Chronic venous disorders are common in the Western world. The current treatment of venous leg ulcers is unsatisfactory despite the availability of well-documented standards of care. Patients today are interested in alternative approaches to modern medicine. We have developed a wound-healing powder containing natural ingredients with absorptive, aromatic, antiseptic, and anti-inflammatory synergistic properties. This report describes 3 cases that were successfully treated with the powder, demonstrating the potential of herbal remedies in the clinical treatment of venous leg ulcers. PMID:24527167

  18. Successful treatment of hydroxyurea-associated chronic leg ulcers associated with squamous cell carcinoma.

    PubMed

    Antar, Ahmad; Ishak, Rim S; Otrock, Zaher K; El-Majzoub, Nadim; Ghosn, Samer; Mahfouz, Rami; Taher, Ali T

    2014-12-01

    Hydroxyurea (HU) is an antineoplastic drug used in the treatment of chronic myeloproliferative neoplasms (MPNs). HU is associated with cutaneous adverse effects, whereas severe complications such as leg ulcers and non-melanoma skin cancers (NMSCs) are rare and only observed after long-term treatment. We herein report a patient with essential thrombocythemia (ET) treated chronically with HU, and who developed refractory bilateral leg ulcers complicated by squamous cell carcinoma (SCC) over both heels. The patient was successfully managed by multiple debridement stages and skin grafting surgeries. PMID:25467031

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

    Microsoft Academic Search

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

    2000-01-01

    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)

  20. Vasculopathy, inflammation, and blood flow in leg ulcers of patients with sickle cell anemia

    PubMed Central

    Minniti, Caterina P.; Delaney, Kara-Marie H.; Gorbach, Alexander M.; Xu, Dihua; Lee, Chyi-Chia Richard; Malik, Nitin; Koroulakis, Antony; Antalek, Matthew; Maivelett, Jordan; Peters-Lawrence, Marlene; Novelli, Enrico M.; Lanzkron, Sophie M.; Axelrod, Karen C.; Kato, Gregory J.

    2013-01-01

    Chronic leg ulcers are frequent and debilitating complications of sickle cell anemia. Inadequate blood supply has been postulated to be an important factor in their occurrence and delayed healing. Little is known about their microcirculatory and histopathological changes. We evaluated the microcirculation of lower extremity ulcers with laser speckle contrast imaging and infrared thermography and obtained clinical and laboratory characteristics in 18 adults with sickle cell anemia and chronic leg ulcers. Skin biopsies were obtained in four subjects. Subjects had markers of severe disease, anemia, high degree of hemolysis, inflammation, and thrombophilia. The highest blood flow was present in the ulcer bed, progressively less in the immediate periwound area, and an unaffected control skin area in the same extremity. Microscopic examination showed evidence of venostasis, inflammation, and vasculopathy. Blood vessels were increased in number, had activated endothelium and evidence of thrombosis/recanalization. High blood flow may be due to chronic inflammation, cutaneous vasodilatation, venostasis, and in situ thrombosis. These changes in skin microcirculation are similar to chronic venous ulcers in the non-sickle cell disease (SCD) population, thus suggesting that leg ulcers may be another end-organ complication with endothelial dysfunction that appears in patients with SCD at a younger age and with higher frequency than in the general population. PMID:23963836

  1. Effectiveness and safety of a novel gel dressing in the management of neuropathic leg ulcers in diabetic patients: a prospective double-blind randomized trial.

    PubMed

    Abbruzzese, L; Rizzo, L; Fanelli, G; Tedeschi, A; Scatena, A; Goretti, C; Macchiarini, S; Piaggesi, A

    2009-09-01

    Neuropathic leg ulcers (NLUs) affect more than 10% of diabetic patients with peripheral neuropathy and represent the most common cause of ulceration of the leg in these patients. Though their pathogenesis is well known, related to the chronic neuropathic edema, the management of NLUs, mainly based on elastocompression, is still controversial, with lower healing rates than nondiabetic venous leg ulcers. The authors tested if a novel gel formulation, containing amino acids and hyaluronic acid (Vulnamin)gel; Errekappa, Milan, Italy), will improve the outcomes of NLUs when used together with elastocompression. Thirty patients affected by NLU were randomized into 2 groups, both treated with 4-layer elastocompressive bandaging: patients in group A were topically treated with the application of Vulnamin) gel, whereas patients in group B received only the inert gel vehicle. The healing rate at 3 months was evaluated as the primary endpoint, whereas the secondary endpoints were healing time, reduction in ulcer area and ulceration score in 4 weeks, number of infective complications, and overall satisfaction of patients. Healing rate was significantly (P < .05) higher in patients in group A when compared with those in group B; healing time, patients' satisfaction, and reduction in ulcer area and ulceration score in 4 weeks were also higher in patients in group A. However, no significant differences were found in the prevalence of infections and other adverse events. The use of Vulnamin) gel with elastocompression is safe and effective in the management of NLUs of diabetic patients. PMID:19703948

  2. Randomized clinical trial of three-layer tubular bandaging system for venous leg ulcers.

    PubMed

    Weller, Carolina D; Evans, Sue M; Staples, Margaret P; Aldons, Pat; McNeil, John J

    2012-01-01

    The safety and efficacy of three-layer (3L) tubular bandaging as a treatment for venous ulcer healing has not been evaluated despite its use in many clinical settings to treat people with venous leg ulcers. We evaluated the safety and efficacy of 3L tubular bandage compared with short-stretch compression bandage to heal venous ulcers in a multicenter, open-label, parallel-group, randomized controlled trial. We randomized 45 patients with venous leg ulcers of up to 20?cm(2) area and an ankle brachial pressure index of >0.8 from hospital outpatient wound clinics in Victoria and Queensland, Australia. We measured time to healing and percentage reduction of wound size from baseline to week 12. Secondary outcomes were proportion of ulcers healed, self-reported compliance of compression bandage, and health-related quality of life, costs, recurrence rates, and adverse events. A total of 27 ulcers healed, the proportion of healed ulcers was higher for the 3L group (17/23 [74%] vs. 10/22 [46%]) (p?=?0.05). Reported bandage tolerance at all treatment visits was 21 (91%) in 3L group vs. 17 (73%) (p?=?0.10). There was no difference between the groups in adverse events. Costs were substantially less in 3L group. PMID:23061541

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

    PubMed Central

    Mieszcza?ski, Pawe?; Wilemska-Kucharzewska, Katarzyna; Taradaj, Jakub; Kuropatnicki, Andrzej; ?liwi?ski, Zbigniew

    2014-01-01

    The aim of the study was to use negative pressure wound therapy (NPWT) in patients with chronic venous leg ulceration. The authors present their experience in treatment of 15 patients whose average ulceration surface area was 62.6?cm2. In 10 patients, the ulcers healed within 6 weeks and in the remaining patients within 20 weeks. Based on the results obtained, the authors imply that NPWT is an effective method in the treatment of chronic venous leg. PMID:24696847

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

    Microsoft Academic Search

    Judith M Watson; Arthur R Kang’ombe; Marta O Soares; Ling-Hsiang Chuang; Gill Worthy; J Martin Bland; Cynthia Iglesias; Nicky Cullum; David Torgerson; E Andrea Nelson

    2011-01-01

    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

  5. An overview of technologies related to care for venous leg ulcers

    Microsoft Academic Search

    Meghan Sarah Hegarty; Edward Grant; Lawrence Reid Jr.

    2010-01-01

    Venous leg ulcers remain a major problem in the United States, with spending reaching more than $1 billion annually. Current treatment options for this condition center around the use of compression therapy delivered by bandages, medical-grade stockings, or pneumatic compression devices. While these forms of therapy can produce dramatic improvements, cost and patient compliance remain an issue. In parallel with

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

    Microsoft Academic Search

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

    1985-01-01

    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

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

    Microsoft Academic Search

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

    1993-01-01

    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

  8. A Comparative Clinical Study on Five Types of Compression Therapy in Patients with Venous Leg Ulcers

    PubMed Central

    Dolibog, Pawel; Franek, Andrzej; Taradaj, Jakub; Dolibog, Patrycja; Blaszczak, Edward; Polak, Anna; Brzezinska-Wcislo, Ligia; Hrycek, Antoni; Urbanek, Tomasz; Ziaja, Jacek; Kolanko, Magdalena

    2014-01-01

    The aim of this study was to compare five types of compression therapy in venous leg ulcers (intermittent pneumatic vs. stockings vs. multi layer vs. two layer short stretch bandages vs. Unna boots). Primary study endpoints were analysis of changes of the total ulcer surface area, volume and linear dimensions inside observed groups. The secondary end points were comparisons between all groups the number of completely healed wounds (ulcer healing rates), Gilman index and percentage change of ulcer surface area. In total, 147 patients with unilateral venous leg ulcers were included to this study. Participants were randomly allocated to the groups: A, B, C, D and E. After two months the healing rate was the highest in group A (intermittent pneumatic compression) - 57.14%, 16/28 patients, B (ulcer stocking system) - 56.66%, 17/30 patients and C (multi layer short stretch bandage) - 58.62%, 17/29 patients. Significantly much worse rate found in group D (two layer short stretch bandages) - only 16.66%, 5/30 patients and E (Unna boots) - 20%, 6/30 patients. The analysis of changes of the percentage of Gilman index and wound total surface area confirmed that intermittent pneumatic compression, stockings and multi layer bandages are the most efficient. The two layer short - stretch bandages and Unna boots appeared again much less effective. PMID:24396284

  9. Healing of Chronic Leg Ulcers in Diabetic Necrobiosis Lipoidica with Local Granulocyte-Macrophage Colony-Stimulating Factor Treatment

    Microsoft Academic Search

    Kari Remes; Tapani Rönnemaa

    1999-01-01

    Two young insulin-dependent diabetic patients suffering from chronic nonhealing leg ulcers of necrobiosis lipoidica diabeticorum were treated by applying topically recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF) on the ulcer repetitively during 10 weeks. Evaluation of ulcer size was assessed with clinical examinations at 1-week or 2-week intervals. Topical GM-CSF healed the ulcers of both patients in 10 weeks. Decrease in

  10. Walk On: Helping Former Drug Users Manage Leg Ulcers

    Microsoft Academic Search

    Amy Oprean

    2010-01-01

    It is one of the lesser known consequences of injection drug use, but one that stays with former users for the rest of their lives. Chronic venous insufficiency, or CVI, which occurs when veins cannot pump a sufficient amount of blood from the legs back to the heart, is a result of veins that have collapsed from damage. Symptoms begin

  11. The K-Four bandage system: evaluating its effectiveness on recalcitrant venous leg ulcers.

    PubMed

    Vowden, K R; Wilkinson, D; Vowden, P

    2001-05-01

    This evaluation examined the effectiveness of the K-Four (Parema) high compression bandage system on 50 patients with recalcitrant 'hard-to-heal' venous leg ulcers and relates the outcome to an earlier randomised study which compared three other four-layer bandage systems. Twelve-week healing rates were 53.2% in the current series, which included patients with poor mobility, large ulcers and long pretreatment ulcer duration, rising to 69.5% at 20 weeks. When account was taken of known risk factors for delayed ulcer healing, no significant difference could be identified between between either K-Four or the earlier evaluated bandages, which included the original Charing Cross system, where the overall healing rates were 64.5% and 80%, respectively, at 12 and 20 weeks. It would seem more likely that treatment outcome is related to patient risk factors for delayed healing and bandaging expertise than to the bandage system employed. PMID:12964326

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

    PubMed

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

    2015-03-01

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

  13. Prevalence of skin problems and leg ulceration in a sample of young injecting drug users

    PubMed Central

    2014-01-01

    Background Drug users suffer harm from the injecting process, and clinical services are reporting increasing numbers presenting with skin-related problems such as abscesses and leg ulcers. Skin breakdown can lead to long-term health problems and increased service costs and is often the first indication of serious systemic ill health. The extent of skin problems in injecting drug users has not previously been quantified empirically, and there is a dearth of robust topical literature. Where skin problems have been reported, this is often without clear definition and generic terms such as ‘soft tissue infection’ are used which lack specificity. The aim of this study was to identify the range and extent of skin problems including leg ulceration in a sample of injecting drug users. Definitions of skin problems were developed and applied to descriptions from drug users to improve rigour. Methods Data were collected in needle exchanges and methadone clinics across Glasgow, Scotland, from both current and former drug injectors using face-to-face interviews. Results Two hundred participants were recruited, of which 74% (n?=?148) were males and 26% (n?=?52) were females. The age range was 21–44 years (mean 35 years). Just under two thirds (64%, n?=?127) were currently injecting or had injected within the last 6 months, and 36% (n?=?73) had previously injected and had not injected for more than 6 months. Sixty per cent (n?=?120) of the sample had experienced a skin problem, and the majority reported more than one problem. Most common were abscesses, lumps, track marks and leg ulcers. Fifteen per cent (n?=?30) of all participants reported having had a leg ulcer. Conclusions This is an original empirical study which demonstrated unique findings of a high prevalence of skin disease (60%) and surprisingly high rates of leg ulceration (15%). Skin disease in injecting drug users is clearly widespread. Leg ulceration in particular is a chronic recurring condition that is costly to treat and has long-term implications for drug users and services caring for current or former injectors long after illicit drug use has ceased. PMID:25119472

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

    PubMed Central

    White-Chu, E Foy; Conner-Kerr, Teresa A

    2014-01-01

    Comprehensive care of chronic venous insufficiency and associated ulcers requires a multipronged and interprofessional approach to care. A comprehensive treatment approach includes exercise, nutritional assessment, compression therapy, vascular reconstruction, and advanced treatment modalities. National guidelines, meta-analyses, and original research studies provide evidence for the inclusion of these approaches in the patient plan of care. The purpose of this paper is to review present guidelines for prevention and treatment of venous leg ulcers as followed in the US. The paper further explores evidence-based yet pragmatic tools for the interprofessional team to use in the management of this complex disorder. PMID:24596466

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

    PubMed Central

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

    2013-01-01

    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. PMID:23843984

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

    PubMed

    Martin, Fiona

    2014-06-01

    The significant impact of leg ulcers upon quality of life and disease burden cannot be overemphasised, with the financial and economic impact from an individual, local and national perspective being widely acknowledged. This article attempts to highlight issues relating to education in leg ulcer management while identifying some current and emerging challenges faced in this area by professionals. With regard to education, formal training and perception of professionals, the provision of more specialised and focused training, increased use of patient-related outcome measures and the concept of knowledge brokering have been identified as important aspects in the planning and further development of education. Issues in the domains of community nursing, technology, pain management, nursing diagnosis, availability of research and recurrence were also highlighted. PMID:24912833

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

    PubMed

    McNichol, Elaine

    2014-09-01

    Securing greater patient and public involvement is a central theme of health policy in many countries ( Coulter, 2011 ) and is a growing health-care phenomenon ( Staniszewska et al, 2011 ; World Health Organization, 2011 ). The challenge is how to ensure these voices are heard among the plethora of 'professional' voices representing different stakeholders of provider organisations, higher education, health-care industries and governments. Historically, in the management of leg ulcers, the professional 'user' voice has had a stronger input than that of the patient. This article outlines an approach that addresses this by moving beyond the concept of 'involving' the patient to putting the patient voice first, so that it sets the direction and leads the process in identifying innovation priorities in the management and treatment of chronic leg ulcers. PMID:25192559

  18. Surgical Correction of Isolated Superficial Venous Reflux Reduces Long-term Recurrence Rate in Chronic Venous Leg Ulcers

    Microsoft Academic Search

    JR Barwell; M Taylor; J Deacon; ASK Ghauri; C Wakely; LK Phillips; Whyman; KR Poskitt

    2000-01-01

    Objectives: surgical correction of isolated superficial venous reflux in ulcerated legs may reduce short term recurrence rates but the longer term benefits are unknown. Design: prospective non-randomised cohort study. Methods: consecutive patients with chronic leg ulcers were prospectively assessed at a one-stop clinic over a 4-year period from July 1995 to July 1999. All patients with ankle brachial pressure indices

  19. Photographic assessment of the appearance of chronic pressure and leg ulcers.

    PubMed

    Houghton, P E; Kincaid, C B; Campbell, K E; Woodbury, M G; Keast, D H

    2000-04-01

    The purpose of this paper was to examine the validity and reliability of using photographs of wounds to accurately assess wound status. The results of assessing wound appearance using wound photographs was compared to results obtained from a bedside assessment using the Pressure Sore Status Tool (PSST). The photographic wound assessment tool (PWAT) used in this comparison represents a modified version of the PSST and includes the six domains that can be determined from wound photographs. The PWAT was used on photographs of both chronic pressure ulcers (n = 56) and leg ulcers due to vascular insufficiency (n = 81). The photographic tool has excellent intrarater (ICC = 0.96) and interrater (ICC = 0.73) reliability and good concurrent validity (r = 0.70) compared with a full bedside assessment PSST. The PWAT has also shown to be sensitive to change in wound appearance of healing ulcers, but not nonhealing ulcers. These results would suggest that in the event that a full bedside assessment is not possible, wound photographs may be used to accurately assess wound appearance of both chronic pressure ulcers located on the trunk and vascular ulcers of the lower extremity. Establishing a valid and reliable assessment of wound healing using photographic images is of great relevance to the advancing fields of computer image analysis and telemedicine. PMID:10788924

  20. Treatment of a patient with a deep leg ulcer using Biatain Adhesive.

    PubMed

    Pritchard, V

    This article looks at the use of Biatain Adhesive, a new foam dressing from Coloplast which is manufactured by incorporating 3D polymer structures within the central pad. It is now available on the Drug Tariff. The article discusses the treatment of exuding wounds and highlights the benefits of Biatain Adhesive by focusing on the case of an 84-year-old woman who had a history of long-standing leg ulcers where previous dressings had failed to promote healing. PMID:10897699

  1. Physical activity in patients with venous leg ulcer - between engagement and avoidance. A patient perspective

    Microsoft Academic Search

    Kirsti Skavberg Roaldsen; Gabriele Biguet; Britt Elfving

    2011-01-01

    Objective: To identify and describe the qualitative variations in how physical activity is perceived and understood by individuals with current or previous venous leg ulcer.Design: A qualitative study using semi-structured interviews.Method: Twenty-two individuals aged 60—85 years were interviewed. The interviews were recorded, transcribed verbatim and analysed by three researchers using a phenomenographic research approach. A set of categories of descriptions

  2. Feasibility and acceptance of telemedicine for wound care in patients with chronic leg ulcers.

    PubMed

    Hofmann-Wellenhof, R; Salmhofer, W; Binder, B; Okcu, A; Kerl, H; Soyer, H P

    2006-01-01

    We examined the feasibility and acceptance of teledermatology for wound management of patients with chronic leg ulcers by home-care nurses. Forty-one chronic leg ulcers of different origin in 14 patients were included. After an initial in-person visit in which leg ulcers were assessed and classified, and underlying diseases noted, follow-up visits were done by home-care nurses. Once a week 1-4 digital images of the wound and surrounding skin and relevant clinical information were transmitted via a secure Website to an expert at the wound care centre. The experts provided an assessment of wound status and therapeutic recommendations. In 89% of the 492 teleconsultations, the quality of images was sufficient or excellent and the experts were confident giving therapeutic recommendations. Treatment modalities were changed or adapted in one-third of the consultations. There was a significant decrease in visits to a general physician or the wound care centre. The acceptance of teledermatology was high in patients, home-care nurses and wound experts. Teledermatology offers great potential for chronic wound care and seems to be accepted both by patients and health-care persons. PMID:16884566

  3. Sickle Cell Leg Ulcers: Associations with Haemolysis and SNPs in Klotho, TEK and Genes of the TGF-?/BMP Pathway

    PubMed Central

    Nolan, Vikki G.; Adewoye, Adeboye; Baldwin, Clinton; Wang, Ling; Ma, Qianli; Wyszynski, Diego F.; Farrell, John J.; Sebastiani, Paola; Farrer, Lindsay A.; Steinberg, Martin H.

    2006-01-01

    Cutaneous leg ulcers are common in sickle cell anaemia and their risk might be genetically determined. We studied sickle cell anaemia patients to examine the relationship of leg ulcers with haemolysis and with SNPs in candidate genes that could affect sickle vasoocclusion. Leg ulcer patients had lower haemoglobin levels and higher levels of lactate dehydrogenase, bilirubin, aspartate aminotransferase and reticulocytes than did control patients with sickle cell anaemia but without leg ulcers. Age-adjusted comparisons showed that sickle cell anaemia-? thalassaemia was more frequent among controls than cases. These results strongly suggested that the likelihood of having leg ulcers was related to the intensity of haemolysis. Two-hundred fifteen SNPs in more than 100 candidate genes were studied. Associations were found with SNPs in Klotho, TEK and several genes in the TGF-?/BMP signaling pathway by genotypic association analyses. KL directly or indirectly promotes endothelial NO production and the TEK receptor tyrosine kinase is involved in angiogenesis. The TGF-?/BMP signaling pathway modulates wound healing and angiogenesis, among its other functions. Haemolysis-driven phenotypes like leg ulcers could be improved by agents that reduce sickle erythrocyte density or increase NO bioavailability. PMID:16681647

  4. Larval therapy for leg ulcers (VenUS II): randomised controlled trial

    PubMed Central

    2009-01-01

    Objective To compare the clinical effectiveness of larval therapy with a standard debridement technique (hydrogel) for sloughy or necrotic leg ulcers. Design Pragmatic, three armed randomised controlled trial. Setting Community nurse led services, hospital wards, and hospital outpatient leg ulcer clinics in urban and rural settings, United Kingdom. Participants 267 patients with at least one venous or mixed venous and arterial ulcer with at least 25% coverage of slough or necrotic tissue, and an ankle brachial pressure index of 0.6 or more. Interventions Loose larvae, bagged larvae, and hydrogel. Main outcome measures The primary outcome was time to healing of the largest eligible ulcer. Secondary outcomes were time to debridement, health related quality of life (SF-12), bacterial load, presence of meticillin resistant Staphylococcus aureus, adverse events, and ulcer related pain (visual analogue scale, from 0 mm for no pain to 150 mm for worst pain imaginable). Results Time to healing was not significantly different between the loose or bagged larvae group and the hydrogel group (hazard ratio for healing using larvae v hydrogel 1.13, 95% confidence interval 0.76 to 1.68; P=0.54). Larval therapy significantly reduced the time to debridement (2.31, 1.65 to 3.2; P<0.001). Health related quality of life and change in bacterial load over time were not significantly different between the groups. 6.7% of participants had MRSA at baseline. No difference was found between larval therapy and hydrogel in their ability to eradicate MRSA by the end of the debridement phase (75% (9/12) v 50% (3/6); P=0.34), although this comparison was underpowered. Mean ulcer related pain scores were higher in either larvae group compared with hydrogel (mean difference in pain score: loose larvae v hydrogel 46.74 (95% confidence interval 32.44 to 61.04), P<0.001; bagged larvae v hydrogel 38.58 (23.46 to 53.70), P<0.001). Conclusions Larval therapy did not improve the rate of healing of sloughy or necrotic leg ulcers or reduce bacterial load compared with hydrogel but did significantly reduce the time to debridement and increase ulcer pain. Trial registration Current Controlled Trials ISRCTN55114812 and National Research Register N0484123692. PMID:19304577

  5. Dressings for venous leg ulcers: systematic review and meta-analysis

    PubMed Central

    Nelson, E Andrea; Michaels, Jonathan A

    2007-01-01

    Objective To review the evidence of effectiveness of dressings applied to venous leg ulcers. Design Systematic review and meta-analysis. Data sources Hand searches of journals and searches of electronic databases, conference proceedings, and bibliographies up to April 2006; contacts with dressing manufacturers for unpublished studies. Studies reviewed All randomised controlled trials that evaluated dressings applied to venous leg ulcers were eligible for inclusion. Data from eligible studies were extracted and summarised independently by two reviewers using a data extraction sheet. Methodological quality was assessed independently by two reviewers. Results The search strategy identified 254 studies; 42 of these fulfilled the inclusion criteria. Hydrocolloids were no more effective than simple low adherent dressings used beneath compression (eight trials; relative risk for healing with hydrocolloid 1.02, 95% confidence interval 0.83 to 1.28). For other comparisons, insufficient evidence was available to allow firm conclusions to be drawn. None of the dressing comparisons showed evidence that a particular class of dressing healed more ulcers. Some differences existed between dressings in terms of subjective outcome measures and ulcer healing rates. The results were not affected by the size or quality of trials or the unit of randomisation. Insufficient data were available to allow conclusions to be drawn about the relative cost effectiveness of different dressings. Conclusions The type of dressing applied beneath compression was not shown to affect ulcer healing. The results of the meta-analysis showed that applying hydrocolloid dressings beneath compression produced no benefit in terms of ulcer healing compared with applying simple low adherent dressings. No conclusive recommendations can be made as to which type of dressing is most cost effective. Decisions on which dressing to apply should be based on the local costs of dressings and the preferences of the practitioner or patient. PMID:17631512

  6. Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil*

    PubMed Central

    Wachholz, Patrick Alexander; Masuda, Paula Yoshiko; Nascimento, Dejair Caitano; Taira, Cecilia Midori Higashi; Cleto, Norma Gondim

    2014-01-01

    BACKGROUND Chronic leg ulcer may have an impact on patients' quality of life. OBJECTIVES This study aimed to identify the impact of leg ulcers on patient's quality of life using the Dermatology Life Quality Index and to define the main factors correlated with this perception. METHOD Cross-sectional, non-probabilistic sampling study. We included patients with chronic leg ulcers being treated for at least 3 months. A sociodemographic and clinical survey was conducted to assess the profile of the ulcers. We administered a screening for depressive symptoms and the Dermatology Life Quality Index. We performed a descriptive statistical analysis, chi-square test and Mann-Whitney test for categorical data, Pearson for numeric variables, and multiple regression for categorical data. RESULTS Forty-one patients were assessed. Their mean age was 61.78 years. Venous ulcers (48.8%) were the most prevalent. Seventy-three percent of the sample perceived no impact/low impact on quality of life in the past week, and 26.8% perceived moderate/high impact. A multiple regression analysis identified the causes of lesion, pain related to the ulcers, time of onset, and severity of the depressive symptoms as the variables that had an influence on quality of life. CONCLUSIONS The majority of the sample perceived low or no impact of the condition on the quality of the life. The variables etiology of the lesion (p<0.001), pain related to the ulcers (p=0.001), time of onset (p=0.006), and severity of the depressive symptoms (p<0.001) had an influence on the quality of life, suggesting the need for further studies with more robust designs to confirm the causal relationship between these characteristics and quality of life. PMID:24626651

  7. Severe upper airway obstruction caused by ulcerative laryngitis

    Microsoft Academic Search

    M Hatherill; L Reynolds; Z Waggie; A Argent

    2001-01-01

    AIMSTo present our experience of severe upper airway obstruction caused by ulcerative laryngitis in children.METHODSRetrospective case note review of 263 children with severe upper airway obstruction and a clinical diagnosis of croup admitted to a paediatric intensive care unit (PICU) over a five year period.RESULTSA total of 148 children (56%) underwent microlaryngoscopy (Storz 3.0 rigid telescope). Laryngeal ulceration with oedema

  8. Clinical investigations of leg ulcer treatment by copper vapor laser therapy-a preliminary report of a novel approach

    NASA Astrophysics Data System (ADS)

    Cai, Boling; Lin, Xiangda; Li, Feng; Pan, Huoyu; Lin, Meiying; Chi, Xinyin

    1994-02-01

    Lower leg ulcer is sometimes a refractory disease. A recently developed copper vapor laser could be a promising light source for the treatment of these lesions. Preliminary results of clinical investigations of five patients with leg ulcer treated by copper vapor laser phototherapy are reported. Among them, three were cured, one obtained significant response, one had no response. Most patients were cured within 15 laser treatments. It was found that lower irradiation power and energy densities were required to obtain better results. Experiment details are given.

  9. Restless Legs Syndrome -- Causes and Symptoms

    MedlinePLUS

    ... miles): 10 25 50 Share: Essentials in Sleep Insomnia Overview & Facts Symptoms & Causes Diagnosis & Self Tests Treatment ... Tips Healthy Sleep Habits Sleep Disorders by Category Insomnias Insomnia Child Insomnia Short Sleeper Hypersomnias Narcolepsy Insufficient ...

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

    PubMed

    Partsch, Hugo

    2014-05-19

    Compression therapy is the most important basic treatment modality in venous leg ulcers. The review focusses on the materials which are used: 1. Compression bandages, 2. Compression stockings, 3. Self-adjustable Velcro-devices, 4. Compression pumps, 5. Hybrid devices. Compression bandages, usually applied by trained staff, provide a wide spectrum of materials with different elastic properties. To make bandaging easier, safer and more effective, most modern bandages combine different material components. Self-management of venous ulcers has become feasible by introducing double compression stockings ("ulcer kits") and self-adjustable Velcro devices. Compression pumps can be used as adjunctive measures, especially for patients with restricted mobility. The combination of sustained and intermittent compression ("hybrid device") is a promising new tool. The interface pressure corresponding to the dosage of compression therapy determines the hemodynamic efficacy of each device. In order to reduce ambulatory venous hypertension compression pressures of more than 50 mm Hg in the upright position are desirable. At the same time pressure should be lower in the resting position in order to be tolerated. This prerequisite may be fulfilled by using inelastic, short stretch material including multicomponent bandages and cohesive surfaces, all characterized by high stiffness. Such materials do not give way when calf muscles contract during walking which leads to high peaks of interface pressure ("massaging effect"). PMID:24843100

  11. Mouth ulcers

    MedlinePLUS

    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 ...

  12. Corneal Ulcer Caused by the New Fungal Species Sarcopodium oculorum

    Microsoft Academic Search

    Josep Guarro; Ana Luisa Hofling-Lima; Josepa Gene ´; Denise De Freitas; Patricio Godoy; Maria Luisa Zorat-Yu; Luis Zaror; Olga Fischman; Disciplina de Oftalmología; Disciplina de Biología Celular

    2002-01-01

    We describe a case of keratitis caused by a new species of the hyphomycetous genus Sarcopodium, S. oculorum. The corneal ulcer developed after 5 months of treatment with corticosteroids in a Brazilian boy diagnosed with allergic conjunctivitis. Fungal hyphae and conidia were detected in corneal scrapings, and repeated cultures were positive for this fungus. The infection was resolved with natamycin

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

    PubMed

    Hindley, Jenny

    2014-09-01

    This article presents the findings of an audit on venous leg ulceration prevalence in a community area as a framework for discussing the concept and importance of audit as a tool to inform practice and as a means to benchmark care against national or international standards. It is hoped that the discussed audit will practically demonstrate how such procedures can be implemented in practice for those who have not yet undertaken it, as well as highlighting the unexpected extra benefits of this type of qualitative data collection that can often unexpectedly inform practice and influence change. Audit can be used to measure, monitor and disseminate evidence-based practice across community localities, facilitating the identification of learning needs and the instigation of clinical change, thereby prioritising patient needs by ensuring safety through the benchmarking of clinical practice. PMID:25191861

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

    PubMed

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

    2013-01-01

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

  15. Abnormal foot pressures alone may not cause ulceration.

    PubMed

    Masson, E A; Hay, E M; Stockley, I; Veves, A; Betts, R P; Boulton, A J

    1989-07-01

    Both rheumatoid arthritis and diabetes have been associated with the development of abnormally high pressures under the feet, and ulceration has been considered to be a problem in both conditions. In order to examine further the relationship between high foot pressure, neurological abnormalities, and ulceration, we have studied two groups of patients: (a) 38 diabetic patients and (b) 37 patients with rheumatoid arthritis who had similar clinical abnormalities of the feet. Thirty-two percent of diabetic patients had a history of plantar ulceration compared with none of the rheumatoid group (p less than 0.01). However, the diabetic group had considerably more severe neuropathy (peroneal nerve motor conduction velocity 35.4 +/- 4.8 m s-1 vs 44.4 +/- 5.2 m s-1 (mean +/- SD), p less than 0.001; vibration perception threshold 33.5 +/- 13.4 vs 16.9 +/- 10.9, p less than 0.001), with a similar frequency of elevated plantar pressures (51% vs 61%, NS). These data emphasize the importance of the loss of sensory awareness in the pathogenesis of diabetic foot ulceration, and suggest that high pressure alone is not a direct cause of ulceration. PMID:2527680

  16. The Effect of a Connexin43-Based Peptide on the Healing of Chronic Venous Leg Ulcers: A Multicenter, Randomized Trial

    PubMed Central

    Ghatnekar, Gautam S; Grek, Christina L; Armstrong, David G; Desai, Sanjay C; Gourdie, Robert G

    2015-01-01

    The gap junction protein, connexin43 (Cx43), has critical roles in the inflammatory, edematous, and fibrotic processes following dermal injury and during wound healing, and is abnormally upregulated at the epidermal wound margins of venous leg ulcers (VLUs). Targeting Cx43 with ACT1, a peptide mimetic of the carboxyl-terminus of Cx43, accelerates fibroblast migration and proliferation, and wound reepithelialization. In a prospective, multicenter clinical trial conducted in India, adults with chronic VLUs were randomized to treatment with an ACT1 gel formulation plus conventional standard-of-care (SOC) protocols, involving maintaining wound moisture and four-layer compression bandage therapy, or SOC protocols alone. The primary end point was mean percent ulcer reepithelialization from baseline to 12 weeks. A significantly greater reduction in mean percent ulcer area from baseline to 12 weeks was associated with the incorporation of ACT1 therapy (79% (SD 50.4)) as compared with compression bandage therapy alone (36% (SD 179.8); P=0.02). Evaluation of secondary efficacy end points indicated a reduced median time to 50 and 100% ulcer reepithelialization for ACT1-treated ulcers. Incorporation of ACT1 in SOC protocols may represent a well-tolerated, highly effective therapeutic strategy that expedites chronic venous ulcer healing by treating the underlying ulcer pathophysiology through Cx43-mediated pathways. PMID:25072595

  17. The effect of a connexin43-based Peptide on the healing of chronic venous leg ulcers: a multicenter, randomized trial.

    PubMed

    Ghatnekar, Gautam S; Grek, Christina L; Armstrong, David G; Desai, Sanjay C; Gourdie, Robert G

    2015-01-01

    The gap junction protein, connexin43 (Cx43), has critical roles in the inflammatory, edematous, and fibrotic processes following dermal injury and during wound healing, and is abnormally upregulated at the epidermal wound margins of venous leg ulcers (VLUs). Targeting Cx43 with ACT1, a peptide mimetic of the carboxyl-terminus of Cx43, accelerates fibroblast migration and proliferation, and wound reepithelialization. In a prospective, multicenter clinical trial conducted in India, adults with chronic VLUs were randomized to treatment with an ACT1 gel formulation plus conventional standard-of-care (SOC) protocols, involving maintaining wound moisture and four-layer compression bandage therapy, or SOC protocols alone. The primary end point was mean percent ulcer reepithelialization from baseline to 12 weeks. A significantly greater reduction in mean percent ulcer area from baseline to 12 weeks was associated with the incorporation of ACT1 therapy (79% (SD 50.4)) as compared with compression bandage therapy alone (36% (SD 179.8); P=0.02). Evaluation of secondary efficacy end points indicated a reduced median time to 50 and 100% ulcer reepithelialization for ACT1-treated ulcers. Incorporation of ACT1 in SOC protocols may represent a well-tolerated, highly effective therapeutic strategy that expedites chronic venous ulcer healing by treating the underlying ulcer pathophysiology through Cx43-mediated pathways. PMID:25072595

  18. Comparing a foam composite to a hydrocellular foam dressing in the management of venous leg ulcers: a controlled clinical study.

    PubMed

    Vanscheidt, Wolfgang; Sibbald, R Gary; Eager, Catherine A

    2004-11-01

    Venous leg ulcers are the most prevalent form of chronic wounds in the Western world. The principles of moist wound healing coupled with the use of graduated compression bandaging have become the cornerstone of treatment for venous leg ulcers but not all moist dressings are alike. To compare the attributes of a foam composite dressing with those of a hydrocellular foam dressing in the management of venous leg ulcers, a prospective, randomized, comparative 12-week study was conducted in 15 centers in the US, Canada, France, Germany, and the UK. Dressings were changed and compression bandages applied per manufacturer recommendations and dressing performance was assessed at every dressing change and at the final evaluation. Patients with venous ulcers were randomized to treatment for 12 weeks with either hydrocellular foam (n = 52) or foam composite (n = 55) dressing. Healing differences between the groups were not statistically significant, with 36% of patients using foam composite dressing healed in a mean of 66 days and 39% of patients using hydrocellular foam dressing healed in a mean of 73 days. However, the foam composite dressing performed significantly better than the hydrocellular foam dressing with regard to condition of the periwound skin - 55% of patients in the foam composite group having healed or markedly improved surrounding skin compared to 37% of patients using hydrocellular foam (P = 0.03). The foam composite dressing was rated significantly better than the hydrocellular foam dressing ("very good" to "excellent") in level of satisfaction with conformability (87% and 75%, respectively, P = 0.05); being non-sensitizing (73% and 52%, respectively, P = 0.02); and ease of application (93% and 81%, respectively, P = 0.01). The findings reported in this study suggest that the foam composite dressing offers significant improvements in the quality of life of patients with venous leg ulcers as well as for their caregivers. PMID:15545697

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

    PubMed Central

    Jawie?, Arkadiusz; Cwajda-Bia?asik, Justyna; Cierzniakowska, Katarzyna; Mo?cicka, Paulina; Hancke, El?bieta

    2010-01-01

    Introduction The aim of the study was to assess the influence of a supervised programme of exercises on ankle joint mobility in patients with venous leg ulcerations. Material and methods The study was carried out between 2008 and 2009 at the Venous Ulcer Treatment Outpatient Clinic and Clinic of General and Vascular Surgery of the Dr Jan Biziel University Hospital no. 2 in Bydgoszcz. It was a randomized control study in which 32 patients with venous leg ulcerations were qualified. Patients 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. PMID:22427773

  20. Vascular pythiosis in a thalassemic patient presenting as bilateral leg ulcers

    PubMed Central

    Keoprasom, Nicha; Chularojanamontri, Leena; Chayakulkeeree, Methee; Chaiprasert, Angkana; Wanachiwanawin, Wanchai; Ruangsetakit, Chanean

    2012-01-01

    Human pythiosis is an emerging disease caused by Pythium insidiosum, a fungus-like aquatic organism. Clinical presentations can be classified into four types: (i) cutaneous/subcutaneous, (ii) ocular, (iii) vascular, and (iv) disseminated pythiosis. Serological tests such as immunodiffusion and immunochromotographic test are useful to make rapid diagnosis in cutaneous and vascular pythiosis. We report a case of 35 year-old male with vascular pythiosis of both legs, diagnosed by serology and molecular techniques. PMID:24432209

  1. Vascular pythiosis in a thalassemic patient presenting as bilateral leg ulcers.

    PubMed

    Keoprasom, Nicha; Chularojanamontri, Leena; Chayakulkeeree, Methee; Chaiprasert, Angkana; Wanachiwanawin, Wanchai; Ruangsetakit, Chanean

    2012-12-01

    Human pythiosis is an emerging disease caused by Pythium insidiosum, a fungus-like aquatic organism. Clinical presentations can be classified into four types: (i) cutaneous/subcutaneous, (ii) ocular, (iii) vascular, and (iv) disseminated pythiosis. Serological tests such as immunodiffusion and immunochromotographic test are useful to make rapid diagnosis in cutaneous and vascular pythiosis. We report a case of 35 year-old male with vascular pythiosis of both legs, diagnosed by serology and molecular techniques. PMID:24432209

  2. Treatment of intractable skin ulcers caused by vascular insufficiency with allogeneic cultured dermal substitute: a report of eight cases.

