These are representative sample records from Science.gov related to your search topic.
For comprehensive and current results, perform a real-time search at Science.gov.
1

[Etiological diagnosis of leg ulcers].  

PubMed

Etiological diagnosis of leg ulcers must be the first step of treatment, even if we know that veinous disease is often present. We can build a clinical decisional diagram, which helps us to understand and not forget the other causes of chronic wounds and choose some basic examination, like ultrasound and histological findings. This diagnosis helps to choose the right treatment in order to cure even the oldest venous ulcers. Educational programs should be improved to prevent recurrence. PMID:21033496

Debure, Clélia

2010-09-20

2

Management of leg ulcers  

PubMed Central

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

Sarkar, P; Ballantyne, S

2000-01-01

3

Malignant transformation of a chronic leg ulcer.  

PubMed

We report a case of a squamous cell carcinoma arising from a chronic leg ulcer initially diagnosed as venous ulcer. Usually, further diagnostic assessment of chronic ulcers is initiated with considerable delay only in cases when appropriate treatment fails to effect cure. PMID:19538196

Erfurt-Berge, Cornelia; Schuler, Gerold; Bauerschmitz, Juergen

2009-06-01

4

Vascular leg ulcers: histopathologic study of 293 patients.  

PubMed

: 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

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

2014-12-01

5

Development, Validity, Reliability, and Responsiveness of a New Leg Ulcer Measurement Tool  

Microsoft Academic Search

OBJECTIVE: To develop and validate an assessment tool—the Leg Ulcer Measurement Tool (LUMT)—that would be able to detect changes in the appearance of lower extremity ulcers. SUBJECTS: Twenty-two subjects with chronic leg ulcers of various etiologies (arterial, venous, diabetes) partici- pated in the validation study. DESIGN: An interdisciplinary panel consisting of 9 local wound care specialists confirmed content validity. Concurrent

M. Gail Woodbury; Pamela E. Houghton; Karen E. Campbell; David H. Keast

2004-01-01

6

Nutritional status of patients with leg ulcers.  

PubMed Central

A group of 30 consecutive patients from a leg ulcer clinic were compared with age- and sex-matched controls in respect of 11 indices which may reflect nutritional deficiency. Twenty-one controls and 23 patients showed a total of 92 abnormalities, of which 48 were classified as severe. Mean indices were not significantly different in the two groups apart from a lower haemoglobin in patients and raised serum ferritin in controls. PMID:3968670

Schraibman, I G; Stratton, F J

1985-01-01

7

Etiology and Incidence of Pressure Ulcers in Surgical Patients  

Microsoft Academic Search

This experimental study was designed to identify the etiology of pressure ulcers in a surgical sample and to evaluate a special OR mattress overlay in preventing pressure ulcer development. Surgical patients (N = 413) were randomized to receive “usual perioperative care” or the new mattress overlay. Over six postoperative days, 89 patients (21.5%) developed pressure ulcers, primarily stage I. Only

Alyce A. Schultz; Maureen Bien; Karen Dumond; Kathleen Brown; Amanda Myers

1999-01-01

8

The etiology of pressure ulcers: Skin deep or muscle bound?  

Microsoft Academic Search

Bouten CV, Oomens CW, Baaijens FP, Bader DL. The etiology of pressure ulcers: skin deep or muscle bound? Arch Phys Med Rehabil 2003;84:616-9. Pressure ulcers are areas of soft tissue breakdown that result from sustained mechanical loading of the skin and underlying tissues; they can affect the quality of life of many individuals. Despite considerable efforts to prevent pressure ulcers,

Carlijn V. Bouten; Cees W. Oomens; Frank P. Baaijens; Daniel L. Bader

2003-01-01

9

Klinefelter's syndrome presenting with leg ulcers.  

PubMed

A 54-year-old man of Persian origin presented to our department with a 1-year history of ulcers on the right leg that had been unresponsive to numerous topical treatments, accompanied by lymphedema of the right leg. Medical history included hypergonadotropic hypogonadism, which had not been further investigated. He was treated for 20 years with testosterone IM once monthly, which he stopped a year before the current hospitalization for unclear reasons. The patient reported no congenital lymphedema. Physical examination revealed two deep skin ulcers (Figure 1) on the right leg measuring 10 cm in diameter with raised irregular inflammatory borders and a boggy, necrotic base discharging a purulent hemorrhagic exudate. Bilateral leg pitting edema and right lymphangitis with lymphadenitis were noted. He had low head hair implantment, sparse hair on the body and head, hyperpigmentation on both legs, onychodystrophia of the toenails (mainly the large toe and less prominent on the other toes), which was atrophic lichen-planus-like in appearance and needed no trimming (Figure 2), normal hand nails, oral thrush, and angular cheilitis. Other physical findings were gynecomastia, pectus excavatum, small and firm testicles, long extremities, asymmetrical goiter, systolic murmur 2/6 in left sternal border, and slow and inappropriate behavior. The patient's temperature on admission was 39 degrees C. Blood cultures were negative for bacterial growth. Results of laboratory investigations included hemoglobin (11.2 g/dL), hematocrit (26.8%), normal mean corpuscular volume and mean corpuscular hemoglobin volume, and red blood cell distribution width (16%). Blood smear showed spherocytes, slight hypochromia, anisocytosis, macrocytosis, and microcytosis. Blood chemistry values were taken for iron (4 micro g/dL [normal range 40-150 micro g/dL]), transferrin (193 mg/dL [normal range 220-400 mg/dL]), ferritin (1128 ng/mL [normal range 14-160 ng/mL]), transferrin saturation (1.5% [normal range 20%-55%]), serum folate (within normal limits), and vitamin B12 (within normal limits). Direct Coombs' test equaled positive 2 + IgG. All these values indicated anemia of chronic diseases combined with hemolytic anemia. Further blood work-up tested antinuclear antibody (positive <1:80 homogeneous pattern), rheumatoid factors (143 IU/mL [positive >8.5 IU/mL]), C-reactive protein (286 mg/L [normal range 0-5 mg/L]), anticardiolipin IgM antibody (9.0 monophosphoryl lipid U/mL [normal range 0-7.00 MPL U/mL]) and antithrombin III activity (135% [normal range 74%-114%]). Results of other blood tests were within normal limits or negative, including lupus anticoagulant, beta2 glycoprotein, anticardiolipin IgG Ab, anti-ss DNA Ab, C3, C4, anti-RO, anti-LA, anti-SC-70, anti-SM Ab, P-ANCA, C-ANCA, TSH, FT4, anti-T microsomal, antithyroglobulin, protein C activity, protein S free, cryoglobulins, serum immunoelectrophoresis, VDRL, hepatitis C antibodies, hepatitis B antigen, and human immunodeficiency virus. Endocrinological work-up examined luteinizing hormone (22.9 mIU/mL [normal range for adult men 0.8-6 mIU/mL]), follicle stimulating hormone (49.7 mIU/mL [normal range for adult men 1-11 mIU/mL]), testosterone (0.24 ng/mL [normal range for adult men 2.5-8.0 ng/mL]), bioavailable testosterone (0.02 ng/mL [normal range for adult men >0.6 ng/mL]), and percent bioavailable test (8.1% [normal value >20%]). These results indicate hypergonadotropic hypogonadism. Plasminogen activator inhibitor 1 was 6 U (normal value 5-20 U/mL). Karyotyping performed by G-banding technique revealed a 47 XXY karyotype, which is diagnostic of Klinefelter's syndrome. Doppler ultrasound of the leg ulcers disclosed partial thrombus in the distal right femoral vein. X-rays and bone scan displayed osteomyelitis along the right tibia. Histological examination of a 4-mm punch biopsy from the ulcer border revealed hyperkeratosis, acanthosis, hypergranulosis, and mixed inflammatory infiltrate containing eosinophils compatible with chronic ulcer. Multiple vessels were seen, compatible with a h

De Morentin, Helena Martinez; Dodiuk-Gad, Roni P; Brenner, Sarah

2004-01-01

10

Large leg ulcers due to autoimmune diseases  

PubMed Central

Summary Background Large leg ulcers (LLU) may complicate autoimmune diseases. They pose a therapeutic challenge and are often resistant to treatment. To report three cases of autoimmune diseases complicated with LLU. Case Report Case 1. A 55-year old woman presented with long-standing painful LLU due to mixed connective tissue disease (MCTD). Biopsy from the ulcer edge showed small vessel vasculitis. IV methylprednisolone (MethP) 1 G/day, prednisolone (PR) 1mg/kg, monthly IV cyclophosphamide (CYC), cyclosporine (CyA) 100mg/day, IVIG 125G, ciprofloxacin+IV Iloprost+enoxaparin+aspirin (AAVAA), hyperbaric oxygen therapy (HO), maggot debridement and autologous skin transplantation were performed and the LLU healed. Case 2. A 45-year old women with MCTD developed multiple LLU’s with non-specific inflammation by biopsy. MethP, PR, hydroxychloroquine (HCQ), azathioprine (AZA), CYC, IVIG, AAVAA failed. Treatment for underlying the LLU tibial osteomyelitis and addition of CyA was followed by the LLU healing. Case 3. A 20-year-old man with history of polyarteritis nodosa (PAN) developed painful LLU’s due to small vessel vasculitis (biopsy). MethP, PR 1 mg/kg, CYC, CyA 100 mg/d, AAVAA failed. MRSA sepsis and relapse of systemic PAN developed. IV vancomycin, followed by ciprofloxacin, monthly IVIG (150 g/for 5 days) and infliximab (5 mg/kg) were instituted and the LLU’s healed. Conclusions LLU are extremely resistant to therapy. Combined use of multiple medications and services are needed for healing of LLU due to autoimmune diseases. PMID:21169912

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

2011-01-01

11

Venous leg ulcer patients: a review of the literature on lifestyle and pain-related interventions  

Microsoft Academic Search

BACKGROUND: Having a leg ulcer has a major impact on daily life. Lifestyle is mentioned in most leg ulcer guidelines but mostly without much emphasis on the subject. AIMS AND OBJECTIVES: Evidence for the effect of nutrition, leg elevation and exercise on the healing of leg ulcers was reconsidered. Furthermore, the evidence for effective pain-related interventions was investigated. DESIGN: Systematic

Maud M. Heinen; Theo van Achterberg; Wilma Scholte op Reimer; H. E. W. de Laat

2004-01-01

12

[Economic aspects of the treatment of leg ulcers].  

PubMed

The authors have compared the healing time and the cost of leg ulcers of venous origin according to whether they were treated on an out-patient basis or by admission to hospital. The healing times were extremely similar, but the cost of cure by hospital admission was twenty times as great. Although one cannot claim to cure all leg ulcers on an out-patient basis, it is clear that significant public economies could be achieved by avoiding or shortening some costly hospital admissions. PMID:545357

Cottenot, F; Carton, F X; Tessler, L; Lamoure, B; Denoeux, J P; Ceccaldi, F; Kerner, S

1979-01-01

13

Leg ulcers in the eighteenth and early nineteenth centuries  

PubMed Central

Compared to today, ulceration of the legs was much more common in the eighteenth and early nineteenth centuries and occurred in much younger people. The evidence for this, based mainly on the records of the hospitals, the dispensaries and medical records of the navy and army, is discussed. It is likely that the underlying pathology was much more varied in the past, with the possibility that ascorbic acid deficiency played a significant part in the high frequency of leg ulcers. Imagesp265-a PMID:7031237

Loudon, I. S. L.

1981-01-01

14

LEG ULCERS IN SICKLE CELL DISEASE: CURRENT PATTERNS AND PRACTICES  

PubMed Central

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

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

2013-01-01

15

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

Microsoft Academic Search

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

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

2003-01-01

16

Wound Teleconsultation in Patients with Chronic Leg Ulcers  

Microsoft Academic Search

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

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

2005-01-01

17

Leg ulcers associated with long-term hydroxyurea therapy  

Microsoft Academic Search

Hydroxyurea is commonly used in the treatment of various hematologic disorders, e.g., chronic myelogenous leukemia (CML), polycythemia vera, and occasionally, at lower doses, for severe psoriasis vulgaris. Cutaneous side effects such as alopecia, diffuse hyperpigmentation, poikiloderma, atrophy of the skin, or nail changes occur, especially with long-term treatment. Painful leg ulcers in association with hydroxyurea have only rarely been reported.

Georg Weinlich; Gerold Schuler; Richard Greil; Heinz Kofler; Peter Fritsch

1998-01-01

18

Topical Treatment of Nonhealing Venous Leg Ulcer with Propolis Ointment  

PubMed Central

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

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

2013-01-01

19

[Leg ulcer due to hydroxyurea. A case report].  

PubMed

Hydroxyurea is an antineoplasic agent usually used in myeloproliferative syndromes, but also in other benign pathological circumstances. Several dermatological manifestations have been recognized as being secondary to its prolonged use, of which the leg ulcer. We report an observation. Mrs. L.D, 47 years, were hospitalized on July 14, 2004 for an ulcer of left ankle in a feverish context. She was followed since 2001 for a chronic myelogenous leukaemia, and took hydroxyurea at a rate of 1500 mg per day, with a good clinical and hematologic answer. She presented a painful ulcer compared to the left external malleolus, with purulent bottom, without signs of vascular attack. The hemogram showed a hyperleucocytosis with 24.000 white elements/mm3 with neutrophilic polynucleosis. Pus sample on the ulcer showed Pseudomonas aeruginosa, and the blood culture was negative. The cure was obtained two months after stopping hydroxyurea. The ulcer of leg related to hydroxyurea is a seldom described pathology. Its occurrence imposes the final stop of the treatment. PMID:17632983

Gning, S B; Debonne, J M; Diagne-Guèye, N M; Ndiaye, B; Fall, F; Mbaye, P S

2006-01-01

20

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

PubMed

Leg ulcers of different etiology disable up to 1% of total population, and up to 15% individuals over 70 years old. It is an old disease, which troubles the patients and medical personnel and is hard to cure. It might take several years to cure the ulcer fully. Most of the patients with leg ulcers are being treated at home, not in the outpatient departments or hospitals; therefore there is not much information on how the ulcer affects the patient's everyday life and its quality. The researchers often analyze only the financial part of this disorder forgetting its human part: pain, social isolation, and decreased mobility. There are many questionnaires and methods to analyze the quality of life of the patients with leg ulceration. It is often unclear if we should treat the ulcer conservatively for a long time or if part of resources should be used for operation (skin grafting) and the time of treatment should be shortened. To see the advantage of both methods and the influence of the ulcer treatment to the quality of life we decided to estimate the functionality of surgical and conservative treatment. We have analyzed the case histories and the data of special questionnaires of 44 patients, which were treated in Department of Plastic Surgery and Burns of Kaunas University of Medicine Hospital in the period of 2001 January-2004 February and had large trophic leg ulcers (m=254 cm2) for 6 months or more. Ten patients were treated conservatively and 34 patients were treated by skin grafting. All of them were interviewed after 3-6 months. We found that the pain in the place of the ulcers has decreased for the patients, who were treated surgically. By making the differences of the pain more exact we found out, that the patients have been feeling pain before the operation and when interviewing them the second time they told that they felt discomfort, not pain. The intensity of pain remained the same for the patients treated conservatively. The regression of pain also proves the decreased usage of painkillers in the group of the patients with the surgical treatment. All the patients (n=44) have had sleep disorders because of the ulcers. In the group of surgically treated patients, ulcers did not disturb the sleep after more than 3 months, and in the group, treated conservatively, the problem remained. We also found that after surgical treatment the patients were more optimistic and cried less. That shows the recovery of their emotional status. We have also found that the patients knew from the surgeon first than from the family doctor or other medical personnel about this disorder. We have made conclusions, that with the reduction of the ulcer area the pain is also reduced. Surgical treatment of ulcers (autodermoplasty) reveals a statistically reliable positive effect on patient life quality (sleep and emotions), but even 50% of patients are unaware of the real leg ulceration causes. PMID:15299989

Jank?nas, Vytautas; Rimdeika, Rytis; Jasenas, Marius; Samsanavicius, Donatas

2004-01-01

21

Malignancy in chronic ulcers and scars of the leg (Marjolin’s ulcer): a study of 21 patients  

Microsoft Academic Search

Objective. To study the imaging features of patients with chronic ulcers of the leg that were associated with malignancy.\\u000a \\u000a \\u000a Design and patients. All patients who on biopsy were proven to have malignancy – the majority of which were squamous cell carcinoma – were included\\u000a in a prospective study. Ulcers limited to the foot were excluded but ulcers of the leg

Julius Smith; Luiz Felipe B. Mello; Norberto C. Nogueira Neto; Walter Meohas; Luciana W. Pinto; Viviane A. Campos; Maysa G. Barcellos; Nelson Jabour Fiod; José Francisco Neto Rezende; Carlos Eduardo L. Cabral

2001-01-01

22

Case series of use of Manuka honey in leg ulceration.  

PubMed

Gethin G, Cowman S. Case series of use of Manuka honey in leg ulceration. Abstract The historical and current literature reports the successful use of honey to manage a diversity of wound aetiologies. However, only in the last 40 years is research on its mode of action and contribution to wound healing being investigated. The challenge of managing chronic non healing wounds generated interest in researching non standard therapies. The aims of the study were to gain insight into the practical use of Manuka honey in wound management. The objective was to test the feasibility of further rigorous research into the use of honey in the management of chronic wounds. Instrumental case series were used to examine the use of Manuka honey in eight cases of leg ulceration. To collect the necessary data, photographs, acetate tracings, data monitoring and patient comments and observations were used to add greater reliability and validity to the findings. The wounds were dressed weekly with Manuka honey. The results obtained showed three males and five females with ulceration of different aetiologies were studied. A mean initial wound size for all wounds of 5.62 cm(2) was obtained. At the end of four-week treatment period, the mean size was 2.25 cm(2). Odour was eliminated and pain reduced. The conclusions drawn were that the use of Manuka honey was associated with a positive wound-healing outcome in these eight cases. Arterial wounds showed minimal improvement only. PMID:16722850

Gethin, Georgina; Cowman, Seamus

2005-03-01

23

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

Microsoft Academic Search

BACKGROUND: A systematic review was conducted to analyse journal articles that describe or measure the impact of leg ulceration on patients' quality of life (QoL) in order to improve the content of an educational programme that aims to enhance self-care agency in leg ulcer patients. METHOD: Original articles published in English and German between 1990 and 2006 were included if

Oliver R Herber; Wilfried Schnepp; Monika A Rieger

2007-01-01

24

Teledermatological Monitoring of Leg Ulcers in Cooperation With Home Care Nurses  

Microsoft Academic Search

Objectives: To examine the feasibility and acceptance of teledermatology for wound management for patients with leg ulcers by home care nurses and evaluate the re- duction of costs and the acceptance of teledermatology by patients and home care nurses. Design: Case series of telemonitored patients with leg ulcers including cost-effectiveness analysis. Setting: Home monitoring by home care nurses. Patients: Sixteen

Barbara Binder; Rainer Hofmann-Wellenhof; Wolfgang Salmhofer; Aslihan Okcu; Helmut Kerl; H. Peter Soyer

2007-01-01

25

Association between venous leg ulcers and sex chromosome anomalies in men.  

PubMed

We report here two cases of men, aged 46 and 23 years, with refractory chronic venous leg ulcers in association with sex chromosome aberrations: one with a 47,XXY/48,XXXY karyotype (Klinefelter syndrome) and the other with a 47,XYY karyotype (Jacob syndrome). In both patients, the occurrence of leg ulcers was the reason for seeking medical care; their medical history was other-wise unremarkable. Chromosomal analyses were performed due to the unusually young age for development of venous leg ulcers. The pathophysiology behind the occurrence of venous leg ulcers in patients with numerical aberrations of the sex chromosomes is incompletely understood. Involvement of elevated plasminogen activator inhibitor-1 levels in the pathogenesis of venous leg ulcers has been reported in patients with Klinefelter syndrome. Notably, our patient with 47,XXY/48,XXXY presented with androgen deficiency but normal plasminogen activator inhibitor-1 activity. PMID:21057745

Gattringer, Cornelia; Scheurecker, Christine; Höpfl, Reinhard; Müller, Hansgeorg

2010-11-01

26

Leg ulcer nursing care in the community: a prospective cohort study of the symptom of pain  

PubMed Central

Background Chronic wounds are managed almost entirely by community nurses. Almost all individuals with leg ulcers report acute pain usually related to dressing change. Little is known about pain after healing. The purpose of this study was to explore the course of pain from baseline to time of healing of leg ulcers (venous or mixed etiology). In order to understand this phenomenon and develop implications for nursing practice, objectives included: 1) Measure incidence and prevalence of pain at baseline and healing; 2) Describe characteristics associated with leg ulcer pain at baseline; 3) Identify predictors of leg ulcer pain at healing. Methods Data were from one randomized controlled trial (2004-2008) of 424 individuals with leg ulcers in the community receiving evidence-informed nursing management. The primary outcome was pain at the time of healing. Predictive factors included demographic, circumstance of living, clinical and ulcer characteristics. Multivariable logistic regression identified the subset of predictors of pain at healing. Odds ratios (OR) and 95% confidence intervals (CI) are reported. Results Eighty-two percent of participants reported pain at baseline and 32% at healing. Five percent with no pain at baseline reported pain at healing. Thirty-seven percent reported moderate to severe pain at baseline and 11% at healing. Twenty percent of all those who healed reported pain interfered with work moderately to extremely at time of healing. Being female (OR=1.64, 95% CI 1.00, 2.68, p=0.05), use of short-stretch vs. four-layer bandages (OR=1.73, 95% CI 1.06, 2.82, p=0.03), lower SF-12 PCS (OR=0.97, 95% CI 0.94, 0.99, p=0.02) and MCS (OR=0.98, 95% CI 0.95-1.00, p=0.04) scores, use of non-steroidal anti-inflammatory drugs (OR=2.28, 95% CI 1.06, 4.88, p=0.03), and tender pain (OR=2.17, 95% CI 1.29, 3.66, p=<0.01) were associated with pain at time of healing. Conclusions Pain is an issue on admission for chronic wounds and at healing, yet 58% with moderate to severe pain on admission were not taking pain medication(s). Future studies should examine the role of pain at healing and at subsequent ulcer recurrence. Mobility and other factors that may contribute to pain at time of healing should also be assessed. Community nurses are encouraged to consider pain when planning care on admission and also after wound healing, when most patients are discharged from care. Trial registration ClinicalTrials.gov, NCT00202267 PMID:23388350

2013-01-01

27

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

PubMed

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

Flaherty, Elaine

28

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

PubMed

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 reulceration 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:16116413

Flaherty, Elaine

2005-08-11

29

[Efficacy of O-(beta-hydroxyethyl)-rutosides in the treatment of venous leg ulcers].  