    PubMed

    Taniguchi, Tomonori; Amoh, Yasuyuki; Tanabe, Kenichi; Katsuoka, Kensei; Kuroyanagi, Yoshimitsu

    2012-03-01

    Chronic leg ulcers have various causes and can be difficult to treat, although topical treatments, including basic fibroblast growth factor and PGE1, have been used. We applied an allogeneic cultured dermal substitute (CDS) to eight patients with intractable ulcers. The patients had various underlying diseases, including diabetes mellitus, systemic lupus erythematosus, antiphospholipid syndrome, necrobiosis lipoidica, stasis dermatitis, livedo vasculopathy, and rheumatoid arthritis. The CDS was prepared by seeding cultured human fibroblasts on a spongy matrix consisting of hyaluronic acid and atelocollagen. Good clinical results were achieved, as demonstrated by reepithelization, healthy granulation tissue formation, and a subsequent decrease in wound size. Daily dressing changes became unnecessary when the allogeneic CDS was used. Based on these results, we suggest that CDS may be useful for the treatment of intractable skin ulcers. PMID:21861088

  3. Root Cause Analysis of Gastroduodenal Ulceration After Yttrium-90 Radioembolization

    SciTech Connect

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

    2013-12-15

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

  4. A Retrospective Clinical Study of 188 Consecutive Patients to Examine the Effectiveness of a Biologically Active Cryopreserved Human Skin Allograft (TheraSkin ®) on the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers

    Microsoft Academic Search

    Adam Scott Landsman; Jeremy Cook; Emily Cook; Arnold Robert Landsman; Philip Garrett; Joonhyun Yoon; Alfred Kirkwood; Eric Desman

    2011-01-01

    A biologically active human skin allograft, currently distributed under the brand name TheraSkin®, was examined for safety and efficacy in the treatment of venous leg ulcers (VLUs) and diabetic foot ulcers (DFUs). The objective was to determine if TheraSkin could serve as a safe and effective alternative to bioengineered skin substitutes such as Apligraf® and Dermagraft®. The authors conducted a

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

    PubMed Central

    2012-01-01

    Background Implementation of lifestyle interventions in patient care is a major challenge. Understanding factors that influence implementation is a first step in programs to enhance uptake of these interventions. A lifestyle-counseling intervention, Lively Legs, delivered by trained nurses, can effectively improve the lifestyle in patients with venous leg ulcers. The aim of this study was to identify factors that hindered or facilitated implementation of this intervention in outpatient dermatology clinics and in home care. Methods A mixed-methods multiple case study in five purposefully selected healthcare settings in the Netherlands was conducted. Measurements to identify influencing factors before and after implementation of Lively Legs included interviews, focus groups, questionnaires, and nurses’ registration. Analyses focused on qualitative data as the main data source. All data were compared across multiple cases to draw conclusions from the study as a whole. Results A total of 53 patients enrolled in the Lively Legs program, which was delivered by 12 trained nurses. Barriers for implementation were mainly organizational. It was difficult to effectively organize reaching and recruiting patients for the program, especially in home care. Main barriers were a lack of a standardized healthcare delivery process, insufficient nursing time, and a lack of motivated nurses to deliver the program. Facilitating factors were nurse-driven coordination of care and a standardized care process to tie Lively Legs into, as this resulted in better patient recruitment and better program implementation. Conclusions This study identified a range of factors influencing the implementation of a lifestyle-counseling program, mainly related to the organization of healthcare. Using a case study method proved valuable in obtaining insight into influencing factors for implementation. This study also shed light on a more general issue, which is that leg ulcer care is often fragmented, indicating that quality improvement is needed. PMID:23101504

  6. Continuity through best practice: design and implementation of a nurse-led community leg-ulcer service.

    PubMed

    Lorimer, Karen

    2004-06-01

    The design of the new service was intended to facilitate continuity. The results after the first year of the new service revealed that care was both more effective and more efficient for all types of leg ulcers (Harrison, Graham, Friedberg, & Lorimer, 2003). Healing rates had dramatically improved, the frequency of nursing visits decreased, and supply costs declined. With the new service, comprehensive standardized assessments are made at baseline on all new admissions for home leg-ulcer care, and reassessments are regularly scheduled if the condition does not improve. With the evidence-based protocol, all providers and sectors of care are "working from the same script." Specific information is obtained on the client's health history, leg-ulcer history, preferences, and social context. Continuity is further facilitated through implementation of the primary nurse model, whereby one provider is responsible for developing the care plan and for subsequent evaluation and revision. Management continuity is advanced through health-care reorganization, with the development of an expert, dedicated nursing team, a consistent approach to training and skill development, improved coordination, an interdisciplinary approach for referral and consultation, and continuous quality improvement measures for education and practice audit. A number of strategies tailored to the new service have been highly effective. Strategic alliances among the researchers, home-care authority, nursing agency, nurses, and physicians are essential to the success of both design and implementation. Ongoing interdisciplinary and intersectoral communication expedites the referral process and helps to resolve issues as they develop. The majority of physicians have been very supportive of the use of the protocol and the evidence-based service. Surveys of care recipients have been mostly positive. Nurses who have been surveyed concerning the supports to implementation of the evidence-based service have indicated the following supports: ongoing education, nursing knowledge, a supportive clinical leader, support from two specialist physicians (a dermatologist and a vascular surgeon), a dedicated nursing team, positive outcomes (improved healing rates), and regional home care and agency support. The greatest challenge has been establishing and maintaining the dedicated nursing team. Continuity is served when nurses are assigned exclusively to the leg-ulcer team, where they can continue to build expertise and skills. The nursing agency was initially reluctant to embrace the concept of a dedicated team, as it viewed wound care as a general function of all nurses. Many of the nurses trained in leg-ulcer care fulfilled a number of other specialized nursing functions. This had resource implications for the nursing agency, as other nurses needed training in various other specialized skills. There should be a balance between the size of the population being served and the size of the team, in order to maintain efficiency and sufficient exposure to skilful assessment and management of leg-ulcer care. During the first year of the leg-ulcer service a number of nurses were lost from the team for various reasons, including: outside opportunities for career advancement, the physical demands of this type of care, retirement, moving from the area, and lack of job security. In addition, the volume of nursing visits was decreased because of Ontario government cutbacks in the area of home-care services. New staff members on the team were laid off in the context of a unionized environment. The lack of long-term security and the reality of lower wages in the community sector have played havoc with recruitment and retention. A recently formed committee at the nursing agency on continuity of care, with representation from nursing, management, and administration, has identified a number of further barriers to continuity. These include fluctuating caseloads, difficulty attracting nurses to the community sector, and a unionized environment in which senior nurses displace junior nurse

  7. Association Between Microbial Bioburden and Healing Outcomes in Venous Leg Ulcers: A Review of the Evidence

    PubMed Central

    Tuttle, Marie S.

    2015-01-01

    Significance: Venous leg ulcers (VLUs) are susceptible to microbial invasion, and serious complications can result without the timely control of infection. Diagnosis of wound infection is primarily based on subjective clinical characteristics and patient-reported symptoms, and the treatment with antimicrobials has not consistently shown improvement in healing outcomes. This is a review of studies using bacterial cultures and/or new molecular-based methods associating microbial bioburden with healing outcomes in VLU patients, with the goal of guiding future studies to better determine significant patterns of microbial involvement in chronic wounds. Recent Advances: Studies reviewed here use cultivation-based identification of bacteria and next-generation sequencing of the bacterial 16S rRNA gene to gain insight into microbial bioburden in VLUs. Further application of sophisticated DNA sequencing and bioinformatic analyses has the potential to revolutionize our ability to further discern, with high resolution, complex microbial communities in chronic wounds. Critical Issues: Few previous studies of microbial bioburden in VLUs have incorporated the knowledge of clinical treatments, which includes close monitoring of patients' symptoms and responses to therapy. Thus, wound care practitioners are currently without evidence-based guidance for the diagnosis and treatment of wound infections. Future Directions: Clinically relevant breakthroughs are possible by combining advanced microbial detection techniques with improved study designs that reflect clinical practices. Well-designed longitudinal studies have great potential to lead to better evidence-based diagnosis of chronic wounds. A greater understanding of microbial bioburden in chronic wounds is likely to lead to better therapies that speed healing and prevent wound infection without risking the development of antimicrobial resistance. PMID:25566410

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

    PubMed Central

    2011-01-01

    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 PMID:21385806

  9. Hemiballism with leg predominance caused by contralateral subthalamic haemorrhage.

    PubMed

    Noda, Kazuyuki; Hattori, Nobutaka; Okuma, Yasuyuki

    2015-01-01

    Hemiballism is a rare movement disorder characterised by high-amplitude movements of the limbs on one side of the body. Stroke of the contralateral basal ganglia, especially the subthalamic nucleus (STN) is the most common aetiology of acute development of hemiballism. Recently, the pathophysiology of hemiballism has been associated with abnormal firing patterns in the globus pallidus interna, with intermittent firing bursts followed by pauses, during which movements occur. An 87-year-old woman presented with a 5-day history of hemiballism predominantly in her leg. On the basis of her brain MRI findings, she was diagnosed as having vascular hemiballism caused by haemorrhage in the contralateral STN. Treatment with risperidone led to the clinical resolution of her condition. We discuss the distribution of the patient's ballistic movements on the basis of the somatotopic organisation of the STN. PMID:25858962

  10. Clinical efficacy of a silver-releasing foam dressing in venous leg ulcer healing: a randomised controlled trial.

    PubMed

    Senet, Patricia; Bause, Renzo; Jørgensen, Bo; Fogh, Karsten

    2014-12-01

    Biatain and Biatain-Ag are two identical wound dressings except the fact that Biatain-Ag releases silver. In the present multinational double-blinded randomised controlled trial the effect of the two dressings were compared for treatment of venous leg ulcers. A total of 181 patients were treated for 6 weeks with either Biatain or Biatain-Ag followed by 4 weeks treatment with Biatain. Biatain-Ag showed superior performance in relative wound area reduction after 6 weeks treatment and the estimated treatment difference increased after 10 weeks indicating that the effect of silver continues at least for 4 weeks after treatment. A subgroup of the patients differed significantly from the others with respect to parameters associated with a poor healing prognosis; patients were older, had significant history of venous thrombosis, larger ulcers with longer duration and more often recurrent. For this subgroup of patients Biatain-Ag showed significant (P < 0·05) better performance in terms of relative ulcer area reduction and healing rate. In conclusion, this study suggests the superior performance of Biatain-Ag compared with the non silver-releasing dressing Biatain in particular for patients having ulcers associated with a poor healing prognosis. PMID:23374589

  11. Aetiology, comorbidities and cofactors of chronic leg ulcers: retrospective evaluation of 1?000 patients from 10 specialised dermatological wound care centers in Germany.

    PubMed

    Jockenhöfer, Finja; Gollnick, Harald; Herberger, Katharina; Isbary, Georg; Renner, Regina; Stücker, Markus; Valesky, Eva; Wollina, Uwe; Weichenthal, Michael; Karrer, Sigrid; Kuepper, Bernhard; Roesch, Alexander; Dissemond, Joachim

    2014-12-01

    Numerous comorbidities and cofactors have been known to influence wound healing processes. In this multicentre study, clinical data of 1?000 patients with chronic leg ulcers from ten specialised dermatological wound care centers were analysed. The patient cohort comprised 567 females and 433 males with an average age of 69·9?years. The wounds persisted on average for 40·8?months and had a mean size of 43·7?cm(2) . Venous leg ulcers represented the most common entity accounting for 51·3% of all chronic wounds, followed by mixed-type ulcers in 12·9% and arterial ulcerations in 11·0% of the patients. Vasculitis was diagnosed in 4·5%, trauma in 3·2%, pyoderma gangrenosum in 2·8%, lymphoedema in 1·7%, neoplasia in 1·0% and delayed post-surgical wound healing in 0·6% of the included patients. In total, 70·5% of patients suffered from arterial hypertension, 45·2% were obese, 27·2% had non-insulin dependent diabetes, and 24·4% dyslipidaemia. Altogether 18·4% suffered from metabolic syndrome. Cofactors and comorbidities of patients with chronic leg ulcers have previously been studied but not in detail. Here, we were able to demonstrate the existence of several potentially relevant cofactors, comorbidities of their associations and geographical distributions, which should be routinely examined in patients with chronic leg ulcers and - if possible - treated. PMID:25483380

  12. Frequency rhythmic electrical modulation system in the treatment of chronic painful leg ulcers

    Microsoft Academic Search

    Aleksandar Jankovi?; Ivana Bini?

    2008-01-01

    Electrical current has been recommended for use on chronic wounds; however, the ability of this modality to improve healing\\u000a of various types of chronic ulcers, arterial, venous, mixed arterial and venous ulcers, diabetic, and pressure ulcers is not\\u000a well established. The purpose of this study was to examine the effect of frequency rhytmic electrical modulation system (FREMS)\\u000a on healing of

  13. Factors that influence healing of chronic venous leg ulcers: a retrospective cohort*

    PubMed Central

    Scotton, Marilia Formentini; Miot, Hélio Amante; Abbade, Luciana Patricia Fernandes

    2014-01-01

    BACKGROUND Venous ulcers have a significant impact on patient quality of life, and constitute a worldwide public health problem. Treatment is complex, with high failure rates. OBJECTIVES To identify clinical and therapeutic factors that influence healing of venous ulcers. METHODS Retrospective cohort study of patients with venous ulcers. Ulcer area was measured at the first visit (T0) and after 6 months (T6) and 1 year (T12). A reduction in ulcer area of 50% or more at T6 and T12 was the outcome of interest, weighted by clinical, demographic and treatment aspects. RESULTS Ninety-four patients were included (137 ulcers). A reduction in ulcer area of 50% or more was seen in 40.1% of patients (95%CI 31.9 to 48.4%) at T6 and 49.6% (95%CI 41.2 to 58.1%) at T12. Complete healing occurred in 16.8% (95%CI 10.5 to 23.1%) at T6 and 27% (95%CI 19.5 to 39.5%) at T12. The lowest ulcer area reductions at T6 were associated with longstanding ulcer (RR=0.95; 95%CI 0.91 to 0.98), poor adherence to compression therapy (RR=4.04; 95%CI 1.31 to 12.41), and infection episodes (RR= 0.42; 95%CI 0.23 to 0.76). At T12, lower reductions were associated with longstanding ulcer (RR=0.95; 95%CI 0.92 to 0.98), longer topical antibiotic use (RR=0.93; 95%CI 0.87 to 0.99), and systemic antibiotic use (RR=0.63; 95%CI 0.40 to 0.99). CONCLUSIONS Longstanding ulcer, infection, poor adherence to compression therapy, and longer topical and systemic antibiotic use were independently correlated with worse healing rates. PMID:24937814

  14. US skin disease assessment: ulcer and wound care.

    PubMed

    Markova, Alina; Mostow, Eliot N

    2012-01-01

    Chronic ulcers are a growing cause of patient morbidity and contribute significantly to the cost of health care in the United States. The most common etiologies of chronic ulcers include venous leg ulcers (VLUs), pressure ulcers (PrUs), diabetic neuropathic foot ulcers (DFUs), and leg ulcers of arterial insufficiency. Chronic wounds account for an estimated $6 to $15 billion annually in US health care costs; however, it is difficult to get accurate measurements on this, because these patients are often seen in a variety of settings or simply fail to access the health care system. PMID:22117872

  15. 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

    Britt-Lousie Anderson

    2003-01-01

    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

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

    SciTech Connect

    Siegel, M.E. (Univ. of Southern California, Los Angeles); Stewart, C.A.; Kwong, P.; Sakimura, I.

    1982-04-01

    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 /sup 201/Tl 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 /sup 201/Tl in 20 out of 23. Ultrasound correctly predicted non-healing in 3 out of 6 cases, compared with 5 out of 6 for /sup 201/Tl. The positive predictive value of the /sup 201/Tl study was 63%, versus 27% for ultrasound, and the negative predictive value was 95% for /sup 201/Tl and 83% for ultrasound. The accuracy of /sup 201/Tl and ultrasound was 86% and 62%, respectively. This limited study suggests that /sup 201/Tl perfusion scanning is a useful noninvasive test of ulcer healing potential and may be more sensitive than Doppler ultrasound.

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

    SciTech Connect

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

    1982-04-01

    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.

  18. [Therapeutic management of massive hemorrhage caused by gastroduodenal ulcer].

    PubMed

    Dancewicz, R; Barcikowski, S; Majchrzak, K; Kowalewski, K; Galikowski, M

    1989-01-01

    Based on 103 patients the authors discussed policy of therapeutic management in gastric and duodenal ulcer disease complicated by massive hemorrhage. In the surgical treatment of such patients the authors prefer resection procedures aimed at simultaneous control of bleeding, prevention of its relapse and radical treatment of peptic ulcer disease. PMID:2808568

  19. Standards of care for venous leg ulcers: compression therapy and moist wound healing.

    PubMed

    Rudolph, D

    2001-03-01

    Venous ulcers are the most common type of cutaneous ulceration of the lower extremity, accounting for 70% to 90% of all cases. Despite recent advances in treatment and the development of new modalities, the current standard of care remains compression therapy in combination with appropriate moist wound care principles. The physiology of the venous system and the pathophysiology of venous disease leading to ulceration are described. A review of the use of gradient compression therapy is provided, including a discussion of several types. The history of moist wound healing and the use of hydrocolloids also are included. It is essential for the vascular nurse to be well versed in the areas of compression therapy and moist wound principles as the most effective treatment for venous ulcers at this time. PMID:11251936

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

    PubMed

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

    2014-10-01

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

  1. Marjolin's Ulcer of the Scalp: a Reconstructive Challenge

    PubMed Central

    Atiyeh, B.S.; Hayek, S.N.; Kodeih, M.G.

    2005-01-01

    Summary In the year 1828 Jean-Nicolas Marjolin described the formation of ulcers specifically in chronic burn scars, and in 1903 De Costa coined the term "Marjolin's ulcer", applying it to tumours arising in simple leg ulcers. The causes of this condition are described, as also treatment protocols, and a case report is presented. PMID:21991007

  2. Marjolin's Ulcer of the Scalp: a Reconstructive Challenge.

    PubMed

    Atiyeh, B S; Hayek, S N; Kodeih, M G

    2005-12-31

    In the year 1828 Jean-Nicolas Marjolin described the formation of ulcers specifically in chronic burn scars, and in 1903 De Costa coined the term "Marjolin's ulcer", applying it to tumours arising in simple leg ulcers. The causes of this condition are described, as also treatment protocols, and a case report is presented. PMID:21991007

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

    Microsoft Academic Search

    Trine Høgsberg; Thomas Bjarnsholt; Jens Schiersing Thomsen; Klaus Kirketerp-Møller; Markus M. Heimesaat

    2011-01-01

    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)

  4. Ulcers

    MedlinePLUS

    ... decaffeinated coffee, tea, chocolate, meat extracts, alcohol, black pepper, chili powder, mustard seed and nutmeg. You may ... and what are the possible side effects? How long will it take to treat my ulcer? Are ...

  5. Testing the effectiveness of a self-efficacy based exercise intervention for adults with venous leg ulcers: protocol of a randomised controlled trial

    PubMed Central

    2014-01-01

    Background Exercise and adequate self-management capacity may be important strategies in the management of venous leg ulcers. However, it remains unclear if exercise improves the healing rates of venous leg ulcers and if a self-management exercise program based on self-efficacy theory is well adhered to. Method/design This is a randomised controlled in adults with venous leg ulcers to determine the effectiveness of a self-efficacy based exercise intervention. Participants with venous leg ulcers are recruited from 3 clinical sites in Australia. After collection of baseline data, participants are randomised to either an intervention group or control group. The control group receive usual care, as recommended by evidence based guidelines. The intervention group receive an individualised program of calf muscle exercises and walking. The twelve week exercise program integrates multiple elements, including up to six telephone delivered behavioural coaching and goal setting sessions, supported by written materials, a pedometer and two follow-up booster calls if required. Participants are encouraged to seek social support among their friends, self-monitor their weekly steps and lower limb exercises. The control group are supported by a generic information sheet that the intervention group also receive encouraging lower limb exercises, a pedometer for self-management and phone calls at the same time points as the intervention group. The primary outcome is the healing rates of venous leg ulcers which are assessed at fortnightly clinic appointments. Secondary outcomes, assessed at baseline and 12 weeks: functional ability (range of ankle motion and Tinetti gait and balance score), quality of life and self-management scores. Discussion This study seeks to address a significant gap in current wound management practice by providing evidence for the effectiveness of a home-based exercise program for adults with venous leg ulcers. Theory-driven, evidence-based strategies that can improve an individual’s exercise self-efficacy and self-management capacity could have a significant impact in improving the management of people with venous leg ulcers. Information gained from this study will provide much needed information on management of this chronic disease to promote health and independence in this population. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12612000475842. PMID:25277416

  6. Stasis Ulcer

    MedlinePLUS

    ... stasis dermatitis) may appear before you notice an ulcer. This is often seen on the inner ankle area first, although any area on the lower leg may be affected. Varicose veins may be present. Sometimes there are hard, ... the skin near the ulcer. The ulcer is a crater-like, irregular area ...

  7. The prevalence of thrombophilia in patients with chronic venous leg ulceration

    Microsoft Academic Search

    Rhoda K. MacKenzie; Christopher A. Ludlam; C. Vaughan Ruckley; Paul L. Allan; Paul Burns; Andrew W. Bradbury

    2002-01-01

    Background: Thrombophilia is increasingly recognized as a risk factor for deep venous thrombosis (DVT), which in turn is a major risk factor for chronic venous ulceration (CVU). However, the relationship between thrombophilia and CVU remains unknown. The aim of this study was to define the prevalence of thrombophilia in patients with CVU and to determine whether this is associated with

  8. A Comparison of Patients who Developed Venous Leg Ulceration Before and After their 50th Birthday

    Microsoft Academic Search

    R. K MacKenzie; D. A Brown; P. L Allan; A. W Bradbury; C. V Ruckley

    2003-01-01

    Background: although chronic venous ulceration (CVU) is often viewed primarily as a disease of the elderly, recent epidemiological data suggest that a significant proportion of patients first develop CVU before middle age. Such patients may represent a distinct group in terms of aetiology, natural history, prognosis and therapeutic options.Aim: to compare patients who developed CVU before (Group 1) and after

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

    PubMed

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

    2013-08-01

    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

  10. Clinical trial of allogeneic cultured dermal substitutes for intractable skin ulcers of the lower leg

    Microsoft Academic Search

    Naoto Yamada; Eiju Uchinuma; Yoshimitsu Kuroyanagi

    2008-01-01

    The efficacy of allogeneic cultured dermal substitute (CDS) on wound healing was evaluated in six patients with intractable\\u000a skin ulcers on the lower extremities. Allogeneic CDS was repeatedly applied to wounds at intervals of 4–7 days to prepare\\u000a a wound bed acceptable for skin grafting or to induce resurfacing through the granulation tissue formation associated with\\u000a epithelialization. In one patient

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

    PubMed Central

    2011-01-01

    Background Objective: To determine the relative effectiveness of evidence-informed practice using two high compression systems: four-layer (4LB) and short-stretch bandaging (SSB) in community care of venous leg ulcers. Design and Setting: Pragmatic, multi-centre, parallel-group, open-label, randomized controlled trial conducted in 10 centres. Cognitively intact adults (?18 years) referred for community care (home or clinic) with a venous ulceration measuring ?0.7cm and present for ?1 week, with an ankle brachial pressure index (ABPI) ?0.8, without medication-controlled Diabetes Mellitus or a previous failure to improve with either system, were eligible to participate. Methods Consenting individuals were randomly allocated (computer-generated blocked randomization schedule) to receive either 4LB or SSB following an evidence-informed protocol. Primary endpoint: time-to- healing of the reference ulcer. Secondary outcomes: recurrence rates, health-related quality of life (HRQL), pain, and expenditures. Results 424 individuals were randomized (4LB n = 215; SSB n = 209) and followed until their reference ulcer was healed (or maximum 30 months). An intent-to-treat analysis was conducted on all participants. Median time to ulcer healing in the 4LB group was 62 days [95% confidence interval (CI) 51 to 73], compared with 77 days (95% CI 63 to 91) in the SSB group. The unadjusted Kaplan-Meier curves revealed the difference in the distribution of cumulative healing times was not significantly different between group (log rank ?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 clinicaltrials.gov Identifier: NCT00202267 PMID:21995267

  12. Ulcerative colitis

    MedlinePLUS

    Inflammatory bowel disease - ulcerative colitis; IBD - ulcerative colitis ... The cause of ulcerative colitis is unknown. People with this condition have problems with the immune system. However, it is not clear if immune ...

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

    Microsoft Academic Search

    Marvin J. Rapaport; Charles Vinnik; Harvey Zarem

    1996-01-01

    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

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

    Microsoft Academic Search

    Bo Jorgensen; Gitte Juel Friis; Finn Gottrup

    2006-01-01

    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. Biatains-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 1012 patients in a single-blinded crossover study against Biatain Non-adhesive

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

    PubMed Central

    Høgsberg, Trine; Bjarnsholt, Thomas; Thomsen, Jens Schiersing; Kirketerp-Møller, Klaus

    2011-01-01

    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. PMID:21655269

  16. ["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].

    PubMed

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

    2013-08-01

    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

  17. Sarcoidosis mimicking a venous ulcer: a case report.

    PubMed

    Joshi, Smita S; Romanelli, Paolo; Kirsner, Robert S

    2009-11-01

    Sarcoidosis--a chronic, multisystem disease of unknown etiology characterized by noncaseating granulomas--may cause ulcerative lesions, particularly in African American women. A case of ulcerative sarcoidosis mimicking a venous ulcer is presented. The patient is a 44-year-old African American hypertensive, obese woman with a nonhealing medially based lower leg ulcer of 3 years' duration clinically consistent with a venous ulcer. The ulcer did not heal with compression therapy and pentoxifylline. Subsequent biopsies showed granulomatous inflammation consistent with sarcoidosis. When intralesional triamcinolone was added to compression therapy, the ulcer resolved after 3 months. Given its propensity toward formation on the lower extremities and ulcerative and atrophic appearance, ulcerative sarcoidosis should be considered in the differential diagnosis of a venous ulcer refractory to standard therapy, especially in African American women. PMID:19934463

  18. Clinically relevant pain relief with an ibuprofen-releasing foam dressing: results from a randomized, controlled, double-blind clinical trial in exuding, painful venous leg ulcers.

    PubMed

    Fogh, Karsten; Andersen, Maibritt B; Bischoff-Mikkelsen, Morten; Bause, Renzo; Zutt, Markus; Schilling, Stephan; Schmutz, Jean-Luc; Borbujo, Jesús; Jimenez, Juan A; Cartier, Hugues; Jørgensen, Bo

    2012-01-01

    The objective of this 6-week, 120-patient, double-blind, randomized, controlled trial was to investigate if a foam dressing with ibuprofen provided clinically relevant pain relief (PAR) for exuding, painful venous leg ulcers in comparison with a similar foam dressing without ibuprofen. Primary outcome parameter was PAR compared with baseline pain during the first 5 days of the investigation. PAR was registered by the patient morning and evening. Main end point was proportion of patients reporting a summed PAR score of at least 50% of the total maximum PAR (i.e., responders) and the corresponding number needed to treat (NNT). Wound-related parameters such as ulcer healing, ulcer area reduction, and peri-ulcer skin condition as well as adverse events were recorded during all 6 weeks of the investigation. PAR was significantly greater in the ibuprofen foam group than the comparator group (p?=?0.0438). There were 34% responders in the ibuprofen foam group vs. 19% in the comparator group (NNT?=?6.8). When evening data were analyzed separately to evaluate PAR over daytime, NNT was 5.3. Wound healing parameters and adverse events were comparable. In conclusion, in this study, the ibuprofen foam dressing provided clinically relevant PAR for patients with exuding, painful venous ulcers. PMID:23110444

  19. Myiasis of the foot and leg caused by Chrysomya bezziana.

    PubMed

    Lam, Kwok Hang; Lui, Tun Hing

    2014-01-01

    Myiasis is the infestation of the skin and mucous membranes by fly larvae. Myiasis of the lower extremity caused by Chrysomya bezziana is rarely fatal, but it can be associated with considerable morbidity. Proper wound exploration and en masse removal of all the larvae using thorough wound debridement can eradicate the infestation and promote wound healing. In the present report, the management of 4 separate cases of lower extremity infestation with fly larvae is described. PMID:23820040

  20. Leg cramps in pregnancy caused by chronic compartment syndrome and relieved by fasciotomy after childbirth

    PubMed Central

    Orlin, Jan Roar; Øen, Jarle; Andersen, John Roger; Tjugum, Ivar Jostein; Westbye, Hans Jacob; Roska, Jomar; Aasved, Helene; Hjelmeland, Kjersti

    2014-01-01

    Key Clinical Message A case of intolerable leg pain in pregnancy, caused by Chronic Compartment Syndrome (CCS), is presented. Increasing amounts of opioids were given throughout the pregnancy. Anesthetical dilemmas and surgery are discussed. In conclusion, early surgery rather than opioids is recommended. PMID:25356260

  1. An environmental Sporothrix as a cause of corneal ulcer

    PubMed Central

    Morrison, Annie S.; Lockhart, Shawn R.; Bromley, Jennifer G.; Kim, Joung Y.; Burd, Eileen M.

    2013-01-01

    In this case we introduce Sporothrix pallida, a non-pathogenic environmental Sporothrix species as a cause of infectious keratitis in a corneal transplant recipient. Human infections caused by S. schenckii are well-known but human infection with Sporothrix pallida has not been previously reported. PMID:24432225

  2. Supraduodenal Branch of the Left Hepatic Artery: A Rare Cause of Bleeding Duodenal Ulcer

    SciTech Connect

    Kapoor, Baljendra S., E-mail: bkapoor@uabmc.ed [University of Alabama at Birmingham NHB H623, Vascular and Interventional Radiology (United States); Berscheid, Bruce [St. Paul's Hospital, Interventional Radiology (Canada); Saddekni, Souheil [University of Alabama at Birmingham NHB H623, Vascular and Interventional Radiology (United States)

    2009-07-15

    This is a case report describing a rare cause of massive duodenal ulcer hemorrhage resulting from the erosion of the supraduodenal branch of the left hepatic artery. This arterial branch is not a well known variation and is rarely recognized as a source of duodenal bleeding.

  3. Endovascular Repair of a Non-Contained Aortic Rupture Caused by a Penetrating Aortic Ulcer

    SciTech Connect

    Pitton, Michael B.; Duber, Christoph [Department of Radiology, University Hospital of Mainz, Mainz (Germany); Neufang, Achim [Department of Cardiovascular Surgery, University Hospital of Mainz, Mainz (Germany); Schlegel, Jens [Department of Pneumology, UniversityHospital of Mainz, Mainz (Germany)

    2002-01-15

    This case report describes the endovascular treatment of an acute non-contained rupture of the descending aorta with a stent-graft as an emergency procedure. The aortic rupture was caused by a penetrating aortic ulcer. One year follow-up documents the complete recovery of the patient.

  4. Stasis dermatitis and ulcers

    MedlinePLUS

    ... hardening of the skin on the legs and ankles (lipodermatosclerosis) A bumpy or cobblestone appearance of the skin Dark brown color Skin sores (ulcers) may develop (called a venous ulcer or stasis ...

  5. Ulcerative Colitis

    MedlinePLUS

    Ulcerative colitis (UC) is a disease that causes inflammation and sores, called ulcers, in the lining of the rectum and colon. It is one of a group of diseases called inflammatory bowel disease. UC can happen at ...

  6. Patient pain drawing in diagnosing the cause of exercise-induced leg pain

    Microsoft Academic Search

    K Rennerfelt; Q Zhang; J Styf

    2011-01-01

    IntroductionClassifying symptoms by patient pain drawing (PPD) may be helpful in diagnosing chronic anterior compartment syndrome (CACS). We have investigated the sensitivity and interobserver reliability of the PPD to diagnose CACS among patients with exercise-induced leg pain (EILP).MethodsThis study included 88 consecutive patients (48 men, 40 women; mean age 33, range 13–66, years). Two observers independently diagnosed the causes of

  7. Comparative effectiveness of a bilayered living cellular construct and a porcine collagen wound dressing in the treatment of venous leg ulcers

    PubMed Central

    Marston, William A; Sabolinski, Michael L; Parsons, Nathan B; Kirsner, Robert S

    2014-01-01

    Using data from a national wound-specific electronic medical record (WoundExpert, Net Health, Pittsburgh, PA), we compared the effectiveness of a bilayered living cellular construct (BLCC) and an acellular porcine small intestine submucosa collagen dressing (SIS) for the treatment of venous leg ulcer. Data from 1,489 patients with 1,801 refractory venous leg ulcers (as defined by failure to have >40% reduction in size in the 4 weeks prior to treatment) with surface areas between 1 and 150?cm2 in size, treated between July 2009 and July 2012 at 158 wound care facilities across the US were analyzed. Patient baseline demographics and wound characteristics were comparable between groups. Kaplan-Meier–derived estimates of wound closure for BLCC (1,451 wounds) was significantly greater (p?=?0.01, log-rank test) by weeks 12 (31% vs. 26%), 24 (50% vs. 41%), and 36 (61% vs. 46%), respectively, compared with SIS (350 wounds). BLCC treatment reduced the median time to wound closure by 44%, achieving healing 19 weeks sooner (24 vs. 43 weeks, p?=?0.01, log-rank test). Treatment with BLCC increased the probability of healing by 29% compared with porcine SIS dressing (hazard ratio?=?1.29 [95% confidence interval 1.06, 1.56], p?=?0.01). PMID:24628712

  8. Solitary tubercular caecal ulcer causing massive lower gastrointestinal bleed: a formidable diagnostic challenge.

    PubMed

    Ram, Duvuru; Karthikeyan, Vilvapathy Senguttuvan; Sistla, Sarath Chandra; Ali, Sheik Manwar

    2014-01-01

    Gastrointestinal (GI) haemorrhage is a common surgical emergency accounting for approximately 1% of acute hospital admissions. Lower GI bleed is less common and less severe than upper GI bleed and is usually caused by diverticulosis, neoplasms, angiodysplasia and inflammatory bowel disease. A 51-year-old man presented with massive lower GI bleed. He had no history of tuberculosis. He underwent colonoscopy and an isolated caecal ulcer was noted. Segmental ileocaecal resection was performed and no specific cause was identifiable on histopathology. PCR was performed on this specimen and it was positive for Mycobacterium tuberculosis. This case reports the unusual presentation of tuberculosis as solitary caecal ulcer with massive lower GI bleed and highlights the role of PCR as an adjuvant diagnostic tool for its diagnosis when characteristic histopathological findings are absent. PMID:24604794

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

    SciTech Connect

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

    1981-02-01

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

  10. Leg ulcer and osteomyelitis due to methicillin-susceptible Staphylococcus aureus infection after fracture repair treatment: a case highlighting the potential role of prostaglandin E1 vasodilator.

    PubMed

    Bentivegna, Erminia; Citarrella, Emanuele; Vivaldi, Roberto; De Luca, Dario; Maira, Giovanna Grazia; Casuccio, Alessandra; Di Carlo, Paola

    2015-03-01

    Prostaglandins appear to reduce biofilm formation and chronicization of infections, and stimulate a rapid and effective clearance of infecting micro-organisms. We report a case of recovery from methicillin-susceptible Staphylococcus aureus (MSSA) osteomyelitis after multidisciplinary management with antibiotics, anti-thrombotics and prostaglandin E1 (PGE1) vasodilator, in a patient with tibial plateau fracture repaired with internal fixation devices. A 47-year-old HIV-negative male with chronic ulcer on the proximal third of the left leg was admitted to the Orthopaedic Unit of the Orestano Clinic in Palermo, Italy, for suspected osteomyelitis. A biopsy of the skin ulcer and blood cultures were performed and resulted positive for MSSA. Labelled leukocyte scintigraphy confirmed osteomyelitis. No clinical improvement was observed after combined antibiotic treatment with rifampicin plus trimethoprim-sulfamethoxazole. The patient underwent a 4-day therapeutic cycle: PGE1 (alprostadil 60 mg/day IV) combined with nadroparin calcium plus gentamicin, followed by treatment with aminaftone plus sulodexide plus levofloxacin. At discharge, the patient's painful symptoms had completely resolved and the ulcer had cicatrized; recovery from osteomyelitis was confirmed by scintigraphy. This treatment protocol including PGE1 may result in a significant improvement in quality of life and functional status of patients with a reduction in direct and indirect costs and economic benefit for the National Health Service. PMID:25819055

  11. [Effect of compression therapy in the management of venous ulcer - practical experience].

    PubMed

    Vranjkovi?, Ivana; Strok, Nevenka; Topolovec, Zeljka; Huljev, Dubravko

    2013-10-01

    Venous insufficiency is one of the most common causes of chronic wounds. Venous ulcers account for about 75% of all leg ulcers, and 50% of venous leg ulcers require long-term treatment lasting for more than 1 year. The most common location of venous ulcers is the lower third of the leg, as it is the site of strongest venous pressure; less often there are multiple venous ulcers that tend to be localized on both lower legs. In addition to the negative impact on the quality of life, such as immobility, pain and social isolation, which significantly affect the course and length of treatment, we cannot ignore the high costs of long-term and often uncertain treatment, which poses a major health, social and economic problem in the world and in our country. PMID:24371985

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

    PubMed Central

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

    2013-01-01

    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. PMID:23869348

  13. Hyperhomocysteinaemia and chronic venous ulcers.

    PubMed

    de Franciscis, Stefano; De Sarro, Giovambattista; Longo, Paola; Buffone, Gianluca; Molinari, Vincenzo; Stillitano, Domenico M; Gallelli, Luca; Serra, Raffaele

    2015-02-01

    Chronic venous ulceration (CVU) is the major cause of chronic wounds of lower extremities, and is a part of the complex of chronic venous disease. Previous studies have hypothesised that several thrombophilic factors, such as hyperhomocysteinaemia (HHcy), may be associated with chronic venous ulcers. In this study, we evaluated the prevalence of HHcy in patients with venous leg ulcers and the effect of folic acid therapy on wound healing. Eighty-seven patients with venous leg ulcers were enrolled in this study to calculate the prevalence of HHcy in this population. All patients underwent basic treatment for venous ulcer (compression therapy ± surgical procedures). Patients with HHcy (group A) received basic treatment and administered folic acid (1·2 mg/day for 12 months) and patients without HHcy (group B) received only basic treatment. Healing was assessed by means of computerised planimetry analysis. The prevalence of HHcy among patients with chronic venous ulcer enrolled in this study was 62·06%. Healing rate was significantly higher (P < 0·05) in group A patients (78·75%) compared with group B patients (63·33%). This study suggests a close association, statistically significant, between HHcy and CVU. Homocysteine-lowering therapy with folic acid seems to expedite wound healing. Despite these aspects, the exact molecular mechanisms between homocysteine and CVU have not been clearly defined and further studies are needed. PMID:23418772

  14. Causes of Ring-Related Leg Injuries in Birds – Evidence and Recommendations from Four Field Studies

    PubMed Central

    Griesser, Michael; Schneider, Nicole A.; Collis, Mary-Anne; Overs, Anthony; Guppy, Michael; Guppy, Sarah; Takeuchi, Naoko; Collins, Pete; Peters, Anne; Hall, Michelle L.

    2012-01-01

    One of the main techniques for recognizing individuals in avian field research is marking birds with plastic and metal leg rings. However, in some species individuals may react negatively to rings, causing leg injuries and, in extreme cases, the loss of a foot or limb. Here, we report problems that arise from ringing and illustrate solutions based on field data from Brown Thornbills (Acanthiza pusilla) (2 populations), Siberian Jays (Perisoreus infaustus) and Purple-crowned Fairy-wrens (Malurus coronatus). We encountered three problems caused by plastic rings: inflammations triggered by material accumulating under the ring (Purple-crowned Fairy-wrens), contact inflammations as a consequence of plastic rings touching the foot or tibio-tarsal joint (Brown Thornbills), and toes or the foot getting trapped in partly unwrapped flat-band colour rings (Siberian Jays). Metal rings caused two problems: the edges of aluminium rings bent inwards if mounted on top of each other (Brown Thornbills), and too small a ring size led to inflammation (Purple-crowned Fairy-wrens). We overcame these problems by changing the ringing technique (using different ring types or larger rings), or using different adhesive. Additionally, we developed and tested a novel, simple technique of gluing plastic rings onto metal rings in Brown Thornbills. A review of studies reporting ring injuries (N?=?23) showed that small birds (<55 g body weight) are more prone to leg infections while larger birds (>35 g) tend to get rings stuck over their feet. We give methodological advice on how these problems can be avoided, and suggest a ringing hazard index to compare the impact of ringing in terms of injury on different bird species. Finally, to facilitate improvements in ringing techniques, we encourage online deposition of information regarding ringing injuries of birds at a website hosted by the European Union for Bird Ringing (EURING). PMID:23300574

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

    PubMed Central

    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.

    2009-01-01

    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. PMID:19351970

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

    ClinicalTrials.gov

    2014-10-29

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

  17. The direct inhibition of MMP-2 and MMP-9 by an enzyme alginogel: a possible mechanism of healing support for venous leg ulcers.

    PubMed

    Grzela, T; Niderla-Bielinska, J; Litwiniuk, M; White, R

    2014-05-01

    Flaminal Forte is an enzyme alginogel,whose activity depends on the absorption and binding of matrix metalloproteinases (MMPs), which are known to play a crucial role in delayed wound healing. The aim of the study was to evaluate the influence of Flaminal on MMP-2/-9 activity in ulcer exudate, ex vivo. Eight patients with bilateral venous leg ulcers were treated for 4 weeks with Flaminal Forte covered by hydrocolloid ('F' wounds), or with hydrocolloid alone ('H' wounds) as a reference control. Clinical assessment did not reveal any differences between F and H wounds regarding surface reduction and general wound condition. Nevertheless, although non-significant, there was a visible difference in peri-wound skin appearance in F wounds, as compared to H wounds. The wound exudate contained high MMP-2/-9 levels, which gradually decreased as wounds healed. The attenuation of MMPs was stronger in F than in H exudate, however, in standard zymography this difference appeared non-significant. Real-time zymography revealed that Flaminal mediated a powerful direct inhibition of gelatinolytic activity of wound exudate and of recombinant MMP-2/-9 in vitro. PMID:24810313

  18. Rapid healing of chronic venous stasis leg ulcers treated by the application of a novel serum-free cultured autologous epidermis.