PubMed

In a prospective 6 weeks study, done in 3 phlebology practices on 107 patients presenting an acute leg ulcer, we compared the efficacy of a combination of compression and HR (O-(Beta-hydroxyethyl)-rutosides with compression alone, based on objective and subjective parameters. These objective and subjective parameters are improved in both groups. A statistically significant superiority of the therapeutic combination is demonstrated in the cure of ulcers. PMID:3554278

Stegmann, W; Hubner, K; Deichmann, B; Muller, B

1987-01-01

30

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

PubMed

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

Skeik, N; Kia, F; Klosterman, D

2014-10-01

31

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

PubMed Central

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

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

2011-01-01

32

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

PubMed Central

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

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

33

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

Microsoft Academic Search

Chronic ulcers of the leg are common in Brazil, perhaps more common than in the developed world. We report a case of a chronic\\u000a ulcer of the leg following extensive scarring due to a bite by a venomous snake, which eventually led to a squamous cell carcinoma.

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

2000-01-01

34

Assessment of venous leg ulcers: an in-depth discussion of a literature-guided approach.  

PubMed

Venous leg ulcers represent a significant public health problem that will increase as the population ages. The elderly, the most likely to be afflicted by this condition, present the clinician with special challenges. The diagnosis of venous leg ulcers involves taking a careful history, paying attention to the existence of factors that predispose individuals to the development of chronic venous insufficiency. Clinical features of venous insufficiency are important because their recognition allows clinicians to distinguish venous from other chronic ulcers. An essential part of the assessment of all patients with chronic wounds is an evaluation of intercurrent diseases, common in the elderly, which may impact on the wound healing process. Thus, in addition to managing venous insufficiency and the wound bed, all other factors, systemic and local, that may impede healing need to be investigated and corrected if necessary. Social and psychological issues common to all chronic illnesses need to be addressed as well. This holistic approach should be standard practice and is applicable to the assessment and management of all chronic leg ulcers. This often requires coordinating a multidisciplinary team of wound healing caregivers. More work needs to be done to clarify a few issues because areas of controversy persist. Although a great deal is known about the effects of vitamin deficiency on acute wounds, less is known about chronic ulcers. Similarly, the role of vitamin supplementation in managing chronic ulcers needs further study. Guidelines are needed to determine indications for wound culturing. In addition, more study is required to establish the most effective means of obtaining quantitative cultures. However, the relationship between bacteria and chronic wound healing goes beyond simple quantitation and other factors such as bacterial virulence and host resistance. These controversial issues will be reviewed. Treatment and prevention of venous leg ulcers will be discussed in a subsequent article. PMID:11889721

Kunimoto, B T

2001-05-01

35

The application of negative pressure wound therapy in the treatment of chronic venous leg ulceration: authors experience.  

PubMed

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 cm(2). 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

Kucharzewski, Marek; Mieszcza?ski, Pawe?; Wilemska-Kucharzewska, Katarzyna; Taradaj, Jakub; Kuropatnicki, Andrzej; Sliwi?ski, Zbigniew

2014-01-01

36

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

PubMed Central

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

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

2014-01-01

37

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

PubMed

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

Chia, Hui Y; Tang, Mark By

2014-12-01

38

Hard-to-heal venous-lymphatic leg ulcers: a special case.  

PubMed

In the treatment of this 56-year-old male, the aim was to attend to his multiple pathologies, reducing his venous-lymphatic oedema on both legs, closing the extended ulcers and improving his quality of life. The patient received treatment in a community-based wound healing clinic. After various local therapies were not successful, the wounds were cleansed with saline and covered with a biocellulose dressing (BWD) and polyhexanide (PHMB), after which a short-stretch bandage system was applied. Compression was then switched to a tubular compression system. At day 0, both lower legs had significant oedema and circumferential venous-lymphatic ulcers, and the left leg showed signs of inflammation. However, at day 8, inflammation, oedema and ulcer area had reduced. After 2 months, the ulcers were almost closed and the oedema had reduced to a level where the tubular compression system could be applied. Treatment using BWD and compression and good adherence to this regimen led to ulcer closure. This improved the patients' quality of life significantly. PMID:22874827

Silva, José António; Filipe, Rosário; Esteves Cardoso, Manuel; Andriessen, Anneke

39

Non healing leg ulcer infected with Stenotrophomonas maltophilia: first reported case from India.  

PubMed

Stenotrophomonas maltophilia is a recently described organism which was mainly reported either in nosocomial setup, or in immunosuppresed individuals. This was rarely reported as cutaneous pathogenic organism causing cellulitis-like lesion, paronychia, mucocutaneous ulcers and ecthyma gangrenosum in immunocompromised individuals. Here we describe a case of leg ulcer caused by S. maltophilia in an immuno-competent patient. The infection was possibly community acquired as the patient had no exposure to hospital environment. The bacillus was sensitive to cotrimoxazole and levofloxacin, and the patient was successfully treated with cotrimoxazole. Our case is unique not only because it is probably the first ever case of leg ulcer caused by S. maltophilia, but also because of its unusual occurrence in immunocompetent patient. PMID:22289105

Nag, Falguni; De, Abhishek; Banerjee, Kokila; Chatterjee, Gobinda

2013-06-01

40

[Extracorporeal shock wave therapy as a treatment of a non-healing chronic leg ulcer].  

PubMed

Extracorporeal shock waves are defined as a sequence of sonic pulses characterized by high peak pressure over 100 MPa, fast pressure rise, and short lifecycle. In the 1980s extracorporeal shock wave lithotripsy (ESWL) was first used for the treatment of urolithiasis. Orthopedic surgeons use extracorporeal shock wave therapy (ESWT) to treat non-union fractures, tendinopathies and osteonecrosis. The first application of ESWT in dermatology was for recalcitrant skin ulcers. Several studies in the last 10 years have shown that ESWT promotes angiogenesis, increases perfusion in ischemic tissues, decreases inflammation, enhances cell differentiation and accelerates wound healing. We successfully treated a non-healing chronic venous leg ulcer with ESWT. Furthermore we observed an improvement of the lymphatic drainage after application of ESWT. We are confident that ESWT is a non-invasive, practical, safe and efficient physical treatment modality for recalcitrant leg ulcers. PMID:23322179

Stieger, M; Schmid, J-P; Bajrami, S; Hunziker, T

2013-06-01

41

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

PubMed Central

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

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

42

Effect of telemedicine follow-up care of leg and foot ulcers: a systematic review.  

PubMed

BackgroundLeg ulcers and diabetes-related foot ulcers are frequent and costly complications of their underlying diseases and thus represent a critical issue for public health. Since the population is aging, the prevalence of these conditions will probably increase considerably and require more resources. Treatment of leg and foot ulcers often demands frequent contact with the health care system, may pose great burden on the patient, and involves follow-up in both primary and specialist care. Telemedicine provides potential for more effective care management of leg and foot ulcers. The objective of this systematic review of the literature was to assess the effect of telemedicine follow-up care on clinical, behavioral or organizational outcomes among patients with leg and foot ulcers.MethodsWe searched Ovid MEDLINE (1980¿), Ovid EMBASE (1980¿), Clinical Trials in the Cochrane Library (via Wiley), Ebsco CINAHL with Fulltext (1981¿) and SveMed¿+¿(1977¿) up to May 2014 for relevant articles. We considered randomized controlled trials, non-randomized trials, controlled before-after studies and prospective cohort studies for inclusion and selected studies according to predefined criteria. Three reviewers independently assessed the included studies using the Cochrane Collaboration risk-of-bias tool. We performed a narrative synthesis of results and assessed the strength of evidence for each outcome using GRADE (grading of recommendations, assessment, development and evaluation).ResultsOnly one non-randomized study was included. The study (n =140) measured the effect of real-time interactive video consultation compared with face-to-face follow-up on healing time, adjusted healing ratio and the number of ulcers at 12 weeks among patients with neuropathic forefoot ulcerations. There were no statistically significant differences in results of the different outcomes between patients receiving telemedicine and traditional follow-up. We assessed the study to have a high risk of bias.ConclusionsThere is insufficient evidence available to unambiguously determine whether telemedicine consultation of leg and foot ulcers is as effective as traditional follow-up. PMID:25373875

Nordheim, Lena; Haavind, Marianne; Iversen, Marjolein M

2014-11-01

43

[A new generation of dressings in the treatment of leg ulcers].  

PubMed

Current methods of topical treatment of leg ulcers are reviewed. Leg ulcers are chronic wounds in a trophically altered tissue that affects the healing capacity. Complete healing requires prolonged and rather expensive treatment and the patient is often disabled during this period. The conventional methods of treatment of leg ulcers, including various compresses, ointments, pastes and other topical drugs, that may possess a considerable sensitizing potential, are to an increasing extent replaced by updated therapy consisting in the use of a new generation of dressings. The latter include a number of materials that have been developed on the basis of recent knowledge of wound healing, such as hydrogels, hydrocolloids, xerogels, hydropolymer dressings, polyurethane foam sheets, alginate dressings, and non-adherent, non-woven cloth impregnated with silver and activated charcoal. The selection of the available materials must depend on the character and stage of the healing process. Each group of dressings exerts specific effects and none of them can recommended generally for the treatment of any types of ulceration. A brief survey of indications is given for each group to avoid their abuse. PMID:9650353

Pospísilová, A

1998-05-01

44

Elevated Levels of Coagulation Factor VIII in Patients With Venous Leg Ulcers.  

PubMed

Chronic venous disease affects millions of people around the world. Venous valvular incompetencies and venous reflux, often a result of outflow obstruction are important contributors to venous disease. The prevalence of thrombophilia is increased in patients with chronic venous insufficiency (CVI). The recognition of underlying thrombophilia particularly in young patients opens new avenues in the management and prevention plan. We emphasize on the consideration of workup for coagulopathy, especially factor VIII deficiency in young patients with venous disease. We report 3 patients with chronic leg ulcers and high levels of FVIII:C activity in plasma and other associated thrombophilic factors. We highlight the need to get a workup done for thrombophilia in young patients with recurrent and chronic leg ulcers related to venous insufficiency or livedoid vasculopathy. Further studies with larger sample sizes are required to define the definite indications for the thrombophilia workups. PMID:24861090

Criado, Paulo Ricardo; Alavi, Afsaneh; Kirsner, Robert S

2014-05-25

45

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

PubMed Central

Background Venous leg ulcers are common, troublesome, and their failure to heal is often related to a heavy bio-burden. Ionized silver has both anti-inflammatory and antimicrobial properties. The ulcer healing properties of the silver releasing foam dressing Biatain Ag has been examined in 4 randomized controlled trials (RCTs). Aim To evaluate ulcer healing through a meta-analytic approach after treatment with either Biatain Ag or a non-active dressing. Patients and Methods 685 subjects with pure or mixed hard-to-heal venous leg ulcers were included in the meta-analysis. Results Biatain Ag showed a significant treatment effect (p<0.0001), responder rate (p<0.001), and healing rate (p?=?0.002). Conclusion The meta-analysis of the 4 RCTs provided statistical significant evidence to support the use of Biatain Ag dressing in treatment of hard-to-heal venous leg ulcers. PMID:23843984

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

2013-01-01

46

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

PubMed Central

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

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

47

Etiological agents of corneal ulcer: five years prospective study in eastern Nepal.  

PubMed

To identify the most common isolates from the corneal ulcers with antimicrobial pattern of bacterial isolates. All patients with suspected corneal ulceration presenting to BP Koirala Institute of Health Sciences from Jan 2004 - Dec 2008 were evaluated. Corneal scraping was performed and processed for direct microscopy, bacteriological and fungal culture. Bacterial isolates were subjected to antimicrobial susceptibility testing. Of 351 specimens examined, growth of etiological agents were obtained in 278 (79.20%). Of these, 113 (40.65%) had pure fungal growth, 108 (38.85%) had pure bacterial growth and 57 (20.50%) had mixed fungal and bacterial infection. The commonest fungal pathogen was Aspergillus spp 50 (33.33%) followed by Fusarium spp 19 (12.66%). Staphylococcal aureus 57 (44.53%) was isolated as commonest bacterial agent. Coagulase Negative Staphylococci 20 (15.6%) was second in the list. Pseudomonas spp 12 (9.40%) was the most common gram negative bacilli isolated. Most of the bacterial isolates were sensitive to commonly used antibiotics. Corneal Ulcer is a common problem in eastern Nepal. Knowledge of both fungal and bacterial agents associated with this condition is of value for the prevention and management of corneal ulcers and their complications. PMID:24047020

Amatya, R; Shrestha, S; Khanal, B; Gurung, R; Poudyal, N; Bhattacharya, S K; Badu, B P

2012-09-01

48

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

PubMed Central

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

Nelson, E Andrea; Michaels, Jonathan A

2007-01-01

49

Etiology and pathogenesis of skin ulcers in menhaden, Brevoortia tyrannis: does Pfiesteria piscicida play a role?  

USGS Publications Warehouse

The toxic dinoflagellate, Pfiesteria piscicida, is widely blamed for adverse human health effects, acute fish kills and skin lesion events in fishes, particularly menhaden, Brevoortia tyrannis, inhabiting coastal waters from Delaware to North Carolina, USA. In response, we initiated studies to clarify the etiology and pathogenesis of presumed 'Pfiesteria-specific' menhaden skin lesions. Histopathologically, all lesions (>150 fish examined) were associated with a highly invasive and pathogenic fungus eliciting severe tissue necrosis and intense granulomatous inflammation. Severity and extent of the host response indicates that ulcers were at least 1 week old or older. Maryland and Virginia currently use menhaden ulcers as one of several indicators of local Pfiesteria activity. However, their chronic nature, advanced age, and consistent fungal involvement suggest that their use for this purpose may not be valid. We recently isolated an Aphanomyces sp. from the menhaden lesions which by appearance in culture, temperature growth curves, pathogenicity studies in snakehead and positive immunohistochemical staining with polyclonal antibodies suggest the infectious agent is A. invadans (cause of epizootic ulcerative syndrome in Asia, Japan and Australia) or a very closely related species. Ongoing research will address pathogenicity of the fungus in menhaden, genetic comparisons of isolates, and the role of environmental stressors, including P. piscicida, in initiation of the infection. Copyright (C) 2000.

Blazer, V.; Vogelbein, W.K.; Densmore, C.; Kator, H.; Zwerner, D.; Lilley, J.

2000-01-01

50

Patients' perceptions and experiences of venous leg ulceration and their attitudes to larval therapy: an in-depth qualitative study.  

PubMed

BACKGROUND: Venous leg ulcers are a common and distressing condition that can impair quality of life. Larval therapy has been widely promoted for the treatment of different types of chronic wounds, yet little is known about its acceptability to patients. OBJECTIVES: To explore patients' experiences of venous leg ulceration and of the acceptability of larval therapy as a treatment. DESIGN: Qualitative study, using semi-structured interviews alongside a randomized controlled trial. Interview data were transcribed and analysed for thematic content. Data were collected from April 2007 to July 2007. SETTING AND PARTICIPANTS: Eighteen people (12 men, 6 women), aged between 29 and 93 years (median age 64 years), with at least one venous leg ulcer, took part in the study. Fourteen people were recruited from two vascular clinics (one attached to a hospital and the other located in a community setting). A further four people were recruited through referral from a team of community nurses. FINDINGS: Participants portrayed lives blighted by the presence of one or more leg ulcers. The majority were willing to try 'maggots' (larvae) and able to overcome feelings of squeamishness because of their strong desire to heal their ulcers. Five people treated with larvae were included in the study. Initial improvements in the condition of their ulcers were not sustained, and two participants experienced severe pain. DISCUSSION AND CONCLUSIONS: Patients may hold unrealistic expectations that larval therapy will effect a longed-for cure for their leg ulcer(s) but an absence of healing may lead to feelings of disappointment or despair. PMID:23409783

McCaughan, Dorothy; Cullum, Nicky; Dumville, Joanne

2013-02-15

51

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

PubMed

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

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

2012-04-01

52

Leg ulcers in elderly on hydroxyurea: a single center experience in Ph- myeloproliferative disorders and review of literature.  

PubMed

Hydroxyurea (HU) is effective in controlling thrombocytosis while reducing the risk of thrombosis in essential thrombocythemia (ET), polycythemia vera (PV) and myelofibrosis (MF). However, HU may carry more or less severe side-effects. Rare cases of patients with painful leg ulcers have been published. We report our experience on such a side-effect in a large cohort of patients with ET and PV treated with HU and review the literature on the topic. Five (4%) out of our 124 patients (69 ET, 51 PV, 4 MF; 49 males, 75 females; mean age at diagnosis 59.1+/-11.8 years) treated with HU developed painful leg ulcers. Sixty-one other patients affected with Phmyeloproliferative disorders (Ph- MPD) developing HU-related painful leg ulcers are described in the English literature. All our five patients were women and developed leg ulcers over the age of 75. Sixty-five percent of all described cases are women; 59% were over 65 years of age and 45% over 70. Most cases received over 1 gr HU per day for at least 1 year. The pathogenesis of HU-induced skin ulcers remains elusive. Treatment is difficult and requires prompt cessation of HU therapy. PMID:16804363

Ruzzon, Elisabetta; Randi, Maria Luigia; Tezza, Fabiana; Luzzatto, Gguido; Scandellari, Raffaella; Fabris, Fabrizio

2006-06-01

53

The Beneficial Toxicity Paradox of Antimicrobials in Leg Ulcer Healing Impaired by a Polymicrobial Flora: A Proof-of-Concept Study  

Microsoft Academic Search

Background: Some of the views contrasting the beneficial and toxic effects of antimicrobials upon wound healing remain controversial. Objective: To assess the clinical relevance of histological findings following antimicrobial applications on chronic leg ulcers. Method: The present study was performed in three parallel groups of 17 patients suffering from at least 2 similar chronic leg ulcers. Clinical planimetric assessments were

I. Fumal; C. Braham; P. Paquet; C. Piérard-Franchimont; G. E. Piérard

2002-01-01

54

Results of the clinical examination of an ointment with marigold (Calendula officinalis) extract in the treatment of venous leg ulcers.  

PubMed

The aim of this study was to determine the therapeutic efficacy of marigold (Calendula officinalis) extract on the epithelialization of lower leg venous ulcers. The experiment was carried out in 34 patients with venous leg ulcers. The patients were divided into two groups. In the first (experimental) group, patients were treated with an ointment containing marigold extract, which was prepared in an apparatus devised by Soxleth and was incorporated into a neutral base. Twenty-one patients with 33 venous ulcers were treated. Therapy was applied twice a day for 3 weeks. The second group was a control group that consisted of 13 patients with 22 venous ulcers. In the control group, saline solution dressings were applied to ulcers for 3 weeks. In the experimental group the total surface of all the ulcers at the beginning of the therapy was 67,544 mm2. After the third week the total surface of all the ulcers was 39,373 mm2 (a decrease of 41.71%). In seven patients, complete epithelialization was achieved. In the control group the total surface of all the ulcers at the beginning of the therapy was 69,722 mm2. After the third week the total surface of all the ulcers was 58,743 mm2 (a decrease of 14.52%). In four patients, complete epithelialization was achieved. There was a statistically significant acceleration of wound healing in the experimental group (p < 0.05). The results obtained are preliminary, but they suggest the positive effects of the ointment with marigold extract on venous ulcer epithelialization. PMID:16372475

Duran, V; Matic, M; Jovanov?, M; Mimica, N; Gajinov, Z; Poljacki, M; Boza, P

2005-01-01

55

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

PubMed Central

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

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

2014-01-01

56

Carbohydrate Intake in the Etiology of Crohn's Disease and Ulcerative Colitis  

PubMed Central

Background: Diet may have a role in the etiology of inflammatory bowel disease. In previous studies, the associations between increased intakes of carbohydrates, sugar, starch, and inflammatory bowel disease are inconsistent. However, few prospective studies have investigated the associations between these macronutrients and incident Crohn's disease (CD) or ulcerative colitis (UC). Methods: A total of 401,326 men and women were recruited between 1991 and 1998. At recruitment, dietary intakes of carbohydrate, sugar, and starch were measured using validated food frequency questionnaires. The cohort was monitored identifying participants who developed incident CD or UC. Cases were matched with 4 controls, and odds ratios were calculated for quintiles of total carbohydrate, sugar, and starch intakes adjusted for total energy intake, body mass index, and smoking. Results: One hundred ten participants developed CD, and 244 participants developed UC during follow-up. The adjusted odds ratio for the highest versus the lowest quintiles of total carbohydrate intake for CD was 0.87, 95% CI = 0.24 to 3.12 and for UC 1.46, 95% CI = 0.62 to 3.46, with no significant trends across quintiles for either (CD, Ptrend = 0.70; UC, Ptrend = 0.41). Similarly, no associations were observed with intakes of total sugar (CD, Ptrend = 0.50; UC, Ptrend = 0.71) or starch (CD, Ptrend = 0.69; UC, Ptrend = 0.17). Conclusions: The lack of associations with these nutrients is in agreement with many case–control studies that have not identified associations with CD or UC. As there is biological plausibility for how specific carbohydrates could have an etiological role in inflammatory bowel disease, future epidemiological work should assess individual carbohydrates, although there does not seem to be a macronutrient effect. PMID:25265262

Luben, Robert; van Schaik, Fiona; Oldenburg, Bas; Bueno-de-Mesquita, H. Bas; Hallmans, Göran; Karling, Pontus; Lindgren, Stefan; Grip, Olof; Key, Timothy; Crowe, Francesca L.; Bergmann, Manuela M.; Overvad, Kim; Palli, Domenico; Masala, Giovanna; Khaw, Kay-Tee; Racine, Antoine; Carbonnel, Franck; Boutron-Ruault, Marie-Christine; Olsen, Anja; Tjonneland, Anne; Kaaks, Rudolf; Tumino, Rosario; Trichopoulou, Antonia; Hart, Andrew R.