    PubMed

    Wille, John J; Burdge, Jeremy J; Pitttelkow, Mark R

    2011-01-01

    The efficacy and durability of wound closure was examined in a prospective randomized unbalanced clinical trial using the application of a living serum-free cultured epidermal autograft in conjunction with wound-area debridement and a four-layer compression wrap (N=10) compared with wound-area debridement and a four-layer compression wrap in patients with hard-to-heal leg ulcers arising from confirmed venous stasis (N=5). All 15 patients who presented with full-thickness venous ulceration were treated weekly for 8 weeks, with a 12-week final evaluation. The average time to wound closure for the grafted wounds was 4.1 weeks for 80% (8/10) of the cases that closed in 12 weeks compared with 12 weeks for the one closed in the control case. All of the grafted wounds remained closed at 12-month follow-up and one more healed at 30 weeks postenrollment. In the control group, one additional wound healed at 21 weeks postenrollment after the placement of an autograft. No serious adverse events were reported and subjective pain assessment was substantially reduced immediately after graft application. The graft treatment significantly improved outcome and provided durable wound closure. The data suggest that this adaption of this procedure may reduce the management costs of these wound types. PMID:21649784

  19. A randomized controlled trial of larval therapy for the debridement of leg ulcers: results of a multicenter, randomized, controlled, open, observer blind, parallel group study.

    PubMed

    Mudge, Elizabeth; Price, Patricia; Walkley, Neal; Neal, Walkley; Harding, Keith G

    2014-01-01

    It has been known for centuries that the application of larvae is useful to heal certain wounds by facilitating debridement of necrotic tissue,(1) yet the efficacy of larval therapy continues to be debatable. This study compared the clinical effectiveness of a larval therapy dressing (BioFOAM) with a standard debridement technique (Purilon gel; hydrogel) in terms of time to debridement of venous (VLU) or mixed arterial/venous (MLU) leg ulcers. Data analyses were conducted on 88 subjects. Sixty-four subjects completed the full study. Of these, 31 of the 32 (96.9%) patients who completed treatment in the larvae arm debrided fully, compared with 11 of the 32 (34.4%) patients who completed the hydrogel arm. In addition, 42 (48%) ulcers fully debrided within the 21-day intervention phase, 31 (67.4%) from the larvae arm (n?=?46), and 11 (26.2%) from the hydrogel arm (n?=?42), which was statistically significant (p?=?0.001) in support of larvae. A statistically significant difference was also observed between treatment arms with regard to numbers of dressing changes during the intervention phase of the study (p?ulcer-related pain or discomfort than subjects in the hydrogel arm (p?

  20. § Simultaneous Superficial Venous Surgery and On-Table Subintimal Angioplasty in the Treatment of Venous Leg Ulcers with Arterial Compromise

    Microsoft Academic Search

    Kent KC

    In this report, all patients were reviewed retrospectively for venous ulcers with arterial compromise and venous disease. The patients were identified as having arterial disease when ankle brachial index (ABI) was below 0.8, or arterial stenosis\\/occlusion was demonstrated on color Doppler ultrasonography, or both. Any reversed flow of more than 0.5 s in the great and small saphenous veins (GSV,

  1. A prospective, randomized, controlled trial comparing the effects of noncontact, low-frequency ultrasound to standard care in healing venous leg ulcers.

    PubMed

    Gibbons, Gary W; Orgill, Dennis P; Serena, Thomas E; Novoung, Aksone; O'Connell, Jessica B; Li, William W; Driver, Vickie R

    2015-01-01

    Current scientific evidence suggests venous leg ulcers (VLUs) that do not respond to guideline-defined care may have a wound microenvironment that is out of physiological balance. A prospective, randomized, controlled, multicenter trial was conducted to compare percent wound size reduction, proportions healed, pain, and quality-of-life (QOL) outcomes in patients randomized to standard care (SC) alone or SC and 40 kHz noncontact, low-frequency ultrasound (NLFU) treatments 3 times per week for 4 weeks. One hundred, twelve (112) eligible participants with documented venous stasis, a VLU >30 days' duration, measuring 4 cm2 to 50 cm2, and demonstrated arterial flow were enrolled. Of these, 81 reduced <30% in size during the 2-week run-in study phase and were randomized (SC, n = 40; NLFU+SC, n = 41). Median age of participants was 59 years; 83% had multiple complex comorbidities. Index ulcers were 56% recurrent, with a median duration of 10.3 months (range 1 month to 204.5 months) and median ulcer area of 11.0 cm2 (range 3.7 cm2-41.3 cm2). All participants received protocol-defined SC compression (30-40 mm Hg), dressings to promote a moist wound environment, and sharp debridement at the bedside for a minimum of 1 time per week. Ulcer measurements were obtained weekly using digital planimetry. Pain and QOL scores were assessed at baseline and after 4 weeks of treatment using the Visual Analog Scale and the Short Form-36 Health Survey. After 4 weeks of treatment, average wound size reduction was 61.6% ± 28.9 in the NLFU+SC compared to 45% ± 32.5 in the SC group (P = 0.02). Reductions in median (65.7% versus 44.4%, P = 0.02) and absolute wound area (9.0 cm2 versus 4.1 cm2, P = 0.003) as well as pain scores (from 3.0 to 0.6 versus 3.0 to 2.4, P = 0.01) were also significant. NLFU therapy with guideline-defined standard VLU care should be considered for healing VLUs not responding to SC alone. The results of this study warrant further research on barriers to healing and the changes occurring in the tissue of the wound to explore theories that the microenvironment impacts wounds that do not heal despite provision of guideline-defined care. PMID:25581604

  2. Aberrant Mucin Assembly in Mice Causes Endoplasmic Reticulum Stress and Spontaneous Inflammation Resembling Ulcerative Colitis

    PubMed Central

    Price, Gareth R; Tauro, Sharyn B; Taupin, Douglas; Thornton, David J; Png, Chin Wen; Crockford, Tanya L; Cornall, Richard J; Adams, Rachel; Kato, Masato; Nelms, Keats A; Hong, Nancy A; Florin, Timothy H. J; Goodnow, Christopher C; McGuckin, Michael A

    2008-01-01

    Background MUC2 mucin produced by intestinal goblet cells is the major component of the intestinal mucus barrier. The inflammatory bowel disease ulcerative colitis is characterized by depleted goblet cells and a reduced mucus layer, but the aetiology remains obscure. In this study we used random mutagenesis to produce two murine models of inflammatory bowel disease, characterised the basis and nature of the inflammation in these mice, and compared the pathology with human ulcerative colitis. Methods and Findings By murine N-ethyl-N-nitrosourea mutagenesis we identified two distinct noncomplementing missense mutations in Muc2 causing an ulcerative colitis-like phenotype. 100% of mice of both strains developed mild spontaneous distal intestinal inflammation by 6 wk (histological colitis scores versus wild-type mice, p < 0.01) and chronic diarrhoea. Monitoring over 300 mice of each strain demonstrated that 25% and 40% of each strain, respectively, developed severe clinical signs of colitis by age 1 y. Mutant mice showed aberrant Muc2 biosynthesis, less stored mucin in goblet cells, a diminished mucus barrier, and increased susceptibility to colitis induced by a luminal toxin. Enhanced local production of IL-1?, TNF-?, and IFN-? was seen in the distal colon, and intestinal permeability increased 2-fold. The number of leukocytes within mesenteric lymph nodes increased 5-fold and leukocytes cultured in vitro produced more Th1 and Th2 cytokines (IFN-?, TNF-?, and IL-13). This pathology was accompanied by accumulation of the Muc2 precursor and ultrastructural and biochemical evidence of endoplasmic reticulum (ER) stress in goblet cells, activation of the unfolded protein response, and altered intestinal expression of genes involved in ER stress, inflammation, apoptosis, and wound repair. Expression of mutated Muc2 oligomerisation domains in vitro demonstrated that aberrant Muc2 oligomerisation underlies the ER stress. In human ulcerative colitis we demonstrate similar accumulation of nonglycosylated MUC2 precursor in goblet cells together with ultrastructural and biochemical evidence of ER stress even in noninflamed intestinal tissue. Although our study demonstrates that mucin misfolding and ER stress initiate colitis in mice, it does not ascertain the genetic or environmental drivers of ER stress in human colitis. Conclusions Characterisation of the mouse models we created and comparison with human disease suggest that ER stress-related mucin depletion could be a fundamental component of the pathogenesis of human colitis and that clinical studies combining genetics, ER stress-related pathology and relevant environmental epidemiology are warranted. PMID:18318598

  3. Structure-activity relations between alkyl nucleophilic chemicals causing duodenal ulcer and adrenocortical necrosis

    SciTech Connect

    Szabo, S.; Reynolds, E.S.; Unger, S.H.

    1982-10-01

    Structure-activity relationships were qualitatively and quantitatively examined for 56 chemicals (e.g., derivatives of propionitrile, acrylonitrile and cysteamine) which caused duodenal ulcer and/or adrenocortical necrosis in rats. For the first time the duodenal ulcerogenic property of numerous chemicals has been studied in a rational and predictive manner. Ulcerogenic activity was most intense in the carbonitriles attached to two or three carbon backbones and diminished by shortening, lengthening, branching, unsaturating, halogenating or hydroxylating the carbon chains. Different modes of action are implied. Adrenocorticolytic potency was associated with unsaturation of the carbon chain and substitution of the nitrile by thiol or amine radicals. An action of these chemicals on the central nervous system has been suggested.

  4. Staple line ulcers: a cause of chronic GI bleeding following STEP procedure.

    PubMed

    Gibbons, Troy E; Casteel, Helen B; Vaughan, Juliana F; Dassinger, Melvin S

    2013-06-01

    Intestinal failure (IF) results from a critical reduction in the functional intestinal mass resulting in dependence on total parenteral nutrition (TPN) for growth and survival. Short bowel syndrome (SBS) is the most common cause of intestinal failure in pediatrics. Following resection, the small bowel undergoes adaptation, a process wherein the bowel elongates and dilates in order to increase intestinal absorptive capacity. Small bowel dilatation can lead to dysmotility and small bowel bacterial overgrowth which may further enhance feeding intolerance. Bowel lengthening procedures are beneficial when there is significant dilatation of the small bowel and subsequent inability to advance enteral feeds. We describe a patient with intestine failure and short bowel syndrome due to gastroschisis who, presented with anemia and occult gastrointestinal bleeding, following Serial Transverse Enteroplasty procedure (STEP). Video capsule endoscopy (VCE) revealed multiple ulcerations at surgical staple sites throughout the distal 2/3 of the remaining small intestine which were the likely source of intestinal blood loss. PMID:23845650

  5. Expression of cyclooxygenase-2 and nitric oxide synthase 2 in swine ulcerative colitis caused by Salmonella typhimurium.

    PubMed

    Cho, W-S; Chae, C

    2004-07-01

    Cyclooxygenase-2 (COX-2) and nitric oxide synthase 2 (NOS2) were detected and localized in 20 pigs with ulcerative colitis caused by natural infection with Salmonella typhimurium. Evidence of NOS2 activity was determined by the formation of nitrotyrosine, a reaction product of peroxynitrite, in NOS2-expressing ulcerative colons by immunohistochemistry. Transcript RNA of COX-2 and NOS2 was consistently detected in colonic tissues from the 20 pigs with ulcerative colitis by using reverse transcription-polymerase chain reaction. Immunohistochemical signals for COX-2 and NOS2 were detected in the ulcerated area of all 20 pigs. Expression of COX-2 and NOS2 was identified continuously within inflammatory intestinal lesions but was minimal in unaffected regions of the colon of S. typhimurium-infected pigs. The immunohistochemistry of serial sections of intestine indicated that the majority of colons containing numerous COX-2-positive cells also had numerous NOS2-positive cells. Localization of NOS2 and a nitrotyrosine antigen was prominent in neutrophils and macrophages in the periphery of the lesions. Simultaneous detection of COX-2 and NOS2 RNA and protein indicated functional activity of prostaglandin and NO production in vivo. This study suggested that COX-2 and NOS2 expression may play a role in the pathophysiologic processes in ulcerative colitis caused by S. typhimurium. PMID:15232145

  6. Effectiveness of acupuncture, special dressings and simple, low-adherence dressings for healing venous leg ulcers in primary healthcare: study protocol for a cluster-randomized open-labeled trial

    PubMed Central

    Vas, Jorge; Modesto, Manuela; Mendez, Camila; Perea-Milla, Emilio; Aguilar, Inmaculada; Carrasco-Lozano, Jesus Manuel; Faus, Vicente; Martos, Francisco

    2008-01-01

    Background Venous leg ulcers constitute a chronic recurring complaint that affects 1.0–1.3% of the adult population at some time in life, and which corresponds to approximately 75% of all chronic ulcers of the leg. Multilayer compression bandaging is, at present, the only treatment that has been proved to be effective in treating this type of ulcer. There is no consensus, however, about the dressings that may be applied, beneath the compression, to promote the healing of this type of ulcer, as there does not seem to be any added benefit from using special dressings rather than simple, low-adherence ones. As well as analgesia, acupuncture provokes peripheral vasodilation, in skin and muscles – which has been demonstrated both experimentally and in clinical practice – probably due to the axon reflex, among other mechanisms. The aim of the present study is to measure the effectiveness and cost of compression treatment for venous leg ulcers combined with special dressings, in comparison with low-adherence ones and acupuncture. Methods/design Cluster-randomized open-labeled trial, at 15 primary healthcare clinics in the Sevilla-Sur Healthcare District, with a control group treated with compression bandaging and low-adherence dressings; the experiment will consist, on the one hand, of the compression treatment applied in combination with special dressings (Treatment 1), and on the other, the compression treatment applied in association with low-adherence dressings, together with acupuncture (Treatment 2). Discussion The results will be measured and recorded in terms of the median time elapsed until complete healing of the ulcer, and the rate of complete healing at 3 months after beginning the treatment. An economic analysis will also be made. This study, carried out in the context of real clinical practice, will provide information for decision-taking concerning the effectiveness of special dressings. Moreover, for the first time a high-quality study will evaluate the effectiveness of acupuncture in the process of healing venous leg ulcers. Trial registration Current Controlled Trials ISRCTN26438275. PMID:18547419

  7. Right leg muscle atrophy and osteopenia caused by renal adenocarcinoma in a cockatiel (Melopsittacus, undulatus).

    PubMed

    Freeman, K P; Hahn, K A; Jones, M P; Toal, R L

    1999-01-01

    A 7-year-old cockatiel presented with a 1 week history of right leg lameness. A renal adenocarcinoma invading and constricting the right ischiatic nerve resulted in disuse atrophy of the affected leg and radiographic evidence of osteopenia. This report illustrates the natural behavior, radiographic, and pathologic appearance of malignant renal tumors in birds. PMID:10225525

  8. Abstract Transfemoral amputees modify their gait in order to compensate for their prosthetic leg. This compensation causes

    E-print Network

    Simon, Dan

    on their prosthesis side [8]. The goal of prosthetics is to mimic the function of human limbs; therefore, the lessAbstract Transfemoral amputees modify their gait in order to compensate for their prosthetic leg. This compensation causes harmful secondary physical conditions due to an over- dependence on the intact limb

  9. Venous ulcers - self-care

    MedlinePLUS

    ... venous ulcers occur on the leg, above the ankle. This type of wound can be slow to heal. ... and legs every day: the tops and bottoms, ankles, and heels. Look ... prevent venous ulcers. If you have a wound, take these steps ...

  10. A severe case of esophageal ulcer causing a tight stricture despite long-term D-penicillamine treatment.

    PubMed

    Yapali, Suna; Turan, Ilker; Ozutemiz, Omer; Tekesin, Oktay

    2014-12-01

    D-penicillamine has long been used in the management of rheumatic diseases due to the effects on inhibition of collagen synthesis. Herein, we report a severe case of esophageal ulcer causing a tight stricture extending through the distal esophagus despite the long-term D-penicillamine treatment in a patient with Wilson's disease. D-penicillamine would theoretically be expected to contribute to the healing of an esophageal ulcer. However, the drug failed to have a favorable outcome, which is notable and worth reporting. PMID:25234939

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

    Microsoft Academic Search

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

    2003-01-01

    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

  12. Trunk orientation causes asymmetries in leg function in small bird terrestrial locomotion.

    PubMed

    Andrada, Emanuel; Rode, Christian; Sutedja, Yefta; Nyakatura, John A; Blickhan, Reinhard

    2014-12-22

    In contrast to the upright trunk in humans, trunk orientation in most birds is almost horizontal (pronograde). It is conceivable that the orientation of the heavy trunk strongly influences the dynamics of bipedal terrestrial locomotion. Here, we analyse for the first time the effects of a pronograde trunk orientation on leg function and stability during bipedal locomotion. For this, we first inferred the leg function and trunk control strategy applied by a generalized small bird during terrestrial locomotion by analysing synchronously recorded kinematic (three-dimensional X-ray videography) and kinetic (three-dimensional force measurement) quail locomotion data. Then, by simulating quail gaits using a simplistic bioinspired numerical model which made use of parameters obtained in in vivo experiments with real quail, we show that the observed asymmetric leg function (left-skewed ground reaction force and longer leg at touchdown than at lift-off) is necessary for pronograde steady-state locomotion. In addition, steady-state locomotion becomes stable for specific morphological parameters. For quail-like parameters, the most common stable solution is grounded running, a gait preferred by quail and most of the other small birds. We hypothesize that stability of bipedal locomotion is a functional demand that, depending on trunk orientation and centre of mass location, constrains basic hind limb morphology and function, such as leg length, leg stiffness and leg damping. PMID:25377449

  13. Lumbar spine stenosis: a common cause of back and leg pain.

    PubMed

    Alvarez, J A; Hardy, R H

    1998-04-15

    Lumbar spine stenosis most commonly affects the middle-aged and elderly population. Entrapment of the cauda equina roots by hypertrophy of the osseous and soft tissue structures surrounding the lumbar spinal canal is often associated with incapacitating pain in the back and lower extremities, difficulty ambulating, leg paresthesias and weakness and, in severe cases, bowel or bladder disturbances. The characteristic syndrome associated with lumbar stenosis is termed neurogenic intermittent claudication. This condition must be differentiated from true claudication, which is caused by atherosclerosis of the pelvofemoral vessels. Although many conditions may be associated with lumbar canal stenosis, most cases are idiopathic. Imaging of the lumbar spine performed with computed tomography or magnetic resonance imaging often demonstrates narrowing of the lumbar canal with compression of the cauda equina nerve roots by thickened posterior vertebral elements, facet joints, marginal osteophytes or soft tissue structures such as the ligamentum flavum or herniated discs. Treatment for symptomatic lumbar stenosis is usually surgical decompression. Medical treatment alternatives, such as bed rest, pain management and physical therapy, should be reserved for use in debilitated patients or patients whose surgical risk is prohibitive as a result of concomitant medical conditions. PMID:9575322

  14. 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.

    PubMed

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

    2012-08-01

    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

  15. Short Communication Caustic Ulcers Caused by Cement Aqua: Report of a Case

    E-print Network

    Alena Machovcova

    2008-01-01

    Abstract: Chromium is widely used in various industries including construction sector. Skin contact with cement has been associated with allergic or irritant contact dermatitis. Contact dermatitis is one of the most frequently reported health problems among construction workers. Irritant contact dermatitis from cement ranges from cement burns to cumulative irritant contact dermatitis. Cement burns are rarely reported and are considered a severe form of acute irritant contact dermatitis. They are associated with amateur user working in a short ready-mix timeframe with poor protective measures. They usually result in significant morbidity and initially are associated with minimal discomfort. We report a typical case. Key words: Caustic ulcers, Cement aqua, Occupational injury Cement is the leading cause of occupational skin disease in the construction industry 1) , mostly due to contact allergy. Cement burns were previously reported, mostly 20 yr ago 2–8). We report another case. A 48-yr-old man presented to our department with necrotic lesions on feet, ankles and shanks. Five days

  16. [Group B streptococcus meningitis and infection surrounding the spinal canal caused by bacterial transmission from rectal ulcer via Batson's plexus].

    PubMed

    Tsutsumi, Ryosuke; Saito, Masaaki; Yoshizawa, Toshihiro

    2011-07-01

    A 62-year-old man was admitted to our hospital because of fever and disturbed consciousness. He suffered from persistent constipation due to diabetic autonomic neuropathy. On admission, neck stiffness and weakness of the lower extremities were observed. Cerebrospinal fluid (CSF) pleocytosis and decreased CSF glucose concentration showed the presence of meningitis. Bacterial culture of CSF was negative. One week after admission, he suddenly suffered from massive bleeding from the rectum, where a hemorrhagic ulcer caused by severe persistent constipation was observed. Contrast-enhanced CT scans and gadolinium-enhanced MR scans demonstrated a lumbar spinal epidural abscess, paraspinal muscle abscess, and cervical osteomyelitis. Streptococcus agalactiae, a bacterial species belonging to the group B streptococci, was isolated from pus obtained by needle puncture of the paraspinal muscle abscess. His entire condition was treated successfully with ampicillin and cefotaxime. Group B streptococci normally colonize the mucous membrane of the genital or lower gastrointestinal regions and rarely cause a spinal epidural abscess. However, in this case, the existence of a rectal ulcer probably made it possible for S. agalactiae to cause an infection of the epidural space or paraspinal muscles via the spinal valveless venous system named Batson's plexus communicating with the sacral, pelvic, and prostatic venous plexus. Our case indicated the importance of Batson's plexus in group B streptococcus infections surrounding the spinal canal and the necessity to explore for intrapelvic lesions including a rectal ulcer. PMID:21823509

  17. Peptic ulcer

    MedlinePLUS

    ... duodenal; Ulcer - gastric; Duodenal ulcer; Gastric ulcer; Dyspepsia - ulcers ... and small intestines can protect itself against strong stomach ... ( gastritis ) An ulcer Most ulcers occur in the first layer of ...

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

    PubMed Central

    Veldhuyzen van Zanten, S J; Sherman, P M

    1994-01-01

    OBJECTIVE: To evaluate current evidence for a causal relation between Helicobacter pylori infection and gastritis, duodenal ulcer, gastric cancer and nonulcer dyspepsia. DATA SOURCES: A MEDLINE search for articles published in English between January 1983 and December 1992 with the use of MeSH terms Helicobacter pylori, gastritis, duodenal ulcer, gastric cancer, dyspepsia and clinical trial; abstracts were excluded. Six journals and Current Contents were searched manually for pertinent articles published in that time frame. STUDY SELECTION: Original studies with at least 25 patients, case reports and reviews that examined the relation between H. pylori and the four gastrointestinal disorders; 350 articles were on gastritis, 122 on duodenal ulcer, 44 on gastric cancer and 96 on nonulcer dyspepsia. DATA EXTRACTION: The quality of the studies was rated independently on a four-point scale. The strength of the evidence was assessed using a six-point scale for each of the eight established guidelines for determining a causal relation. DATA SYNTHESIS: There was conclusive evidence of a causal relation between H. pylori infection and histologic gastritis. Koch's postulates for the identification of a microorganism as the causative agent of a disease were fulfilled for H. pylori as a causative agent of gastritis. There was strong evidence that H. pylori is the main cause of duodenal ulcers not induced by nonsteroidal anti-inflammatory drugs, but all of Koch's postulates were not fulfilled. There was moderate epidemiologic evidence of an association between chronic H. pylori infection and gastric cancer. There was a lack of convincing evidence of a causal association between H. pylori and nonulcer dyspepsia. CONCLUSIONS: The evidence supports a strong causal relation between H. pylori infection and gastritis and duodenal ulcer and a moderate relation between such infection and gastric cancer. Further studies are needed to clarify the role of H. pylori in these disorders. Thus far, there is no evidence of a causal relation between H. pylori and nonulcer dyspepsia. PMID:8287340

  19. JAMA Patient Page: Diabetic Foot Ulcers

    MedlinePLUS

    ... American Medical Association JAMA PATIENT PAGE Diabetic Foot Ulcers D iabetic foot ulcers are sores or wounds on the feet that ... preventing diabetic foot ulcers. WHAT CAUSES DIABETIC FOOT ULCERS? FOR MORE INFORMATION • National Diabetes Information Clearinghouse 1- ...

  20. [A Dutchman from Mali with a perianal ulcer caused by cutaneous amoebiasis].

    PubMed

    Kroft, E B M; Warris, A; Jansen, L E; van Crevel, R

    2005-02-01

    A 66-year-old Dutchman, living in Mali, presented with an extensive progressive perianal ulcer despite local and antibiotic treatment. Microscopic examination of the stool revealed Entamoeba histolytica/dispar cysts and phagocytosing trophozoites were seen in fresh scrapings of the ulcer, a diagnostic feature of infection with E. histolytica. The diagnosis was cutaneous amoebiasis and the patient was effectively treated with metronidazole and local debridements. Primary cutaneous amoebiasis is a rare disease. Diagnosis and treatment are relatively simple but lack of familiarity with the disease may lead to misdiagnosis or diagnosis at a late stage ofthe infection. PMID:15730040

  1. Diagnosing oral ulcers.

    PubMed

    Bruce, Alison J; Dabade, Tushar S; Burkemper, Nicole M

    2015-02-01

    Oral ulcers are common and can have many causes, making diagnosis challenging. This article provides an overview of common oral ulcers and an algorithmic approach to establishing the correct diagnosis. Factors such as duration, pattern of recurrence, clinical appearance, mucosal location, and presence or absence of systemic symptoms are useful clues to determining an ulcer's cause. PMID:25621959

  2. Efficacy of Daflon 500 mg in Venous Leg Ulcer Healing: A Double-Blind, Randomized, Controlled Versus Placebo Trial in 107 Patients

    Microsoft Academic Search

    Jean-Jacques Guilhou; Olivier Dereure; Loïc Marzin; Pierre Ouvry; François Zuccarelli; Clélia Debure; Hervé Van Landuyt; Marie-Noëlle Gillet-Terver; Bernard Guillot; Hervé Levesque; Jean Mignot; Gérard Pillion; Benoit Février; Dominique Dubeaux

    1997-01-01

    The objective of this study was to evaluate the efficacy of Daflon® 500 mg (Dios)* in venous ulcers. A multicenter, double-blind, randomized, controlled versus placebo (Plac) trial was conducted, with stratification according to the size of ulcer (? 10 cm and > 10 cm). The protocol called for a two-month treatment with Dios (one tablet = 450 mg micronized purified

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

    PubMed Central

    Mercer, James B.; Nielsen, Stig Pors; Hoffmann, Gerd

    2008-01-01

    Background: Water-filtered infrared-A (wIRA) is a special form of heat radiation with a high tissue-penetration and with a low thermal burden to the surface of the skin. wIRA is able to improve essential and energetically meaningful factors of wound healing by thermal and non-thermal effects. Aim of the study: prospective study (primarily planned randomised, controlled, blinded, de facto with one exception only one cohort possible) using wIRA in the treatment of patients with recalcitrant chronic venous stasis ulcers of the lower legs with thermographic follow-up. Methods: 10 patients (5 males, 5 females, median age 62 years) with 11 recalcitrant chronic venous stasis ulcers of the lower legs were treated with water-filtered infrared-A and visible light irradiation (wIRA(+VIS), Hydrosun® radiator type 501, 10 mm water cuvette, water-filtered spectrum 550–1400 nm) or visible light irradiation (VIS; only possible in one patient). The uncovered wounds of the patients were irradiated two to five times per week for 30 minutes at a standard distance of 25 cm (approximately 140 mW/cm2 wIRA and approximately 45 mW/cm2 VIS). Treatment continued for a period of up to 2 months (typically until closure or nearly closure of the ulcer). The main variable of interest was “percent change of ulcer size over time” including complete wound closure. Additional variables of interest were thermographic image analysis, patient’s feeling of pain in the wound, amount of pain medication, assessment of the effect of the irradiation (by patient and by clinical investigator), assessment of feeling of the wound area (by patient), assessment of wound healing (by clinical investigator) and assessment of the cosmetic state (by patient and by clinical investigator). For these assessments visual analogue scales (VAS) were used. Results: The study showed a complete or nearly complete healing of lower leg ulcers in 7 patients and a clear reduction of ulcer size in another 2 of 10 patients, a clear reduction of pain and pain medication consumption (e.g. from 15 to 0 pain tablets per day), and a normalization of the thermographic image (before the beginning of the therapy typically hyperthermic rim of the ulcer with relative hypothermic ulcer base, up to 4.5°C temperature difference). In one patient the therapy of an ulcer of one leg was performed with the fully active radiator (wIRA(+VIS)), while the therapy of an ulcer of the other leg was made with a control group radiator (only VIS without wIRA), showing a clear difference in favour of the wIRA treatment. All mentioned VAS ratings improved remarkably during the period of irradiation treatment, representing an increased quality of life. Failures of complete or nearly complete wound healing were seen only in patients with arterial insufficiency, in smokers or in patients who did not have venous compression garment therapy. Discussion and conclusions: wIRA can alleviate pain considerably (with an impressive decrease of the consumption of analgesics) and accelerate wound healing or improve a stagnating wound healing process and diminish an elevated wound exudation and inflammation both in acute and in chronic wounds (in this study shown in chronic venous stasis ulcers of the lower legs) and in problem wounds including infected wounds. In chronic recalcitrant wounds complete healing is achieved, which was not reached before. Other studies have shown that even without a disturbance of wound healing an acute wound healing process can be improved (e.g. reduced pain) by wIRA. wIRA is a contact-free, easily used and pleasantly felt procedure without consumption of material with a good penetration effect, which is similar to solar heat radiation on the surface of the earth in moderate climatic zones. Wound healing and infection defence (e.g. granulocyte function including antibacterial oxygen radical formation of the granulocytes) are critically dependent on a sufficient energy supply (and on sufficient oxygen). The good clinical effect of wIRA on wounds and also on problem woun

  4. Penetrating atherosclerotic aortic ulcer rupture causing a right hemothorax; a rare presentation of acute aortic syndrome.

    PubMed

    Siegel, Yoel

    2013-04-01

    Acute aortic syndrome is a spectrum of diseases that have similar presentation and clinical background and include aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer. Presented here is an 82-year-old woman with a medical history of diabetes, hypertension, nephrectomy, and chronic renal failure who complained of sudden abdominal pain radiating to epigastrium and back. At presentation, the patient was hemodynamically stable with a hemoglobin level of 10.2 and white blood cell count of 12. Chest x-ray showed a right pleural effusion and lung opacity with interstitial pulmonary edema. Computed tomography demonstrated an aortic penetrating atherosclerotic ulcer that ruptured into the right pleural space resulting in right hemothorax. A percutaneous endostent was placed with subsequent discharge of the patient 10 days after admission. PMID:23399335

  5. Muscle hypertrophy of the lower leg caused by L5 radiculopathy.

    PubMed

    Kottlors, Michael; Mueller, Klaus; Kirschner, Janbernd; Glocker, Franz Xaver

    2009-10-01

    We report on a case with hypertrophy of the tibial muscles and to a lesser extent of the calf muscles preceded by a lumbar syndrome and sciatica. Lumbar myelography disclosed a discogenic compression of the L5 nerve root. Muscle biopsy of the peroneal muscles showed a marked type I fibre predominance and hypertrophy but no inflammatory infiltration. We consider the possibility that radiculopathy not only of the S1 nerve root but also of the L5 root can trigger hypertrophy of the musculature and must be taken into account of the differential diagnosis of unilateral focal hypertrophy of the lower leg. PMID:19523866

  6. Gastrointestinal symptoms resembling ulcerative proctitis caused by larvae of the drone fly Eristalis tenax.

    PubMed

    Desoubeaux, Guillaume; Gaillard, Julien; Borée-Moreau, Diane; Bailly, Éric; Andres, Christian R; Chandenier, Jacques

    2014-04-01

    We report a case of facultative intestinal myiasis due to larvae of the drone fly Eristalis tenax, also named the rat-tailed maggots. The development of larvae in the lower bowel was responsible for non-specific gastrointestinal symptoms that resembled ulcerative proctitis. The diagnosis was established upon the observation of four spontaneously excreted mobile larvae. The definite identification of the E. tenax species was made possible by scanning electron microscopy. The clinical outcome was satisfactory. PMID:24766340

  7. Gastrointestinal symptoms resembling ulcerative proctitis caused by larvae of the drone fly Eristalis tenax

    PubMed Central

    Desoubeaux, Guillaume; Gaillard, Julien; Borée-Moreau, Diane; Bailly, Éric; Andres, Christian R; Chandenier, Jacques

    2014-01-01

    We report a case of facultative intestinal myiasis due to larvae of the drone fly Eristalis tenax, also named the rat-tailed maggots. The development of larvae in the lower bowel was responsible for non-specific gastrointestinal symptoms that resembled ulcerative proctitis. The diagnosis was established upon the observation of four spontaneously excreted mobile larvae. The definite identification of the E. tenax species was made possible by scanning electron microscopy. The clinical outcome was satisfactory. PMID:24766340

  8. Spontaneous Gastric Ulcer Perforation and Acute Spleen Infarction Caused by Invasive Gastric and Splenic Mucormycosis

    PubMed Central

    Enani, Mushira Abdulaziz; Alharthi, Bandar N; Dewanjee, Nancy; Bhat, Nadeem A; Fagih, Mosa

    2014-01-01

    Mucormycosis is a rare life-threatening fungal infection mostly affecting immunocompromised hosts. The main categories of human disease with the Mucorales are sinusitis/rhinocerebral, pulmonary, cutaneous/subcutaneous, gastrointestinal and disseminated disease. Other disease states occur with a much lower frequency and include cystitis, vaginitis; external otitis and allergic disease. We report a diabetic patient with comorbidities, who developed gastric perforation clinically indistinguishable from perforated peptic ulcer due to invasive gastric mucormycosis complicated by spleen infarction. PMID:25191054

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

    USGS Publications Warehouse

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

    2010-01-01

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

  10. Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): randomised controlled trial

    Microsoft Academic Search

    Manjit S Gohel; Jamie R Barwell; Maxine Taylor; Terry Chant; Chris Foy; Jonothan J Earnshaw; Brian P Heather; David C Mitchell; Mark R Whyman; Keith R Poskitt

    2007-01-01

    Objective To determine whether recurrence of leg ulcers may be prevented by surgical correction of superficial venous reflux in addition to compression. Design Randomised controlled trial. Setting Specialist nurse led leg ulcer clinics in three UK vascular centres. Participants 500 patients (500 legs) with open or recently healed leg ulcers and superficial venous reflux. Interventions Compression alone or compression plus

  11. Reduced arterial circulation to the legs in spinal cord injury as a cause of skin breakdown lesions.

    PubMed

    Deitrick, George; Charalel, Joseph; Bauman, William; Tuckman, John

    2007-01-01

    Skin breakdown lesions (SBLs) of the legs are common in spinal cord injury (SCI). It is assumed that the cause is deficient sensitivity and immobility of the limbs, which result in areas subjected to prolonged pressures. However, poor circulation may also be a significant factor. Indeed, strong reasons suggest that small vessel circulation is decreased in SCI because these patients have increased arteriosclerotic risk factors. Patients in the SCI population have advanced age, are sedentary, often have abnormal carbohydrate and lipid metabolism, and many use tobacco products. Total blood flow (TBF) to the legs and skin blood flows (SBFs) to 4 areas of the feet were measured simultaneously by duplex Doppler sonography and laser Doppler flowmetry in 10 healthy control and 10 chronic subjects with SCI when supine and during 30 minutes in a wheelchair. The average supine control TBF was 540 mL/minute, but greatly reduced between 24-76 mL/minute in 4 of the subjects. During sitting, the average TBF fell by 41% in the controls and increased by 6% in SCI. Nonetheless, in all control and SCI subjects the average sitting SBFs were severely decreased in all areas between 53-75%, similar to results found by others elsewhere in the foreleg. Ischemia of the skin and underlying muscles is important as a cause for the poor healing of SBLs in persons with SCI who daily spend many hours in a wheelchair. PMID:17495266

  12. Neuroleptics as a cause of painful legs and moving toes syndrome.

    PubMed

    Azzi, Jacques; Atweh, Samir; Saade, Nayef; Jabbour, Rosette

    2014-01-01

    Painful legs and moving toes syndrome is rare. It is predominantly diagnosed in middle-aged adults following a history of spinal cord surgery or trauma. The syndrome consists of abnormal repetitive movements, most commonly in the lower extremities, accompanied by pain in the affected limb. Pain usually precedes the movements. We report a case in a young patient that we believe was induced by the intake of a low-potency neuroleptic, which was prescribed to him for anxiety. The patient was treated with carbamazepine with mild relief of pain and later on with botulinum injection, which significantly reduced the movements and mildly improved the pain. After stopping the treatment, the beneficial effect lasted for about 3 months after which his condition gradually returned to its initial state. PMID:25535220

  13. Acute Hemorrhagic Rectal Ulcer: An Important Cause of Lower Gastrointestinal Bleeding in the Critically Ill Patients

    Microsoft Academic Search

    Cheng-Kuan Lin; Cheng-Chao Liang; Hou-Tai Chang; Fang-Ming Hung; Tzong-Hsi Lee

    Background and Aim  The occurrence of acute hemorrhagic rectal ulcer (AHRU) in patients in the intensive care unit (ICU) has not been well investigated.\\u000a The aims of this study were to evaluate the clinical manifestations and outcomes in these patients.\\u000a \\u000a \\u000a \\u000a \\u000a Method  The patients developing significant acute lower gastrointestinal (LGI) bleeding after ICU admission from July 2002 to December\\u000a 2007 were retrospectively reviewed.

  14. Oral Mucosal Ulceration Caused by the Topical Application of a Concentrated Propolis Extract

    PubMed Central

    Wimardhani, Yuniardini Septorini

    2014-01-01

    Propolis is a resinous mixture that is collected by honey bees from tree buds, sap flow, and other botanical sources. Propolis has been extensively used in medicine, dentistry, and cosmetics; however, unwanted effects have been reported. This paper reports a case of oral mucosal burn in a 50-year-old patient, who used an overnight application of concentrated propolis to overcome a throbbing pain in the right upper posterior mucosa. The patient was otherwise healthy and was not receiving any medication. She presented with painful shallow multiple irregular ulcers measuring 0.3–1?cm in diameter that were located on the right buccal mucosa and hard palate mucosa, in addition to the gingival mucosa surrounding tooth 17. Propolis-induced oral mucosal burn was diagnosed. The ulcer cleared after the prescription of tetracycline mouthwash, accompanied with Doloneurobion. The patient was further treated with carbamazepine to address the persistent throbbing pain in the affected area, which was suspected to be trigeminal neuralgia. This report provides another alert to clinicians about the potential adverse effects of propolis use for the treatment of oral diseases, despite its natural origin. PMID:25276439

  15. The magnitude of intramuscular deoxygenation during exercise is an unreliable measure to diagnose the cause of leg pain.

    PubMed

    Zhang, Q; Rennerfelt, K; Styf, J

    2012-10-01

    We measured intramuscular oxygenation in the anterior tibial muscle of 176 patients with exercise-induced leg pain by noninvasive near-infrared spectroscopy before, during, and after an exercise test that elicited the symptoms. Clinical investigation was performed after each test. Intramuscular pressure was measured in patients with nonconclusive findings. Chronic anterior compartment syndrome (CACS) was diagnosed in 47 patients, and other causes for the leg pain were diagnosed in 129 patients by clinical means. The mean level of oxygenation decreased to 33?±?19% in patients with CACS and to 34?±?19% in patients without CACS compared with baseline level (100%) at rest before exercise. The level of oxygenation was below 20% during the exercise test in 12 of 47 (26%) patients with CACS and in 30 of 129 (23%) patients without CACS. The time required for reoxygenation after the cessation of exercise was 61?±?34?s in patients with CACS and 46?±?20?s in patients without CACS (P?

  16. Leg Injuries and Disorders

    MedlinePLUS

    ... affect the entire leg, or just the foot, ankle, knee, or hip. Certain diseases also lead to leg problems. For example, knee osteoarthritis, common in older people, can cause pain and limited motion. Problems in your veins in your legs can lead to varicose veins or deep vein thrombosis.

  17. A dynamic compression system for improving ulcer healing: Design of a sensing garment

    Microsoft Academic Search

    M. Hegarty; E. Grant; L. Reid; T. Henderson

    2008-01-01

    Venous leg ulcers remain a major problem in the United States, with spending reaching upwards of $1 billion annually. Current treatment options center around the use of compression therapy, which is often delivered in the form of compression bandages, medical-grade stockings, or pneumatic devices. These technologies suffer from a lack of adaptability and\\/or portability, which may cause inefficient healing. A

  18. Person Number leg1 leg2 leg3 leg4

    E-print Network

    Bergstein, Paul

    Real_Num Occupation ssn Num Univ-employee Grad TA Prof CoachUndergrad Admin asst Student salarygpa#12;#12;Leg color owner Ident Person Number ssn Table leg1 leg2 leg3 leg4 Owner Person Company:Leg l3:Leg l4:Leg color owner i1:Ident p1:Person n1:Number ssn #12;#12;Basket OneOrMore Several

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

    PubMed

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

    1999-04-01

    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

  20. Bilateral idiopathic calf muscle hypertrophy: An exceptional cause of unsightly leg curvature.

    PubMed

    Herlin, C; Chaput, B; Rivier, F; Doucet, J C; Bigorre, M; Captier, G

    2015-04-01

    The authors present the management of a young female patient who presented with longstanding bilateral calf muscle hypertrophy, with no known cause. Taking into account the patient's wishes and the fact that the hypertrophy was mainly located in the posteromedial compartment, we chose to carry out a subtotal bilateral resection of medial gastrocnemius muscles. This procedure was performed with an harmonic scalpel, permitting a excellent cosmetic result while avoiding complications or functional impairment. After a reviewing of the commonly used techniques, the authors discuss the chosen surgical approach taking into account its clinical particularity. PMID:25236976

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

    SciTech Connect

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

    1987-03-01

    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)

  2. Cryptogenia multifocal ulcerous stenosing enteritis: an entity on its own as a cause of abdominal pain, iron deficiency anemia and protein-losing enteropathy.