2014-01-01

57

Etiology of ulcerative lesions of Atlantic menhaden ( Brevoortia tyrannus ) from James River, Virginia  

Microsoft Academic Search

We observed ulcerative lesions on live Atlantic menhaden, Brevoortia tyrannus, during ichthyofaunal sampling in the tidal James River in October 1999 (near Jamestown, VA, USA). Other synoptically collected fishes exhibited no signs of lesions or pre-ulcerative tissues. Live fish were classified as unremarkable (no dermal anomalies), pre-ulcerative (integument intact with boil-like swelling), and ulcerative (severe focal lesions). Specimens were analyzed

Stanley R. Webb; Gregory C. Garman; Stephen P. McIninch; Thomas A. Nerad; Michael T. Peglar; Patrick M. Gillevet; Bonnie L. Brown

2005-01-01

58

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

PubMed Central

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

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

2015-01-01

59

Etiology of ulcerative lesions of Atlantic menhaden (Brevoortia tyrannus) from James River, Virginia.  

PubMed

We observed ulcerative lesions on live Atlantic menhaden, Brevoortia tyrannus, during ichthyofaunal sampling in the tidal James River in October 1999 (near Jamestown, VA, USA). Other synoptically collected fishes exhibited no signs of lesions or pre-ulcerative tissues. Live fish were classified as unremarkable (no dermal anomalies), pre-ulcerative (integument intact with boil-like swelling), and ulcerative (severe focal lesions). Specimens were analyzed for bacteria, fungi, and pathogenic protozoans including amphizoic amoebae, Pfiesteria piscicida, and Kudoa sp. No Pfiesteria were detected in any tissue specimen. All B. tyrannus examined, including tissues from unremarkable fish, tested positive for presence of the known fish parasite Kudoa. Only ulcerative lesions were also colonized by bacteria, fungi, and amphizoic amoebae. The absence of bacteria, fungi, and protozoans from unremarkable and pre-ulcerative fish suggests that association of other potential pathogens with B. tyrannus ulcers was due to secondary colonization following lesion formation as a result of Kudoa infection. PMID:16133297

Webb, Stanley R; Garman, Gregory C; McIninch, Stephen P; Nerad, Thomas A; Peglar, Michael T; Gillevet, Patrick M; Brown, Bonnie L

2005-11-01

60

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

PubMed

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

Al-Najjar, Mahmoud; Jackson, Mark J

2011-10-01

61

State-of-the-art treatment of chronic leg ulcers: a randomized controlled trial comparing vacuum-assisted closure (V.A.C.) with modern wound dressings  

Microsoft Academic Search

Background: Current treatment modalities for chronic leg ulcers are time consuming, expensive, and only moderately successful. Recent data suggest that creating a subatmospheric pressure by vacuum-assisted closure (V.A.C., KCI Concepts, San Antonio, Texas) therapy supports the wound healing process. Methods: The efficacy of vacuum-assisted closure in the treatment of chronic leg ulcers was prospectively studied in a randomized controlled trial

Jeroen D. D. Vuerstaek; Tryfon Vainas; Jan Wuite; Patty Nelemans; Martino H. A. Neumann; Joep C. J. M. Veraart

62

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

PubMed Central

Chronic venous leg ulcers (CVLUs) affect approximately 600,000 people annually in the United States and accrue yearly treatment costs of US$2.5–5 billion. As the population ages, demands on health care resources for CVLU treatments are predicted to drastically increase because the incidence of CVLUs is highest in those ?65 years of age. Furthermore, regardless of current standards of care, healing complications and high recurrence rates prevail. Thus, it is critical that factors leading to or exacerbating CVLUs be discerned and more effective, adjuvant, evidence-based treatment strategies be utilized. Previous studies have suggested that CVLUs’ pathogenesis is related to the prolonged presence of high numbers of activated neutrophils secreting proteases in the wound bed that destroy growth factors, receptors, and the extracellular matrix that are essential for healing. These events are believed to contribute to a chronically inflamed wound that fails to heal. Therefore, the purpose of this project was to review studies from the past 15 years (1996–2011) that characterized neutrophil activity in the microenvironment of human CVLUs for new evidence that could explicate the proposed relationship between excessive, sustained neutrophil activity and CVLUs. We also appraised the strength of evidence for current and potential therapeutics that target excessive neutrophil activity. PMID:23551462

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

2013-01-01

63

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

PubMed

Leg ulcer is a disabling complication in patients with sickle cell anemia (SCA) but the exact pathophysiological mechanisms are unknown. The aim of this study was to identify the hematological and hemorheological alterations associated with recurrent leg ulcers. Sixty-two SCA patients who never experienced leg ulcers (ULC-) and 13 SCA patients with a positive history of recurrent leg ulcers (ULC+)--with no leg ulcers at the time of the study--were recruited. All patients were in steady state condition. Blood was sampled to perform hematological, biochemical (hemolytic markers) and hemorheological analyses (blood viscosity, red blood cell deformability and aggregation properties). The hematocrit-to-viscosity ratio (HVR), which reflects the red blood cell oxygen transport efficiency, was calculated for each subject. Patients from the ULC+ group were older than patients from the ULC- group. Anemia (red blood cell count, hematocrit and hemoglobin levels) was more pronounced in the ULC+ group. Lactate dehydrogenase level was higher in the ULC+ group than in the ULC- group. Neither blood viscosity, nor RBC aggregation properties differed between the two groups. HVR was lower and RBC deformability tended to be reduced in the ULC+ group. Our study confirmed increased hemolytic rate and anemia in SCA patients with leg ulcers recurrence. Furthermore, our data suggest that although systemic blood viscosity is not a major factor involved in the pathophysiology of this complication, decreased red blood cell oxygen transport efficiency (i.e., low hematocrit/viscosity ratio) may play a role. PMID:24223994

Connes, Philippe; Lamarre, Yann; Hardy-Dessources, Marie-Dominique; Lemonne, Nathalie; Waltz, Xavier; Mougenel, Danièle; Mukisi-Mukaza, Martin; Lalanne-Mistrih, Marie-Laure; Tarer, Vanessa; Tressières, Benoit; Etienne-Julan, Maryse; Romana, Marc

2013-01-01

64

Decreased Hematocrit-To-Viscosity Ratio and Increased Lactate Dehydrogenase Level in Patients with Sickle Cell Anemia and Recurrent Leg Ulcers  

PubMed Central

Leg ulcer is a disabling complication in patients with sickle cell anemia (SCA) but the exact pathophysiological mechanisms are unknown. The aim of this study was to identify the hematological and hemorheological alterations associated with recurrent leg ulcers. Sixty-two SCA patients who never experienced leg ulcers (ULC-) and 13 SCA patients with a positive history of recurrent leg ulcers (ULC+) - but with no leg ulcers at the time of the study – were recruited. All patients were in steady state condition. Blood was sampled to perform hematological, biochemical (hemolytic markers) and hemorheological analyses (blood viscosity, red blood cell deformability and aggregation properties). The hematocrit-to-viscosity ratio (HVR), which reflects the red blood cell oxygen transport efficiency, was calculated for each subject. Patients from the ULC+ group were older than patients from the ULC- group. Anemia (red blood cell count, hematocrit and hemoglobin levels) was more pronounced in the ULC+ group. Lactate dehydrogenase level was higher in the ULC+ group than in the ULC- group. Neither blood viscosity, nor RBC aggregation properties differed between the two groups. HVR was lower and RBC deformability tended to be reduced in the ULC+ group. Our study confirmed increased hemolytic rate and anemia in SCA patients with leg ulcers recurrence. Furthermore, our data suggest that although systemic blood viscosity is not a major factor involved in the pathophysiology of this complication, decreased red blood cell oxygen transport efficiency (i.e., low hematocrit/viscosity ratio) may play a role. PMID:24223994

Connes, Philippe; Lamarre, Yann; Hardy-Dessources, Marie-Dominique; Lemonne, Nathalie; Waltz, Xavier; Mougenel, Danièle; Mukisi-Mukaza, Martin; Lalanne-Mistrih, Marie-Laure; Tarer, Vanessa; Tressières, Benoit; Etienne-Julan, Maryse; Romana, Marc

2013-01-01

65

Blood Viscosity and the Expression of Inflammatory and Adhesion Markers in Homozygous Sickle Cell Disease Subjects with Chronic Leg Ulcers  

PubMed Central

Objective To determine differences in TNF-?, IL-1?, IL-10, sICAM-1 concentrations, leg hypoxia and whole blood viscosity (WBV) at shear rates of 46 sec-1 and 230 sec-1 in persons with homozygous S sickle cell disease (SCD) with and without chronic leg ulceration and in AA genotype controls. Design & Methods: fifty-five age-matched participants were recruited into the study: 31 SS subjects without leg ulcers (SSn), 24 SS subjects with leg ulcers (SSu) and 18 AA controls. Haematological indices were measured using an AC.Tron Coulter Counter. Quantification of inflammatory, anti-inflammatory and adhesion molecules was performed by ELISA. Measurement of whole blood viscosity was done using a Wells Brookfield cone-plate viscometer. Quantification of microvascular tissue oxygenation was done by Visible Lightguide spectrophotometry. Results TNF-? and whole blood viscosity at 46 sec-1 and 230 sec-1 (1.75, 2.02 vs. 0.83, 1.26, p<0.05) were significantly greater in sickle cell disease subjects than in controls. There were no differences in plasma concentration of sICAM-1, IL-1? and IL-10 between SCD subjects and controls. IL-1? (median, IQR: 0.96, 1.7 vs. 0, 0.87; p<0.01) and sICAM-1 (226.5, 156.48 vs. 107.63, 121.5, p<0.005) were significantly greater in SSu group compared with SSn. However there were no differences in TNF-? (2, 3.98 vs. 0, 2.66) and IL-10 (13.34, 5.95 vs. 11.92, 2.99) concentrations between SSu and SSn. WBV in the SSu group at 46 sec-1 and at 230 Sec 1 were 1.9 (95%CI; 1.2, 3.1) and 2.3 (1.2, 4.4) times greater than in the SSn group. There were no differences in the degree of tissue hypoxia as determined by lightguide spectrophotometry. Conclusion Inflammatory, adhesion markers and WBV may be associated with leg ulceration in sickle cell disease by way of inflammation-mediated vasoocclusion/vasoconstriction. Impaired skin oxygenation does not appear to be associated with chronic ulcers in these subjects with sickle cell disease. PMID:23922670