    PubMed

    Guisado Vasco, P; Fraile Rodríguez, G

    2014-01-01

    We studied a patient with edema secondary to protein losing enteropathy, and recurrent bouts of bloating and abdominal pain secondary to intestinal subocclusion episodes. After the clinical study, the patient was diagnosed of cryptogenic multifocal ulcerous stenosing enteritis (CMUSE), that is a rare disease, probably caused by mutations in the gene PLA2G4A, and characterized by multiple short stenosis of the small bowel with superficial ulcers, which do not exceed the submucosa layer. Inflammatory bowel disease (Chron's disease), intestinal tuberculosis and intestinal ulcers secondary to non-steroidal anti-inflammatory drugs are the main differential diagnosis. To sum up, physicians should included CMUSE in the differential diagnosis of recurrent abdominal pain, iron deficiency anaemia, occult intestinal bleeding, edema and protein losing enteropathy. PMID:24035666

  3. First report of myiasis caused by Cochliomyia hominivorax (Diptera: Calliphoridae) in a diabetic foot ulcer patient in Argentina.

    PubMed

    Olea, María Sofía; Centeno, Néstor; Aybar, Cecilia Adriana Veggiani; Ortega, Eugenia Silvana; Galante, Guillermina Begoña; Olea, Luis; Juri, María Julia Dantur

    2014-02-01

    Myiasis is usually caused by flies of the Calliphoridae family, and Cochliomyia hominivorax is the etiological agent most frequently found in myiasis. The first case of myiasis in a diabetic foot of a 54-year-old male patient in Argentina is reported. The patient attended the hospital of the capital city of Tucumán Province for a consultation concerning an ulcer in his right foot, where the larval specimens were found. The identification of the immature larvae was based on their morphological characters, such as the cylindrical, segmented, white yellow-coloured body and tracheas with strong pigmentation. The larvae were removed, and the patient was treated with antibiotics. The larvae were reared until the adults were obtained. The adults were identified by the setose basal vein in the upper surface of the wing, denuded lower surface of the wing, short and reduced palps, and parafrontalia with black hairs outside the front row of setae. The main factor that favoured the development of myiasis is due to diabetes, which caused a loss of sensibility in the limb that resulted in late consultation. Moreover, the poor personal hygiene attracted the flies, and the foul-smelling discharge from the wound favoured the female's oviposition. There is a need to implement a program for prevention of myiasis, in which the population is made aware not only of the importance of good personal hygiene and home sanitation but also of the degree of implication of flies in the occurrence and development of this disease. PMID:24623889

  4. First Report of Myiasis Caused by Cochliomyia hominivorax (Diptera: Calliphoridae) in a Diabetic Foot Ulcer Patient in Argentina

    PubMed Central

    Olea, María Sofía; Centeno, Néstor; Aybar, Cecilia Adriana Veggiani; Ortega, Eugenia Silvana; Galante, Guillermina Begoña; Olea, Luis

    2014-01-01

    Myiasis is usually caused by flies of the Calliphoridae family, and Cochliomyia hominivorax is the etiological agent most frequently found in myiasis. The first case of myiasis in a diabetic foot of a 54-year-old male patient in Argentina is reported. The patient attended the hospital of the capital city of Tucumán Province for a consultation concerning an ulcer in his right foot, where the larval specimens were found. The identification of the immature larvae was based on their morphological characters, such as the cylindrical, segmented, white yellow-coloured body and tracheas with strong pigmentation. The larvae were removed, and the patient was treated with antibiotics. The larvae were reared until the adults were obtained. The adults were identified by the setose basal vein in the upper surface of the wing, denuded lower surface of the wing, short and reduced palps, and parafrontalia with black hairs outside the front row of setae. The main factor that favoured the development of myiasis is due to diabetes, which caused a loss of sensibility in the limb that resulted in late consultation. Moreover, the poor personal hygiene attracted the flies, and the foul-smelling discharge from the wound favoured the female's oviposition. There is a need to implement a program for prevention of myiasis, in which the population is made aware not only of the importance of good personal hygiene and home sanitation but also of the degree of implication of flies in the occurrence and development of this disease. PMID:24623889

  5. Ulcerative Colitis

    MedlinePLUS

    ... Disease Organizations?? (PDF, 341 KB)????? Alternate Language URL Ulcerative Colitis Page Content DUE TO UNFORESEEN CIRCUMSTANCES, PUBLICATION ORDERS ... Research References For More Information Acknowledgments What is ulcerative colitis? Ulcerative colitis is a chronic, or long lasting, ...

  6. Corneal Ulcer

    MedlinePLUS

    ... Health News Consumer Alerts What Is a Corneal Ulcer? Tweet A corneal ulcer is an open sore on the cornea — the ... covers the face of a watch. A corneal ulcer usually results from an eye infection, though it ...

  7. Durability of healing from spray-applied cell therapy with human allogeneic fibroblasts and keratinocytes for the treatment of chronic venous leg ulcers: a 6-month follow-up.

    PubMed

    Kirsner, Robert S; Marston, William A; Snyder, Robert J; Lee, Tommy D; Cargill, D Innes; Zhang, Yuxin; Dickerson, Jaime E; Slade, Herbert B

    2013-01-01

    Patients who participated in a Phase 2 trial of HP802-247 for venous leg ulcers were invited to participate in this 24-week follow-up study to assess the durability of healing, document additional ulcer closures, and evaluate posttreatment safety. Consent was given by 90% (206/228), with 80% (183/228) completing all visits. Blinding was retained from the previous trial in which subjects had been randomized to vehicle or one of four cell therapy regimens. Visits were every 8 weeks. Among the 183 subjects, 43% (21/49) previously treated with cells and entering follow-up with an open wound achieved closure, compared with 35% (7/20) previously treated with vehicle, while 10% (11/106) and 17% (3/18), respectively, experienced reopening of a previously closed wound. Subjects previously treated with cells closed more open wounds than those previously treated with vehicle (OR 1.39, 95% CI 0.47-4.10; p = 0.739), and less subjects with a previously closed wound reopened (OR 0.65, CI 0.16-2.60; p = 0.821); however, these findings were not statistically significant. At the final visit, the difference in proportion of subjects with wounds closed continued to favor the best dose from the prior trial (83% closed vs. 58%, delta 25%). Follow-up beyond 12 weeks is necessary to evaluate the full benefit of this therapy, as treatment with cells may provide stimulus toward healing that persists for up to several weeks following the last application. The results show that the greater proportional benefit achieved by HP802-247 relative to standard care after 12 weeks of treatment persists over a meaningful timeframe. PMID:23927847

  8. Effect of psychotropic drugs on gastric ulcers induced by immobilization: Increased protective effect of amitriptyline caused by chlordiazepoxide

    NASA Technical Reports Server (NTRS)

    Blum, J. E.; Huerlimann, A.

    1980-01-01

    Amitriptyline, but not chlordiazepoxide, protects rats from the occurrence of gastric erosions and ulcers following immobilization. When, however, chlordiazepoxide is given together with amitriptyline the protective effect of the latter is markedly increased.

  9. Endocrinopathies and peptic ulcer

    Microsoft Academic Search

    Seymour J. Gray

    1964-01-01

    T HERF. IS PROBABI.Y no single cause of peptic ulcer, nor a single defense against it. Peptic ulcer is more than a localized lesion in the stomach or duodenum. It is the end result of a complex and dynamic interplay between the neurogenic, humoral, and other influences which encourage tdceration and the defenses of the gastric mucosa. Indeed, under conditions

  10. Ulcerative Colitis

    NSDL National Science Digital Library

    Patient Education Institute

    This patient education program discusses ulcerative colitis and explains the anatomy of the digestive system, causes, symptoms, diagnosis, and treatment options for this disease. This resource is a MedlinePlus Interactive Health Tutorial from the National Library of Medicine, designed and developed by the Patient Education Institute. NOTE: This tutorial requires a special Flash plug-in, version 4 or above. If you do not have Flash, you will be prompted to obtain a free download of the software before you start the tutorial. You will also need an Acrobat Reader, available as a free download, in order to view the Reference Summary.

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

    PubMed

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

    2011-01-01

    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

  12. Diagnostic Performance of Filter Paper Lesion Impression PCR for Secondarily Infected Ulcers and Nonulcerative Lesions Caused by Cutaneous Leishmaniasis?

    PubMed Central

    Boggild, Andrea K.; Ramos, Ana Pilar; Valencia, Braulio Mark; Veland, Nicolas; Calderon, Flor; Arevalo, Jorge; Low, Donald E.; Llanos-Cuentas, Alejandro

    2011-01-01

    We compared traditional cutaneous leishmaniasis diagnostic methods to filter paper lesion impression (FPLI) PCR for secondarily infected ulcers and nonulcerative lesions. The sensitivity and specificity of FPLI PCR for secondarily infected lesions (n = 8) were 100%. In primarily nonulcerative lesions (n = 15), the sensitivity of FPLI PCR was inferior to that of pooled-invasive-specimen PCR (72.7% versus 100%) (P = 0.10). FPLI PCR is sensitive, specific, and unlike invasive procedures, can be used in secondarily infected ulcers. Invasive specimen collection is superior in nonulcerative lesions. PMID:21177908

  13. Peptic ulcer disease - discharge

    MedlinePLUS

    ... better manage stress. Avoid drugs such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn). Take acetaminophen ( ... choices if your ulcer was caused by aspirin, ibuprofen, or other NSAIDs. You may be able to ...

  14. A randomised controlled 8-week crossover clinical evaluation of the 3M Coban 2 Layer Compression System versus Profore to evaluate the product performance in patients with venous leg ulcers.

    PubMed

    Moffatt, Christine J; Edwards, Lynfa; Collier, Mark; Treadwell, Terry; Miller, Michael; Shafer, Laura; Sibbald, Gary; Brassard, Alain; McIntosh, Andrea; Reyzelman, Alex; Price, Patricia; Kraus, Stacia Merkel; Walters, Shelley-Ann; Harding, Keith

    2008-06-01

    This study compared a two-layer (Coban 2 Layer) and a four-layer (Profore) compression bandage system in venous leg ulcer patients. Participants (n = 81) were enrolled into an 8-week, randomised, open-label, ten-centre, crossover clinical trial. The primary endpoint was bandage slippage measured at each dressing change. Secondary endpoints included wound healing, health-related quality of life (HRQoL) and patient preference. Mean slippage estimated from a mixed analysis of variance model (697 visits) was 2.48 cm for the two-layer system and 4.17 cm for the four-layer system (P < 0.001). There were no significant differences in percent of wounds that healed (Fisher's exact test, P = 0.30), in wound area reduction (Wilcoxon rank-sum test, P = 0.88) or in linear healing rate (Wilcoxon rank-sum test, P = 0.94). The HRQoL Physical Symptoms and Daily Living scores were significantly higher with the two-layer system (pooled two-sample t-test, P < 0.05). Patients had a strong preference for the two-layer system (72%) than the four-layer system (22%), with 6% having no preference. In conclusion, the two-layer system exhibited significantly less bandage slippage than the four-layer system. While less bandage slippage did not appear to impact wound healing, there was indication that it may have influenced patient preference in favour of the two-layer system and potentially impacted patients' HRQoL. PMID:18494632

  15. Peptic Ulcer

    MedlinePLUS

    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 ...

  16. Pterygotus legs

    NSDL National Science Digital Library

    2001-03-01

    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).

  17. Capsaicin and Gastric Ulcers

    Microsoft Academic Search

    M. N. Satyanarayana

    2006-01-01

    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

  18. Connective Tissue Ulcers

    PubMed Central

    Dabiri, Ganary; Falanga, Vincent

    2013-01-01

    Connective tissue disorders (CTD), which are often also termed collagen vascular diseases, include a number of related inflammatory conditions. Some of these diseases include rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis (scleroderma), localized scleroderma (morphea variants localized to the skin), Sjogren’s syndrome, dermatomyositis, polymyositis, and mixed connective tissue disease. In addition to the systemic manifestations of these diseases, there are a number of cutaneous features that make these conditions recognizable on physical exam. Lower extremity ulcers and digital ulcers are an infrequent but disabling complication of long-standing connective tissue disease. The exact frequency with which these ulcers occur is not known, and the cause of the ulcerations is often multifactorial. Moreover, a challenging component of CTD ulcerations is that there are still no established guidelines for their diagnosis and treatment. The morbidity associated with these ulcerations and their underlying conditions is very substantial. Indeed, these less common but intractable ulcers represent a major medical and economic problem for patients, physicians and nurses, and even well organized multidisciplinary wound healing centers. PMID:23756459

  19. Pressure Ulcer Prevention

    PubMed Central

    2009-01-01

    Executive Summary In April 2008, the Medical Advisory Secretariat began an evidence-based review of the literature concerning pressure ulcers. Please visit the Medical Advisory Secretariat Web site, http://www.health.gov.on.ca/english/providers/program/mas/tech/tech_mn.html to review these titles that are currently available within the Pressure Ulcers series. Pressure ulcer prevention: an evidence based analysis The cost-effectiveness of prevention strategies for pressure ulcers in long-term care homes in Ontario: projections of the Ontario Pressure Ulcer Model (field evaluation) Management of chronic pressure ulcers: an evidence-based analysis (anticipated pubicstion date - mid-2009) Purpose A pressure ulcer, also known as a pressure sore, decubitus ulcer, or bedsore, is defined as a localized injury to the skin/and or underlying tissue occurring most often over a bony prominence and caused by pressure, shear, or friction, alone or in combination. (1) Those at risk for developing pressure ulcers include the elderly and critically ill as well as persons with neurological impairments and those who suffer conditions associated with immobility. Pressure ulcers are graded or staged with a 4-point classification system denoting severity. Stage I represents the beginnings of a pressure ulcer and stage IV, the severest grade, consists of full thickness tissue loss with exposed bone, tendon, and or muscle. (1) In a 2004 survey of Canadian health care settings, Woodbury and Houghton (2) estimated that the prevalence of pressure ulcers at a stage 1 or greater in Ontario ranged between 13.1% and 53% with nonacute health care settings having the highest prevalence rate (Table 1). Executive Summary Table 1: Prevalence of Pressure Ulcers* Setting Canadian Prevalence,% (95% CI) Ontario Prevalence,Range % (n) Acute care 25 (23.8–26.3) 23.9–29.7 (3418) Nonacute care† 30 (29.3–31.4) 30.0–53.3 (1165) Community care 15 (13.4–16.8) 13.2 (91) Mixed health care‡ 22 (20.9–23.4) 13.1–25.7 (3100) All health care settings 26 (25.2–26.8) 13.1–53.3 (7774) * CI indicates confidence interval. † Nonacute care included sub-acute care, chronic care, complex continuing care, long-term care, and nursing home care. ‡ Mixed health care includes a mixture of acute, nonacute, and/or community care health care delivery settings. Pressure ulcers have a considerable economic impact on health care systems. In Australia, the cost of treating a single stage IV ulcer has been estimated to be greater than $61,000 (AUD) (approximately $54,000 CDN), (3) while in the United Kingdom the total cost of pressure ulcers has been estimated at £1.4–£2.1 billion annually or 4% of the National Health Service expenditure. (4) Because of the high physical and economic burden of pressure ulcers, this review was undertaken to determine which interventions are effective at preventing the development of pressure ulcers in an at-risk population. Review Strategy The main objective of this systematic review is to determine the effectiveness of pressure ulcer preventive interventions including Risk Assessment, Distribution Devices, Nutritional Supplementation, Repositioning, and Incontinence Management. A comprehensive literature search was completed for each of the above 5 preventive interventions. The electronic databases searched included MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, EMBASE, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature. As well, the bibliographic references of selected studies were searched. All studies meeting explicit inclusion and exclusion criteria for each systematic review section were retained and the quality of the body of evidence was determined using the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) system. (5) Where appropriate, a meta-analysis was undertaken to determine the overall estimate of effect of the preventive intervention under review. Summary of Findings Ris

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

    PubMed

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

    1997-09-01

    Although genital ulcers are a common manifestation of Behçet's disease, bleeding from these lesions is unusual. In this report, a patient with excessive bleeding from genital ulcers is presented. A 22-year-old man with recurrent oral and genital ulcers, erythema nodosum, folliculitis, positive pathergic reaction, uveitis, superior vena cava syndrome, and generalized lymphadenopathy fulfilled the diagnostic criteria of Behçet's disease. Three years after presenting he was admitted to our clinic with excessive bleeding from large ulcers on the scrotum and upper thighs and with a leg ulcer. Bleeding was controlled with compresses. Examination of a biopsy specimen obtained from the leg ulcer showed findings consistent with Kaposi-like acroangiodermatitis. Results of various radiologic investigations showed thrombosis of the inferior vena cava, peritesticular varicosities, and venous insufficiency of the lower extremities. We suggest that the bleeding was secondary to the extension of genital ulcers to the varicose veins. PMID:9314623

  1. Crohn's Disease and Ulcerative Colitis: Emotional Factors

    MedlinePLUS

    ... Factors Q & A Go Back Crohn’s Disease and Ulcerative Colitis: Emotional Factors Q & A Email Print + Share The ... of clinical experience. WHAT IS THE CAUSE OF ULCERATIVE COLITIS AND CROHN’S DISEASE? The origin of IBD is ...

  2. Lumbosacral reconstruction for intractable pyogenic spondylitis using a total leg flap with a vascularized tibia graft.

    PubMed

    Iwakiri, Kentaro; Miyauchi, Akira; Okuda, Shinya; Matsuda, Ken; Yamamoto, Tomio; Iwasaki, Motoki

    2008-05-01

    This report describes an effective technique of using a total leg flap for treating a 57-year-old male paraplegic patient with intractable sacral pyogenic spondylitis caused by methicillin-resistant Staphylococcus aureus. Spondylitis was accompanied by severe instability of the lumbosacral area, a large lumbosacral ulcer, and a large bone and muscle defect, which made it difficult for the patient to maintain a sitting position. A total leg flap procedure, a modification of the total thigh flap procedure, was performed as a 1-stage salvage surgery. The vascularized tibia and fibula were grafted between the lumbar and sacral vertebrae, and a musculocutaneous flap was used to cover the extensive ulceration in the lumbosacral skin defect. The intractable lesion of the lumbosacral spine, which had not been cured for more than 2 years despite repeated debridement, intravenous antibiotic injections, sugar treatment, pyoktanin treatment, and hyperbaric O(2) treatment, subsided and stabilized within 1 year of surgery. The patient returned to activities of daily living using a wheelchair, and was very satisfied with the results. Use of a total leg flap with a vascularized tibia graft is an effective treatment for intractable pyogenic spondylitis accompanied by a large bone defect and large lumbosacral ulcers. PMID:18447694

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

    USGS Publications Warehouse

    Kitaysky, A.S.; Kitaiskaia, E.V.; Wingfield, J.C.; Piatt, J.F.

    2001-01-01

    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) chicks exposed to prolonged restrictions in energy content and/or nutritional quality (low versus high lipid content) of their food. Starting at the age of 15 days, chicks were fed either high- or low-lipid fish at 40%, 65%, and 100% of ad libitum energy intake. Body mass measurements and baseline plasma samples were taken on a weekly basis after beginning of the treatment. After 3 weeks of treatment, chicks were exposed to a standardized acute handling and restraint stress protocol, where in addition to a baseline sample, three plasma samples were taken at intervals up to 50 min. We found that food-restricted chicks had lower body mass, chronically (during 2-3 weeks) elevated baseline and higher acute stress-induced levels of corticosterone compared to chicks fed ad libitum. Low lipid content of food further exacerbated these effects. An increase in baseline levels of corticosterone was observed within a week after energy requirements of food-restricted chicks exceeded their daily energy intake. A tendency for suppression of adrenocortical activity was observed in treatments fed low-lipid diets only at the end of the experiment. We suggest that nest-bound chicks, if food-stressed, might suffer deleterious effects of chronic elevation of corticosterone.

  4. Atypical ulcers.

    PubMed

    Hoffman, Mark D

    2013-01-01

    Atypical ulcers of the skin challenge the dermatologist with respect to recognition, diagnosis, management, and treatment. The entire gamut of pathogenic categories including vascular, inflammatory, neoplastic, genetic, medication-related, and infectious processes may give rise to atypical ulcers. By definition, these ulcers are unusual, and accurate diagnosis may ultimately require the clinician to violate the dictum that "common things are common." Atypical ulcers may present with features that the clinician has not previously encountered, or may present with seemingly typical features that actually mislead due to phenotypic mimicry. Because skin ulcers are inherently tissue-destructive, and may reflect an underlying systemic disease process, there is heightened urgency to achieving an accurate diagnosis and initiating appropriate therapy. PMID:23742283

  5. Leg muscles

    NSDL National Science Digital Library

    Uwe Gille (None; )

    2007-07-29

    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.

  6. Leg Strain

    MedlinePLUS

    ... that begins at the lower end of the femur (the large bone of the upper leg), stretches ... National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse National Institutes of Health 1 AMS ...

  7. Ulcerative Sarcoidosis Successfully Treated with Apligraf

    Microsoft Academic Search

    M. Streit; L. M. Böhlen; L. R. Braathen

    2001-01-01

    The case of a 73-year-old female patient is reported with a 25-year-long history of widespread cutaneous sarcoidosis without any known extracutaneous manifestations. The skin manifestations started with erythematous and plaque-like lesions that had ulcerated on the legs for the last half-year. A relevant venous insufficiency or other etiology of the ulcers could not be found. Histology from lesions of the

  8. Cutaneous ulcer as leading symptom of systemic cytomegalovirus infection.

    PubMed

    Guo, Richard F; Gebreab, Frew H; Tang, Emily Hsiang-Ho; Piao, Zhe; Lee, Steve S; Perez, Mario L

    2015-01-01

    Cytomegalovirus (CMV) infection rarely manifests with skin ulcerations. We describe a case report of a 64-year-old woman with chronic immunosuppression for treatment of mixed connective tissue disease, presenting with new onset leg ulcerations after a recent change in immunosuppressive regimen. She subsequently developed fulminant hepatitis, encephalopathy, and pancytopenia and was found to have severe systemic CMV viremia. Skin ulcer biopsy was positive by immunohistochemical staining for CMV infected endothelial cells. Both systemic disease and skin ulcer rapidly improved after stopping immunosuppression and administering intravenous ganciclovir. New onset skin ulcers in an immunosuppressed individual, especially with recent changes in immunosuppressive regimen, should raise the suspicion of reactivation of CMV. PMID:25785212

  9. Cutaneous Ulcer as Leading Symptom of Systemic Cytomegalovirus Infection

    PubMed Central

    Guo, Richard F.; Gebreab, Frew H.; Tang, Emily Hsiang-Ho; Piao, Zhe; Lee, Steve S.; Perez, Mario L.

    2015-01-01

    Cytomegalovirus (CMV) infection rarely manifests with skin ulcerations. We describe a case report of a 64-year-old woman with chronic immunosuppression for treatment of mixed connective tissue disease, presenting with new onset leg ulcerations after a recent change in immunosuppressive regimen. She subsequently developed fulminant hepatitis, encephalopathy, and pancytopenia and was found to have severe systemic CMV viremia. Skin ulcer biopsy was positive by immunohistochemical staining for CMV infected endothelial cells. Both systemic disease and skin ulcer rapidly improved after stopping immunosuppression and administering intravenous ganciclovir. New onset skin ulcers in an immunosuppressed individual, especially with recent changes in immunosuppressive regimen, should raise the suspicion of reactivation of CMV.

  10. 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...

  11. Venous ulcers.

    PubMed

    Reichenberg, Jason; Davis, Mark

    2005-12-01

    Veneous ulcers are extremely common, accounting for a large proportin of all lower extremity ulcers. Due to their chronicity and relatively high prevalence, their impact on the cost of healthcare and the lives of the patients affected is quite significant. There has been progress in understanding the pathophysiology, clinical features, and diagnosis of these ulcers, but the basic principles of care have remained consistent for almost a half century. To allow for optimal healing, it is important to maintain a clean moist wound bed, treat any clinically significant infection, and decrease surrounding edema. PMID:16387266

  12. Management of Chronic Pressure Ulcers

    PubMed Central

    2009-01-01

    Executive Summary In April 2008, the Medical Advisory Secretariat began an evidence-based review of the literature concerning pressure ulcers. Please visit the Medical Advisory Secretariat Web site, http://www.health.gov.on.ca/english/providers/program/mas/tech/tech_mn.html to review these titles that are currently available within the Pressure Ulcers series. Pressure ulcer prevention: an evidence based analysis The cost-effectiveness of prevention strategies for pressure ulcers in long-term care homes in Ontario: projections of the Ontario Pressure Ulcer Model (field evaluation) Management of chronic pressure ulcers: an evidence-based analysis 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

  13. Pressure ulcer

    MedlinePLUS

    ... now develops an open, sunken hole called a crater. There is damage to the tissue below the ... turn white. Also look for blisters, sores, or craters. Take the following steps to prevent pressure ulcers: ...

  14. Ugh! Ulcers

    MedlinePLUS

    ... Video: Am I Normal? (Girls and Puberty) Movie: Digestive System How the Body Works Main Page Ugh! Ulcers ... gets through to the sensitive tissues lining the digestive system underneath. Acid and bacteria directly irritate this lining ...

  15. Peptic Ulcers

    MedlinePLUS

    ... the doctor see the lining of the esophagus, stomach, and duodenum to check for possible ulcers, inflammation, or food allergies . It also can be used to perform tissue tests to check for H. pylori . The endoscopy ...

  16. A Dynamic Compression System for Improving Ulcer Healing: Design of a Sensing Garment

    E-print Network

    Henderson, Thomas C.

    1 A Dynamic Compression System for Improving Ulcer Healing: Design of a Sensing Garment M. Hegarty1 Company, 3 School of Computing, University of Utah Abstract--Venous leg ulcers remain a major problem ulcers, auscul- tation, bio-impedance. I. INTRODUCTION Between 500,000-600,000 persons living

  17. Proceedings of the 17th Annual European Pressure Ulcer Meeting Stockholm, Sweden

    E-print Network

    Payan, Yohan

    Proceedings of the 17th Annual European Pressure Ulcer Meeting Stockholm, Sweden Copyright © 2014, 4 IDS, France, 5 AGIM, France Introduction It is now well known that deep pressure ulcers are due particularly suffer from pressure ulcers in the buttock area because of the inactivity of their leg muscles

  18. Giant ulcerative dermatofibroma.

    PubMed

    Karlidag, Turgut; Keles, Erol; Orhan, Israfil; Kaplama, Mehmet Erkan; Cobanoglu, Bengu

    2013-01-01

    Dermatofibroma is a slowly growing common benign cutaneous tumor characterized by hard papules and nodules. The rarely seen erosions and ulcerations may cause difficulties in the diagnosis. Dermatofibrosarcoma protuberans, which is clinically and histopathologically of malignant character, displays difficulties in the diagnosis since it has similarities with basal cell carcinoma, epidermoid carcinoma, and sarcomas. Head and neck involvement is very rare. In this study, a giant dermatofibroma case, which is histopathologically, ulcerative dermatofibroma, the biggest lesion of the head and neck region and seen rarely in the literature that has characteristics similar to dermatofibrosarcoma protuberans, has been presented. PMID:24371537

  19. Athletes' leg pains.

    PubMed Central

    Orava, S.; Puranen, J.

    1979-01-01

    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, comprising 9.5% of all exertion injuries and 60% of the leg exertion pains. Together with stress fracture of the tibia, the second most common exertion pain of the leg, it accounted for 75% of the total leg pains. There are certain difficulties in differentiating between the medial tibial syndrome and stress fracture of the tibia. They both occur at the same site with similar symptoms. Radiological examination and isotope scanning are needed. The medial tibial syndrome is an overuse injury at the medial tibial border caused by running exercises. The pain is elicited by exertional ischaemia. The pathogenesis is explained by increased pressure in the fascial compartment of the deep flexor muscles due to prolonged exercise. Similar chronic ischaemic pains from exercise are also found in other fascial compartments of the leg, especially in the anterior compartment. The only treatment needed for stress fractures is rest from training. Fascial compartment pains also usually subside. If chronic fascial syndromes prevent training, fasciotomy is recommended as a reliable method to restore the athlete to normal training without pains. PMID:486888

  20. Leg pain

    MedlinePLUS

    ... bone tumors ( osteosarcoma , Ewing sarcoma) Legg-Calve-Perthes disease -- poor blood flow to the hip that may stop or slow the normal growth of the leg Noncancerous (benign) tumors or cysts of the femur or tibia (osteoid osteoma) Sciatic nerve pain (radiating ...

  1. Types of Ulcerative Colitis

    MedlinePLUS

    ... Ulcerative Colitis? > Types of Ulcerative Colitis Types of Ulcerative Colitis Email Print + Share If you are diagnosed with ... left side of the abdomen, and bleeding. Pan-ulcerative (total) Colitis Affects the entire colon. Symptoms include diarrhea, severe ...

  2. Leg CT scan

    MedlinePLUS

    CAT scan - leg; Computed axial tomography scan - leg; Computed tomography scan - leg; CT scan - leg ... your health care provider if you take the diabetes medicine metformin (Glucophage). You may need to take ...

  3. Differentiating nocturnal leg cramps and restless legs syndrome.

    PubMed

    Rana, Abdul Qayyum; Khan, Fatima; Mosabbir, Abdullah; Ondo, William

    2014-07-01

    Leg pain and discomfort are common complaints in any primary physician's clinic. Two common causes of pain or discomfort in legs are nocturnal leg cramps (NLC) and restless leg syndrome (RLS). NLC present as painful and sudden contractions mostly in part of the calf. Diagnosis of NLC is mainly clinical and sometimes involves investigations to rule out other mimics. RLS is a condition characterized by the discomfort or urge to move the lower limbs, which occurs at rest or in the evening/night. The similarity of RLS and leg cramps poses the issue of errors in diagnosing and differentiating the two. In this paper we review the pathopysiology of each entity and their diagnosis as well as treatment. The two conditions are then compared to appreciate the differences and similarities. Finally, suggestions are recommended for complete assessment. PMID:24931546

  4. Endoscopic Management of Peptic Ulcer Bleeding

    PubMed Central

    Kim, Joon Sung; Park, Sung Min

    2015-01-01

    Acute upper gastrointestinal bleeding is a common medical emergency around the world and the major cause is peptic ulcer bleeding. Endoscopic treatment is fundamental for the management of peptic ulcer bleeding. Despite recent advances in endoscopic treatment, mortality from peptic ulcer bleeding has still remained high. This is because the disease often occurs in elderly patients with frequent comorbidities and are taking ulcerogenic medications. Therefore, the management of peptic ulcer bleeding is still a challenge for clinicians. This article reviews the various endoscopic methods available for management of peptic ulcer bleeding and the techniques in using these methods.

  5. [The outcomes of program based on complex decongestive physiotherapy for a patient with secondary lymphedema caused by infection on the leg].

    PubMed

    Nakao, Fujiko; Furutani, Akira; Yoshimura, Koichi; Hamano, Kimikazu; Kinoshita, Yumiko; Kawamoto, Rieko; Nakao, Hisako; Suzuki, Shizue

    2009-06-01

    Lymphedema is a chronic problem causing distress and loss of functions throughout the lifespan. Complex decongestive physiotherapy (CDP) is in common use in developed countries but has only recently been used in Japan for people in outpatient settings. CDP is a representative conservative treatment for lymphedema, conducted by combining four kinds of physical therapies: skin care, manual lymph drainage (MLD), bandage and exercise. This research project lead by a nurse is underway using CDP in an outpatient department. We report a case of secondary lymphedema caused by infection successfully treated by CDP. A 22-year-old man suffered from cellulitis of unknown origin when he was a high school student. After this event, he had been repeatedly admitted to hospital with infections as a result of the lymphedema. He underwent MLD once or twice monthly and received health education for skin care, self-massage and exercise, and was advised to wear compression stockings. Within 7 months the leg swelling had significantly reduced and his feelings of malaise and pain disappeared. Fourteen months later the circumferences of his knee and ankle had kept the sizes, and he has not re-entered hospital for infections. For this man, CDP had a positive outcome, as it has for many others around the world. Our experience has found it very important to establish adequate support systems for such people in outpatient and community settings. However, more research and knowledge sharing are required to understand the usefulness and effectiveness about this program as a primary treatment combined with health education in community settings in Japan. PMID:19670806

  6. Changes in the apparently normal limb in unilateral venous ulceration.

    PubMed

    Stacey, M C; Burnand, K G; Pattison, M; Thomas, M L; Layer, G T

    1987-10-01

    Forty-seven patients with unilateral venous ulceration have been investigated to determine if any abnormalities were present in the contralateral limbs which had not had lipodermatosclerosis or ulceration. Ascending phlebography in the non-ulcerated limbs showed post-thrombotic changes in 28 per cent and incompetent lower leg communicating veins in 19 per cent. This incidence was not significantly different to the limbs with healed ulceration (45 and 23 per cent respectively, chi 2 test, P = 0.10). Half volume refilling time measured by foot volumetry suggested that 79 per cent of the non-ulcerated limbs had evidence of deep vein incompetence or incompetent lower leg communicating veins, which was again similar to the incidence in the previously ulcerated limbs (85 per cent). Transcutaneous oxygen readings, expressed as a ratio of a reading at a standard site in the gaiter region of the leg over a reading from the upper arm, were significantly lower in non-ulcerated limbs (mean 0.84 +/- 0.26 s.d.) than in a cohort of age and sex matched controls (mean 1.02 +/- 0.14, Student's t test, P less than 0.001), and significantly higher than in previously ulcerated limbs (mean 0.68 +/- 0.31, P less than 0.01). Abnormalities in venous anatomy and function have been shown, in conjunction with evidence of reduced oxygen diffusion, through the gaiter skin before overt skin changes develop. PMID:3664226

  7. [Marjolin ulcer].

    PubMed

    Garzón, R; Burgos, E B; Garzón, F L; Cippitelli, L; de Cabalier, E D; Cabalier, L R

    2001-01-01

    Marjolin's ulcers can produce neoplasms. They appear on previous scars produced by old three degree burns. Sometimes they appear after 50 years of the previous accident. Three patients showing squamous cell epitheliomas are presented, and the opportunity and technique of the surgical treatment is discussed. PMID:12934265

  8. Combined NADPH Oxidase 1 and Interleukin 10 Deficiency Induces Chronic Endoplasmic Reticulum Stress and Causes Ulcerative Colitis-Like Disease in Mice

    PubMed Central

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

    2014-01-01

    Ulcerative colitis (UC) is a chronic inflammatory bowel disease affecting the rectum which progressively extents. Its etiology remains unknown and the number of treatments available is limited. Studies of UC patients have identified an unbalanced endoplasmic reticulum (ER) stress in the non-inflamed colonic mucosa. Animal models with impaired ER stress are sensitive to intestinal inflammation, suggesting that an unbalanced ER stress could cause inflammation. However, there are no ER stress-regulating strategies proposed in the management of UC partly because of the lack of relevant preclinical model mimicking the disease. Here we generated the IL10/Nox1dKO mouse model which combines immune dysfunction (IL-10 deficiency) and abnormal epithelium (NADPH oxidase 1 (Nox1) deficiency) and spontaneously develops a UC-like phenotype with similar complications (colorectal cancer) than UC. Our data identified an unanticipated combined role of IL10 and Nox1 in the fine-tuning of ER stress responses in goblet cells. As in humans, the ER stress was unbalanced in mice with decreased eIF2? phosphorylation preceding inflammation. In IL10/Nox1dKO mice, salubrinal preserved eIF2? phosphorylation through inhibition of the regulatory subunit of the protein phosphatase 1 PP1R15A/GADD34 and prevented colitis. Thus, this new experimental model highlighted the central role of epithelial ER stress abnormalities in the development of colitis and defined the defective eIF2? pathway as a key pathophysiological target for UC. Therefore, specific regulators able to restore the defective eIF2? pathway could lead to the molecular remission needed to treat UC. PMID:25014110

  9. [Marjölin ulcer].

    PubMed

    Paredes, F

    1998-02-01

    Marjölin Ulcer is a squamous cell carcinoma developed in a burn scar. The term was applied to all malignancies developed in scars or chronic draining sinuses, and its connotation with burn scars has been forgotten. It is an uncommon tumour in the developed world. The scars with iterative ulcerations are the ones that could be the origin of a carcinoma. As regards pathogenesis, it is attractive to speculate about the relation between wound healing and cutaneous malignancy since these processes share common tissue factors. The author presents his experience in the treatment of these tumours. Regarding prognosis and treatment, it is the author's opinion that carcinoma from scars are curable by adequate local excision, contrally to carcinoma of chronic sinuses, namely osteomyelitis, because cancer cells tend to follow the fistulous tract and multiply inside the bone cavity, generally only amputation is effective. Finally the author stresses that with good treatment vicious scars or draining sinuses could be prevented, therefore Marjölin Ulcer is an entity that disappears with good health care. PMID:9567417

  10. Malignancy in scars, chronic ulcers, and sinuses

    PubMed Central

    Cruickshank, A. H.; McConnell, E. Mavis; Miller, D. G.

    1963-01-01

    A collection of 44 cases of malignancy in scars, chronic ulcers, and sinuses, included the following predisposing lesions: a 20-year-old sinus from ischial bursitis, a 23-year-old bed sore, a congenital gumma about 50 years old, three burn scars (average age of scar 56 years), 11 sinuses from chronic osteomyelitis, and 27 chronic ulcers of the leg. The osteomyelitis cases included two rapidly fatal sarcomas, one in a sinus present for 16 years, the other in a 20-year-old sinus. The remaining tumours in this group were squamous carcinomas that developed in sinuses with an average duration of 37 years. In the cases of varicose ulcer, the ulcer had been present on the average for 21 years before the onset of malignancy. One patient in this group, with an ulcer not known to be more than five years old, developed a sarcoma that was fatal in six months. The biopsy diagnosis was difficult in 17 cases, including one of the cases of sarcoma. The difficulty was greatest in cases of osteomyelitis. The conditions discussed are now known as `Marjolin's ulcer'. In the present series, the degree of malignancy in tumours arising in scars may be low but the malignancy of tumours arising in chronic ulcers and sinuses may be high. Images PMID:14076377

  11. Leg lengthening - series (image)

    MedlinePLUS

    ... bones of the leg, the tibia and the femur. Surgical treatment may be recommended for severe unequal ... lower leg bone (tibia) or upper leg bone (femur). Metal pins or screws are inserted into and ...

  12. Leg MRI scan

    MedlinePLUS

    ... imaging - leg; Magnetic resonance imaging - lower extremity; MRI - ankle; Magnetic resonance imaging - ankle; MRI - femur; MRI - leg ... or bone scan Birth defects of the leg, ankle, or foot Bone pain and fever Broken bone ...

  13. Colonic motility in ulcerative colitis

    PubMed Central

    Antonelli, Elisabetta; Villanacci, Vincenzo; Baldoni, Monia; Dore, Maria Pina

    2014-01-01

    Background Inflammatory conditions affecting the gut may cause motility disturbances, and ulcerative colitis – one of the main disorders among the inflammatory bowel diseases – may display abnormal colonic motility. Aim To review the abnormalities of the large bowel in ulcerative colitis, by considering the motility, laboratory (in vitro) and pathological studies dealing with this topic. Methods A comprehensive online search of Medline and the Science Citation Index was carried out. Results Patients with ulcerative colitis frequently display colonic motor abnormalities, including lack of contractility, an increase of propulsive contractile waves, an excessive production of nitric oxide, vasoactive intestinal polypeptide nerves, interleukin 1 beta, neurotensin, tachykinins levels and the weaker action of substance P, likely related to a neuromuscular dysfunction due to the inflammatory process. Conclusions A better understanding of the pathophysiological grounds of altered colonic motility in ulcerative colitis may lead to a more in-depth knowledge of the accompanying symptoms and to better and more targeted therapeutic approaches. PMID:25452840

  14. Diagnosis and management of genital ulcers.

    PubMed

    Roett, Michelle A; Mayor, Mejebi T; Uduhiri, Kelechi A

    2012-02-01

    Herpes simplex virus infection and syphilis are the most common causes of genital ulcers in the United States. Other infectious causes include chancroid, lymphogranuloma venereum, granuloma inguinale (donovanosis), secondary bacterial infections, and fungi. Noninfectious etiologies, including sexual trauma, psoriasis, Behçet syndrome, and fixed drug eruptions, can also lead to genital ulcers. Although initial treatment of genital ulcers is generally based on clinical presentation, the following tests should be considered in all patients: serologic tests for syphilis and darkfield microscopy or direct fluorescent antibody testing for Treponema pallidum, culture or polymerase chain reaction test for herpes simplex virus, and culture for Haemophilus ducreyi in settings with a high prevalence of chancroid. No pathogen is identified in up to 25 percent of patients with genital ulcers. The first episode of herpes simplex virus infection is usually treated with seven to 10 days of oral acyclovir (five days for recurrent episodes). Famciclovir and valacyclovir are alternative therapies. One dose of intramuscular penicillin G benzathine is recommended to treat genital ulcers caused by primary syphilis. Treatment options for chancroid include a single dose of intramuscular ceftriaxone or oral azithromycin, ciprofloxacin, or erythromycin. Lymphogranuloma venereum and donovanosis are treated with 21 days of oral doxycycline. Treatment of noninfectious causes of genital ulcers varies by etiology, and ranges from topical wound care for ulcers caused by sexual trauma to consideration of subcutaneous pegylated interferon alfa-2a for ulcers caused by Behçet syndrome. PMID:22335265

  15. Ulcerative colitis - discharge

    MedlinePLUS

    Inflammatory bowel disease - ulcerative colitis - discharge; Ulcerative proctitis - discharge; Colitis - discharge ... You were in the hospital because you have ulcerative colitis, swelling of the inner lining of your colon ...

  16. Effectiveness of olive oil for the prevention of pressure ulcers caused in immobilized patients within the scope of primary health care: study protocol for a randomized controlled trial

    PubMed Central

    2013-01-01

    Background Pressure ulcers are considered an important issue, mainly affecting immobilized older patients. These pressure ulcers increase the care burden for the professional health service staff as well as pharmaceutical expenditure. There are a number of studies on the effectiveness of different products used for the prevention of pressure ulcers; however, most of these studies were carried out at a hospital level, basically using hyperoxygenated fatty acids (HOFA). There are no studies focused specifically on the use of olive-oil-based products and therefore this research is intended to find the most cost-effective treatment and achieve an alternative treatment. Methods/design The main objective is to assess the effectiveness of olive oil, comparing it with HOFA, to treat immobilized patients at home who are at risk of pressure ulcers. As a secondary objective, the cost-effectiveness balance of this new application with regard to the HOFA will be assessed. The study is designed as a noninferiority, triple-blinded, parallel, multi-center, randomized clinical trial. The scope of the study is the population attending primary health centers in Andalucía (Spain) in the regional areas of Malaga, Granada, Seville, and Cadiz. Immobilized patients at risk of pressure ulcers will be targeted. The target group will be treated by application of an olive-oil-based formula whereas the control group will be treated by application of HOFA to the control group. The follow-up period will be 16 weeks. The main variable will be the presence of pressure ulcers in the patient. Secondary variables include sociodemographic and clinical information, caregiver information, and whether technical support exists. Statistical analysis will include the Kolmogorov-Smirnov test, symmetry and kurtosis analysis, bivariate analysis using the Student’s t and chi-squared tests as well as the Wilcoxon and the Man-Whitney U tests, ANOVA and multivariate logistic regression analysis. Discussion The regular use of olive-oil-based formulas should be effective in preventing pressure ulcers in immobilized patients, thus leading to a more cost-effective product and an alternative treatment. Trial registration Clinicaltrials.gov identifier: NCT01595347. PMID:24152576

  17. Approach to skin ulcers in older patients.

    PubMed Central

    Frank, Christopher

    2004-01-01

    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. PMID:15648380

  18. Foot, leg, and ankle swelling

    MedlinePLUS

    Swelling of the ankles - feet - legs; Ankle swelling; Foot swelling; Leg swelling; Edema - peripheral; Peripheral edema ... Foot, leg, and ankle swelling is common with the following situations: Being overweight Blood clot in the leg Increased age Leg infection Veins ...

  19. Leg lengthening.

    PubMed

    Bridgman, S A; Bennet, G C; Evans, G A; Stirling, J

    1993-04-01

    The combined experience of the Royal Hospital for Sick Children, Glasgow and the Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry in lengthening 52 lower limb segments with the Orthofix device is reviewed. Forty-eight segments were lengthened by callotasis, 24 in patients with achondroplasia. Attempted lengthening with chondrodiatasis was performed in 4 patients with leg length discrepancy. With callotasis, planned lengthening was achieved in 43/48 (90%) of segments. There was a small number of significant complications. Angulation or buckling of the new bone was the commonest major complication, and was seen in 10% of segments. Pin tract infection was the predominant minor complication. Premature union was noted commonly in the femurs of achondroplastics, but could usually be overcome with manipulation under anaesthesia. We confirm that callotasis achieves its objectives with fewer complications and operations than the commonly used Wagner method which it should supersede. By contrast, we had major complications in all cases with chondrodiatasis and have abandoned this method. PMID:8478826

  20. Some Effects of Sustained Compression On Ulcerated Tissues

    Microsoft Academic Search

    Geoff Roberts; Lina Hammad; Carol Collins; Cliff Shearman; Raj Mani

    2002-01-01

    Sustained leg compression is the first line of treatment for patients with chronic venous ulcers. The success rates of this treatment vary, and the mode(s) of action are not well understood. In this study, tissue oxygen tension (TcPO2), surface pH, and reactive hyperemia measure ments were made to observe changes associated with sustained compression in patients with chronic venous ulcers.

  1. Long-term successful healing of ulcerated necrobiosis lipoidica after topical therapy with becaplermin.

    PubMed

    Tauveron, V; Rosen, A; Khashoggi, M; Abdallah-Lotf, M; Machet, L

    2013-10-01

    We report a case of chronic leg ulceration occurring in a patient with necrobiosis lipoidica (NL). After many topical treatments had failed to achieve healing, treatment with topical becaplermin was started, which resulted in rapid improvement and ultimately complete healing of the ulceration. Treatment of ulcerated NL is often disappointing. Many topical and systemic drugs have been tried. Becaplermin is a platelet-derived growth factor indicated for the treatment of neuropathic diabetic ulcers measuring < 50 mm in size. To our knowledge, this is only the second case reported in the literature of ulcerated NL successfully treated with becaplermin. PMID:23962308

  2. Management of radiation ulcers

    SciTech Connect

    Shack, R.B.

    1982-12-01

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

  3. Severe and Refractory Peptic Ulcer Disease: The Diagnostic Dilemma

    Microsoft Academic Search

    James L. Guzzo; Mona Duncan; Barbara L. Bass; Grant V. Bochicchio; Lena M. Napolitano

    2005-01-01

    The recognition of Helicobacter pylori infection as a cause of peptic ulcer disease, medical regimens to eradicate the organism, and the widespread use of proton pump inhibition to suppress gastric acid secretion have revolutionized the management of peptic ulcer disease. As a result, successful medical management of peptic ulcer disease has largely supplanted the need for gastric surgery by general

  4. Persistence of gastric ulcers caused by plain aspirin or nonsteroidal antiinflammatory agents in patients treated with a combination of cimetidine, antacids, and enteric-coated aspirin

    Microsoft Academic Search

    Richard Jaszewski; Ricardo Calzada; Ravi Dhar

    1989-01-01

    Twenty-three patients chronically ingesting plain aspirin or nonsteroidal antiinflammatory drugs, who had endoscopically proven solitary or multiple gastric ulcers, were treated for eight weeks with cimetidine and antacids. Plain aspirin and nonsteroidal antiinflammatory drugs were discontinued in all patients. Seven patients received enteric-coated aspirin throughout the treatment phase and continuously for the entire study period (2.5–12 months). The remainder of

  5. Expressions of MMPs and TIMP-1 in Gastric Ulcers May Differentiate H. pylori-Infected from NSAID-Related Ulcers

    PubMed Central

    Cheng, Hsiu-Chi; Yang, Hsiao-Bai; Chang, Wei-Lun; Chen, Wei-Ying; Yeh, Yi-Chun; Sheu, Bor-Shyang

    2012-01-01

    Background. Two major causes of gastric ulcers are Helicobacter pylori (H. pylori) infection and nonsteroidal anti-inflammatory drug (NSAID) use. Aims. This study aimed to determine if there were different expressions of matrix metalloproteinases (MMPs) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) between H. pylori-infected and NSAID-related ulcers. Methods. The 126 gastric ulcer patients (H. pylori infected n = 46; NSAID related n = 30; combined with two factors n = 50) provided ulcer and nonulcer tissues for assessment of MMP-3, -7, and -9 and TIMP-1 expression by immunohistochemical staining. Results. Gastric ulcer tissues had significantly higher MMP-3, -7, and -9 and TIMP-1 expressions than nonulcer tissues (P < 0.05). H. pylori-infected gastric ulcers had even higher MMP-7, MMP-9, and TIMP-1 expressions in epithelial cells than NSAID-related gastric ulcers (P < 0.05). In patients with the two combined factors, gastric ulcers expressed similar proportions of antral ulcers and MMP-7 and MMP-9 intensities to NSAID-related gastric ulcers, but lower MMP-9 and TIMP-1 than H. pylori-infected gastric ulcers (P < 0.05). Conclusions. H. pylori-infected gastric ulcers express higher MMP-7, MMP-9, and TIMP-1 than NSAID-related ulcers. In patients with the two combined factors, ulcer location and MMP-7 and MMP-9 intensities are similar to NSAID use. PMID:22645431

  6. Leg Problems

    MedlinePLUS

    ... and use an anti-inflammatory medicine such as ibuprofen. Avoid activities that cause pain. No A MUSCLE ... pain. Use an anti-inflammatory medicine such as ibuprofen and apply ice to the area. See your ...

  7. An in vivo Investigation on the Wound-Healing Effect of Two Medicinal Herbs Using an Animal Model with Foot Ulcer

    Microsoft Academic Search

    T. W. Lau; D. S. Sahota; C. H. Lau; C. M. Chan; F. C. Lam; Y. Y. Ho; K. P. Fung; C. B. S. Lau; P. C. Leung

    2008-01-01

    Background\\/Aim: Over 190 million people in the world suffer from diabetes mellitus. Diabetics are 25 times more likely to have a leg amputated because of unhealing foot ulcers. Herbal medicine has been used in China to salvage the ulcerated limb. With the aim to study the efficacy of two commonly used herbs for ulcer healing, namely Radix Astragali and Radix

  8. Factors related to venous ulceration: a cross-sectional study.

    PubMed

    Vlajinac, Hristina; Marinkovic, Jelena; Maksimovic, Milos; Radak, Djordje

    2014-10-01

    The aim of the study was to determine the factors related to venous ulceration. Patients with venous ulceration (278 patients) were compared with 1401 patients in other categories of clinical classification of venous disease (clinical, etiologic, anatomic, and pathophysiological [CEAP]). Demographic, anthropometric, and clinical data were collected. Univariate and multivariate logistic regression analyses were used. According to multivariate analyses, risk factors for venous ulceration were age, male sex, personal history of superficial and deep venous thrombosis, diabetes, high blood pressure, skeletal or joint disease in the legs and emphysema or chronic obstructive pulmonary disease, higher body mass index and physical inactivity, parental history of ankle ulcer as well as reflux in deep and perforator veins, deep obstruction, and combination of reflux and obstruction. It seems reasonable to pay special attention to patients in whom the postulated risk factors for venous ulceration are present. PMID:24165114

  9. Pressure ulcer classification: defining early skin damage.

    PubMed

    Russell, Linda

    2002-09-01

    This article is the second of a two-part series. The first part (Russell, 2002) looked at various systems and pitfalls of pressure ulcer classification systems. This article focuses on the difficulties of defining early skin damage. Patients' quality of life suffers significantly with a pressure ulcer. The smell of the exudate may be an embarrassment to the patient. The pain and the distress the patient will experience will not easily be forgotten, i.e. the number of dressings required for a deep pressure ulcer, even after the pressure ulcer has healed, will be a memorable intrusion to the patient's daily routine. Early detection of pressure ulcers and timely intervention are essential in the management of patients with pressure ulcers. Controversy exists over the definition of the first three stages of pressure ulcers, but there is consensus on the definition of deep tissue damage. If the pressure ulcer is covered with black necrotic tissue it is difficult to establish depth of the tissue damage. Intact skin can cause problems, as a sacrum may be purple but intact. There is still considerable debate with regard to reactive hyperaemia, as the exact time parameters for persistent erythema to occur are unknown. Little is understood with regard to the exact pathophysiology of reactive hyperaemia and this area requires further investigation. Blistered skin and skin tone also cause confusion in grading of pressure ulcers. The problems associated with classification of pressure ulcers, using colour classification systems, are discussed and the implications for practice are considered. The confusion surrounding early classification of pressure ulcers is discussed and it is hoped that such confusion can be addressed by standardizing training using one national classification system. PMID:12362151

  10. [Prevention of pressure ulcer (bedsore)].

    PubMed

    Sedmak, Dijana; Vrhovec, Marina; Huljev, Dubravko

    2013-10-01

    Although progress in many fields of science, medicine and technology is evident, we are still witnessing the appearance of bedsores and its consequences. However, in the last fifty years there has been considerable progress in the understanding of its causes, prevention and treatment. Prevention and treatment of pressure ulcers are complicated by the many misconceptions. However, with due knowledge of the process of healing of acute and chronic wounds and of the pathophysiological processes, in many cases chronic wounds, like pressure ulcers, can now be prevented and cured, and thus reduce the cost of treatment, as well as the mortality rate. PMID:24371973

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

    PubMed Central

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

    2012-01-01

    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. PMID:23555488

  12. Sitting can cause ischaemia in the subcutaneous tissue of the buttocks, which implicates multilayer tissue damage in the development of pressure ulcers.

    PubMed

    Thorfinn, Johan; Sjoberg, Folke; Lidman, Disa

    2009-01-01

    A better understanding of how pressure ulcers develop in the buttocks will improve prophylactic measures. Our aim was to investigate signs of reduced perfusion and ischaemia in the subcutaneous fat in the buttocks during sitting. A microelectrode was used to quantify oxygen (pO(2)). Metabolites that indicate aerobic or anaerobic metabolism (glucose, lactate, pyruvate, and glycerol) were quantified using microdialysis. Sixteen healthy people were studied while they sat on a wheel chair cushion, and a hard surface. Sitting pressures were mapped, and the thickness of the subcutaneous fatty layer was measured. The results showed that pO(2) and glucose were significantly reduced during sitting, and for pO(2) the effect is significantly more profound during sitting on a hard surface. After loading, both glucose and pO(2) increased significantly. We conclude that the subcutaneous adipose tissue covering the ischial tuberosities becomes ischaemic during sitting. This finding supports the theory that not only is the skin involved in early development of pressure ulcers, but also the deeper tissues. PMID:19308858

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

    SciTech Connect

    Schaefer, C.

    1994-11-01

    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.

  14. Restless legs syndrome

    MedlinePLUS

    ... and restless legs syndrome: a systematic review and meta-analysis. Eur J Neurol. 2013;20:605-615. Wilt ... primary restless legs syndrome: a systematic review and meta-analysis. JAMA Internal Med. 2013;173:496-505.

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

    PubMed

    Casian, D; Gutsu, E; Culiuc, V

    2009-04-01

    A case of severe chronic venous insufficiency caused by pulsatile varicose veins in a 46-year-old man with tricuspid regurgitation is presented. Active venous leg ulcer complicated with recurrent venous bleeding and inefficacy of conservative management serve as indications for surgical treatment. This case demonstrates the possibility of radical surgical correction of pathological venous reflux by means of saphenofemoral ligation, foam sclerotherapy and subfascial endoscopic perforator surgery. PMID:19299276

  16. Skin zinc concentrations in patients with varicose ulcers

    SciTech Connect

    Ackerman, Z.; Loewenthal, E.; Seidenbaum, M.; Rubinow, A.; Gorodetsky, R. (Hadassah Univ. Hospital, Jerusalem (Israel))

    1990-06-01

    The concentration of zinc in the skin has been determined noninvasively in patients with varicose vein ulcers. The examinations were performed with the use of diagnostic x-ray spectrometry, a method based on x-ray fluorescence for in vivo noninvasive evaluation of trace elements. Four skin foci were examined: at the periphery of the ulcer and control areas in a nonulcerated area in the diseased leg, in the noninvolved leg, and in the proximal inner surface of the arm. Zinc levels around the ulcer (mean +/- SD, 9.8 +/- 4.0 micrograms of zinc in 1 g of wet tissue) were higher than those in the nonulcerated skin in the diseased leg (6.9 +/- 3.0 micrograms/g, p greater than 0.05) and those in the noninvolved leg (5.4 +/- 2.0 micrograms/g, p less than 0.01). The concentration of zinc in the inner proximal surface of the arm (9.8 +/- 2.8 micrograms/g) was significantly higher than those of a control group (5.3 +/- 1.9 micrograms/g, p less than 0.01). These results suggest a defect of zinc distribution in patients with varicose vein ulcers.

  17. Preventing pressure ulcers

    MedlinePLUS

    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. You have a risk of developing ...

  18. Pressure ulcers: Back to the basics

    PubMed Central

    Agrawal, Karoon; Chauhan, Neha

    2012-01-01

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

  19. Marjolin's warty ulcer.

    PubMed

    Sharma, Amit; Schwartz, Robert A; Swan, Kenneth G

    2011-02-01

    Marjolin's ulcer refers to malignant change within burn scar. The French surgeon Jean-Nicolas Marjolin is honored with the eponym. Marjolin described the "warty ulcer" in the first edition of Dictionnaire de Medécine. In his description, Marjolin did not actually state that this ulcer represented malignant transformation. Credit for noting the specific association involved in Marjolin's ulcer belongs to Caesar Hawkins, an English Surgeon, who described skin cancer arising in burn and flogging scars. PMID:21259256

  20. Bilateral leg edema in an older woman.

    PubMed

    Thaler, H W; Pienaar, S; Wirnsberger, G; Roller-Wirnsberger, R E

    2015-01-01

    Bilateral leg edema is a frequent symptom in older people and an important concern in geriatric medicine. Further evaluation is frequently not performed and simple therapy with diuretics is prescribed. Particularly in older patients, long-term use of diuretics can lead to severe electrolyte imbalances, volume depletion, and falls. In this case report we want to focus the physicians' attention on the necessity to determine the cause and show a correspondingly effective treatment for bilateral leg edema in older people. A thorough approach is required to recognize diseases and to avoid adverse drug events as geriatric patients often show an atypical presentation or minor symptoms. The cause of swollen legs is often multifactorial; therefore, the patient's individual history and an appropriate physical examination are important. Depending on the clinical symptoms, evaluation including basic laboratory tests, urinalysis, chest radiography, and echocardiogram may be indicated. The most probable cause of bilateral edema in older patients is chronic venous insufficiency. Heart failure is also a common cause. Other systemic causes such as renal disease or liver disease are much rarer. Antihypertensive and anti-inflammatory drugs can frequently cause leg edema, but the incidence of drug-induced leg swelling is unknown. With the help of this special case we tried to develop an approach to the diagnosis of symmetric leg edema in older patients, a problem frequently neglected in geriatric medicine. PMID:24271146

  1. Peptic ulcer and dyspepsia

    Microsoft Academic Search

    Andrew H. Soil

    1999-01-01

    Peptic ulcers are defects in the gastrointestinal mucosa that extend through the muscularis mucosae. They persist as a function of the acid or peptic activity in gastric juice. Twenty years ago, most ulcers were considered idiopathic, but a revolution in knowledge has occurred, so that it is now understood that the great majority of ulcers results from infection with Helicobacter

  2. Leg length measurement: a new method to assure the correct leg length in total hip arthroplasty.

    PubMed

    Affatato, S; Toni, A

    2000-07-01

    The precise measurement of leg length plays an important role in total hip arthroplasty. Leg length inequality occurs frequently after total hip arthroplasty and may cause patient discomfort. Current clinical methods used for measuring leg length are not accurate enough to meet the demands of precision required for hip replacement. The aim of this study was to examine the validity of determining leg length differences using an ultrasound system. The proposed system measures the distance between three points, in millimetres, so that the difference between preoperative and postoperative measurements gives an indication about the leg length. The mean ultrasound variation observed in in vitro measurements showed a relative error of 1.7% (range: 52-133 mm) that means a leg length inequality of about 0.4 mm (range: 52-133 mm). The method is non-invasive (ultrasound is not limited by radiation hazards), easy, quick to use, and can be used for standard clinical screening. PMID:11086255

  3. A colored leg banding technique for Amazona parrots

    USGS Publications Warehouse

    Meyers, J.M.

    1995-01-01

    A technique for individual identification of Amazona was developed using plastic leg bands. Bands were made from 5- and 7-mm-wide strips of laminated PVC coiled 2.5 times with an inside diameter 4-5 mm gt the maximum diameter of the parrot's leg. Seventeen parrots were captured in Puerto Rico, marked with individual plastic leg bands, and observed for 204-658 d with only one lost or damaged plastic band. Plastic leg bands did not cause injury to or calluses on parrots' legs. The plastic material used for making leg bands was available in 18 colors in 1994, which would allow unique marking of 306 individuals using one plastic leg band on each leg.

  4. [Gastroduodenal ulcer refractory to conservative treatment].

    PubMed

    Velenciuc, Natalia; Melinte, C; Velenciuc, I

    2006-01-01

    This is a 20-year retrospective study on 205 patients in which surgery for gastroduodenal ulcer was performed. In 51 one of these patients (24,8%) surgery was required by drug therapy failure, cases labeled as drug-resistant ulcers. Some causes of drug therapy failure are discussed, failure being also recorded in patients who benefited from modem ulcer drugs that proved only partially effective. The authors emphasize that surgery can no longer represent a therapeutic option, an utter substantiation not only from the surgeon but also from the entire team of specialists in various investigation types and therapeutics being mandatory. PMID:17438892

  5. Automatic system for corneal ulcer diagnostic

    NASA Astrophysics Data System (ADS)

    Ventura, Liliane; de Sousa, Sidney J. F.

    1997-05-01

    Corneal Ulcer is a very common disease in agricultural countries and it is responsible for 10% of the blindness causes. One of the main aspects to be observed in these cases is the increasing or decreasing of the affected area. We have been developing an automatic optical system in order to evaluate the affected area (the ulcer) to be implemented in a public hospital (400 patients per week are analyzed). The optical system is implemented in a Slit Lamp and connected to a CCD detector. The image is displayed in a PC monitor by a commercial frame grabber and a dedicated software for determining the area of the ulcer has been developed.

  6. Restoring Psychology's Role in Peptic Ulcer

    PubMed Central

    Overmier, J Bruce; Murison, Robert

    2013-01-01

    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. PMID:23457084

  7. Recurrence of chronic venous ulcers on the basis of clinical, etiologic, anatomic, and pathophysiologic criteria and air plethysmography

    Microsoft Academic Search

    Huey B. McDaniel; William A. Marston; Mark A. Farber; Robert R. Mendes; Lewis V. Owens; Mary L. Young; Patty F. Daniel; Blair A. Keagy

    2002-01-01

    Introduction: Leg ulcers associated with chronic venous insufficiency (CVI) frequently recur after healing. The risk of recurrence has not been well defined for patients in different anatomic and hemodynamic groups. We reviewed the risk of ulcer recurrence on the basis of clinical, etiologic, anatomic, and pathophysiologic criteria and hemodynamic characteristics of the affected limb as assessed with air plethysmography (APG).

  8. Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): randomised controlled trial

    PubMed Central

    Gohel, Manjit S; Barwell, Jamie R; Taylor, Maxine; Chant, Terry; Foy, Chris; Earnshaw, Jonothan J; Heather, Brian P; Mitchell, David C; Whyman, Mark R

    2007-01-01

    Objective To determine whether recurrence of leg ulcers may be prevented by surgical correction of superficial venous reflux in addition to compression. Design Randomised controlled trial. Setting Specialist nurse led leg ulcer clinics in three UK vascular centres. Participants 500 patients (500 legs) with open or recently healed leg ulcers and superficial venous reflux. Interventions Compression alone or compression plus saphenous surgery. Main outcome measures Primary outcomes were ulcer healing and ulcer recurrence. The secondary outcome was ulcer free time. Results Ulcer healing rates at three years were 89% for the compression group and 93% for the compression plus surgery group (P=0.73, log rank test). Rates of ulcer recurrence at four years were 56% for the compression group and 31% for the compression plus surgery group (P<0.01). For patients with isolated superficial reflux, recurrence rates at four years were 51% for the compression group and 27% for the compress plus surgery group (P<0.01). For patients who had superficial with segmental deep reflux, recurrence rates at three years were 52% for the compression group and 24% for the compression plus surgery group (P=0.04). For patients with superficial and total deep reflux, recurrence rates at three years were 46% for the compression group and 32% for the compression plus surgery group (P=0.33). Patients in the compression plus surgery group experienced a greater proportion of ulcer free time after three years compared with patients in the compression group (78% v 71%; P=0.007, Mann-Whitney U test). Conclusion Surgical correction of superficial venous reflux in addition to compression bandaging does not improve ulcer healing but reduces the recurrence of ulcers at four years and results in a greater proportion of ulcer free time. Trial registration Current Controlled Trials ISRCTN07549334. PMID:17545185

  9. Legged robots that balance

    SciTech Connect

    Raibert, M.H.

    1985-01-01

    This book presents implications for theories of human motor control. The author describes the study of physical machines that run and balance on just one leg, including analysis, computer simulation, and laboratory experiments. He reveals that, contrary to expectations, control of such machines is not particularly difficult. He shows how the principles of locomotion with one leg can be extended to systems with several legs and reports preliminary experiments with a quadruped machine that runs using these principles.

  10. Diabetic foot ulcers. Pathophysiology, assessment, and therapy.

    PubMed Central

    Bowering, C. K.

    2001-01-01

    OBJECTIVE: To review underlying causes of diabetic foot ulceration, provide a practical assessment of patients at risk, and outline an evidence-based approach to therapy for diabetic patients with foot ulcers. QUALITY OF EVIDENCE: A MEDLINE search was conducted for the period from 1979 to 1999 for articles relating to diabetic foot ulcers. Most studies found were case series or small controlled trials. MAIN MESSAGE: Foot ulcers in diabetic patients are common and frequently lead to lower limb 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. PMID:11398715

  11. Antimicrobial therapy of peptic ulcers

    Microsoft Academic Search

    Stephan Miehlke; David Y. Graham

    1997-01-01

    It is now accepted that peptic ulcer disease, whether duodenal or gastric, is one manifestation of infection with the bacterium Helicobacter pylori. This realization has revolutionized the management of peptic ulcer disease and changed the dictum from no acid no ulcer, to no H. pylori, no ulcer. When confronted with a patient with peptic ulcer disease, the physician must now

  12. A Mysterious Cause of Gastrointestinal Bleeding Disguising Itself as Diverticulosis and Peptic Ulcer Disease: A Review of Diagnostic Modalities for Aortoenteric Fistula

    PubMed Central

    Senadhi, Viplove; Brown, James C.; Arora, Deepika; Shaffer, Rebecca; Shetty, Dhiren; Mackrell, Peter

    2010-01-01

    An 81-year-old male with a history of hypertension, hyperlipidemia, smoking, and peptic ulcer disease (PUD) presented with 2 episodes of maroon stools for 3 days and was found to be orthostatic. His PUD was thought to have accounted for a previous upper gastrointestinal (GI) bleed. A colonoscopy revealed 3 polyps and a few diverticuli throughout the colon that were considered to be the source of the bleeding. Two months later, the patient had massive lower GI bleeding and developed hypovolemic shock with a positive bleeding scan in the splenic flexure; however, angiography was negative. A repeat colonoscopy revealed transverse/descending colon diverticular disease and the patient was scheduled for a left hemicolectomy for presumed diverticular bleeding. Intraoperatively, an aortoenteric (AE) fistula secondary to an aorto-bi-iliac bypass graft placed during an abdominal aortic aneurysm (AAA) repair 14 years prior was discovered and was found to be the source of the bleeding. The patient had an AE fistula repair and did well postoperatively without further bleeding. AE fistulas can present with either upper GI or lower GI bleeding, and are universally deadly if left untreated. AE fistulas often present with a herald bleed before life-threatening bleeding. A careful history should always be elicited in patients with risk factors of AAAs such as hypertension, hyperlipidemia and a history of smoking. Strong clinical suspicion in the setting of a scrupulous patient history is the most important factor that allows for the diagnosis of an AE fistula. There are numerous diagnostic modalities for AE fistula, but there is not one specific test that universally diagnoses AE fistulas. Nuclear medicine scans and angiography should not be completely relied on for the diagnosis of AE fistulas or other lower GI bleeds for that manner. Although the conventional paradigm for evaluating lower GI bleeds incorporates nuclear medicine scans and angiography, there is evidence that early endoscopy with enteroscopy may have a better role in severe lower GI bleeding. PMID:21151635

  13. l1:Leg l2:Leg l3:Leg l4:Leg p1:Person n1:Number

    E-print Network

    Bergstein, Paul

    ssn gpa major course- assigned salary course- assigned #12;Occupation ssn Number University_employee Area Economics Comp_Sci major Occupation ssn Number University_employee TA Professor Undergrad:Number ssn #12;Leg color owner Ident Person Number ssn Table leg1 leg2 leg3 leg4 Owner Person Company

  14. Our experience with the lateral supramalleolar island flap for reconstruction of the distal leg and foot: a review of 20 cases.

    PubMed

    Demiri, Efterpi; Foroglou, Periclis; Dionyssiou, Dimitrios; Antoniou, Antonios; Kakas, Paraskevas; Pavlidis, Leonidas; Lazaridis, Lampis

    2006-01-01

    We describe our experience with, and evaluate the reliability of, the lateral supramalleolar flap that was used in 20 patients for reconstruction of the distal leg and foot. There were 14 men and six women, age range 20-83 years. Nine were diabetic. The causes of the skin defects included trauma, diabetic ulcer, and deep burn. Sites of defects were the lower leg, the Achilles tendon, the dorsal and lateral aspect of the foot, and the ankle. Nineteen flaps survived and provided satisfactory coverage of the defect. Four flaps showed partial necrosis and required revision. We think that the lateral supramalleolar flap is a good way to reconstruct soft tissue defects of the lower extremity. Based on a secondary vascular axis, it has a large skin paddle and a wide rotation arc that reaches the distal areas of the foot. PMID:16537258

  15. Marjolin’s Ulcer

    PubMed Central

    Sawhney, Sukhpal; Jain, Rajeev; Kakaria, Anupam; Chopra, Pradeep

    2009-01-01

    Marjolin’s ulcers are malignancies that arise in chronic venous ulcers, scars, burns, long standing wounds or sinuses. Radiography provides important information regarding bone destruction and periosteal reaction, and magnetic resonance (MR) imaging provides excellent soft tissue detail, like tumour extent, depth, margins, any underlying bone cortical or marrow involvement, or involvement of adjacent neuro-vascular structures. We report two cases of Marjolin’s ulcer and describe their radiographic and MR appearances. PMID:21509294

  16. Science Nation: Ulcer Answers

    NSDL National Science Digital Library

    Every year, nearly four million people in the United States are afflicted with stomach ulcers. The explanation of how you contract an ulcer has evolved from what seemed like an educated guess 50 years ago to something based more in scientific fact today. In 1982, two Australian scientists were able to link a specific bacteria to most stomach ulcers. They eventually went on to win the 2005 Nobel Prize in Medicine for their work.

  17. Automatic analysis of the corneal ulcer

    NASA Astrophysics Data System (ADS)

    Ventura, Liliane; Chiaradia, Caio; Faria de Sousa, Sidney J.

    1999-06-01

    A very common disease in agricultural countries is the corneal ulcer. Particularly in the public hospitals, several patients come every week presenting this kind of pathology. One of the most important features to diagnose the regression of the disease is the determination of the vanishing of the affected area. An automatic system (optical system and software), attached to a Slit Lamp, has been developed to determine automatically the area of the ulcer and to follow up its regression. The clinical procedure to isolate the ulcer is still done, but the measuring time is fast enough to not cause discomfort to the patient as the traditional evaluation does. The system has been used in the last 6 months in a hospital that has about 80 patients per week presenting corneal ulcer. The patients follow up (which is an indispensable criteria for the cure of the disease) has been improved by the system and has guaranteed the treatment success.

  18. Juxta CURES: compression for healing venous leg ulcers.

    PubMed

    Nugent, Lisa

    2013-09-01

    Clinicians are expected to show improved healing rates, reduction in recurrence rates and to demonstrate greater patient satisfaction. All patients should rightly expect a high standard of holistic care that supports both their physical and emotional needs. Keeping the patient engaged in the "healing process" has many beneficial outcomes, not least to their emotional wellbeing. Managing to heal the wounds within a realistic timeframe is the required outcome for all parties. This article demonstrates how a new compression device, Juxta CURES, has a positive impact on patients' quality of life, also benefiting the clinician while maintaining cost-saving efficiencies. PMID:24575602

  19. Gnawing Pains, Festering Ulcers, and Nightmare Suffering: Selling Leprosy as a Humanitarian Cause in the British Empire, c. 1890-1960

    PubMed Central

    Vongsathorn, Kathleen

    2014-01-01

    When British attention was drawn to the issue of leprosy in the Empire, humanitarian organisations rose to take on responsibility for the ‘fight against leprosy’. In an effort to fundraise for a distant cause at a time when hundreds of charities competed for the financial support of British citizens, fundraisers developed propaganda to set leprosy apart from all other humanitarian causes. They drew on leprosy’s relationship with Christianity, its debilitating symptoms, and the supposed vulnerability of leprosy sufferers in order to mobilise Britain’s sense of humanitarian, Christian, and patriotic duty. This article traces the emergence of leprosy as a popular imperial humanitarian cause in modern Britain and analyses the narratives of religion, suffering, and disease that they created and employed in order to fuel their growth and sell leprosy as a British humanitarian cause. PMID:24932060

  20. Randomised, comparative study of three primary dressings for the treatment of venous ulcers.

    PubMed

    Charles, H; Callicot, C; Mathurin, D; Ballard, K; Hart, J

    2002-06-01

    In this article, we describe a randomised trial in which two established primary dressings - Comfeel (Coloplast, UK) and Granuflex improved formulation (Convatec, UK) - were compared to Cutinova foam (Beiersdorf Medical, UK) in the management of venous leg ulcers. Patients that met the study trial criteria were randomised to receive one of the three primary dressings. All ulcers were secondarily bandaged with Comprilan (Beiersdorf Medical, UK) short-stretch compression. The three dressings were compared in terms of their ability to promote ulcer healing (closure rate and healing rate) and reduce the prevalence and severity of ulcer-associated pain, over a 12-week period. The ease with which dressings could be used in a busy outpatient clinic setting was also considered. On enrollment, groups were well matched in terms of all of the patient and ulcer parameters studies. Six patients were withdrawn for reasons unrelated to study dressings or trial procedures. Following non-parametric analysis of the study data, the three dressings were found to be equally effective at promoting ulcer healing and alleviating ulcer-associated pain. Study personnel rated Cutinova Foam as easy, if not easier, to use than Comfeel or Granuflex. This study suggests that Cutinova Foam is as safe and effective as both Comfeel and Granuflex, in the treatment of venous leg ulcers. PMID:12066081

  1. PEPTIC ULCER DISEASE

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Peptic ulcer disease (PUD) is an ulcerative condition of the stomach or duodenum that may be accompanied by mucosal inflammation. PUD is classified as primary when it occurs in healthy children and as secondary when underlying disorders associated with injury, illness, or drug therapy co-exists. Pri...

  2. Diabetic foot ulcers

    Microsoft Academic Search

    William J Jeffcoate; Keith G Harding

    2003-01-01

    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-

  3. The effect of ankle range of motion on venous ulcer healing rates.

    PubMed

    Yim, Elizabeth; Richmond, Nicholas A; Baquerizo, Katherine; Van Driessche, Freya; Slade, Herbert B; Pieper, Barbara; Kirsner, Robert S

    2014-01-01

    Limitation of ankle movement may contribute to calf muscle pump failure, which is thought to contribute to venous leg ulcer formation, which affects nearly 1 million Americans. We therefore wished to study ankle movement in patients with venous leg ulcers and its effect on healing. Using goniometry, we measured baseline ankle range of motion in venous leg ulcer patients from a Phase 2 dose-finding study of an allogeneic living cell bioformulation. Two hundred twenty-seven patients were enrolled in four active treatment groups and one standard-care control group, all receiving compression therapy. Goniometry data from a control group of 49 patients without venous disease, from a previous study, was used for comparison. We found patients with active venous leg ulcers had significantly reduced ankle range of motion compared with the control group (p?=?0.001). After 12?weeks of therapy, baseline ankle range of motion was not associated with healing, as there was no significant difference between healed and nonhealed groups, suggesting that ankle range of motion is not important in venous leg ulcer healing or, more likely, is overcome by compression. However, patients with venous ulcers located on the leg (as opposed to the ankle) had significantly higher ankle range of motion for plantar flexion and inversion (p?=?0.021 and p?=?0.034, respectively) and improved healing with both cell bioformulation and standard care (p?=?0.011), suggesting that wound location is an important variable for ankle range of motion as well as for healing outcomes. PMID:25041619

  4. 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

    2012-01-01

    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. PMID:22471884

  5. Infection with Mansonella perstans Nematodes in Buruli Ulcer Patients, Ghana

    PubMed Central

    Frimpong, Michael; Sarfo, Fred S.; Kretschmer, Birte; Beissner, Marcus; Debrah, Alexander; Ampem-Amoako, Yaw; Abass, Kabiru M.; Thompson, William; Duah, Mabel Sarpong; Abotsi, Justice; Adjei, Ohene; Fleischer, Bernhard; Bretzel, Gisela; Wansbrough-Jones, Mark; Jacobsen, Marc

    2014-01-01

    During August 2010–December 2012, we conducted a study of patients in Ghana who had Buruli ulcer, caused by Mycobacterium ulcerans, and found that 23% were co-infected with Mansonella perstans nematodes; 13% of controls also had M. perstans infection. M. perstans co-infection should be considered in the diagnosis and treatment of Buruli ulcer. PMID:24857346

  6. Growth arrest and leg-length discrepancy.

    PubMed

    Shailam, Randheer; Jaramillo, Diego; Kan, J Herman

    2013-03-01

    Identification of congenital and acquired etiologies causing alignment disorders and leg-length discrepancies (LLD) in children is important for management. Minor differences in the lengths of the lower extremities are considered a normal variation and usually have no clinical significance. However, LLD of greater than 1 cm can cause altered biomechanics, resulting in scoliosis, back and lower extremity joint pain, pelvic tilt, abnormal gait and premature degenerative joint disease. The purpose of this pictorial essay is to review the imaging spectrum of growth arrest and resultant alignment and leg-length discrepancies in children. PMID:23478931

  7. 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....

  8. Restless Legs Syndrome

    MedlinePLUS

    ... to minimize or prevent the sensations. They may pace the floor, constantly move their legs while sitting, ... disruption (e.g., sleep apnea), which may impact management of the disorder. Diagnosing RLS in children may ...

  9. Peripheral artery disease - legs

    MedlinePLUS

    ... affected artery or arteries for moderate-to-severe cases that are not candidates for surgery. Medicine to ... Most cases of peripheral artery disease of the legs can be controlled without surgery. Although surgery provides good symptom ...

  10. Legs of Mesolimulus

    NSDL National Science Digital Library

    2001-03-01

    This specimen of the horseshoe crab Mesolimulus displays the impression of three segmented arms. Although capable of walking on these legs, modern horseshoe crabs use them mainly for burrowing for prey (clams and worms).