Bowers, Andre S.; Reid, Harvey L.; Greenidge, Andre; Landis, Clive; Reid, Marvin

2013-01-01

66

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

PubMed Central

Background International studies report that nurse clinics improve healing rates for the leg ulcer population. However, these studies did not necessarily deliver similar standards of care based on evidence in the treatment venues (home and clinic). A rigorous evaluation of home versus clinic care is required to determine healing rates with equivalent care and establish the acceptability of clinic-delivered care. Methods Health Services RCT was conducted where mobile individuals were allocated to either home or nurse clinic for leg ulcer management. In both arms, care was delivered by specially trained nurses, following an evidence protocol. Primary outcome: 3-month healing rates. Secondary outcomes: durability of healing (recurrence), time free of ulcers, HRQL, satisfaction, resource use. Data were collected at base-line, every 3 months until healing occurred, with 1 year follow-up. Analysis was by intention to treat. Results 126 participants, 65 randomized to receive care in their homes, 61 to nurse-run clinics. No differences found between groups at baseline on socio-demographic, HRQL or clinical characteristics. mean age 69 years, 68% females, 84% English-speaking, half with previous episode of ulceration, 60% ulcers at inclusion < 5 cm2 for < 6 months. No differences in 3-month healing rates: clinic 58.3% compared to home care at 56.7% (p = 0.5) or in secondary outcomes. Conclusion Our findings indicate that organization of care not the setting where care is delivered influences healing rates. Key factors are a system that supports delivery of evidence-based recommendations with care being provided by a trained nursing team resulting in equivalent healing rates, HRQL whether care is delivered in the home or in a community nurse-led clinic. Trial registration ClinicalTrials.gov Protocol Registration System: NCT00656383 PMID:19036149

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

2008-01-01

67

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

PubMed Central

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

Tuttle, Marie S.

2015-01-01

68

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

PubMed

During 2005-2007 128 patients at the age from 21 to 80 years with extensive trophic ulcers of legs were treated in the contaminated surgery department of A.V. Vishnevsky Surgery Institute and Korolenko Hospital. In 87 patients (69.9%) varicosity was the cause of venous insufficiency, in 41 patients--post-thrombotic disease. 23 patients (17.97%) had double-sided throphic ulcers. In 50 patients (39.1%) ulcer area exceeded 40 cm2. In microscopical analysis fungi were discovered in 87 patients (89.06%). In the remaining 15 patients diagnosis was verified culturally. System etiotropic antimycotic antibacterial treatment including hyposensitizative, anti-inflammatory, antihistamine drugs was carried out. 34 patients (26.57%) received broad spectrum antibiotic from terbinafine group (Terbizil) in dosage 250 mg once a day during 3 moths with concurrent use of topical antimycotics. 34 patients (26.56%) recieved pulse therapy with broad spectrum antibiotic Rumicoz 400 mg a day during 7 days in combination with topical antimycotics. Nizoral 400 mg a day during 30 days was prescribed to 26 patients (20.3%). 34 patients (26.56%) were treated only with topical antimycotics. After preoperative preparation and reduction of inflammatory process 64 patients had underwent excision of trophic ulcers whereupon the therapy was continued. In these patients regress of varicose eczema manifestation was achieved on the 10th day. In patients who hadn't received surgical cure regress of varicose eczema was signed on the 23-25th day after onset of treatment. Question of plastic closing of throphic ulcers and wounds after their excision was solved particularly. 14 patients needed recurring surgical management becose inflammatory process was continued. Comprehensive approach to therapy taking into account mycotic semination appears to be appropriate and effective. Proactive surgical tactics (excision of throphic ulcer) allows to quicken preoperative preparation for correction of venous blood flow. PMID:19301489

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

2008-01-01

69

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

PubMed

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

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

2014-12-01

70

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

PubMed

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

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

71

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

PubMed Central

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

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

2014-01-01

72

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

PubMed

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

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

2014-10-01

73

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

Microsoft Academic Search

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

Astrid Langer; Wolf Rogowski

2009-01-01

74

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

PubMed Central

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

2014-01-01

75

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

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

Bo Jorgensen; Gitte Juel Friis; Finn Gottrup

2006-01-01

76

["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

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

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

2013-08-01

77

Silver treatments and silver-impregnated dressings for the healing of leg wounds and ulcers: a systematic review and meta-analysis.  

PubMed

Previous systematic reviews of silver-impregnated dressings have been contradictory regarding the healing of leg wounds/ulcers. Our systematic review was restricted to randomized controlled trials. Cochrane Library, Scopus, and MEDLINE databases were searched using the term "silver" in combination with "wound" or "ulcer" (and plural versions) without date/language restriction. Study quality was assessed and meta-analysis conducted for complete wound healing, wound size reduction, and healing rates. Overall study quality was fair with most studies having some bias. Evidence for wound healing using individual studies was poor. Meta-analyses found strong evidence for wound healing based on wound size reduction but no evidence based on complete wound-healing or healing rates. Although our results provide some evidence that silver-impregnated dressings improve the short-term healing of wounds and ulcers, long-term effects remain unclear. Clinical trial data with longer follow-up times are needed to address these issues. PMID:20471135

Carter, Marissa J; Tingley-Kelley, Kimberly; Warriner, Robert A

2010-10-01

78

Factors influencing the sporulation and cyst formation of Aphanomyces invadans, etiological agent of ulcerative mycosis in Atlantic menhaden, Brevoortia tyrannus  

Microsoft Academic Search

Oomycete infections caused by Aphano- myces invadans occur in freshwater and estuarine fishes around the world. Along the east coast of the USA, skin ulcers caused by A. invadans are prevalent in Atlantic menhaden, Brevoortia tyrannus. From lab- oratory observations low salinities appear crucial to transmission of the pathogen. To better understand aspects of transmission, we characterized sporulation and cyst

Yasunari Kiryu; Vicki S. Blazer; Wolfgang K. Vogelbein; Howard Kator; Jeffrey D. Shields

2005-01-01

79

A randomized, controlled, double-blind prospective trial with a Lipido-Colloid Technology-Nano-OligoSaccharide Factor wound dressing in the local management of venous leg ulcers.  

PubMed

Venous leg ulcers (VLUs) are the most prevalent chronic wounds in western countries with a heavy socioeconomic impact. Compression therapy is the etiologic treatment of VLU but until now no wound dressing has been shown to be more effective than another. The aim of this study was to assess the efficacy of a new dressing in the management of VLU. Adult patients presenting a noninfected VLU and receiving effective compression therapy were enrolled in this randomized, controlled, double-blind trial. The VLUs were assessed every 2 weeks for 8 weeks. The primary study outcome was the relative Wound Area Reduction (WAR, in %), and the secondary objectives were absolute WAR, healing rate, and percentage of wounds with >40% surface area reduction. One hundred eighty-seven patients were randomly allocated to treatment groups. Median WAR was 58.3% in the Lipido-Colloid Technology-Nano-OligoSaccharide Factor (TLC-NOSF) dressing group (test group) and 31.6% in the TLC dressing group (control group) (difference: -26.7%; 95% confidence interval: -38.3 to -15.1%; p = 0.002). All other efficacy outcomes were also significant in favor of the TLC-NOSF dressing group. Clinical outcomes for patients treated with the new dressing are superior to those patients treated with the TLC dressing (without NOSF compound), suggesting a strong promotion of the VLU healing process. PMID:22681551

Meaume, Sylvie; Truchetet, François; Cambazard, Frédéric; Lok, Catherine; Debure, Clélia; Dalac, Sophie; Lazareth, Isabelle; Sigal, Michèle-Léa; Sauvadet, Anne; Bohbot, Serge; Dompmartin, Anne

2012-01-01

80

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

PubMed Central

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

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

2014-01-01

81

Diabetic Ulcer (Neurogenic Ulcer)  

MedlinePLUS

newsletter | contact Share | Diabetic Ulcer (Neurogenic Ulcer) Information for adults A A A A neurogenic ulcer begins with thickening and a callus on ... the right. Overview Neurogenic ulcers, also known as diabetic ulcers, are ulcers that occur most commonly on ...

82

A Real World, Observational Registry of Chronic Wounds and Ulcers  

ClinicalTrials.gov

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

2014-10-29

83

Factors influencing the sporulation and cyst formation of Aphanomyces invadans, etiological agent of ulcerative mycosis in Atlantic menhaden, Brevoortia tyrannus.  

PubMed

Oomycete infections caused by Aphanomyces invadans occur in freshwater and estuarine fishes around the world. Along the east coast of the USA, skin ulcers caused by A. invadans are prevalent in Atlantic menhaden, Brevoortia tyrannus. From laboratory observations low salinities appear crucial to transmission of the pathogen. To better understand aspects of transmission, we characterized sporulation and cyst formation of secondary zoospores of two isolates of A. invadans at different salinities and temperatures. Sporulation occurred only at low salinities. At room temperature (ca. 20-22 C), using "pond water" augmented with artificial sea salts, the endemic strain WIC and the Thailand strain PA7 of A. invadans produced free-swimming secondary zoospores at salinities of 0, 1 and 2 psu (practical salinity unit = per thousand), but not at 4 psu or higher. Secondary zoospores of another species, ATCC-62427 (Aphanomyces sp.), were observed at 1, 2, 4 and 8 psu but not at 0 and 12 psu. Secondary zoospores of all three isolates, especially WIC, were abundant and motile 1-2 d postsporulation. Sporulation was temperature dependent and occurred over a relatively narrow range. No sporulation occurred at 4, 30 or 35 C for either WIC or PA7. For both strains zoospore production within 1-3 d after the initiation of sporulation was more prolific at 25 C than at 20 and 15 C. At 15 C production of zoospores was sustained over 11 d for WIC and 5 d for PA7. At room temperature single WIC secondary zoospores remained motile 12-18 h. Salinities exceeding 4 psu or vigorous shaking caused immediate cyst formation of WIC secondary zoospores. Exposure to menhaden tissue, but not tissues of other fishes to secondary zoospores (WIC), caused rapid (2 h) cyst formation. Cysts were capable of excysting when transferred to 1 psu water within 2-3 h of cyst formation. Cysts that had remained encysted in 6.5 psu for 24 h did not excyst when transferred to 1 psu water. Salinity and temperature requirements for sporulation indicate that juvenile menhaden must acquire infections during rain or in low salinity oligohaline waters. PMID:16392244

Kiryu, Yasunari; Blazer, Vicki S; Vogelbein, Wolfgang K; Kator, Howard; Shields, Jeffrey D

2005-01-01

84

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

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

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

2008-01-01

85

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

PubMed

Venous leg ulcers produce significant clinical and economic burdens on society and often require advanced wound therapy. The purpose of this multicenter, randomized, controlled study is to evaluate the safety and efficacy of one or two applications of dehydrated human amnion/chorion membrane allograft and multilayer compression therapy vs. multilayer compression therapy alone in the treatment of venous leg ulcers. The primary study outcome was the proportion of patients achieving 40% wound closure at 4 weeks. Of the 84 participants enrolled, 53 were randomized to receive allograft and 31 were randomized to the control group of multilayer compression therapy alone. At 4 weeks, 62% in the allograft group and 32% in the control group showed a greater than 40% wound closure (p?=?0.005), thus showing a significant difference between the allograft-treated groups and the multilayer compression therapy alone group at the 4-week surrogate endpoint. After 4 weeks, wounds treated with allograft had reduced in size a mean of 48.1% compared with 19.0% for controls. Venous leg ulcers treated with allograft had a significant improvement in healing at 4 weeks compared with multilayer compression therapy alone. PMID:25224019