  11. Severe and Refractory Peptic Ulcer Disease: The Diagnostic Dilemma Case Report and Comprehensive Review

    Microsoft Academic Search

    JAMES L. GUZZO; MONA DUNCAN; BARBARA L. BASS; GRANT V. BOCHICCHIO; LENA M. NAPOLITANO

    2008-01-01

    The recognition of Helicobacter pylori infection as a cause of peptic ulcer disease, medical regimens to eradicate the organism, and the widespread use of proton pump inhibition to suppress gastric acid secretion have revolutionized the management of peptic ulcer disease. As a result, successful medical management of peptic ulcer disease has largely supplanted the need for gastric surgery by general

  12. Solitary ulcer of the rectum

    Microsoft Academic Search

    M. R. Madigan; B. C. Morson

    1969-01-01

    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

  13. Helicobacter pylori-negative, non-steroidal anti-inflammatory drug: Negative idiopathic ulcers in Asia

    PubMed Central

    Iijima, Katsunori; Kanno, Takeshi; Koike, Tomoyuki; Shimosegawa, Tooru

    2014-01-01

    Since the discovery of Helicobacter pylori (H. pylori) infection in the stomach, the bacteria infection and non-steroidal anti-inflammatory drugs (NSAIDs) use had been considered to be the 2 main causes of peptic ulcers. However, there have been recent reports of an increase in the proportion of peptic ulcers without these known risk factors; these are termed idiopathic peptic ulcers. Such trend was firstly indicated in 1990s from some reports in North America. In Asia, numerous studies reported that idiopathic ulcers accounted for a small percentage of all ulcers in the 1990s, but in the 2000s, multiple studies reported that the proportion of idiopathic ulcers had reached 10%-30%, indicating that the incidence of idiopathic ulcers in Asia has also been rising in recent years. While a decline in H. pylori infection rates of general population in Asia is seen as the main reason for the increased incidence of idiopathic ulcers, it is also possible that the absolute number of idiopathic ulcer cases has increased. Advanced age, serious systemic complication, and psychological stress are considered to be the potential risk factors for idiopathic ulcers. Management of idiopathic ulcers is challenging, at present, because there is no effective preventative measure against recurrence in contrast with cases of H. pylori-positive ulcers and NSAIDs-induced ulcers. As it is expected that H. pylori infection rates in Asia will decline further in the future, measures to treat idiopathic ulcers will also likely become more important. PMID:24574744

  14. Helicobacter pylori-negative, non-steroidal anti-inflammatory drug: negative idiopathic ulcers in Asia.

    PubMed

    Iijima, Katsunori; Kanno, Takeshi; Koike, Tomoyuki; Shimosegawa, Tooru

    2014-01-21

    Since the discovery of Helicobacter pylori (H. pylori) infection in the stomach, the bacteria infection and non-steroidal anti-inflammatory drugs (NSAIDs) use had been considered to be the 2 main causes of peptic ulcers. However, there have been recent reports of an increase in the proportion of peptic ulcers without these known risk factors; these are termed idiopathic peptic ulcers. Such trend was firstly indicated in 1990s from some reports in North America. In Asia, numerous studies reported that idiopathic ulcers accounted for a small percentage of all ulcers in the 1990s, but in the 2000s, multiple studies reported that the proportion of idiopathic ulcers had reached 10%-30%, indicating that the incidence of idiopathic ulcers in Asia has also been rising in recent years. While a decline in H. pylori infection rates of general population in Asia is seen as the main reason for the increased incidence of idiopathic ulcers, it is also possible that the absolute number of idiopathic ulcer cases has increased. Advanced age, serious systemic complication, and psychological stress are considered to be the potential risk factors for idiopathic ulcers. Management of idiopathic ulcers is challenging, at present, because there is no effective preventative measure against recurrence in contrast with cases of H. pylori-positive ulcers and NSAIDs-induced ulcers. As it is expected that H. pylori infection rates in Asia will decline further in the future, measures to treat idiopathic ulcers will also likely become more important. PMID:24574744

  15. Actuator device for artificial leg

    NASA Technical Reports Server (NTRS)

    Burch, J. L. (inventor)

    1976-01-01

    An actuator device is described for moving an artificial leg of a person having a prosthesis replacing an entire leg and hip joint. The device includes a first articulated hip joint assembly carried by the natural leg and a second articulated hip joint assembly carried by the prosthesis whereby energy from the movement of the natural leg is transferred by a compressible fluid from the first hip joint assembly to the second hip joint assembly for moving the artificial leg.

  16. [Uncommon cutaneous ulcerative and systemic sarcoidosis. Successful treatment with hydroxychloroquine and compression therapy].

    PubMed

    Meyersburg, D; Schön, M P; Bertsch, H P; Seitz, C S

    2011-09-01

    Sarcoidosis is a granulomatous multisystemic disease of unclear etiology, which can affect any organ. The cutaneous manifestations are variable, but ulcerative cutaneous sarcoidosis is very rare. One must rule out other granulomatous skin diseases, especially necrobiosis lipoidica. There is no standarized therapy; usually an interdisciplinary approach over years taking multiple side effects into consideration is needed. A 58-year-old woman with a long history of cutaneous, nodal and pulmonary sarcoidosis suddenly developed ulcerations within the disseminated skin lesions on her legs. The combination of systemic hydroxychloroquine and modern wound management lead to complete healing of the ulcers and a significant improvement in the remaining skin lesions. PMID:21656110

  17. Interventions for leg edema and varicosities in pregnancy

    Microsoft Academic Search

    Anthony Akinloye Bamigboye; George Justus Hofmeyr

    2006-01-01

    Leg oedema from venous insufficiency is not dangerous but it can cause women symptoms such as pain, feelings of heaviness, night cramps and paraesthesiae. Leg oedema can be a sign of pre-eclampsia when associated with raised blood pressure or proteinuria. The objective of this review was to assess the effects of treatment to relieve the symptoms associated with varicosity in

  18. Peripheral Ulcerative Keratitis

    MedlinePLUS

    ... Resources for Help and Information The One-Page Merck Manual of Health Medical Terms Conversion Tables Manuals available ... Peripheral Ulcerative Keratitis Keratoconus Bullous Keratopathy Corneal Transplantation Merck Manual > Patients & Caregivers > Eye Disorders > Corneal Disorders 4 Peripheral ...

  19. Continuous ambulatory peritoneal dialysis (CAPD) associated peritonitis in a child: a rare case of peritonitis caused by sphingomonous paucimobilis.

    PubMed

    Tambawala, Arwa Quresh; Hamid, Sadaf; Khan, Iqtidar; Ali, Asad

    2011-02-01

    First identified in 1977, Sphingomonous Paucimobilis has emerged as an opportunistic human pathogen. It is primarily known to cause a range of mostly nosocomial, non-life-threatening infections that typically are easily treated by antibiotic therapy. Sources of its isolation linked to clinical disease include blood, spinal fluid and leg ulcers. It has also been reported as a rare cause of peritonitis in patients on continuous ambulatory peritoneal dialysis. We present a case of a child with peritonitis due to this organism. Clinical features, bacteriology and treatment option and response have been discussed. PMID:21375172

  20. Cancer and Ulcerative Colitis

    PubMed Central

    Aylett, Stanley

    1971-01-01

    Ulcerative colitis is a potential precursor of cancer of the colon or rectum. In a series of patients with ulcerative colitis operated on between 1952 and 1968 seven developed carcinoma in the residual rectal stump after total colectomy and ileorectal anastomis. After assessment of the risks of the other available forms of treatment, I believe that ileorectal anastomosis is the best operation in the majority of cases. PMID:5575952

  1. Burns and Ulcerative Colitis

    PubMed Central

    Castana, O.; Makrodimou, M.; Mantzaris, G.; Tsandoulas, Z.; Prigouris, S.; Alexakis, D.

    2006-01-01

    Summary The co-existence of an extensive burn with a systemic disease negatively affects the outcome of the burn as well as the progress of the disease. A case report is presented regarding a 70-yr-old female patient with 45% total body surface area burns and ulcerative colitis under treatment. The outcome of the burns is described and it is pointed out that the healing process of the burns and the remission of the ulcerative colitis were related. PMID:21991043

  2. Burns and ulcerative colitis.

    PubMed

    Castana, O; Makrodimou, M; Mantzaris, G; Tsandoulas, Z; Prigouris, S; Alexakis, D

    2006-09-30

    The co-existence of an extensive burn with a systemic disease negatively affects the outcome of the burn as well as the progress of the disease. A case report is presented regarding a 70-yr-old female patient with 45% total body surface area burns and ulcerative colitis under treatment. The outcome of the burns is described and it is pointed out that the healing process of the burns and the remission of the ulcerative colitis were related. PMID:21991043

  3. Treatment of venous ulcers

    Microsoft Academic Search

    Tami S. De Araujo; Camile Luiza Hexsel; Robert S. Kirsner

    2005-01-01

    Optional statement  Underlying the pathogenesis of venous ulceration is venous hypertension. Therefore, the use of multilayered compression therapy\\u000a is the gold standard in the treatment of a venous ulcer. As treatment progresses, an important determinant of response is\\u000a wound assessment, which should be performed on initial visit and subsequently thereafter. Among the methods to assess improvement\\u000a are digital photography and planimetry,

  4. Ulcers and gastritis.

    PubMed

    Kashiwagi, H

    2005-02-01

    This article reviews recently published reports on ulcers and gastritis. Helicobacter pylori is known to be an important pathogen involved in gastroduodenal inflammation and peptic ulcers. Conventional endoscopy is of limited usefulness in the evaluation of gastritis, but magnifying endoscopy is evidently helpful in the diagnosis of chronic atrophic gastritis, intestinal metaplasia, and H. pylori infection. A significant reduction in the incidence of refractory ulcers and the prevalence of H. pylori infection in patients with peptic ulcer disease followed the introduction of H. pylori eradication treatment. Chronic H. pylori infection is associated with gastric cancer, and the effect of H. pylori eradication on the prevention of gastric cancer is an important issue that is still a matter of controversy. Endoscopic hemostasis and intravenous proton-pump inhibitor (PPI) infusion represent a widely accepted approach to the treatment of peptic ulcer bleeding. In clinical practice, it is important to prevent recurrent bleeding and to treat patients who do not respond to endoscopic therapy or PPI treatment. Laparoscopic repair for peptic ulcer perforations, with postoperative eradication treatment, has gradually met with acceptance in patients with H. pylori infection. H. pylori infection and its treatment continue to be interesting problems in this field. PMID:15692925

  5. Modern Endoscopic Therapy of Peptic Ulcer Bleeding

    Microsoft Academic Search

    Shajan Peter; C. Mel Wilcox

    2008-01-01

    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

  6. Initial healing rates as predictive factors of venous ulcer healing: the use of a laser-based three-dimensional ulcer measurement.

    PubMed

    Kecelj Leskovec, Nada; Perme, Maja Pohar; Jezersek, Matija; Mozina, Janez; Pavlovi?, Milos D; Lunder, Tomaz

    2008-01-01

    There is a need for practical methods to predict the healing time of venous leg ulcers. In a prospective cohort study of 81 patients with venous leg ulcers, we used a recently described laser-based three-dimensional measurement of the ulcers at days 0 and 28 to estimate the predictive power of horizontal (HIHR) and vertical initial healing rates (VIHR) for wound healing by week 24. The rates were calculated by Gilman's equation [(A(1)-A(2))/((p(1)+p(2))/2)((0-4))] and by its modification [(V(1)-V(2))/((A(1)+A(2))/2)((0-4))], respectively. The influence of risk factors on both the initial healing rates was also studied. The HIHR and VIHR are important predictors of healing at 24 weeks. They are not influenced by age, ulcer duration, initial ulcer area, and insufficient sapheno-femoral junction, and/or calf perforating veins. Together with ulcer duration, they are independent predictors of the 24-week healing (the area under ROC curve equals to 0.9). VIHR gives us additional information and significantly improves the prediction of 24-week healing. PMID:18638269

  7. Recurrent myopericarditis with extensive ulcerative colitis

    PubMed Central

    Freeman, Hugh James; Salh, Baljinder

    2010-01-01

    A 26-year-old man with ulcerative colitis was independently evaluated in different emergency rooms on two occasions, separated by six years, for episodes of severe chest pain consistent with myopericarditis. Cardiac enzyme and electrocardiographic changes were accompanied by extensive colonic inflammatory changes. Treatment with corticosteroids led to resolution. While his cardiac findings were initially believed to be caused by a previously reported drug hypersensitivity to mesalamine (5-aminosalicylate), sulphasalazine was tolerated. Recurrent myopericarditis with ulcerative colitis appears to be rare, but responsive to steroids. It may occur more often than is currently appreciated and may lead to fatal arrhythmias or cardiac failure. PMID:21165365

  8. Endoscopic management of acute peptic ulcer bleeding.

    PubMed

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

    2014-12-01

    This review discusses the indications, technical aspects, and comparative effectiveness of the endoscopic treatment of upper gastrointestinal bleeding caused by peptic ulcer. Pre-endoscopic considerations, such as the use of prokinetics and timing of endoscopy, are reviewed. In addition, this article examines aspects of postendoscopic care such as the effectiveness, dosing, and duration of postendoscopic proton-pump inhibitors, Helicobacter pylori testing, and benefits of treatment in terms of preventing rebleeding; and the use of nonsteroidal anti-inflammatory drugs, antiplatelet agents, and oral anticoagulants, including direct thrombin and Xa inhibitors, following acute peptic ulcer bleeding. PMID:25440919

  9. Thyroid Storm Precipitated by Duodenal Ulcer Perforation

    PubMed Central

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

    2015-01-01

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

  10. 20. DETAIL, TYPICAL LEG CONNECTION, CROSS BRACING AT LEG, WITH ...

    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

  11. Diabetic foot ulcerations: an overview.

    PubMed

    Daniels, T R

    1998-09-01

    The development of a diabetic neuropathic ulcer is a multifactorial process with an emphasis on mechanical abnormalities. In the absence of vascular compromise, up to 90 percent of neuropathic ulcers will heal with proper ulcer debridement, treatment of infection and relief of weight from the ulcerated area. A thorough understanding of the etiology of a neuropathic ulcer is an essential component in the appropriate management of these patients. Treatment of the diabetic neuropathic ulcer is a multidisciplinary clinical problem and each member of the team has a unique role to play. PMID:9866607

  12. Changes in leg volume during microgravity simulation

    NASA Technical Reports Server (NTRS)

    Thornton, William E.; Hedge, Vickie; Coleman, Eugene; Uri, John J.; Moore, Thomas P.

    1992-01-01

    Little published information exists regarding the magnitude and time course of cephalad fluid shift resulting from microgravity simulations. Six subjects were exposed to 150 min each at horizontal bed rest, 6-deg head-down tilt, and horizontal water immersion. Fluid shift was estimated by calculating leg volumes from eight serial girth measurements from groin to ankle before, during, and after exposure. Results were compared with data from the first 3 h of spacecraft. By the end of exposure, total leg volume for the six subjects decreased by 2.6 +/- 0.8 percent, 1.7 +/- 1.2 percent, and 4.0 +/- 1.6 percent for horizontal, head-down, and immersion, respectively. Changes had plateaued for horizontal and head-down and had slowed for immersion. Relatively more fluid was lost from the lower leg than the thigh for all three conditions, particularly head-down. During the first 3 h of spaceflight, total leg volume decreased by 8.6 percent, and relatively more fluid was lost from the thigh than the lower leg. The difference in volume changes in microgravity and simulated microgravity may be caused by the small transverse pressures still present in ground-based simulations and the extremely nonlinear compliance of tissue.

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

    PubMed Central

    Chatterjee, Sasanka S.

    2012-01-01

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

  14. Metastable legged-robot locomotion

    E-print Network

    Byl, Katie

    2008-01-01

    A variety of impressive approaches to legged locomotion exist; however, the science of legged robotics is still far from demonstrating a solution which performs with a level of flexibility, reliability and careful foot ...

  15. Leg or foot amputation

    MedlinePLUS

    ... your muscles to make them stronger Strengthen your arms and legs Begin walking with a walking aid and parallel bars Start moving around the bed and into the chair in your hospital room Keep your joints mobile Sit or lay in different positions to keep ...

  16. Athletes' leg pains

    Microsoft Academic Search

    S. Orava; J. Puranen

    1979-01-01

    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,

  17. Chronic exertional compartment syndrome of the leg

    Microsoft Academic Search

    Alicia K. Tucker

    2010-01-01

    Chronic exertional compartment syndrome (CECS) is an underdiagnosed cause of chronic exertional leg pain. The syndrome most\\u000a commonly occurs in young adult recreational runners, elite athletes, and military recruits. CECS is caused by increased intracompartmental\\u000a pressure within a fascial space; however, the mechanism of why pain occurs is unknown. Symptoms are classically pain in the\\u000a affected compartment at the same

  18. Ulcer disease of trout

    USGS Publications Warehouse

    Fish, F.F.

    1934-01-01

    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.

  19. Gait Generation For Legged Robots

    Microsoft Academic Search

    David Wettergreen; Chuck Thorpe

    1992-01-01

    Gait generation is the formulation and selection of a sequence of coordinated leg and body motions that propel a legged robot along a desired path. Approaches to gait generation can be classified into control, behavioral, rule-based, and constraint- based paradigms. We survey these models of gait generation and introduce the Ambler, a hexapod robot that can circulate its legs to

  20. Treatment of restless legs syndrome.

    PubMed

    Comella, Cynthia L

    2014-01-01

    Restless legs syndrome (RLS) is a common disorder diagnosed by the clinical characteristics of restlessness in the legs associated often with abnormal sensations that start at rest and are improved by activity, occurring with a diurnal pattern of worsened symptoms at night and improvement in the morning. RLS is the cause of impaired quality of life in those more severely afflicted. Treatment of RLS has undergone considerable change over the last few years. Several classes of medications have demonstrated efficacy, including the dopaminergic agents and the alpha-2-delta ligands. Levodopa was the first dopaminergic agent found to be successful. However, chronic use of levodopa is frequently associated with augmentation that is defined as an earlier occurrence of symptoms frequently associated with worsening severity and sometimes spread to other body areas. The direct dopamine agonists, including ropinirole, pramipexole, and rotigotine patch, are also effective, although side effects, including daytime sleepiness, impulse control disorders, and augmentation, may limit usefulness. The alpha-2-delta ligands, including gabapentin, gabapentin enacarbil, and pregabalin, are effective for RLS without known occurrence of augmentation or impulse control disorders, although sedation and dizziness can occur. Other agents, including the opioids and clonazepam do not have sufficient evidence to recommend them as treatment for RLS, although in an individual patient, they may provide benefit. PMID:24363103

  1. Evaluation of technetium-99m phosphate imaging for predicting skin ulcer healing

    SciTech Connect

    Lawrence, P.F.; Syverud, J.B.; Disbro, M.A.; Alazraki, N.

    1983-12-01

    We have developed criteria for radionuclide angiography to assess skin ulcer perfusion as an indicator of healing capacity. Twenty-six studies were performed on 21 consecutive patients with nonhealing ulcers of the lower leg; 20 mCi of technetium-99m phosphate was injected intravenously with immediate sequential scintillation camera imaging of the ulcer and surrounding area at 2 second intervals, followed by blood pool and delayed static images. Two radiologists without clinical bias graded the perfusion to the ulcer on the images as normal, increased, or reduced with respect to the opposite limb. Patients were either followed as outpatients for more than 10 days, as inpatients for at least 10 days, or both to determine whether ulcers showed clinical evidence of wound healing with optimal outpatient and in-hospital care. Of the 17 patients whose ulcers healed, imaging with technetium-99m phosphate predicted the outcome in 16. In nine patients the ulcers did not heal. This was correctly predicted by technetium-99m phosphate in eight of the patients. Overall, the sensitivity was 94 percent and the specificity was 89 percent. This technique appears to be a simple, reliable way to predict the microcirculatory adequacy for ulcer healing.

  2. A Placebo-controlled, Double-blind Study of Mesoglycan in the Treatment of Chronic Venous Ulcers

    Microsoft Academic Search

    E. Arosio; G. Ferrari; L. Santoro; F. Gianese

    2001-01-01

    Objectives to assess the effect of treatment with mesoglycan, a sulphated polysaccharide compound, on the healing of venous ulcers. Design randomised, placebo-controlled, double-blind, multicentre trial. Methods non-diabetic outpatients with chronic venous insufficiency confirmed by duplex ultrasound, normal ankle\\/arm pressure index and presence of a leg ulcer were eligible. Patients were randomised to mesoglycan, 30 mg\\/day intramuscularly for 3 weeks followed

  3. Improvement of severe ulcer of buerger’s disease by bone-marrow mononuclear cell transplantation: a case report

    Microsoft Academic Search

    Teruko Soda; Hiroshi Suzuki; Taro Kusuyama; Yuya Yokota; Yasutoshi Omori; Takatoshi Sato; Fumiyoshi Tsunoda; Makoto Shoji; Yoshitaka Iso; Shinji Koba; Eiichi Geshi; Takashi Katagiri; Shigeru Tomoyasu

    [Case Report] A 47-year-old man with Buerger’s disease was admitted with complaints of progressive ulcer of left planta pedis\\u000a and resting pain of the left leg. The ulcer was not healed under medical therapy nor lumbar sympathetic ganglion block, and\\u000a angioplasty or bypass surgery was not applicable. All his toes showed cyanotic and left third and fifth toes were gangrene,

  4. Tendon Achilles lengthening for the treatment of neuropathic ulcers causes a temporary reduction in forefoot pressure associated with changes in plantar flexor power rather than ankle motion during gait

    Microsoft Academic Search

    K. S. Maluf; M. J. Mueller; M. J Strube; J. R. Engsberg; J. E. Johnson

    2004-01-01

    The purposes of this study were to determine the effects of tendon Achilles lengthening (TAL) on ambulatory plantar pressures and ankle range of motion, moment, and power, and to determine whether changes in forefoot pressure after treatment of a neuropathic ulcer are related to changes in ankle dorsiflexion range of motion (DFROM) or plantar flexor (PF) power during gait. Pressure

  5. ORTHOPEDIC LEG BRACE

    NASA Technical Reports Server (NTRS)

    Myers, William Neil (Inventor)

    2005-01-01

    Knee braces generally have been rigid in both the knee bending direction and in the knee straightening direction unless a manually operated release is incorporated in them to allow the knee to bend. Desirably a braced knee joint should effectively duplicate the compound, complex, actions of a normal knee. The key to knee braces is the knee joint housing. The housing herein carries a number of cam action pawls. with teeth adapted to engage the internal teeth of a ratchet ring mounted in the housing. Cam action return springs and the shape of the cam action pawl teeth allow rotation of the ratchet ring in a leg straightening direction while still supporting a load. The leg can then be extended during walking while at the same time being prevented by the cam action pawls from buckling in the knee bending direction.

  6. [Managing perilesional pressure ulcers].

    PubMed

    Perceau, Géraldine

    2013-01-01

    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

  7. Methotrexate and oral ulceration

    Microsoft Academic Search

    G M J Deeming; J Collingwood; M N Pemberton

    2005-01-01

    Methotrexate is well established in the drug treatment of various neoplastic diseases. More recently it has become increasingly used as a once-weekly, low-dose treatment of disorders such as psoriasis and rheumatoid arthritis. Clinical trials have shown its effectiveness in these conditions and it is likely that dentists will encounter patients taking this drug in general dental practice. Oral ulceration can

  8. Effects of weekly LED therapy at 625 nm on the treatment of chronic lower ulcers.

    PubMed

    Siqueira, Cláudia Patrícia Cardoso Martins; de Paula Ramos, Solange; Gobbi, Cynthia A A; Shigaki, Leonardo; Kashimoto, Roberto K; Venâncio, Emerson José; de Oliveira Toginho Filho, Dari; Castaldin, André G; Felinto, Alan S; Silva, Francisco Pereira; Silva, Ricardo B; Dias, Ivan Frederico Lupiano

    2015-01-01

    The aim of this study was to evaluate the effects of LED therapy associated with compression therapy on chronic venous leg ulcers (CVUs). The study included CVU patients (n?=?17, eight men) who were eligible for Unna's boot treatment. Ulcers were treated on a weekly basis with either LED therapy (625 nm, 4 J/cm(2)) and an Unna's boot (LED ulcers, n?=?14) or a placebo treatment and an Unna's boot (control ulcers, n?=?14). The total surface area of the ulcers, the relative ulcer area, and the healing rate were recorded over a period of 30 weeks. Ulcer exudates were collected for determination of local tumor necrosis factor alpha (TNF-?) levels. The total area was not significantly different between the LED and control ulcers (P?>?0.05, Mann-Whitney U test) throughout the study. However, the relative area indicated that non-healing treatment resistant ulcers (n?=?6) persisted in the control group after 19 weeks (P?ulcers (19.5 weeks). No differences in TNF-? levels were detected (P?>?0.05, Mann-Whitney U test). The results suggest that LED therapy improved the effectiveness of the Unna's boot since no refractory ulcer was observed in the LED group after 19 weeks. However, LED therapy did not alter the local secretion of TNF-? nor accelerate wound healing. PMID:25315022

  9. [Dermatoses in leg amputees].

    PubMed

    Wlotzke, U; Hohenleutner, U; Landthaler, M

    1996-07-01

    Dermatologic disorders of the stump in patients with a leg amputation may have characteristic pathophysiologic and clinical features. A knowledge of these factors may lead to earlier diagnosis and avoid immobilization. There ist no German language review of this aspect of dermatology. After providing an overview of the problem, including a discussion of prostheses, we review the following problems: mechanically induced blisters, follicular keratoses, epidermoid cysts, stump edema syndrome, acroangiodermatitis (pseudo-kaposi sarcoma) and verrucous hyperplasia. PMID:8926163

  10. 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).

  11. Factors associated with ulceration and amputation in the neuropathic foot.

    PubMed

    Birke, J A; Patout, C A; Foto, J G

    2000-02-01

    The purpose of this paper is to review selected literature on the relationship of neuropathy and other related factors in foot ulceration and lower extremity amputation. There is strong evidence that sensory loss and mechanical stress are the primary cause of foot ulceration and common factors in the pathway to lower extremity amputation. Foot stress results from extrinsic factors such as footwear and intrinsic factors such as deformity and limited joint mobility. Understanding the interplay of these factors is valuable in identifying persons whose feet are at risk, effectively preventing and treating foot ulcerations and ultimately preventing lower extremity amputation. PMID:10693087

  12. Squamous Cell Carcinoma (Marjolin's Ulcer) Arising in a Sacral Decubitus Ulcer Resulting in Humoral Hypercalcemia of Malignancy.

    PubMed

    O'Malley, John T; Schoppe, Candace; Husain, Sameera; Grossman, Marc E

    2014-01-01

    Long-standing burns, fissures, and ulcers that undergo malignant transformation into a variety of malignancies, including squamous cell carcinoma, is commonly referred to as a Marjolin's ulcer. It is well recognized that squamous cell carcinomas of the lung and esophagus can cause humoral hypercalcemia of malignancy secondary to paraneoplastic secretion of parathyroid hormone-related peptide. However, it is extremely rare for a squamous cell carcinoma developing in a sacral decubitus ulcer to cause humoral hypercalcemia of malignancy. We describe the first case of a patient found to have elevated serum levels of parathyroid hormone related peptide related to his Marjolin's ulcer. A 45-year-old African American man with T6 paraplegia and a sacral decubitus ulcer present for 20 years was admitted for hypercalcemia of unclear etiology. He was subsequently found to have elevated parathyroid hormone related peptide and an excisional biopsy from the ulcer showed invasive squamous cell carcinoma suggestive of humoral hypercalcemia of malignancy. The patient ultimately succumbed to sepsis while receiving chemotherapy for his metastatic squamous cell carcinoma. Humoral hypercalcemia of malignancy is a rare and likely underrecognized complication that can occur in a Marjolin's ulcer. PMID:25197285

  13. Squamous Cell Carcinoma (Marjolin's Ulcer) Arising in a Sacral Decubitus Ulcer Resulting in Humoral Hypercalcemia of Malignancy

    PubMed Central

    O'Malley, John T.; Schoppe, Candace; Husain, Sameera; Grossman, Marc E.

    2014-01-01

    Long-standing burns, fissures, and ulcers that undergo malignant transformation into a variety of malignancies, including squamous cell carcinoma, is commonly referred to as a Marjolin's ulcer. It is well recognized that squamous cell carcinomas of the lung and esophagus can cause humoral hypercalcemia of malignancy secondary to paraneoplastic secretion of parathyroid hormone-related peptide. However, it is extremely rare for a squamous cell carcinoma developing in a sacral decubitus ulcer to cause humoral hypercalcemia of malignancy. We describe the first case of a patient found to have elevated serum levels of parathyroid hormone related peptide related to his Marjolin's ulcer. A 45-year-old African American man with T6 paraplegia and a sacral decubitus ulcer present for 20 years was admitted for hypercalcemia of unclear etiology. He was subsequently found to have elevated parathyroid hormone related peptide and an excisional biopsy from the ulcer showed invasive squamous cell carcinoma suggestive of humoral hypercalcemia of malignancy. The patient ultimately succumbed to sepsis while receiving chemotherapy for his metastatic squamous cell carcinoma. Humoral hypercalcemia of malignancy is a rare and likely underrecognized complication that can occur in a Marjolin's ulcer. PMID:25197285

  14. Genital Ulcerative Pyoderma Gangrenosum in Behçet's Disease: A Case Report and Review of the Literature.

    PubMed

    Ozuguz, Pinar; Kacar, Seval Dogruk; Manav, Vildan; Karaca, Semsettin; Aktepe, Fatma; Ulu, Sena

    2015-01-01

    Behçet's disease (BD), first described by Hulusi Behcet, is a multisystemic disease characterized by recurrent oral and genital ulcerations, ocular and cutaneous lesions, arthritis and vascular disease. Pyoderma gangrenosum (PG) is a rare, chronic, sterile pustular and progressive ulcerative process of unknown cause; sometimes can participate in the differential diagnosis of Behcet's ulceration. A 33-year-old woman complained a severe genital ulcer. She had a purulent oozing and stinky ulceration on the right side of labium minor measuring 5-8 cm. A punch biopsy at ulcer margin showed that the lymphocytic panniculitis was extending to the subcutaneous fat tissue without fibrin deposition or necrotic changes in the vessel wall. Based on the clinical and histological findings, she was diagnosed as genital ulcerative PG, which occurred during the exacerbation of BD. PMID:25657430

  15. Epidemiology of Helicobacter pylori Infection: Disease Management Implications for Peptic Ulcer Disease

    Microsoft Academic Search

    Hoda M. Malaty; David Y. Graham

    1999-01-01

    The discovery of Helicobacter pylori revolutionised thinking about the cause of peptic ulcer disease. The most common causes of peptic ulcers are H. pylori infection and use of nonsteroidal anti-inflammatory drugs. H. pylori is typically acquired in childhood. The risk of acquiring an H. pylori infection is inversely related the standard of living especially sanitary conditions. As the general health

  16. "Take your medicine": nonadherence issues in patients with ulcerative colitis.

    PubMed

    Turnbough, Lisa; Wilson, Lindsay

    2007-01-01

    Ulcerative colitis is a lifelong disease causing inflammation and ulceration of the colon. Symptoms of ulcerative colitis include abdominal pain, bloody diarrhea, bloating, and fecal urgency. The current standard therapy for mild to moderate ulcerative colitis is the use of 5-aminosalicylates, with patients requiring continuous treatment to maintain remission. A substantial proportion of patients, however, are nonadherent to prescribed 5-aminosalicylate treatment regimens, resulting in a greater chance of disease relapse with severe associated symptoms. There are many reasons why a patient with ulcerative colitis may be nonadherent including the patient's perception of the condition or a lack of understanding about the disease or treatment. Multiple daily dosing or rectal administration of 5-aminosalicylate medications also can adversely affect adherence rates. Because gastrointestinal nurses often are the primary points of contact for patients with ulcerative colitis, they are in a unique position to take simple steps that will improve adherence rates and thus increase the efficacy of prescribed therapy. This article highlights important aspects of education and patient care for patients with ulcerative colitis. PMID:17568260

  17. [Cell therapy in treatment of trophic ulcers of lower extremities].

    PubMed

    Sedov, V M; Andreev, D Iu; Smirnova, T D; Paramonov, B A; En'kina, T N; Sominina, A A; Kiselev, O I; Suissi, Iu Iu; Lebedev, L V

    2006-01-01

    The aim of the work was to study the effectiveness of using human embryo fibroblast culture in complex treatment of trophic ulcers of venous etiology in 23 patients with trophic ulcers of lower extremities. The cause of the appearance of ulcers was postthrombophlebitic disease in 16 patients and varicose disease in 7 patients. A control group consisted of 25 patients (postthrombophlebitic disease in 18 patients and varicose disease in 7 patients). The human embryo cell culture grown on the wound cover "Foliderm" was used at the stage of epithelization in the main group, while in the control group the modern alginate, collagen, hydrogel, polyurethane and hydrocolloid covers Suprosorb--Suprosorb A, Suprosorb C, Suprosorb G, Suprosorb F and Suprosorb H were used. Healing of the varicose trophic ulcers in the control group was achieved in 86% of patients, of post-thrombophlebitic--in 78% of patients. The average period of healing was 3.6 and 3.9 months respectively. Healing of trophic ulcers in the main group took place in 100% of patients. The average period of healing was 1.5 week for varicose and 3.2 weeks for postthrombophlebitic ulcers. The cell therapy was shown to be a highly effective method in treatment of venous trophic ulcers. PMID:16752648

  18. Smoking and peptic ulcer in the Helicobacter pylori era.

    PubMed

    Parasher, G; Eastwood, G L

    2000-08-01

    Before the recent understanding of the central importance of Helicobacter pylori in the pathogenesis of peptic ulcer disease, smoking had been regarded as an important contributor to the cause and perpetuation of the disease. In this review, we find that (1) clinical observations indicate that smokers are more likely to develop ulcers, ulcers in smokers are more difficult to heal, and relapse of ulcer disease is more likely in smokers, (2) smoking adversely affects the gastroduodenal mucosal protective mechanisms, thus predisposing to ulcer disease, (3) smoking adversely affects gastroduodenal motility, allowing reflux of harmful duodenal contents into the stomach, (4) smokers appear to be at higher risk of becoming infected with H. pylori and this increased risk may be due to the adverse effects of smoking on antioxidants or the immune system that may interfere with the normal protection against H. pylori, and (5) once H. pylori is eradicated in smokers, they appear to be at no greater risk of peptic ulcer disease. We conclude that smoking in itself appears not to be an independent ulcerogen, but may act by augmenting the harmful effects of H. pylori, both by adversely affecting upper gastrointestinal mucosal protection and physiology and by increasing the risk of H. pylori infection. Thus, we recommend that appropriate advice to ulcer patients who smoke continues to be: stop smoking. PMID:10958211

  19. Circadian variation in restless legs syndrome.

    PubMed

    Baier, P C; Trenkwalder, C

    2007-09-01

    Restless legs syndrome (RLS) is a clinical disorder that currently is not characterized by a uniform pathophysiologiocal definition. The diagnosis of RLS requires circadian variation in symptoms, although no pathophysiological basis has been verified. Clinical observations and research studies confirm the variation in symptoms, of both sensory and motor components, over the course of the day. This contribution reviews the current literature on circadian variation in RLS and discusses potential intrinsic and extrinsic causes. PMID:17383937

  20. Buruli ulcer disease: prospects for a vaccine

    Microsoft Academic Search

    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

    2009-01-01

    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

  1. Wooden Legs Videos

    NSDL National Science Digital Library

    Suzanne Alejandre

    2011-12-01

    This page from Suzanne Alejandre's Math Forum blog has links to nine short videos (5 minutes or less) of Ms. Alejandre implementing the "Wooden Legs" Problem of the Week with a fifth grade class. The "Notice/Wonder" strategy is used to introduce the problem, and additional materials describe other problem solving strategies. The blogpost describes the goals of the lesson and also includes links to the teacher materials including the problem, solution, sample student answers, a scoring rubric, and teaching suggestions. Suggested browsers are Chrome, Firefox, or Safari. (It's been reported to us that when using IE9 (PC) the videos do not display.)

  2. Ulcerative colitis and pregnancy

    Microsoft Academic Search

    C P Willoughby; S C Truelove

    1980-01-01

    A survey has been made of pregnancy occurring in patients who were attending the Ulcerative Colitis Clinic at Oxford during the 20-year period, 1960-79 inclusive. There were 256 married women of child-bearing age who attended during this period. Of these, 100 were excluded from the survey for various reasons, such as that they had completed their family before the onset

  3. Diabetic Foot Ulcers

    Microsoft Academic Search

    Andrew Boulton; Frank Bowling

    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

  4. Arterial disease ulcers, part 1: clinical diagnosis and investigation.

    PubMed

    Weir, Gregory Ralph; Smart, Hiske; van Marle, Jacobus; Cronje, Frans Johannes

    2014-09-01

    Arterial disease (peripheral vascular disease) is the result of narrowing of the blood vessel lumen. The classic clinical signs need to be recognized early before progression to arterial predominant disease and limb ischemia. Arterial ulcers or tissue breakdown can result from trauma, infection, or other etiologies with diabetes, smoking, increasing age, and hypertension the most important risk factors. Diagnostic testing starts with a palpable pulse with special investigation including handheld Doppler for ankle brachial pressure index ratios, segmental duplex leg Doppler waveforms, and more specialized procedures, including transcutaneous oxygen saturation. PMID:25133344

  5. Celecoxib compared with lansoprazole and naproxen to prevent gastrointestinal ulcer complications

    Microsoft Academic Search

    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

    2005-01-01

    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

  6. Effects of Introduced Mosquitofish and Bullfrogs on the Threatened California Red-Legged Frog

    Microsoft Academic Search

    Sharon P. Lawler; Deborah Dritz; Terry Strange; Marcel Holyoak

    1999-01-01

    Exotic species have frequently caused declines of native fauna and may contribute to some cases of amphibian decline. Introductions of mosquitofish ( Gambusia affinis ) and bullfrogs ( Rana catesbeiana ) are suspected to have caused the decline of California red-legged frogs ( Rana aurora draytonii ). We tested the ef- fects of mosquitofish and bullfrog tadpoles on red-legged frog

  7. Maneuvers during legged locomotion.

    PubMed

    Jindrich, Devin L; Qiao, Mu

    2009-06-01

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

  8. Maneuvers during legged locomotion

    NASA Astrophysics Data System (ADS)

    Jindrich, Devin L.; Qiao, Mu

    2009-06-01

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

  9. Marjolin ulcer: an overlooked entity.

    PubMed

    Pavlovic, Sasha; Wiley, Elizabeth; Guzman, Grace; Morris, David; Braniecki, Marylee

    2011-08-01

    Marjolin ulcer is a well-defined, but uncommon malignant ulcer that occurs in chronic wounds and cutaneous scars. Jean-Nicolas Marjolin was credited with describing this phenomenon in 1828. This entity is frequently overlooked and therefore inadequately treated leading to a poor prognosis. The malignant transformation of an ulcer is most commonly associated with burn scars, but has been reported in many other types of chronic, non healing wounds such as traumatic wounds, venous stasis and chronic pressure ulcers, fistulas, lacerations and leprosy ulcers. Development of malignancy tends to be slow with an average time of approximately 25 years. Various theories concerning pathogenesis of Marjolin ulcer have been proposed. Well-differentiated squamous cell carcinoma (SCC) is the most common histological type of Marjolin ulcer. Biopsy with histopathologic interpretation remains the gold standard for the diagnosis, with radical surgical excision being the treatment of choice. A high index of suspicion should be held by any health care provider when evaluating a chronic, non healing wound. This is a case report of a Marjolin ulcer arising on the left buttock of a patient with a long-standing history of a traumatic wound. PMID:21585661

  10. JAMA Patient Page: Pressure Ulcers

    MedlinePLUS

    ... Lower Back Hip Sacrum Sacrum Between Knees and Ankles Ear Hip Elbow Elbow Heel Heel S K I N C O N D I T I O N S The Journal of the American Medical Association JAMA PATIENT PAGE Pressure Ulcers A pressure ulcer is an injury to the ...

  11. Claw Lesions Causing Clinical Lameness in Lactating Holstein Frisian Crossbred Cows

    PubMed Central

    Zahid, Umar Nazir; Randhawa, Swaran Singh; Hussain, Syed Ashaq; Randhawa, Sarnarinder Singh; Dua, Kirti

    2014-01-01

    The objective of this study was to identify claw lesions causing clinical lameness in lactating Holstein Frisian (HF) crossbred cows in dairy cattle. Seventy dairy farmers were interviewed at the monthly meetings of Progressive Dairy Farmers Association of Ludhiana, Punjab, India. Ten dairy farms were randomly selected as per probability proportional to size and a total of 450 lactating HF crossbred cows were taken into the study. All the lactating cows were scored for locomotion and rear leg view index. Trimming was done in all the clinically lame animals (animals with locomotion scores 2 and 3) and equal number of animals selected randomly from those with locomotion scores 0 and 1. Various claw lesions were evaluated in both the groups. There was a significant relationship between locomotion score and rear leg view index to identify lameness. Sole ulcers and white line fissures were the lesions responsible for clinical lameness. Other lesions did not cause clinical lameness but increased the asymmetry in lactating HF crossbred cows. Both locomotion score and rear leg view index could be reliably used to identify clinical lameness in lactating cattle. PMID:25133012

  12. Athermal laser treatment of the diabetic leg

    NASA Astrophysics Data System (ADS)

    Ignat, P.; Suteanu, S.; Brojbeanu, Gabriela; Vasiliu, Virgil V.

    1995-03-01

    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.

  13. Gastric urease and peptic ulcer disease in Ireland in the 1940s

    Microsoft Academic Search

    HJ O' Connor; Oliver Fitzgerald

    1 The seminal discovery of H. pylori infection ranks as one of the major medical advances of the 20th century. By causing chronic gastroduodenitis, H. pylori infection is of fundamental importance in the aetiology of peptic ulcer disease and gastric neoplasia. 2 The discovery by Coghlan et al, that eradication of H. pylori could effectively cure peptic ulcer disease was

  14. Effectiveness of intermittent electrical stimulation for the prevention of deep pressure ulcers

    Microsoft Academic Search

    Leandro R. Solis; Daniel Hallihan; Richard E. Uwiera; Vivian K. Mushahwar

    Pressure ulcers are a common medical complication associated with individuals who, due to injury or disease have compromised mobility and\\/or sensation. Pressure ulcers that start at the bone-muscle interfaces are the most perilous, as they can cause extensive damage to the deep tissue layers before exhibiting any signs in the skin. Lack of oxygenation to the tissue and the cascade

  15. Evolution of Atherosclerotic Carotid Plaque Morphology: Do Ulcerated Plaques Heal? A Serial Multidetector CT Angiography Study

    Microsoft Academic Search

    M. J. van Gils; P. J. Homburg; S. Rozie; T. T. de Weert; D. W. J. Dippel; A. van der Lugt

    2011-01-01

    Background: Atherosclerotic carotid plaque rupture may lead to thromboembolization, causing transient ischemic attack or ischemic stroke. Carotid plaque ulceration on angiography is associated with plaque rupture. Although healing of ruptured plaques has been described in coronary arteries, little is known about the natural development of plaque ulcerations in carotid arteries. We therefore explored the evolution of carotid plaque surface morphology

  16. Functional Outcome and Patient Satisfaction after Flexor Tenotomy for Plantar Ulcers of the Toes

    Microsoft Academic Search

    Tim Schepers; Heleen A. Berendsen; I. Hok Oei; Jan Koning

    2010-01-01

    Ulcers of the toes may cause a severe physical burden, especially in patients with diabetes, in whom they occur most frequently. Several treatments have been proposed for the underlying anatomical abnormalities, but they vary in effectiveness. We evaluated our results in using flexor tenotomy to treat ulcers with underlying flexible clawing of the toes. For 42 toes from 23 patients,

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

    PubMed Central

    2014-01-01

    Background Pressure ulcer remains a significant problem in the healthcare system. In addition to the suffering it causes patients, it bears a growing financial burden. Although pressure ulcer prevention and care have improved in recent years, pressure ulcer still exists and occurs in both hospital and community settings. In Jordan, there are a handful of studies on pressure ulcer. This study aims to explore levels of knowledge and knowledge sources about pressure ulcer prevention, as well as barriers to implementing pressure ulcer prevention guidelines among Jordanian nurses. Methods Using a cross-sectional study design and a self-administered questionnaire, data was collected from 194 baccalaureate and master’s level staff nurses working in eight Jordanian hospitals. From September to October of 2011, their knowledge levels about pressure ulcer prevention and the sources of this knowledge were assessed, along with the barriers which reduce successful pressure ulcer care and prevention. ANOVA and t-test analysis were used to test the differences in nurses’ knowledge according to participants’ characteristics. Means, standard deviation, and frequencies were used to describe nurses’ knowledge levels, knowledge sources, and barriers to pressure ulcer prevention. Results The majority (73%, n = 141) of nurses had inadequate knowledge about pressure ulcer prevention. The mean scores of the test for all participants was 10.84 out of 26 (SD = 2.3, range = 5–17), with the lowest score in themes related to PU etiology, preventive measures to reduce amount of pressure/shear, and risk assessment. In-service training was the second source of education on pressure ulcer, coming after university training. Shortage of staff and lack of time were the most frequently cited barriers to carrying out pressure ulcer risk assessment, documentation, and prevention. Conclusions This study highlights concerns about Jordanian nurses’ knowledge of pressure ulcer prevention. The results of the current study showed inadequate knowledge among Jordanian nurses about pressure ulcer prevention based on National Pressure Ulcer Advisory Panel guidelines. Also, the low level of nurses’ pressure ulcer knowledge suggests poor dissemination of pressure ulcer knowledge in Jordan, a suggestion supported by the lack of relationship between years of experience and pressure ulcer knowledge. PMID:24565372

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

    PubMed

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

    2007-04-01

    Female genital ulcer is a disease that affects a large number of women, and its etiologic diagnosis can be difficult. The disease may increase the risk of acquiring HIV. Genital ulcer may be present in sexually transmitted diseases (STD)--syphilis, chancroid, genital herpes, donovanosis, lymphogranuloma venereum; and other non-STD disorders (NSTD)--Behçet's syndrome, pemphigus, Crohn's disease, erosive lichen planus and others. This study evaluated the clinical-histopathologic-microbiologic characteristics of female genital ulcers. A cross-sectional descriptive prospective study was conducted during a six-month period to investigate the first 53 women without a definitive diagnosis, seeking medical care for genital ulcers at a genital infections outpatient facility in a university hospital. A detailed and specific history was taken, followed by a dermatologic and gynecologic examination. In addition to collecting material from the lesions for microbiologic study, a biopsy of the ulcer was performed for histopathologic investigation. The average age of the patients was 32.7 years, 56.6% had junior high school education and higher education. The most frequent etiology was herpetic lesion, followed by auto-immune ulcers. At the time of their first consultation, around 60% of the women were using inadequate medication that was inconsistent with the final diagnosis. Histologic diagnosis was conclusive in only 26.4% of the patients (14/53). Cure was obtained in 99% of the cases after proper therapy. The female genital ulcers studied were equally distributed between sexually transmitted and non-sexually transmitted causes. Herpes was the most frequent type of genital ulcer, affecting women indiscriminately, mostly between the ages of 20 and 40 years. The etiologic diagnosis of herpetic ulcers is difficult to make even when various diagnostic methods are applied. It is imperative that NSTD should be included in the differential diagnoses of female genital ulcers. The histopathologic exam is not a diagnostic tool in the majority of cases and should not be considered the gold standard test, being of little value in cases of NSTD and STD ulcers. PMID:17625773

  19. Getting Your Sea Legs

    PubMed Central

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

    2013-01-01

    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. PMID:23840560

  20. Influence of the calcaneus morphology on the risk of posterior heel ulcer creation Vincent Luboz, Antoine Perrier, Marek Bucki, Bruno Diot, Francis Cannard, Nicolas Vuillerme,

    E-print Network

    Payan, Yohan

    Influence of the calcaneus morphology on the risk of posterior heel ulcer creation Vincent Luboz percent of the reanimation or geriatric patients develop a pressure ulcer, of which 40 % are posterior heel ulcers. The main suspected causes are the excessive pressure intensity (leading to internal

  1. Design of robotic quadruped legs

    E-print Network

    McKenzie, Jacob Elijah

    2012-01-01

    Prized for their performance on prepared surfaces, wheeled vehicles are often limited in mobility by rough and unstructured terrain. Conversely, systems that rely on legs have shown promising rough terrain performance but ...

  2. A metabolically efficient leg brace

    E-print Network

    Carvey, Andrew W. (Andrew Williams), 1980-

    2006-01-01

    Locomotion assistive devices can be broadly classified as either being passive or powered. Both have been created to aid in the leg's generation of a ground reaction force which supports the torso during locomotion, yet ...

  3. Extended somatostatin treatment of a patient with bleeding ulcer.

    PubMed

    Mattes, P; Raptis, S; Heil, T; Rasche, H; Scheck, R

    1975-11-01

    The results of a 67 hour cyclic somatostatin continuous infusion in a patient with a bleeding ulcer are reported. The subject was a 65 year old male with very heavy gastrointestinal bleeding on the 9th postoperative day following a high BI-resection. Endoscopy revealed the bleeding to be caused by two residual ulcers in the area of the anastomosis. Somatostatin treatment led to an immediate cessation of the bleeding after 1 hour. Gastric secretion as well as gastrin, insulin and growth hormone levels were significantly inhibited by somatostatin. Endoscopy at the end of the treatment period showed two ulcers in the process of healing. The raised blood glucose levels caused by somatostatin were easily controlled with max. 14 IU cristalline insulin daily. Except for dryness in the mouth, no adverse side effects were apparent. There was no evidence from laboratory investigations of hemostatic defects or bleeding tendency in the patient. PMID:1213658

  4. Corneal cross-linking in 9 horses with ulcerative keratitis

    PubMed Central

    2013-01-01

    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. PMID:23803176

  5. Methotrexate and oral ulceration.

    PubMed

    Deeming, G M J; Collingwood, J; Pemberton, M N

    2005-01-22

    Methotrexate is well established in the drug treatment of various neoplastic diseases. More recently it has become increasingly used as a once-weekly, low-dose treatment of disorders such as psoriasis and rheumatoid arthritis. Clinical trials have shown its effectiveness in these conditions and it is likely that dentists will encounter patients taking this drug in general dental practice. Oral ulceration can occur as a side effect of methotrexate therapy. This may be due to lack of folic acid supplementation or overdosage due to confusion regarding its once-weekly regime. Illustrations of these problems, which have initially presented in a dental setting, are given. Important drug interactions of methotrexate relevant to dentistry are discussed. PMID:15702101

  6. Mucocutaneous ulcerations secondary to methotrexate.

    PubMed

    Warner, Jennifer; Brown, Alissa; Whitmore, S Elizabeth; Cowan, David A

    2008-05-01

    Although methotrexate (MTX) is used in several medical specialties including dermatology, rheumatology, and oncology, drug-induced mucocutaneous ulcerations rarely are reported. We present a 36-year-old woman with plaque psoriasis and psoriatic arthritis being treated with oral MTX (12.5 mg weekly) and oral methoxsalen plus UVA. Following an increase in MTX dose, she developed erosions and ulcerations on her oral mucosa and within her psoriatic plaques. All erosions and ulcerations healed within 2 weeks upon discontinuation of MTX. PMID:18543592

  7. Genetic correlations between claw health and feet and leg conformation in Norwegian Red cows.

    PubMed

    Ødegård, C; Svendsen, M; Heringstad, B

    2014-07-01

    The aim of this study was to estimate genetic correlations between claw disorders and feet and leg conformation traits in Norwegian Red cows. A total of 188,928 cows with claw health status recorded at claw trimming from 2004 to September 2013 and 210,789 first-lactation cows with feet and leg conformation scores from 2001 to September 2013 were included in the analyses. Traits describing claw health were corkscrew claw, infectious claw disorders (dermatitis, heel horn erosion, and interdigital phlegmon), and laminitis-related claw disorders (sole ulcer, white line disorder, and hemorrhage of sole and white line). The feet and leg conformation traits were rear leg rear view (new and old definition), rear leg side view, foot angle, and hoof quality. Feet and leg conformation traits were scored linearly from 1 to 9, with optimum scores depending on the trait. Claw disorders were defined as binary (0/1) traits for each lactation. Threshold sire models were used to model claw disorders, whereas the feet and leg conformation traits were described by linear sire models. Three multivariate analyses were performed, each including the 5 feet and leg conformation traits and 1 of the 3 claw disorders at a time. Posterior means of heritability of liability of claw disorders ranged from 0.10 to 0.20 and heritabilities of feet and leg conformation traits ranged from 0.04 to 0.11. Posterior standard deviation of heritability was ?0.01 for all traits. Genetic correlations between claw disorders and feet and leg conformation traits were all low or moderate, except between corkscrew claw and hoof quality (-0.86), which are supposed to measure the same trait. The genetic correlations between rear leg rear view (new) and infectious claw disorders (-0.20) and laminitis-related claw disorders (0.26), and between hoof quality and laminitis-related claw disorders (-0.33) were moderate. Eight of the 15 genetic correlations between claw disorders and feet and leg conformation traits had 0 included in the 95% highest posterior density interval. These results imply that selection for feet and leg conformation is not an efficient approach to genetically improve claw health in Norwegian Red cattle. PMID:24767887

  8. [The daily life of men who lives with chronic venous ulcer: phenomenological study].

    PubMed

    da Silva, Marcelo Henrique; de Jesus, Maria Cristina Pinto; Merighi, Miriam Aparecida Barbosa; de Oliveira, Deise Moura; Biscotto, Priscilla Ribeiro; Silva, Greyce Pollyne Santos

    2013-09-01

    The chronic venous leg ulcer is the major therapeutic problem of lower limb injuries, which can trigger changes in the daily life of the person affected by it. This study aimed to understand the daily life of men who lives with chronic venous ulcers. A phenomenological study was conducted with eight men, who were interviewed during June and July of 2001. The study asked questions related to: "Restrictions in social life" and "Recovering the skin integrity and restart the activities affected by the wound". The answers revealed that men with these ulcers have social implications in the areas of productivity and sexuality. This leads to restrictions in everyday life with loss in performance of socially established roles for men, leading to anxiety for his return at full performance of his social role. The findings suggest significant experiential aspects that may guide professionals in the planning and implementation of health actions aimed to treat these patients. PMID:24344590

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

    PubMed Central

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

    2012-01-01

    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. PMID:22666297

  10. Pathogenesis of acute ulceration response (AUR) in hybrid striped bass.

    PubMed

    Udomkusonsri, Pareeya; Noga, Edward J; Monteiro-Riviere, Nancy A

    2004-11-01

    In a previous study, we discovered that acute confinement stress causes rapid ulceration of the fins of hybrid striped bass Morone saxatilis female x M. chrysops male (Noga et al. 1998. Vet Pathol 35:102-107). In this paper, we report the development of a reproducible model for studying this phenomenon in juvenile hybrid striped bass. We also determined how quickly ulceration could develop in acutely stressed fish and documented the sequential light microscopic and ultrastructural changes associated with this response. When hybrid striped bass were subjected to a standardized confinement protocol, the pathological response was extremely rapid (fin ulceration began to develop within 15 min of confinement). Grossly, the distal edges of the fins became blanched, and melanophores aggregated near the basement membrane and dermis after 15 min of confinement. Microscopically, the earliest detectable change in the fins, which occurred within 15 min of confinement, was swelling and loss of microridges of the outermost epidermal cells; this was followed by epidermal erosion. After 30 min of stress, epidermal ulceration developed at the distal edges of the fins. At this time, both necrotic and apoptotic epidermal cells were present. The middle and basal epidermal layers were severely spongiotic and the dermis and hypodermis were edematous. Over longer periods (up to 2 h), lesions were similar but increasingly more severe, progressing from the distal edge of the fin towards the base. The response to acute stress showed a significant correlation between confinement period and severity of the pathological changes (epidermal degeneration, epidermal ulceration and leukocyte infiltration). Also, we demonstrated that epidermal damage was not restricted to the fins but also affected the body skin and eyes. The ventral area of the body and the corneal epithelium of stressed fish were ulcerated; however, skin on the head and operculum was not affected, suggesting a site-specific mode of damage. In stressed fish, epidermal ulceration was found in 67 to 97% of all fins, 88% of skin on the ventrum, and 67% of corneas, while control fish had only very mild epidermal ulceration in the few fish in which it was present (on 5 to 10% of the fins, but not on the ventral skin or corneas). Due to the widespread damage to epidermal tissues of the body surface, we have named this the acute ulceration response (AUR). Our study indicates that acute confinement can rapidly cause significant damage to epidermal and ocular epithelium. AUR might be a primary cause of morbidity in acutely stressed fish. PMID:15609875

  11. An Alternative Therapy for Recurrent Stasis Ulcers in Chronic Venous Insufficiency: Venocuff

    PubMed Central

    Yavuz, Celal; Demirtas, Sinan; Guclu, Orkut; Karahan, Oguz; Yazici, Suleyman; Caliskan, Ahmet; Mavitas, Binali

    2012-01-01

    Chronic venous insufficiency may cause stasis ulcers that significantly impact on the quality of life. Many methods have been described for preventing or treating these ulcers. However, stasis ulcers often recur as a result of continuing venous insufficiency. Here we report a 30-year-old male patient with chronic venous insufficiency. He was admitted to the hospital owing to recurrent stasis ulcers. He had a history of various flavonoid drug usage and compression therapies over the previous six years. Venous Doppler sonography revealed combined saphenofemoral and deep femoral venous insufficiency. Venocuff was applied to the prejunctional and postjunctional parts of the femoral vein and the saphenofemoral junction. The patient was discharged on the postoperative second day, and a low-molecular-weight heparin dressing composed of calcium alginate was applied to the ulcer wound for one week after the operation. The stasis ulcer wound was totally healed after one month. The patient was followed up six months after the operation, and no postoperative complications or new ulceration was observed. Recurrent stasis ulcers are major reasons for hospitalization in patients with chronic venous insufficiency. Venocuff application for reducing venous insufficiency may be a good option for adjunctive ulcer therapy and for preventing recurrences of the problem. PMID:23304628

  12. Pustular ulcerative dermatosis of the scalp.

    PubMed

    Jacyk, W K

    1988-03-01

    Six young African patients are described with erosive pustular scalp lesions leading to extensive ulceration. No bacterial or fungal cause was found. Biopsies showed non-specific changes of atrophy with subacute or chronic inflammation. Four patients were malnourished and anaemic and three were infested with hookworm. The condition did not respond to antibiotics. Healing was obtained in one patient with systemic steroids. The relationship of this disorder to erosive pustular dermatosis of the scalp and to pyoderma gangrenosum of atypical distribution is discussed. PMID:3355784

  13. Stance leg control: variation of leg parameters supports stable hopping.

    PubMed

    Riese, Sebastian; Seyfarth, Andre

    2012-03-01

    The spring-loaded inverted pendulum describes the planar center-of-mass dynamics of legged locomotion. This model features linear springs with constant parameters as legs. In biological systems, however, spring-like properties of limbs can change over time. Therefore, in this study, it is asked how variation of spring parameters during ground contact would affect the dynamics of the spring-mass model. Neglecting damping initially, it is found that decreasing stiffness and increasing rest length of the leg during a stance phase are required for orbitally stable hopping. With damping, stable hopping is found for a larger region of rest-length rates and stiffness rates. Here, also increasing stiffness and decreasing rest length can result in stable hopping. Within the predicted range of leg parameter variations for stable hopping, there is no need for precise parameter tuning. Since hopping gaits form a subset of the running gaits (with vanishing horizontal velocity), these results may help to improve leg design in robots and prostheses. PMID:22183256

  14. Role of the Oral Glucose Tolerance Test (OGTT) in the idiopathic restless legs syndrome

    Microsoft Academic Search

    Domenico Bosco; Massimiliano Plastino; Antonietta Fava; Maria Ettore; Francesca Bosco; Caterina Ermio; Federico Tallarigo; Domenico Pirritano; Domenico Consoli

    2009-01-01

    BackgroundRestless legs syndrome (RLS) is a sensorimotor disorder characterised by a distressing urge to move the legs. Several clinical conditions have been associated with RLS, such as iron deficiency, uraemia, pregnancy, polyneuropathy and Diabetes Mellitus (DM). However the causes remain unknown in about 70–80% of cases.

  15. Treatment and prognosis in peptic ulcer bleeding.

    PubMed

    Laursen, Stig Borbjerg

    2014-01-01

    Peptic ulcer bleeding is a frequent cause of admission. Despite several advances in treatment the 30-day mortality seems unchanged at a level around 11%. Use of risk scoring systems is shown to be advantageous in the primary assessment of patients presenting with symptoms of peptic ulcer bleeding. Studies performed outside Denmark have demonstrated that use of risk scoring systems facilitates identification of low-risk patients suitable for outpatient management. Nevertheless, these systems have not been implemented for routine use in Denmark. This is mainly explained by concerns about the external validity due to considerable inter-country variation in patients' characteristics. In recent years, transcatheter arterial embolization (TAE) has become increasingly used for achievement of hemostasis in patients with peptic ulcer bleeding not responding to endoscopic therapy. As rebleeding is associated with poor outcome TAE could, in theory, also be beneficial as a supplementary treatment in patients with ulcer bleeding responding to endoscopic therapy. This has not been examined previously. Several studies have concluded that peptic ulcer bleeding is associated with excess long-term mortality. These findings are, however, questioned as the studies were based on life-table analysis, unmatched control groups, or did not perform adequate adjustment for comorbidity. Treatment with blood transfusion is, among patients undergoing cardiac bypass surgery, shown to increase the long-term mortality. Despite frequent use of blood transfusion in treatment of peptic ulcer bleeding a possible adverse effect of on long-term survival has not been examined in these patients. The aims of the present thesis were: 1. To examine which risk scoring system is best at predicting need of hospital-based intervention, rebleeding, and mortality in patients presenting with upper gastrointestinal bleeding (Study I) 2. To evaluate if supplementary transcatheter arterial embolization (STAE) after successful endoscopic haemostasis improves outcome in patients with PUB with active bleeding, a non-bleeding visible vessel, or an adherent clot (Study II) 3. To examine the short- and long-term mortality in PUB compared to a matched control group including identification of predictive factors for adverse outcome, identification of underlying causes of death, and investigation of a possible association between treatment with blood transfusion and long-term mortality (Study III). Study I was conducted as a prospective validation study. During a two-year period 831 patients presenting with upper gastrointestinal haemorrhage were included. The study demonstrated that the Glasgow Blatchford Score (GBS) was superior to the other risk scoring systems at predicting need for hospital-based intervention. The GBS was found to be favourable for the assessment of Danish patients presenting with symptoms of upper gastrointestinal haemorrhage. According to the findings of Study 1 implementation of the GBS at a 1000-bed hospital would be associated with a 90.000 EUR annual saving through avoidance of admission of patients in very low risk of needing hospital-based intervention. None of the examined risk scoring systems were suitable for predicting risk of rebleeding or 30-day mortality. Study II was designed as a non-blinded, stratified, parallel group, randomized controlled trial. Patients were randomized in a 1:1 ratio to receive STAE within 24 hours from therapeutic endoscopy or to continue standard treatment. A total of 105 patients were included. After adjustment for possible imbalances STAE was associated with a clear trend of reduced rate of rebleeding (P=.079). Numbers needed to treat in order to avoid one case of rebleeding was 10. Study III was conducted as a prospective cohort study. The long-term survival of 455 patients admitted with peptic ulcer bleeding was compared to an age- and sex-matched control group consisting of 2224 individuals selected from the same geographical area. Long-term mortality was adjusted for differences in comorbidity using the Charlson com

  16. An outbreak of chromium ulcer in a manufacturing plant.

    PubMed

    Deng, J F; Fleeger, A K; Sinks, T

    1990-04-01

    On May 23, 1989, managers of a manufacturing plant requested an investigation of an outbreak of hand ulceration and skin discoloration among workers. The plant has manufactured kitchen ranges for 30 years and employs approximately 633 hourly workers. The affected employees worked in the enamel department, where metallic range tops are coated with a "ground coat" or sprayed with an enamel coloring, and then baked in ovens at 1200F. Our evaluation included physical examinations, environmental sampling, and a questionnaire eliciting information concerning skin ulceration job history, demographics, and use of protective practices. We identified 10 enamel department workers (13.5%) who developed chromium ulcers between January 1st and June 30th, 1988. Ulcers were found on hands, forearms, periumbilical area and/or axillae. Within the enamel department, workers who handled conveyer hooks used to suspend range tops as they passed through the oven were at greatest risk (rate ratio (RR) = 12.44, 95% confidence interval (CI) = 2.90-53.35). Workers who wore gloves were protected from developing ulcers (RR = 0.08, 95% CI = 0.01-0.60). Normally, trivalent chromium (Cr+3) does not cause skin ulcers unless it is oxidized to hezavalent chromium Cr+6). The enamel used contained only Cr+3, not Cr+6, but analysis of hooks that had passed through the oven revealed Cr+6 on their surface. A mechanical failure of the oven resulted in the formation of sharp edges of the parts and consequently causing the abrasion of exposed skin. We believe Cr+3 was converted to Cr+6 during the baking process which associated with the mechanical failure of the oven causing this outbreak. PMID:2139265

  17. Pipe crawler with extendable legs

    DOEpatents

    Zollinger, W.T.

    1992-06-16

    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.

  18. Pipe crawler with extendable legs

    DOEpatents

    Zollinger, William T. (3927 Almon Dr., Martinez, GA 30907)

    1992-01-01

    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 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.

  19. Differences in Peptic Ulcer Between the East and the West

    Microsoft Academic Search

    Rupert W. Leong

    2009-01-01

    Despite improved understanding of peptic ulcer disease (PUD)\\u000a pathogenesis, advances in diagnostic modalities, and the availability of\\u000a modern pharmalogical, endoscopic and surgical treatments, gastroduodenal\\u000a ulcer remains a major cause of morbidity and mortality worldwide. The\\u000a predominant risk factors of this disorder remain Helicobacter pylori and\\u000a ulcerogenic drugs. However, the proportion of idiopathic PUD is\\u000a increasing worldwide often coinciding with the

  20. Randomised controlled trial comparing European standard class 1 to class 2 compression stockings for ulcer recurrence and patient compliance.

    PubMed

    Clarke-Moloney, Mary; Keane, Niamh; O'Connor, Veronica; Ryan, Mary Anna; Meagher, Helen; Grace, Pierce A; Kavanagh, Eamon; Walsh, Stewart R; Burke, Paul E

    2014-08-01

    The aim of this study was to determine the rate of venous ulcer recurrence and the level of compliance in patients wearing European class 1 or class 2 compression stockings. A total of 100 patients with healed venous leg ulcers were recruited, and were randomised to either class 1 (n = 50) or class 2 (n = 50) compression stockings. Follow-up was at 1 week, 3, 6, 9 and 12 months to monitor ulcer recurrence and compliance. Patients had a duplex scan to identify the source of venous incompetence. The rate of ulcer recurrence after 12 months was 16·1%, and the difference in recurrence rate between classes was not statistically significant (P = 0·287) although greater numbers in class 1 developed a recurrence. Participants (88·9%) were compliant; non-compliant patients were at a significantly greater risk of recurrence (P? 0·0001). Thirteen patients had both superficial and deep incompetence; those randomised to class 1 stockings (n = 4) developed ulcer recurrence. Patients with a history of multiple episodes of ulceration were more likely to develop a recurrence (P = 0·001). The lowest venous ulcer recurrence rates were seen in patients who were compliant with hosiery regardless of the compression level. Patients with both superficial and deep incompetence had a lower rate of recurrence with class 2 compression. PMID:23078587

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

    PubMed Central

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

    2013-01-01

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

  2. Intramuscular pressures beneath elastic and inelastic leggings

    NASA Technical Reports Server (NTRS)

    Murthy, G.; Ballard, R. E.; Breit, G. A.; Watenpaugh, D. E.; Hargens, A. R.

    1994-01-01

    Leg compression devices have been used extensively by patients to combat chronic venous insufficiency and by astronauts to counteract orthostatic intolerance following spaceflight. However, the effects of elastic and inelastic leggings on the calf muscle pump have not been compared. The purpose of this study was to compare in normal subjects the effects of elastic and inelastic compression on leg intramuscular pressure (IMP), an objective index of calf muscle pump function. IMP in soleus and tibialis anterior muscles was measured with transducer-tipped catheters. Surface compression between each legging and the skin was recorded with an air bladder. Subjects were studied under three conditions: (1) control (no legging), (2) elastic legging, and (3) inelastic legging. Pressure data were recorded for each condition during recumbency, sitting, standing, walking, and running. Elastic leggings applied significantly greater surface compression during recumbency (20 +/- 1 mm Hg, mean +/- SE) than inelastic leggings (13 +/- 2 mm Hg). During recumbency, elastic leggings produced significantly higher soleus IMP of 25 +/- 1 mm Hg and tibialis anterior IMP of 28 +/- 1 mm Hg compared to 17 +/- 1 mm Hg and 20 +/- 2 mm Hg, respectively, generated by inelastic leggings and 8 +/- 1 mm Hg and 11 +/- 1 mm Hg, respectively, without leggings. During sitting, walking, and running, however, peak IMPs generated in the muscular compartments by elastic and inelastic leggings were similar. Our results suggest that elastic leg compression applied over a long period in the recumbent posture may impede microcirculation and jeopardize tissue viability.(ABSTRACT TRUNCATED AT 250 WORDS).

  3. Effects of audio-visual stimulation on the incidence of restraint ulcers on the Wistar rat

    NASA Technical Reports Server (NTRS)

    Martin, M. S.; Martin, F.; Lambert, R.

    1979-01-01

    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.

  4. The treatment of venous ulcers of the lower extremities

    PubMed Central

    2007-01-01

    Venous hypertension from failure of proper venous valve function in the veins of thelower extremities causes changes over time in the microcirculation of the skin of the distal extremity. These changes set the stage for the development of a chronic nonhealing ulceration, which typically occurs at the ankle. The mainstay of treatment has been conservative, with compression dressings and elevation of the extremity. However, results have been less than satisfactory because of delay in healing and high recurrence rates after successful healing. Elimination of the venous hypertension should be the goal of therapy using more recent minimally invasive surgical techniques, including ablation of incompetent truncal veins with laser or radiofrequency energy and use of ultrasound-guided foam sclerosant injections to close incompetent perforator veins that are frequently found in or near the ulcer bed. This approach will shorten ulcer healing time and reduce recurrence rates as well as patient suffering and expense. PMID:17948110

  5. Oral ulcer: an uncommon site in primary tuberculosis.

    PubMed

    Aoun, N; El-Hajj, G; El Toum, S

    2015-03-01

    Tuberculosis is a chronic infectious disease and a major cause of morbidity and mortality worldwide. It can affect any part of the body, including the oral cavity. Oral lesions of tuberculosis, though uncommon, have been observed in both primary and secondary stages of the disease. This article presents a case of primary tuberculosis manifested as a non-healing, tender ulcer on the lingual mucosa of the edentulous right mandibular arch molar zone, an uncommon site. The diagnosis was confirmed after histopathology examination, polymerase chain reaction and purified protein derivative tests and chest radiograph. A recommended treatment plan of six months with four anti-tuberculotic antibiotics was commenced. Clinically, the oral ulcer disappeared three months after the commencement of treatment. The resurgence of tuberculosis should compel clinicians to include the disease in the differential diagnosis of various types of non-healing oral ulcers. PMID:25721285

  6. Transdermal deferoxamine prevents pressure-induced diabetic ulcers.

    PubMed

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

    2015-01-01

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

  7. Treatment of Chronic Posttraumatic Leg Injury Using Autologous Fat Graft

    PubMed Central

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

    2012-01-01

    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

  8. Prometheus Hot Leg Piping Concept

    NASA Astrophysics Data System (ADS)

    Gribik, Anastasia M.; DiLorenzo, Peter A.

    2007-01-01

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

  9. Interventions for leg edema and varicosities in pregnancy. What evidence?

    PubMed

    Bamigboye, Anthony Akinloye; Hofmeyr, George Justus

    2006-11-01

    Leg oedema from venous insufficiency is not dangerous but it can cause women symptoms such as pain, feelings of heaviness, night cramps and paraesthesiae. Leg oedema can be a sign of pre-eclampsia when associated with raised blood pressure or proteinuria. The objective of this review was to assess the effects of treatment to relieve the symptoms associated with varicosity in pregnancy and to reduce leg oedema. We searched the Cochrane Pregnancy and Childbirth Group trials register in October 2004 for randomised trials of any form of treatment for varicosity and or leg oedema in pregnancy. Trial quality was assessed and data were extracted. Four trials of three different treatments were included. In one trial, women given rutoside capsules in the last 3 months of pregnancy noted an improvement in symptoms compared with placebo (relative risk 0.54 95% CI 0.32, 0.89). They had a decrease in ankle circumference at 36 weeks' gestation after 8 weeks of treatment, while women given placebo had a small increase. In one trial, women with ankle oedema had a small non-significant reduction in lower leg volume when treated with external pneumatic intermittent compression for 30 min. In another trial compression stockings prophylactically reduced the emergence of leg symptoms but not venous varicosities (relative risk 0.74 95% CI 0.59, 0.93). Lymphatic reflexology was studied in too few women to draw conclusions. In conclusions, rutosides appear to relieve symptoms of venous insufficiency in late pregnancy. However, it is not known if the drug is safe in pregnancy. External pneumatic compression appears to reduce ankle swelling and compression stockings reduce leg symptoms but not varicose veins. PMID:16678328

  10. Muscle injuries of the lower leg.

    PubMed

    Counsel, Peter; Breidahl, William

    2010-06-01

    Muscle injuries of the lower leg are a common cause for time off from sports, and may also be a cause of disability in nonathletes who have a running or "pushing off" injury as part of their activities of daily living. Most injuries can be managed without imaging, but in selected cases advanced imaging techniques can demonstrate the exact site and extent of the injury and potentially modify rehabilitation and return to sports. In experienced hands ultrasonography can identify the location of muscle injuries as well as aid in hematoma aspiration. It is useful for excluding differential diagnoses such as deep vein thrombosis or Baker's cyst and may be superior for investigating certain conditions such as muscle hernia. Magnetic resonance imaging is more sensitive for injury to deeper muscles and dual injuries and is generally the modality of choice in elite athletes. PMID:20486025

  11. Effects of gabapentin enacarbil on restless legs syndrome and leg pain in dementia with Lewy bodies.

    PubMed

    Fujishiro, Hiroshige

    2014-06-01

    Restless legs syndrome (RLS) is a common neurological disorder. Dementia with Lewy bodies (DLB) is the second most common form of neurodegenerative dementia after Alzheimer's disease. Both RLS and DLB can be effectively treated by dopaminergic medications, suggesting the role of dopamine dysfunction in the pathogenesis of both diseases. Here, I report on a Japanese woman with probable DLB and RLS who was treated with gabapentin enacarbil, a non-dopaminergic agent. Because a dopamine agonist, a first-line therapy for moderate to severe RLS, caused the occurrence of metamorphopsia, an alternative treatment of gabapentin enacarbil was used; this treatment improved the patient's RLS without worsening her psychiatric symptoms. An alternative treatment is desirable for DLB patients with RLS because they often experience intolerable side-effects with a dopamine agonist, especially visual hallucinations. Administering gabapentin enacarbil also improved the continuous leg pain that occurred in conjunction with the development of RLS. Although the neurobiological mechanism in the development of pain remains unclear, a range of non-dopaminergic structures likely mediated pain processing in DLB in the present case based on neuropharmacological results. This is the first report reporting the effects of gabapentin enacarbil for RLS and leg pain in a DLB patient with psychiatric symptoms. PMID:24528871

  12. OCEAN DRILLING PROGRAM LEG 120 SCIENTIFIC PROSPECTUS

    E-print Network

    Co-Chief Scientist, Leg 120 Institute de Physique du Globe Lab. de Geophysique Marine 5 rue Rene Descartes 67084 Strasbourg Cedex, France Dr. Sherwood W. Wise, Jr. Co-Chief Scientist, Leg 120 Department

  13. 38 CFR 4.110 - Ulcers.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE FOR RATING DISABILITIES Disability Ratings The Digestive System § 4.110 Ulcers. Experience has shown that the term “peptic ulcer” is not sufficiently specific for...

  14. 38 CFR 4.110 - Ulcers.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE FOR RATING DISABILITIES Disability Ratings The Digestive System § 4.110 Ulcers. Experience has shown that the term “peptic ulcer” is not sufficiently specific for...

  15. 38 CFR 4.110 - Ulcers.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE FOR RATING DISABILITIES Disability Ratings The Digestive System § 4.110 Ulcers. Experience has shown that the term “peptic ulcer” is not sufficiently specific for...

  16. 38 CFR 4.110 - Ulcers.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE FOR RATING DISABILITIES Disability Ratings The Digestive System § 4.110 Ulcers. Experience has shown that the term “peptic ulcer” is not sufficiently specific for...

  17. 38 CFR 4.110 - Ulcers.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE FOR RATING DISABILITIES Disability Ratings The Digestive System § 4.110 Ulcers. Experience has shown that the term “peptic ulcer” is not sufficiently specific for...

  18. Pressure ulcers - what to ask your doctor

    MedlinePLUS

    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 ...

  19. Why Dont Whales Have Legs?

    NSDL National Science Digital Library

    S. Bedell

    In this lesson, students are given a variety of materials and are asked to design a heat loss experiment that will result in a reasonable explanation of why whales do not have legs. Students will learn that natural selection favors a body design that is energy efficient.

  20. Animation of dynamic legged locomotion

    Microsoft Academic Search

    Marc H. Raibert; Jessica K. Hodgins

    1991-01-01

    This paper is about the use of control algorithms to animate dynamic legged locomotion. Control could free the animator from specifying the details of joint and limb motion while producing both physically realistic and natural looking results. We implemented computer animations of a biped robot, a quadruped robot, and a kangaroo. Each creature was modeled as a linked set of

  1. Rotational joint for prosthetic leg

    NASA Technical Reports Server (NTRS)

    Jones, W. C.; Owens, L. J.

    1977-01-01

    Device is installed in standard 30 millimeter tubing used for lower leg prosthetics. Unit allows proper rotation (about 3 degrees) of foot relative to the hip, during normal walking or running. Limited rotational movement with restoring force results in a more natural gait.

  2. Tissue therapy with autologous dermal and epidermal culture cells for diabetic foot ulcers.

    PubMed

    Marcelo, Dinato; Beatriz, Puzzi Maria; Jussara, Rehder; Fabiana, Batista

    2012-06-01

    A great part of diabetic ulcers on the lower extremities have difficult healing and represent the most common cause of non-traumatic amputation In case of patients unresponsive to the classical therapy with debridement, dressings and systemic antibiotic therapy, cell therapy may be an excellent indication. The objective of this study was to assess the efficacy of autologous skin cell (fibroblasts and keratinocytes) implants cultivated ex vivo and applied to long-standing (9-34 years) skin ulcers of five diabetic patients (4 DM2 and 1 DM1) with autologous fibrin glue. There were six ulcers of onset between 4 months and 20 years before and from 4.0 to 36.62 cm(2) in size, located on the lower limbs and unresponsive to the several conventional treatments. Complete healing was observed in five ulcers (83.3%), after 21-120 days. The patient who presented the largest ulcer had partial improvement in 40 days. It is believed that the more distal ulcer location is, the worse is its prognosis. There probably is a correlation between healing time, ulcer size and prior duration. No adverse reactions derived from the treatment occurred. It is concluded that this method is an excellent therapeutic option for diabetic ulcers, allowing faster healing. Its great advantage is being a minimally invasive procedure that can be carried out in an outpatient clinic. PMID:21442296

  3. Nonhealing Ulcer: Acroangiodermatitis of Mali

    PubMed Central

    Varyani, Neeraj; Thukral, Anubhav; Kumar, Nilesh; Gupta, Kailash Kumar; Tandon, Ravi; Tripathi, Kamlakar

    2011-01-01

    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. PMID:23259075

  4. Nonhealing ulcer: acroangiodermatitis of mali.

    PubMed

    Varyani, Neeraj; Thukral, Anubhav; Kumar, Nilesh; Gupta, Kailash Kumar; Tandon, Ravi; Tripathi, Kamlakar

    2011-01-01

    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. PMID:23259075

  5. [Psychological factors in duodenal ulcers].

    PubMed

    Bauer, B; Bergmann, M

    1981-01-01

    With the aid of a clinical questionnaire and the I-N-R-personality test of Eysenck (as modified by Böttcher), we examined 127 male patients with clinically and radiologically proven ulcer compared to 145 age-matched persons without gastric affections. The features extraversion, neuroticism (emotional lability) and rigidity were determined and the question of an association with symptoms, age at onset of disease as well as occupational and familial factors statistically analyzed. With high significance, duodenal ulcer patients are more often emotionally labile and psychically more rigid. In the event the disease manifests under the age of 30, in ulcer patients introversion too is pronounced with highly significant frequency. Those patients complaining of conflicts with collaborators, lack of sleep, occupational overexertion, noise, draught at work place, present, compared to others without these complaints, a frequently emotional lability with high significance. PMID:7341221

  6. Kayexalate-induced colonic ulcer

    PubMed Central

    Albeldawi, Mazen; Gaur, Varun; Weber, Luke

    2014-01-01

    A 61-year-old male presents to the emergency room with complaints of fatigue, dizziness and bright red blood per rectum (BRBPR) for 2 days. Past medical history was significant for gastroesophageal reflux disease, non-steroidal anti-inflammatory drug (NSAID) induced ulcer, and end-stage renal disease (GFR < 30) status post 2 failed renal grafts. Pertinent medications include pantoprazole and sodium polystyrene sulfonate in sorbitol (Kayexalate 30 g/d orally). On esophagogastroduodenoscopy (EGD) there was a single shallow, flat, non-bleeding gastric ulcer (3 mm) in the pre-pyloric region of the stomach with no stigmata of bleeding. A colonoscopy was performed showing evidence of colitis and localized ulcerations in the cecum which were biopsied. Histopathology revealed basophilic, nonpolarizable, rhomboid-like crystals without evidence of necrosis. PMID:24759345

  7. Kayexalate-induced colonic ulcer.

    PubMed

    Albeldawi, Mazen; Gaur, Varun; Weber, Luke

    2014-08-01

    A 61-year-old male presents to the emergency room with complaints of fatigue, dizziness and bright red blood per rectum (BRBPR) for 2 days. Past medical history was significant for gastroesophageal reflux disease, non-steroidal anti-inflammatory drug (NSAID) induced ulcer, and end-stage renal disease (GFR < 30) status post 2 failed renal grafts. Pertinent medications include pantoprazole and sodium polystyrene sulfonate in sorbitol (Kayexalate 30 g/d orally). On esophagogastroduodenoscopy (EGD) there was a single shallow, flat, non-bleeding gastric ulcer (3 mm) in the pre-pyloric region of the stomach with no stigmata of bleeding. A colonoscopy was performed showing evidence of colitis and localized ulcerations in the cecum which were biopsied. Histopathology revealed basophilic, nonpolarizable, rhomboid-like crystals without evidence of necrosis. PMID:24759345

  8. Ulcerative Lichen Planus in Childhood

    PubMed Central

    Padmini, Chiyadu; Bai, K. Yellamma; Chaitanya, Vinil; Reddy, M. Shilpa

    2013-01-01

    Lichen planus (LP) is a chronic inflammatory mucocutaneous condition which is relatively common in adults but rarely affects children. The present study is a report on an unusual case of ulcerative oral LP involving the dorsum of tongue in a 12-year-old boy. Patient complained of painful oral lesion on the tongue which was burning in nature and obstructing talking and eating spicy foods. On intraoral examination, a white ulcerative lesion on the dorsum of tongue was observed. Diagnosis was made based on clinical examination and histopathological features. We instituted local treatment and patient responded well to the treatment. Although rarely reported in childhood, lichen planus should be considered in a differential diagnosis of hyperkeratotic, reticular, and ulcerative lesions of the oral mucosa in children. PMID:24455324

  9. [Peptic ulcer recurrence after selective proximal vagotomy].