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

2014-11-01

86

LEG CRAMPS  

PubMed Central

Foot and leg cramps are among the most frequent complaints presented by patients of both sexes, especially older persons. Similar cramping may occur in the thighs or in other skeletal muscles of the extremities and trunk. Foot and leg cramps usually occur after unusual exertion or during sleep. “Nocturnal leg cramps” may be of sufficient intensity to prevent sleep. “Pregnancy cramps” are particularly distressing. Effective treatment of foot and leg cramps requires an understanding of the etiology, pathophysiology and diagnostic techniques. Weight reduction and improved diet are essential. Among the useful supplementary medications are calcium lactate or gluconate, vitamin-mineral supplements, sympathetic blocking agents, vasodilators, ataraxics, muscle relaxants, quinine, hydrochloride, antihistamines, and nonmercurial diuretics. Improved foot care and correction of foot imbalance is usually required. Edema and venous insufficiency are improved by elastic support, by repeated foot elevation for massages, by manipulations and exercises and by the use of diuretics. There may be need for operations on the veins and for sclerotherapy. Patients with arterial insufficiency are often benefited by lumbar sympathetic blocks with long-acting anesthetics and intra-arterial injections with relaxants, vasodilators, thrombolytic enzymes and anticoagulants. Sympathectomy, angiography and reconstructive arterial operations are indicated in only a small proportion of patients with foot and leg cramps. PMID:13822692

Fields, Albert

1960-01-01

87

Molecular Detection of Cellulosimicrobium cellulans as the Etiological Agent of a Chronic Tongue Ulcer in a Human Immunodeficiency Virus-Positive Patient  

PubMed Central

Ulcerations appeared on the tongue of a 48-year-old human immunodeficiency virus-positive man. Histological findings of the biopsy specimen and the fact that the patient had resided in Louisiana led us to suspect “American histoplasmosis.” A new ulcer appeared while the patient was being treated with itraconazole, and the gene for 16S rRNA of Cellulosimicrobium cellulans was amplified. The lesions healed during treatment with oral penicillin and azithromycin. PMID:16081997

Heym, Beate; Gehanno, Pierre; Friocourt, Véronique; Bougnoux, Marie-Elisabeth; Le Moal, Michèle; Husson, Corinne; Leibowitch, Jacques; Nicolas-Chanoine, Marie-Hélène

2005-01-01

88

Molecular detection of Cellulosimicrobium cellulans as the etiological agent of a chronic tongue ulcer in a human immunodeficiency virus-positive patient.  

PubMed

Ulcerations appeared on the tongue of a 48-year-old human immunodeficiency virus-positive man. Histological findings of the biopsy specimen and the fact that the patient had resided in Louisiana led us to suspect "American histoplasmosis". A new ulcer appeared while the patient was being treated with itraconazole, and the gene for 16S rRNA of Cellulosimicrobium cellulans was amplified. The lesions healed during treatment with oral penicillin and azithromycin. PMID:16081997

Heym, Beate; Gehanno, Pierre; Friocourt, Véronique; Bougnoux, Marie-Elisabeth; Le Moal, Michèle; Husson, Corinne; Leibowitch, Jacques; Nicolas-Chanoine, Marie-Hélène

2005-08-01

89

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

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

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

2008-01-01

90

Venous ulcers - self-care  

MedlinePLUS

... When these valves become weak, blood can flow backward and pool in your legs. This is called ... are at risk for venous ulcers, take these steps to help prevent problems. Raise your feet above ...

91

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

PubMed Central

The basis for the new procedure is the simultaneous transcutaneous measurement of the peri-ulceral oxygen partial pressure (tcPO2), using a minimum of 4 electrodes which are placed as close to the wound margin as possible, additionally, as a challenge the patient inhales pure oxygen for approximately 15 minutes. In order to evaluate the measurement data and to characterise the wounds, two new oxygen parameters were defined: (1) the oxygen characteristic (K-PO2), and (2) the oxygen inhomogeneity (I-PO2) of a chronic wound. The first of these is the arithmetic mean of the two lowest tcPO2 measurement values, and the second is the variation coefficient of the four measurement values. Using the K-PO2 parameter, a grading of wound hypoxia can be obtained. To begin with, the physiologically regulated (and still compensated) hypoxia with K-PO2 values of between 35 and 40 mmHg is distinguished from the pathological decompensated hypoxia with K-PO2 values of between 0 and 35 mmHg; the first of these still stimulates self-healing (within the limits of the oxygen balance). The decompensated hypoxia can be (arbitrarily) divided into “simple” hypoxia (Grade I), intense hypoxia (Grade II) and extreme hypoxia (Grade III), with the possibility of intermediate grades (I/II and II/III). Measurements were carried out using the new procedure on the skin of the right inner ankle of 21 healthy volunteers of various ages, and in 17 CVI (chronic venous insufficiency) wounds. Sixteen of the 17 CVI wounds (i.e., 94%) were found to be pathologically hypoxic, a state which was not found in any of the healthy volunteers. The oxygen inhomogeneity (I-PO2) of the individual chronic wounds increased exponentially as a function of the hypoxia grading (K-PO2), with a 10-fold increase with extreme hypoxia in contrast to a constant value of approximately 14% in the healthy volunteers. This pronounced oxygen inhomogeneity explains inhomogeneous wound healings, resulting in the so-called mosaic wounds. The hypoxia grades found in all of the chronic wounds was seen to be evenly distributed with values ranging from 0 to 40 mmHg, and therefore extremely inhomogeneous. In terms of oxygenation, chronic wounds are therefore inhomogeneous in two respects: (1) within the wound itself (intra-individual wound inhomogeneity) and (2) between different wounds (inter-individual wound inhomogeneity). Due to the extreme oxygen inhomogeneity, single measurements are not diagnostically useful. In healthy individuals the oxygen inhalation challenge (see above) results in synchronised tcPO2 oscillations occurring at minute rhythms, which are not seen in CVI wounds. These oscillations can be interpreted as a sign of a functioning arterial vasomotor system. The new procedure is suitable for the routine characterisation of chronic wounds in terms of their oxygen status, and correspondingly, their metabolically determining (and limiting) potential for healing and regeneration. The oxygen characteristic K-PO2 can furthermore be used as a warning of impending ulceration, since the oxygen provision worsens over time prior to the demise of the ulcerated tissue, thus making a controlled prophylaxis possible. PMID:22737104

Barnikol, Wolfgang K. R.; Pötzschke, Harald

2012-01-01

92

Pyoderma gangrenosum: skin grafting and hyperbaric oxygen as adjuvants in the treatment of a deep and extensive ulcer*  

PubMed Central

Pyoderma gangrenosum is a rare dermatosis of unknown etiology and variable clinical presentation. The disease is challenging for the medical staff, from the frequent diagnostic difficulties to the lack of scientific evidence with a good level to support the management of extensive and refractory cases. Our patient is a 50 year-old man with an extensive and deep ulcer on the left leg, which exemplifies the therapeutic difficulties inherent to the disease and who, fortunately, has progressed with excellent result after association of hyperbaric oxygen therapy and skin grafting to the immunosuppression therapy initially proposed. PMID:24346912

Araújo, Fernanda Mendes; Kondo, Rogério Nabor; Minelli, Lorivaldo

2013-01-01

93

Pyoderma gangrenosum: skin grafting and hyperbaric oxygen as adjuvants in the treatment of a deep and extensive ulcer.  

PubMed

Pyoderma gangrenosum is a rare dermatosis of unknown etiology and variable clinical presentation. The disease is challenging for the medical staff, from the frequent diagnostic difficulties to the lack of scientific evidence with a good level to support the management of extensive and refractory cases. Our patient is a 50 year-old man with an extensive and deep ulcer on the left leg, which exemplifies the therapeutic difficulties inherent to the disease and who, fortunately, has progressed with excellent result after association of hyperbaric oxygen therapy and skin grafting to the immunosuppression therapy initially proposed. PMID:24346912

Araújo, Fernanda Mendes; Kondo, Rogério Nabor; Minelli, Lorivaldo

2013-01-01

94

Etiology and management of recurrent aphthous stomatitis  

Microsoft Academic Search

Recurrent aphthous stomatitis (RAS) is an ulcerative condition that affects the oral mucosa without evidence of an underlying\\u000a medical disorder. RAS is characterized by the appearance of round, shallow ulcerations surrounded by inflammation that chiefly\\u000a involves the nonkeratinized mucosa. The etiology of RAS is unknown, but has a strong hereditary component and appears to be\\u000a related to an immune reaction

Martin S. Greenberg; Andres Pinto

2003-01-01

95

Peptic Ulcers  

MedlinePLUS

... ulcer. Also make sure that your child avoids coffee, tea, sodas, and foods that contain caffeine , which ... movements bloody vomit or vomit that looks like coffee grounds If your child has peptic ulcer disease, ...

96

Corneal Ulcer  

MedlinePLUS

... Eye Health News Consumer Alerts What Is a Corneal Ulcer? Tweet A corneal ulcer is an open sore on the cornea — the clear front window of the eye. The cornea covers the iris (the colored portion of the ...

97

Leg muscles  

NSDL National Science Digital Library

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

Uwe Gille (None;)

2007-07-29

98

The clinical problem of stress ulcers.  

PubMed

True stress ulcers are primarily superficial gastric fundic lesions that occur in the clinical setting of severe shock, trauma, burns, and sepsis, especially peritonitis. They are to be clearly differentiated from Cushing's ulcers, exacerbation of pre-existent chronic ulcers, and drug-induced gastritis, all of which have completely different pathogenetic mechanisms. The etiology of true stress ulcers is most importantly related to ischemia and tissue acidosis, although luminal acid and pepsin are requisite for ulceration to occur. The sole clinical manifestation of stress ulcers is hemorrhage. Prophylaxis with antacids alone, or with a combination of antacids and H2 receptor antagonists is highly efficacious if luminal pH is carefully monitored. The treatment of exsanguinating hemorrhage, once established, carries with it an extremely high morbidity and mortality. PMID:2887324

Silen, W

1987-05-01

99

[Surgical management of varicose ulcers].  

PubMed

One of the most often diseases of the European population is the venous chronic leg ulcer. It requires a long-term and expensive therapy. Basic elements of the therapy are elastic banding of the leg, diuretics, antibiotics and local treatment. In some cases a profit can be acquired from surgical procedure, which includes the stripping and/or crossectomy of the saphenous vein or the subfascial ligation of insufficient perforators and skin grafting (two phases operation). This procedure shorts the time of therapy and prevents the ulcer recurrence, because it resolves the reason and the results of the disease. We present 22 patients treated by this cure during the last 3 years at our surgery department of the 3rd faculty of medicine Charles University in Prague. 21 patients (95.5%) are healed. PMID:16447575

Ston, R; Havl?j, L; Ocadlík, M; Masri, A

2005-12-01

100

Genetic markers and duodenal ulcer.  