    PubMed

    Polous, Iu M; Shidlovski?, V A; Gorbunova, V I; Va?sberg, G R

    1989-04-01

    A study of the structure of recurrences of ulcer disease was made on the basis of long-term follow-up results in 257 patients with selective proximal vagotomies. Real (with the presence of an ulcer) and false (without ulcer) recurrences are distinguished. The clinical aspects of the course and diagnosis of real and false recurrences are described. The principles of prophylaxis and treatment of ulcer disease recurrences are outlined. PMID:2756674

  10. The first leg video endoscopic groin lymphadenectomy in vulvar cancer: A case report

    PubMed Central

    Naldini, Angelica; Rossitto, Cristiano; Morciano, Andrea; Panico, Giovanni; Campagna, Giuseppe; Paparella, Pierluigi; Scambia, Giovanni

    2014-01-01

    INTRODUCTION The current management of vulvar cancer depends on the extension of disease, and includes primary tumor resection with safety margin as well as inguinofemoral lymph node staging. We report the case of the first leg videoendoscopic inguinal lymphadenectomy performed in a woman with a squamous cell vulvar carcinoma. PRESENTATION OF CASE A 74 years old female referred to our institution complaining of vulvar mass associated with bleeding and swelling from external genitals, vaginal burning sensation and dysuria for 5 months. A vulvar–vaginal examination under narcosis reported a right major labium lesion of 5 cm with an irregular and ulcerated surface, easily bleeding on palpation, involving anteriorly the clitoral region and with a histological finding of a poorly differentiated squamous cell invasive carcinoma of the vulva ulcerating the surface epithelium. We performed, after adequate informed consent, a radical vulvectomy with a standard right inguinofemoral lymphadenectomy and a contralateral simultaneous video endoscopic inguinal lymphadenectomy-Leg procedure. DISCUSSION Our minimally invasive VEIL-Leg approach, performed for the first time in literature in a woman with vulvar cancer, could reduce the presence of high risk factors represented by surgical incision and by procedure-related complications, including wound infection and breakdown, hematoma, cellulitis and hernia formation. CONCLUSION A multicenter prospective randomized study will be helpful to clarify how this procedure could replace the standard laparotomic approach to inguinal lymphadenectomy in the vulvar cancer treatment and staging. PMID:24973526

  11. A non-adhesive foam dressing for exuding venous leg ulcers and pressure ulcers: six case studies.

    PubMed

    Charles, H; Corser, R; Varrow, S; Hart, J

    2004-02-01

    Six patients had their wounds dressed with 3M Foam Dressing, a highly absorbent polyurethane foam covered with a breathable layer, for up to four weeks. The dressing was assessed for its effect on the wound and patient comfort, with promising results. PMID:14999990

  12. MAGIC Leg0 CRUISE REPORT MAGIC Leg0 Cruise on the M/V Horizon Spirit

    E-print Network

    MAGIC Leg0 CRUISE REPORT 2012-06-14 MAGIC Leg0 Cruise on the M/V Horizon Spirit under the command Laboratory) Mike Reynolds (Remote Measurements and Research Company) #12;2 MAGIC Leg0 Cruise Report, 2012-06-14 Abstract MAGIC cruise Leg0 occurred on the M/V Horizon Spirit, under the command of Captain Walt Rankin

  13. PSYCHIATRIC FACTORS IN ULCERATIVE COLITIS

    PubMed Central

    Chakraborty, P.K.; Shah, Anil V.; Parikh, N.K.

    1983-01-01

    SUMMARY Controlled study on 20 patients of ulcerative colitis was conducted at Gastroenterology Department of Civil Hospital, Ahmedabad. It has been observed that in three fourth of the cases, age of onset is before 40 years; & male, female ratio 4:1. No significant trend emerged in marital status, type of family, birth order, dietary habit and parental profile. The disease is common in lower socio-economic status. Ulcerative colitis patients are particularly exposed to stressful life situations and more prone to develop illness. PMID:21847291

  14. A Leg (or Three) to Stand On

    NSDL National Science Digital Library

    Molly Weinburgh

    2003-03-01

    The three "legs" on which science instruction rests are the content of science, process of science, and the nature of science. Each leg performs its own function and need not be competitive with the others. This article uses the metaphor of a three-legged stool to remind teachers that good science instruction must have a balance that is both stable and engaging.

  15. Acute Pancreatitis Due to a Duodenal Ulcer

    PubMed Central

    Pyeon, Sung Ik; Kim, Yong Tae; Lee, Ban Seok; Lee, Sang Ho; Lee, Jae Nam; Cheong, Jae Hoon; Oh, Kong Jin

    2014-01-01

    Duodenal ulcers and acute pancreatitis are two of the most commonly encountered gastrointestinal diseases among the general population. However, duodenal ulcer-induced pancreatitis is very rarely reported worldwide. This report elaborates on a distinct medical treatment that contributes to partial or complete treatment of acute pancreatitis induced by a duodenal ulcer scar. PMID:25505728

  16. Approach to microangiolopathic ulcerations: Diagnosis and therapy

    Microsoft Academic Search

    Patricia Cristodor; E. Sfetcu; Viorica Frantescu; F. C. Rada; M. Hancu; Monica Botez; Lavinia Serban

    1994-01-01

    Microangiolopatic ulcerations represent a peculiar kind of ulceration. Though not rare, there is still not enough known about them and treatment is inadequate, usually long term and deceiving. We have followed 66 patients with microangiolopathic ulcerations secondary to metabolic disorders (diabetes mellitus), vascular disorders (vascularitis, atherosclerosis, high blood pressure, arteritis, postthrombotic syndrome, atrophie blanche), postcombustive syndrome, scleroderma, lupus eritematosus, and

  17. Is gastric emptying abnormal in duodenal ulcer?

    Microsoft Academic Search

    Stephen Holt; Robert C. Heading; Thomas V. Taylor; John A. Forrest; Peter Tothill

    1986-01-01

    To investigate the possibility that an abnormality of gastric emptying exists in duodenal ulcer and to determine if such an abnormality persists after ulcer healing, scintigraphic gastric emptying measurements were undertaken in 16 duodenal ulcer patients before, during, and after therapy with cimetidine; in 12 patients with pernicious anemia, and in 12 control subjects. No difference was detected in the

  18. Computed tomographic findings in penetrating peptic ulcer

    SciTech Connect

    Madrazo, B.L.; Halpert, R.D.; Sandler, M.A.; Pearlberg, J.L.

    1984-12-01

    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.

  19. Healing refractory venous ulcers: new treatments offer hope.

    PubMed

    Kirsner, Robert S; Baquerizo Nole, Katherine L; Fox, Joshua D; Liu, Sophia N

    2015-01-01

    Non-healing wounds are associated with an inflammatory and proteolytic wound environment, and recent therapeutic strategies have been focused on reversing these changes. Connexins, as members of gap junctions, are important in intercellular signaling and wound repair. Connexin 43 (Cx43) downregulation is associated with normal wound healing, and it has been found to be upregulated in non-healing venous leg ulcers (VLUs). Ghatnekar et al. (2014) report findings of a small phase II trial performed in Indian patients with chronic VLUs, reporting that ACT1, a mimetic peptide of Cx43, accelerates healing in the treatment group. Despite standard care with compression therapy and adjuvant therapy for refractory wounds, at present in clinical practice a significant number of patients remain unhealed. The potential for ACT1 exists to help heal refractory VLUs, but it faces additional regulatory hurdles. PMID:25501380

  20. Abstract--A pressure ulcer is a damaged tissue area induced by an unrelieved pressure compressing the tissue during a

    E-print Network

    Paris-Sud XI, Université de

    Abstract-- A pressure ulcer is a damaged tissue area induced by an unrelieved pressure compressing algorithm is presented and evaluated on a PVA-cryogel phantom, mimicking a pressure ulcer at an early stage tissues, caused by a high and prolonged pressure at the body interface. This pathology concerns any people

  1. Chapter 12. Atherosclerosis and peptic ulcer

    PubMed Central

    Sternby, N. H.

    1976-01-01

    Aortic and coronary atherosclerosis and the frequency of coronary stenosis and myocardial lesions were studied in subjects with peptic ulcer, in two subgroups with acute and chronic peptic ulcer, and in subjects who had undergone a stomach operation. In all these respects the groups were similar to each other. Men with peptic ulcer had the same amount of aortic atherosclerosis as the standardized average coronary atherosclerosis group but less coronary atherosclerosis, while women with peptic ulcer had less aortic and much less coronary atherosclerosis. The prevalence of coronary stenosis, fresh myocardial infarction, and myocardial scar was very low in those with peptic ulcer, especially in women. PMID:1087198

  2. Pressure ulcer prevention in the community setting.

    PubMed

    Jones, Donna

    Pressure ulcers are associated with reduced quality of life, affecting individuals physically, socially and emotionally. The financial cost to the NHS of preventing and treating such ulcers is substantial. Although largely preventable, pressure ulcers are still common. The Department of Health is committed to eliminating all avoidable pressure ulcers in NHS-provided care. This article explores methods of preventing pressure ulcers, with particular focus on risk assessment, skin inspection, pressure-relieving measures, nutrition and hydration, and patient and carer education. PMID:24044860

  3. Hallux Ulceration in Diabetic Patients

    Microsoft Academic Search

    Mohamed ElMakki Ahmed; Abdulhakim O. Tamimi; Seif I. Mahadi; AbuBakr H. Widatalla; Mohamed A. Shawer

    2010-01-01

    We undertook a prospective cohort study to assess risk factors associated with hallux ulceration, and to determine the incidence of healing or amputation, in consecutive patients with diabetes mellitus who were treated over the observation period extending from September 2004 to March 2005, at the Jabir Abu Eliz Diabetic Centre, Khartoum City, Sudan. There were 122 diabetic patients in the

  4. Restless Legs Syndrome as the Initial Presentation of Multiple Sclerosis

    PubMed Central

    Vurall?, Doga; Karacay Ozkalayc?, Sebnem

    2013-01-01

    The restless legs syndrome (RLS) is a common central nervous system disorder. It is characterized by complaints of unpleasant sensation in the legs occurring during periods of leg inactivity which worsen or only occur in the evening or at night and relieved partially or totally by movement. The RLS may be idiopathic or due to secondary causes. It is associated with several pathological or physiological conditions. Iron metabolism and dysfunctions of the dopaminergic system are the most important factors in the pathophysiology. There are several studies suggesting multiple sclerosis as one of the causes of symptomatic RLS. Here, we report a case of RLS as the initial presentation of MS. The sudden onset of RLS symptoms in our patient suggested the possibility of an underlying cause. His diagnostic evaluation excluded other causes of RLS and his clinical course suggested that RLS was due to MS. MS with the spinal cord involvement is mostly associated with RLS, but any lesion in the hypothalamic-spinal connection may cause disinhibition of lower spinal levels, resulting in RLS. RLS as the initial presentation of MS reflects that the pathophysiology of RLS in MS is related to inflammatory demyelination rather than axonal degeneration. PMID:24454396

  5. Experimental gastric ulcers induced by immobilization and electric shock of rats and their pharmacotherapy

    NASA Technical Reports Server (NTRS)

    Zabrodin, O. N.

    1980-01-01

    The mechanism of development of experimental gastric ulcers, induced in rats by combined immobilization and electric shock, was analyzed pharmacologically with peripheral neurotropic agents. It is concluded that: (1) The most marked preventive effect in the development of the experimentally induced gastric ulcers was displayed by agents capable of blocking the ascending activation system of the reticular formation. (2) Sympathetic fibers, which disrupt the trophism of the gastric wall, form the efferent portion of the reflex arc. (3) Gastric secretion does not appear to be the primary cause of ulceration.

  6. Low-power laser use in the treatment of alopecia and crural ulcers

    NASA Astrophysics Data System (ADS)

    Ciuchita, Tavi; Usurelu, Mircea; Antipa, Ciprian; Vlaiculescu, Mihaela; Ionescu, Elena

    1998-07-01

    The authors tried to verify the efficacy of Low Power Laser (LPL) in scalp alopecia and crural ulcers of different causes. Laser used was (red diode, continuous emission, 8 mW power, wave length 670 nm spot size about 5 mm diameter on some points 1 - 2 minutes per point. We also use as control classical therapy. Before, during and after treatment, histological samples were done for alopecia. For laser groups (alopecia and ulcers) the results were rather superior and in a three or twice time shorter than control group. We conclude that LPL therapy is a very useful complementary method for the treatment of scalp alopecia and crural ulcers.

  7. The Significance of Introducing Permanent Assignments for Nursing Assistants at a Long-Term Care Setting on the Incidence Rate of Facility-Acquired Pressure Ulcers Among Elderly Patients

    Microsoft Academic Search

    Erlynda Mangaco-Borja

    2011-01-01

    Pressure ulcer prevalence remains a major health concern in long-term care facilities. The treatment of these pressure ulcers causes a financial drain on health care resources and adds potential costs for the family of the institutionalized elderly, according to the Agency for Healthcare Research and Quality. The prevention of pressure ulcer development continues to be an essential objective of caregivers

  8. Prevention and management of diabetic foot ulcers.

    PubMed

    Turns, Martin

    2015-03-01

    As part of an annual foot review, trained and competent personnel should examine patients' feet to detect risk factors for ulceration. Foot examination with shoes and stockings removed should include: palpation of foot pulses; testing foot sensations using 10g monofilament or vibration; inspection for significant callus or deformed nails; inspection for any structural deformity; asking about any previous ulceration; checking for signs of ulceration; asking about any pain; and inspecting footwear. Following assessment, a foot risk classification score should be given. The person with diabetes should then be informed of their risk score, with education offered regarding future foot-care management. Diabetic foot complications include ulceration, Charcot foot, painful neuropathy, gangrene and amputation. Risk factors for ulceration include non-palpable pulses, insensate foot, significant callus, deformed nails, history of previous ulcer or amputation, tissue damage or signs of ulceration, foot pain and unsuitable footwear. PMID:25757381

  9. Drug treatment of chronic venous insufficiency and venous ulceration: a review.

    PubMed Central

    Cheatle, T R; Scurr, J H; Smith, P D

    1991-01-01

    Treatment of venous insufficiency and venous ulceration has for many years relied on established principles of compression and limb elevation. Drug treatment has been of little benefit. In recent years, a better understanding of the pathological mechanisms underlying skin damage in venous disease has allowed more rational pharmacotherapeutic approaches to be made. This review examines these, with special reference to current theories of the cause of venous ulceration. PMID:2061904

  10. The Importance of the Microenvironment of Support Surfaces in the Prevalence of Pressure Ulcers

    Microsoft Academic Search

    Steven I. Reger; Vinoth K. Ranganathan

    Soft tissue breakdown is a major cause of disablement in the United States. External pressure has been the most frequently\\u000a discussed stress factor in the formation of ulcers. Analysis of published data on the prevalence of pressure ulcers and interface\\u000a pressures at various anatomic sites indicate a nearly non-existent or slightly negative correlation between prevalence and\\u000a interface pressure for the

  11. Chronic ulcers: MATRIDERM® system in smoker, cardiopathic, and diabetic patients

    PubMed Central

    Gentile, Pietro; Agovino, Annarita; Migner, Alessia; Orlandi, Fabrizio; Delogu, Pamela; Cervelli, Valerio

    2013-01-01

    Diabetic ulcers and pressure ulcers represent a more frequent cause of chronic wounds in aging populations. It is estimated that approximately 15% of the diabetic population will develop diabetic ulcers during their life and over half of these patients develop an infection, often osteomyelitis, with 20% requiring amputation. The authors report a case of a 65-year-old woman affected by a post-traumatic loss of substance due to road accidents with soft tissue exposure (comprising muscle tendon) of the left knee combined with the fracture of the right fibula previously subjected to surgery and reconstruction of muscle tendon. The patient was affected by diabetes type II, hypertension, and ischemic heart disease. In 2008, she underwent a double bypass surgery and coronary angioplasty. Initially, the patient was treated with cycles of advanced dressings, with fibrinolytic ointments, hydrocolloid, and subsequently, when the bottom began granulated with fibrinolytic and idrocellulosa, Hydrofibra-Ag, and Ag-alginate, three times a week for 30 days. In the second step, the authors decided to treat the ulcer with the MATRIDERM system and auto skin graft. Following the first treatment, 7 days after the procedure, the authors found the reduction of the loss of substance until its complete closure. The wound’s infection was evaluated by a buffer negative confirmation performed every 2 weeks four times. We obtained decrease of limb edema and full functional rehabilitation. The skin appeared renovated, with volume restoration and an improvement of the texture. PMID:24020011

  12. Marjolin ulcer of the scalp: intruder of a burn scar.

    PubMed

    Calikapan, Gaye Taylan; Akan, Mithat; Karaca, Mustafa; Aköz, Tayfun

    2008-07-01

    Childhood burn accidents are still a problem all over the world. Besides the contractures and hypertrophic scar conditions, malignant transformation in the burn scar is one of the primary concerns later in adulthood. Marjolin ulcer, commonly seen after burn scar, is a neoplastic change in the scar tissue. The scalp region necessitates additional attention because of the inevitable structures it protects. The long-standing ulcers with malignant transformation may cause invasion of different layers of the scalp. As the cranium is invaded, reconstruction after wide excision of these tumors becomes more difficult to deal with. Scalp invasion of Marjolin ulcers with different levels is presented in the following study. Consistent with the literature, histopathology of the tumors was squamous cell carcinoma in most patients. Although rare, mesenchymal tumor is involved in 2 of 9 patients. The latent period of the tumor is inversely proportional to the age at the time of burn injury. As the patient is younger at the time of injury, the occurrence of the ulcer is longer than expected. Lag period as long as 81 years is detected in the study. The delayed diagnosis due to social considerations such as financial limitations increases the likelihood of cranial invasion. A single huge scalp flap is often sufficient for soft tissue defects, and cranioplasty with methyl methacrylate is an appropriate option for reconstruction. PMID:18650725

  13. When is a grade 4 pressure ulcer not grade 4?

    PubMed

    Briggs, Shiu-Ling

    The adoption of the European Pressure Ulcer Advisory Panel (EPUAP) (2009) pressure ulcer classification system within healthcare trusts in the UK has provided health professionals with a common approach for the description of tissue damage for pressure ulcers. However, the omission of the 'unstageable/unclassified' and 'suspected deep tissue injury under intact skin' has caused difficulties when the visual appearance of pressure ulcers falls outside the four grades listed in the classification system. These difficulties lead health professionals to overestimate the degree of tissue damage, resulting in confusion in regards to determining the true extent of the tissue damage and often misdirection of scarce resources (Moore, 2005). The Berkshire Tissue Viability Nurses Group attempted to bring clarity to the situation by highlighting the issues to raise awareness and stimulate discussion among health professionals. The author, with support of the Berkshire Tissue Viability Nurses Group, first presented the content of this article at a meeting of the No Needless Skin Breakdown Work Stream meeting of the South Central Strategic Health Authority Patient Safety Federation in January 2011. PMID:22067935

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

    PubMed Central

    Serra, Raffaele; Gallelli, Luca; Conti, Angela; De Caridi, Giovanni; Massara, Mafalda; Spinelli, Francesco; Buffone, Gianluca; Caliò, Francesco Giuseppe; Amato, Bruno; Ceglia, Simona; Spaziano, Giuseppe; Scaramuzzino, Luca; Ferrarese, Alessia Giovanna; Grande, Raffaele; de Franciscis, Stefano

    2014-01-01

    Background Mixed venous and arterial ulcers account for approximately 15%–30% of all venous leg ulcerations. Several studies have shown that matrix metalloproteinases (MMPs) and neutrophil gelatinase-associated lipocalin (NGAL) play a central role in the pathophysiology of venous and arterial diseases. Some studies have shown the efficacy of glycosaminoglycans, such as sulodexide (SDX), in treating patients with leg ulcers. The aim of this study was to evaluate clinical effects of SDX and its correlation with MMPs and NGAL expression in patients with mixed arterial and venous leg ulcers. Methods Patients eligible for this study were of both sexes, older than 20 years, and with a clinical and instrumental diagnosis of mixed ulcer. Results Fifty-three patients of both sexes were enrolled and divided into two groups by means of randomization tables. Group A (treated group) comprised 18 females and ten males (median age: 68.7 years) treated with standard treatment (compression therapy and surgery) + SDX (600 lipoprotein lipase-releasing units/day intramuscularly) for 15 days followed by SDX 250 lipase-releasing units every 12 hours day orally for 6 months as adjunctive treatment. Group B (control group) comprised 17 females and eight males (median age: 64.2 years) treated with standard treatment only (compression therapy and surgery). The type of surgery was chosen according to anatomical level of vein incompetence: superficial venous open surgery and/or subfascial endoscopic perforating surgery. In all enrolled patients, blood samples were collected in order to evaluate the plasma levels of MMPs and NGAL through enzyme-linked immunosorbent assay. These results were compared to another control group (Group C) of healthy individuals. Moreover, biopsies of ulcers were taken to evaluate the tissue expression of MMPs and NGAL through Western blot analysis. Our results revealed that SDX treatment is able to reduce both plasma levels and tissue expression of MMPs improving the clinical conditions in patients with mixed ulcers. Conclusion Inhibition of MMPs could represent a possible therapeutic intervention to limit the progression of leg ulceration. In particular, our findings demonstrate the efficacy of SDX in patients with mixed arterial and venous chronic ulcers of the lower limbs. PMID:24872682

  15. Gastrointestinal ulcers, role of aspirin, and clinical outcomes: pathobiology, diagnosis, and treatment

    PubMed Central

    Cryer, Byron; Mahaffey, Kenneth W

    2014-01-01

    Peptic ulcer disease is a major cause of morbidity and mortality in the US with more than six million diagnoses annually. Ulcers are reported as the most common cause of hospitalization for upper gastrointestinal (GI) bleeding and are often a clinical concern due to the widespread use of aspirin and nonsteroidal anti-inflammatory drugs, both of which have been shown to induce ulcer formation. The finding that Helicobacter pylori infection (independent of aspirin use) is associated with the development of ulcers led to a more thorough understanding of the causes and pathogenesis of ulcers and an improvement in therapeutic options. However, many patients infected with H. pylori are asymptomatic and remain undiagnosed. Complicating matters is a current lack of understanding of the association between aspirin use and asymptomatic ulcer formation. Low-dose aspirin prescriptions have increased, particularly for cardioprotection. Unfortunately, the GI side effects associated with aspirin therapy continue to be a major complication in both symptomatic and asymptomatic patients. These safety concerns should be important considerations in the decision to use aspirin and warrant further education. The medical community needs to continue to improve awareness of aspirin-induced GI bleeding to better equip physicians and improve care for patients requiring aspirin therapy. PMID:24741318

  16. Management of ulcers in lymphoedematous limbs

    PubMed Central

    Karnasula, Vishnu M.

    2012-01-01

    Lymphoedema is a progressive condition that can have a marked physical and psychological impact on affected patients and significantly reduce the quality of life. The ulcers on chronic lymphoedema patient, which often also makes it impossible for them to work. If left untreated, tends to progress or worsen. Ulcers in lymphoedema patients, therefore, represent not only a medical but also a psychological problem. The treatment is often regarded as being worse than it actually is. In our study of more than 25 years shows around 10% cases are due to chronic lymphodema. Ulcers of chronic lymphoedema are classified into four stages according to their presentation. Their management depends upon their stage of presentation. Patients with chronic lymphoedema and ulceration require a different approach to treatment. The specific issues associated with managing the patient with lymphoedematous ulceration include, limb shape distortion i.e., elephantiasis, care of the skin creases and folds, and swelling of the toes and fore foot. Stage I ulcers will heal with conservative treatment without any surgical intervention. Stage II ulcers needs debridement of the wound and split-thickness skin grafting. The most difficult to treat are the stage III and IV ulcers, due to associated skin changes and reduced vascularity. These cases need debulking along with excision of the ulcer. In order to prevent recurrence of the ulcer in all the four stages needs prolonged follow-up and limb care. PMID:23162225

  17. Ulcerative colitis with inflammatory polyposis in a teenage boy: A case report

    PubMed Central

    Feng, Jin-Shan; Ye, Ying; Guo, Can-Can; Luo, Bo-Tao; Zheng, Xue-Bao

    2015-01-01

    Ulcerative colitis in addition to inflammatory polyposis is common. The benign sequel of ulcerative colitis can sometimes mimic colorectal carcinoma. This report describes a rare case of inflammatory polyposis with hundreds of inflammatory polyps in ulcerative colitis which was not easy to distinguish from other polyposis syndromes. A 16-year-old Chinese male suffering from ulcerative colitis for 6 mo underwent colonoscopy, and hundreds of polyps were observed in the sigmoid, causing colonic stenosis. The polyps were restricted to the sigmoid. Although rectal inflammation was detected, no polyps were found in the rectum. A diagnosis of inflammatory polyposis and ulcerative colitis was made. The patient underwent total colectomy and ileal pouch anal anastomosis. The patient recovered well and was discharged on postoperative day 8. Endoscopic surveillance after surgery is crucial as ulcerative colitis with polyposis is a risk factor for colorectal cancer. Recognition of polyposis requires clinical, endoscopic and histopathologic correlation, and helps with chemoprophylaxis of colorectal cancer, as the drugs used postoperatively for colorectal cancer, ulcerative colitis and polyposis are different. PMID:25624746

  18. Aspirin- and Indomethacin-Induced Ulcers and their Antagonism by Anthihistamines

    NASA Technical Reports Server (NTRS)

    Brown, Patricia A.; Sawrey, James M.; Vernikos, Joan

    1978-01-01

    Gastric ulceration produced by aspirin and indomethacin was compared in acutely stressed and non-stressed rats. We found a synergism between these anti-inflammatory agents and acute stress in the production of gastric ulcers. Even at relatively high doses, neither agent caused appreciable gastric damage in non-stressed rats, whereas moderate doses of both agents produced massive ulceration in stressed rats. The synergism appears unrelated to the effect of these agents on the pituitary-adrenal response. The size and regional distribution of ulcers produced by aspirin and indomethacin in stressed rats were comparable. However, the dose--response curves of the two drugs were markedly dissimilar. Furthermore, the ulceration produced by indomethacin was attenuated by both H(sub 1) and H(sub 2) histamine receptor antagonists, whereas ulceration produced by aspirin was attenuated only by an H(sub 2) antagonist. The results suggest that the ulcerogenic mechanism of indomethacin may differ from that of aspirin and add to the growing evidence on the importance of endogenous histamine in various forms of gastric ulceration.

  19. Wound fixation for pressure ulcers: A new therapeutic concept based on the physical properties of wounds.

    PubMed

    Mizokami, Fumihiro; Takahashi, Yoshiko; Nemoto, Tetsuya; Nagai, Yayoi; Tanaka, Makiko; Utani, Atsushi; Furuta, Katsunori; Isogai, Zenzo

    2015-02-01

    A pressure ulcer is defined as damage to skin and other tissues over a bony prominence caused by excess pressure. Deep pressure ulcers that develop over specific bony prominences often exhibit wound deformity, defined as a change in the 3-dimensional shape of the wound. Subsequently, the wound deformity can result in undermining formation, which is a characteristic of deep pressure ulcers. However, to date, a concept with respect to alleviating wound deformity has yet to be defined and described. To clarify the issue, we propose a new concept called "wound fixation" based on the physical properties of deep pressure ulcers with wound deformity. Wound fixation is defined here as the alleviation of wound deformity by exogenous materials. The wound fixation methods are classified as traction, anchor, and insertion based on the relation between the wound and action point by the exogenous materials. A retrospective survey of a case series showed that wound fixation was preferentially used for deep pressure ulcers at specific locations such as the sacrum, coccyx, and greater trochanter. Moreover, the methods of wound fixation were dependent on the pressure ulcer location. In conclusion, our new concept of wound fixation will be useful for the practical treatment and care of pressure ulcers. Further discussion and validation by other experts will be required to establish this concept. PMID:25660756

  20. Hydrophilic polymer microemboli in a patient with a chronic cutaneous ulcer: a case report.

    PubMed

    Hamidi, Sepehr; Stevens, Ryan; DeClerck, Brittney; Kim, Gene H

    2014-12-01

    Hydrophilic polymer coatings were designed to reduce friction between the catheter and vessel wall and facilitate intravascular manipulations during catheterization and placement of drug-eluting stents. One newly reported complication of such hydrophilic coatings is the fragmentation and embolization of the polymer, which can lead to ischemia and infarct by blocking the small vasculature. In this report, we present a patient with a non-healing ulcer on the leg. Biopsy from the ulcer revealed the presence of hydrophilic polymer emboli within the dermal vessels. This is one of the few reports of such a complication involving the skin. Our objective is to emphasize the histopathologic features of this uncommon iatrogenic phenomenon. PMID:25370782

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

    PubMed Central

    Ashraf, Mohammad; Biswas, Jaydip

    2010-01-01

    We report here a case of Marjolin’s ulcer developing in a long-standing, inadequately treated, chronic ringworm infestation of the lower limb. A 35-year-old female patient with a ten-year history of a chronic ringworm infestation had developed a nonhealing ulcer in an area of infestation on the right leg. A biopsy revealed well-differentiated squamous cell carcinoma associated with the ringworm infection. A below-knee amputation by an inguinal block dissection was performed. We conclude that proper and timely treatment of fungal infections of the skin is needed to allow for healing of dermal infections and thus the prevention of the disastrous consequences that recurrent mechanical trauma from scratching of the affected area, leading to occult malignancy, which may occur in a small number of patients. PMID:21139833

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

    PubMed

    Shen, Z H; Seipel, J E

    2012-12-01

    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

  3. Cancer morbidity in ulcerative colitis

    Microsoft Academic Search

    P Prior; S N Gyde; J C Macartney; H Thompson; J A Waterhouse; R N Allan

    1982-01-01

    Cancer morbidity at all sites has been studied in a series of 676 patients with ulcerative colitis under long-term review, of whom more than two-thirds had extensive disease, and the level and pattern of risk over time examined. Age-, sex-, and site-specific incidence rates were used to compute the number of cancers that might have been expected to occur. A

  4. Asenapine-induced restless legs syndrome: differentiation from akathisia.

    PubMed

    McCall, W Vaughn; Riley, Mary Anne; Hodges, Chelsea; McCloud, Laryssa; Phillips, Marjorie; Rosenquist, Peter B

    2014-01-01

    Akathisia and restless legs syndrome (RLS) share some common clinical features and a common relationship with dopamine dysfunction. However, the underlying causes and appropriate treatments for akathisia and RLS are different. Herein we describe a case of RLS that was precipitated by a single dose of asenapine, which is an atypical antipsychotic, and dissect the features that support the contention that this was indeed a case of RLS and not akathisia. PMID:25325577

  5. Compartment Syndrome of the Lower Leg and Foot

    Microsoft Academic Search

    Michael Frink; Frank Hildebrand; Christian Krettek; Jurgen Brand; Stefan Hankemeier

    2010-01-01

    Compartment syndrome of the lower leg or foot, a severe complication with a low incidence, is mostly caused by high-energy\\u000a deceleration trauma. The diagnosis is based on clinical examination and intracompartmental pressure measurement. The most\\u000a sensitive clinical symptom of compartment syndrome is severe pain. Clinical findings must be documented carefully. A fasciotomy\\u000a should be performed when the difference between compartment

  6. Visceral gout in a rough legged hawk (Buteo lagopus).

    PubMed

    Murnane, R D; Garner, M M

    1987-07-01

    Visceral gout is reported for the first time in a rough legged hawk (Buteo lagopus). Urate crystals were present on the pericardium, thoracic and abdominal air sacs, and the ventral surface of the liver. The liver and spleen also had urate crystals throughout the parenchyma. There was no indication of articular or renal involvement. The immediate cause of death in this hawk was not identified, but appeared to result from multiple factors, including the visceral gout. PMID:3625918

  7. Tool Blunts Cotter Pin Legs for Safety

    NASA Technical Reports Server (NTRS)

    Stein, J. A.; Helble, D. R.

    1982-01-01

    Jaws on new insertion tool contain upset point and anvil. Point forces cotter-pin legs into loop as it engages anvil. Cotter pin before insertion consists of loop and straight shaft composed of two legs welded together as tips. After insertion, welded legs have been shaped into loop. Tool used to prevent bent loose ends of cotter pins from scratching workers' fingers or cutting and entangling wires.

  8. The Legs Problem--For All Ages

    ERIC Educational Resources Information Center

    Way, Jenni

    2005-01-01

    This article presents an example of a versatile multi-solution problem that can be used right across the primary years. The basic problem is: "Noah saw 16 legs go past him into the Ark. How many creatures did he see?" Any even number can be used, although, 2 legs allows only one answer and with 16 legs there are already 14 different solutions, so…

  9. Multiple cutaneous neutropenic ulcers associated with azathioprine

    PubMed Central

    Laha, Baisakhi; Guha, Rajib; Hazra, Avijit

    2012-01-01

    We report a case of neutropenic ulceration in a 42-year-old woman receiving azathioprine for pemphigus vulgaris. She developed multiple indolent ulcers involving the nose, neck, and back, after about 6–8 weeks following commencement of azathioprine 50 mg daily. The ulcers were large, disfiguring, dry, and with basal necrotic slough. They were painless and did not discharge pus. The absolute neutrophil count was severely depressed initially, but normalized following azathioprine withdrawal. Swab culture revealed colonization with Klebsiella pneumoniae and the ulcers healed with local debridement, treatment with imipenem, and topical application of mupirocin. However, nasal disfigurement persisted. Neutropenic ulceration is known to be associated with azathioprine therapy but we report this case because of the unusual presentation—indolent cutaneous ulcers. Early recognition of the problem and drug withdrawal can prevent complications like disfigurement. PMID:23112431

  10. Common Leg Injuries of Long-Distance Runners

    PubMed Central

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

    2012-01-01

    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. PMID:24179587

  11. Radiation of anginal pain to the legs.

    PubMed

    Kolettis, M T; Kalogeropoulos, C K; Tzannetis, G C; Vitakis, S K; Xaplanteris, P P; Novas, I A

    1986-02-01

    Pain radiated from the chest to one or both legs (17 cases), or from the legs to the chest (two cases) in 19 patients with angina or acute myocardial infarction. The leg pain was assumed to be related to the angina pectoris when both were of a similar character and occurred together, when the leg pain occurred at rest, and when there were normal peripheral pulses in the leg. Pain was felt in the left leg by 10 patients, the right leg by two patients, and in both legs by seven. Three patients experienced pain in the thigh(s), six in the shin(s), and 10 had pain in both. In six patients the pain extended down to the inner two to four toes. The pain was always felt in front of the legs. This distribution accords with the suggestion that some sensory cardiac nerve fibres occur in the lumbar sympathetic ganglia and that pain is projected into the corresponding dermatomes. PMID:3942655

  12. Ulcerative necrobiosis lipoidica responsive to colchicine.

    PubMed

    Schofield, Clare; Sladden, Michael J

    2012-08-01

    Necrobiosis lipoidica is an uncommon granulomatous disease of unknown aetiology. Few treatments have emerged with consistent efficacy and the ulcerated form of necrobiosis lipoidica can be particularly difficult to treat. A 56-year-old non-diabetic woman with chronic ulcerative necrobiosis lipoidica unresponsive to other therapies was commenced on colchicine treatment. Complete resolution of the ulcers was observed after 2 months' therapy with colchicine 500?µg twice daily. PMID:22881474

  13. Scrotal ulceration in HIV-positive patients.

    PubMed Central

    Hillman, R J; Goldmeier, D; Taylor-Robinson, D

    1990-01-01

    Four patients with scrotal ulceration were seen during a period of 9 months. All of them were HIV-positive homosexual men with coexisting skin conditions. Herpes simplex virus was not isolated from any of the ulcers, but a variety of bacteria was recovered. It is suggested that multiple factors peculiar to HIV-positive individuals may account for the development of such ulcers. Images PMID:2341146

  14. Gastric emptying abnormal in duodenal ulcer

    SciTech Connect

    Holt, S.; Heading, R.C.; Taylor, T.V.; Forrest, J.A.; Tothill, P.

    1986-07-01

    To investigate the possibility that an abnormality of gastric emptying exists in duodenal ulcer and to determine if such an abnormality persists after ulcer healing, scintigraphic gastric emptying measurements were undertaken in 16 duodenal ulcer patients before, during, and after therapy with cimetidine; in 12 patients with pernicious anemia, and in 12 control subjects. No difference was detected in the rate or pattern of gastric emptying in duodenal ulcer patients before and after ulcer healing with cimetidine compared with controls, but emptying of the solid component of the test meal was more rapid during treatment with the drug. Comparison of emptying patterns obtained in duodenal ulcer subjects during and after cimetidine treatment with those obtained in pernicious anemia patients and controls revealed a similar relationship that was characterized by a tendency for reduction in the normal differentiation between the emptying of solid and liquid from the stomach. The similarity in emptying patterns in these groups of subjects suggests that gastric emptying of solids may be influenced by changes in the volume of gastric secretion. The failure to detect an abnormality of gastric emptying in duodenal ulcer subjects before and after ulcer healing calls into question the widespread belief that abnormally rapid gastric emptying is a feature with pathogenetic significance in duodenal ulcer disease.

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

    NASA Astrophysics Data System (ADS)

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

    2014-03-01

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

  16. Factor analysis of the International Restless Legs Syndrome Study Group's scale for restless legs severity

    Microsoft Academic Search

    Richard P. Allen; Clete A. Kushida; Mark J. Atkinson

    2003-01-01

    Objective: The International Restless Legs Syndrome Study Group has developed and validated a ten-item scale for assessing the severity of the restless legs syndrome. This International Restless Legs Severity Scale (IRLS) is reported to have a high degree of internal consistency and it has generally been used as a single scale. This study uses a factor analytic approach to evaluate

  17. Automated Pressure Ulcer Lesion Diagnosis for Telemedicine Systems

    E-print Network

    Kosmopoulos, Dimitrios I.

    Automated Pressure Ulcer Lesion Diagnosis for Telemedicine Systems Dimitrios I. Kosmopoulos dkosmo Force Hospital 11525 Athens, Greece Abstract The timely diagnosis and treatment of pressure ulcers for automated pressure ulcer stage classification can be integrated into an asynchronous telemedicine system

  18. Chronic ulcerative stomatitis: Clinical, histopathologic, and immunopathologic findings

    E-print Network

    Dennett, Daniel

    Chronic ulcerative stomatitis: Clinical, histopathologic, and immunopathologic findings Lynn W, Ky STATE UNIVERSITY OF NEW YORK, UNIVERSITY OF KENTUCKY, AND IMMCO DIAGNOSTICS INC Chronic ulcerative involve the skin. Clinically, CUS patients exhibit erosive or ulcerative lesions of the oral mucosa

  19. Running with a load increases leg stiffness.

    PubMed

    Silder, Amy; Besier, Thor; Delp, Scott L

    2015-04-13

    Spring-mass models have been used to characterize running mechanics and leg stiffness in a variety of conditions, yet it remains unknown how running while carrying a load affects running mechanics and leg stiffness. The purpose of this study was to test the hypothesis that running with a load increases leg stiffness. Twenty-seven subjects ran at a constant speed on a force-measuring treadmill while carrying no load, and while wearing weight vests loaded with 10%, 20%, and 30% of body weight. We measured lower extremity motion and created a scaled musculoskeletal model of each subject, which we used to estimate lower extremity joint angles and leg length. We estimated dimensionless leg stiffness as the ratio of the peak vertical ground reaction force (normalized to body weight) and the change in stance phase leg length (normalized to leg length at initial foot contact). Leg length was calculated as the distance from the center of the pelvis to the center-of-pressure under the foot. We found that dimensionless leg stiffness increased when running with load (p=0.001); this resulted from an increase in the peak vertical ground reaction force (p<0.001) and a smaller change in stance phase leg length (p=0.025). When running with load, subjects had longer ground contact times (p<0.020), greater hip (p<0.001) and knee flexion (p=0.048) at the time of initial foot contact, and greater peak stance phase hip, knee, and ankle flexion (p<0.05). Our results reveal that subjects run in a more crouched posture and with higher leg stiffness to accommodate an added load. PMID:25728581

  20. Help-Seeking for Pre-Ulcer and Ulcer Conditions of Mycobacterium ulcerans Disease (Buruli Ulcer) in Ghana

    PubMed Central

    Ackumey, Mercy M.; Gyapong, Margaret; Pappoe, Matilda; Weiss, Mitchell G.

    2011-01-01

    This study examined sociocultural features of help-seeking for Buruli ulcer–affected persons with pre-ulcers and ulcers in a disease-endemic area in Ghana. A sample of 181 respondents were purposively selected. Fisher's exact test was used to compare help-seeking variables for pre-ulcers and ulcers. Qualitative phenomenologic analysis of narratives clarified the meaning and content of selected quantitative help-seeking variables. For pre-ulcers, herbal dressings were used to expose necrotic tissues and subsequently applied as dressings for ulcers. Analgesics and left-over antibiotics were used to ease pain and reduce inflammation. Choices for outside-help were influenced by the perceived effectiveness of the treatment, the closeness of the provider to residences, and family and friends. Health education is required to emphasize the risk of self-medication with antibiotics and the importance of medical treatment for pre-ulcers, and to caution against the use of herbs to expose necrotic tissues, which could lead to co-infections. PMID:22144453