PubMed

Serum pepsinogen, alpha 1-antitrypsin (alpha 1-AT) and blood groups were studied as genetic markers in 32 patients with endoscopically proven duodenal ulcer and 44 control subjects with no family history of ulcer disease. Serum pepsinogen was determined by the modified method of Edward et al, alpha 1-AT by single radial immunodiffusion (RID) and phenotyping was carried out by isoelectric focusing (IEF). Duodenal ulcer patients with hyper- pepsinogenemia (28%) and low serum alpha 1-AT (35%) had a dominant blood group O, lower mean age, an early onset of disease, a higher frequency of gastrointestinal (GI) bleeding and ulcer perforation. These parameters were found considerably different in patients with normal serum pepsinogen and alpha 1-AT. Phenotype analysis of alpha 1-AT revealed that four duodenal ulcer patients had partial deficiency of the protease inhibitor and none of the normal exhibited the deficiency pattern. The etiology of the disease appears to be genetic anomaly in 28% of patients while the rest (72%) had ulcers as a result of neuroendocrinological or environmental factors. PMID:9230579

Shahid, A; Zuberi, S J; Siddiqui, A A; Waqar, M A

1997-05-01

101

Ugh! Ulcers  

MedlinePLUS

... or ulcers, are caused. Continue Who Has H. Pylori Infection? By testing someone's blood, doctors can figure ... he or she has been exposed to H. pylori . When tested, lots of people have H. pylori ...

102

Ulcerative Colitis  

MedlinePLUS Videos and Cool Tools

... form in places where the inflammation has killed cells in the lining of the colon. The ulcers ... inflamed. The immune system is made of blood cells and chemicals that find bacteria and viruses in ...

103

Stomach ulcer  

MedlinePLUS Videos and Cool Tools

... the small intestine. It produces acid and various enzymes that break down food into simple substances. The ... the stomach is protected from the acid and enzymes by a mucous lining. Ulcers are caused when ...

104

Mechanisms of Disease: pathogenesis of Crohn's disease and ulcerative colitis  

Microsoft Academic Search

Crohn's disease and ulcerative colitis are idiopathic, chronic, relapsing, inflammatory conditions that are immunologically mediated. Although their exact etiologies remain uncertain, results from research in animal models, human genetics, basic science and clinical trials have provided important new insights into the pathogenesis of chronic, immune-mediated, intestinal inflammation. These studies indicate that Crohn's disease and ulcerative colitis are heterogeneous diseases characterized

R Balfour Sartor

2006-01-01

105

[Ulcerative colitis].  

PubMed

Ulcerative colitis in children has been seldom described in Chile. The cases of a 14 year old girl and a 10 year old boy with this disease are presented. Both had diarrhea for more than two months--which was continuous in the first case and intermittent in the other one--, bloody stools, weight loss, anemia and abdominal pain. Bacteriological and parasitological examination of stools were negative. Diagnosis of ulcerative colitis was based on barium enema, which showed mucosal ulceration and loss of the normal claustral pattern, rectosigmoidoscopy, that revealed hyperemia, friability and erosions of the corresponding segments of intestinal mucosa, and on histological examination of multiple mucosal biopsies, which disclosed crypt abscess, distorted crypt pattern, inflammation of the lamina propria and decreased number of goblet cells. Both cases were treated with salazosulfapyridine with satisfactory response. PMID:1688231

Chávez, E; Ceresa, S; Rossel, M; Las Heras, J

1991-01-01

106

Dutch Venous Ulcer guideline update.  

PubMed

The revised guideline of 2013 is an update of the 2005 guideline "venous leg ulcer". In this special project four separate guidelines (venous leg ulcer, varicose veins, compression therapy and deep venous disorders) were revised and developed simultaneously. A meeting was held including representatives of any organisation involved in venous disease management including patient organizations and health insurance companies. Eighteen clinical questions where defined, and a new strategy was used to accelerate the process. This resulted in two new and two revised guidelines within one year. The guideline committee advises use of the C of the CEAP classification as well as the Venous Clinical Severity Score (VCSS) and a Quality of life (QoL) score in the assessment of clinical signs. These can provide insight into the burden of disease and the effects of treatment as experienced by the patient. A duplex ultrasound should be performed in every patient to establish the underlying aetiology and to evaluate the need for treatment (which is discussed in a separate guideline). The use of the TIME model for describing venous ulcers is recommended. There is no evidence for antiseptic or antibiotic wound care products except for a Cochrane review in which some evidence is presented for cadexomer iodine. Signs of infection are the main reason for the use of oral antibiotics. When the ulcer fails to heal the use of oral aspirin and pentoxifylline can be considered as an adjunct. For the individual patient, the following aspects should be considered: the appearance of the ulcer (amount of exudate) according to the TIME model, the influence of wound care products on moisturising the wound, frequency of changing compression bandages, pain and allergies. The cost of the dressings should also be considered. Education and training of patients t improves compliance with compression therapy but does not influence wound healing rates. PMID:24843102

Maessen-Visch, M Birgitte; de Roos, Kees-Peter

2014-05-19

107

[Contact granuloma: symptoms, etiology, diagnosis, therapy].  

PubMed

Contact ulcer granuloma has a multifactorial etiology but vocal abuse is considered the most important etiological factor. Some other possible factors are well-known: tuberculosis, allergies, hormonal or autonomic imbalance, psychosomatic influences, reflux-esophagitis, pathological conditions of the nose, nasal accessory sinus, tonsils. Constitutional factors play also an important role. The symptoms range from mild huskiness to severe hoarseness with pain extending to the ear, dysphagia, sometimes hemoptysis and chronic cough. Failure to recognize the pathological features of this frequently overlooked lesion leads to diagnosis of larynx cancer, angiosarcoma or hemangioma. Indication for microsurgical removal is only severe dyspnea by size of mass or if the dignity is not clear, because any surgical procedure has only temporary value and does not eliminate the etiological factors. The dignity can normally be proved by stroboscope. Vocal rehabilitation and re-education are an essential appropriate means of treatment for this disease if other causative factors are excluded. PMID:1575850

Sieron, J; Johannsen, H S

1992-04-01

108

Lower extremity arterial and venous ulcers.  

PubMed

The prevalence of peripheral arterial disease in the general population is high, but the awareness of primary care providers of the disease process is low. The disease is not recognized by primary care providers. Early recognition and treatment of venous diseases that progress to postphlebotic syndrome, such as after a deep vein thrombosis, will prevent venous ulcers that add considerable expense to the health care system. Vascular assessment, including routine ABI measurement of patients who are in risk categories for vascular disease will identify those patients so that prevention programs can be put into place early. Major contributions to the understanding and management of leg ulcers and wound healing have been made in the last decade. However, there is still confusion as to the exact mechanism behind ulcer development and the best method to manage, cure,and prevent these ulcers has yet to be found. PMID:15924901

Sieggreen, Mary

2005-06-01

109

Peripheral artery disease - legs  

MedlinePLUS

... legs; Arterial insufficiency of the legs; Recurrent leg pain and cramping; Calf pain with exercise ... The main symptoms of PAD are pain, achiness, fatigue, burning, or ... These symptoms usually appear during walking or exercise, ...

110

Focal Myositis of Unilateral Leg  

PubMed Central

Focal myositis is a rare, benign inflammatory pseudotumor of the skeletal muscle of unknown etiology. In Korea, there is no case report of focal myositis, which is not combined with connective tissue disease. We present an unusual case of focal myositis with ankle contracture, involving more than two muscles. A 26-year-old man visited our clinic complaining of right ankle contracture and leg muscle pain. Physical examination revealed no muscle weakness or any other neurological abnormality. T2-weighted magnetic resonance imaging of the right leg demonstrated diffuse high signal intensity of the right gastrocnemius, flexor digitorum longus, and tibialis anterior muscles. Needle electromyography showed profuse denervation potentials with motor unit action potentials of short duration and small amplitude from the involved muscles. All these findings suggested a diagnosis of focal inflammatory myositis and the patient was put under oral prednisolone and physical therapy. PMID:22506226

Jun, Jin; Im, Sun; Park, Joo Hyun; Yoo, Soon Hei

2011-01-01

111

Depression in patients with chronic venous ulceration.  

PubMed

As leg ulcer research has generally focused on aspects of treatment, the psychosocial impact of leg ulceration remains understudied. This article reports the findings of a study exploring the prevalence of anxiety and depression in 190 patients with chronic venous ulceration across 9 Trusts in the northwest of England. The hospital anxiety and depression scale (HADS) was used to screen patients for the presence of anxiety and depression using a cut-off point of 9 for level of "caseness". A total of 52 (27%) people scored as depressed while 50 (26%) scored as anxious. The two symptoms which appeared to be associated with anxiety and depression were pain and odour, while there was no association found between living alone, mobility and exudate. These findings suggest that the focus of care needs to be redirected for many patients for whom cure is not an option, but who are left to live with a chronic wound. Furthermore, psychological factors, including depression, should be a focus in assessment and ongoing review of patients with leg ulceration. PMID:16835511

Jones, June; Barr, Wally; Robinson, Jude; Carlisle, Caroline

112

Pressure ulcers  

PubMed Central

Introduction Unrelieved pressure or friction of the skin, particularly over bony prominences, can lead to pressure ulcers in up to a third of people in hospitals or community care, and a fifth of nursing home residents. Pressure ulcers are more likely in people with reduced mobility and poor skin condition, such as older people or those with vascular disease. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of preventive interventions in people at risk of developing pressure ulcers? What are the effects of treatments in people with pressure ulcers? We searched: Medline, Embase, The Cochrane Library and other important databases up to February 2007 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 60 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: air-filled vinyl boots, air-fluidised supports, alternating pressure surfaces (including mattresses), alternative foam mattresses, constant low-pressure supports, debridement, electric profiling beds, electrotherapy, hydrocellular heel supports, low-air-loss beds (including hydrotherapy beds), low-level laser therapy, low-tech constant low-pressure supports, medical sheepskin overlays, nutritional supplements, orthopaedic wool padding, pressure-relieving overlays on operating tables, pressure-relieving surfaces, repositioning (regular "turning"), seat cushions, standard beds, standard care, standard foam mattresses, standard tables, surgery, therapeutic ultrasound, topical lotions and dressings, topical negative pressure, and topical phenytoin. PMID:19450317

2008-01-01

113

Pressure ulcers  

PubMed Central

Introduction Unrelieved pressure or friction of the skin, particularly over bony prominences, can lead to pressure ulcers in up to one third of people in hospitals or community care, and one fifth of nursing home residents. Pressure ulcers are more likely in people with reduced mobility and poor skin condition, such as older people or those with vascular disease. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of preventive interventions in people at risk of developing pressure ulcers? What are the effects of treatments in people with pressure ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 64 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: air-filled vinyl boots, air-fluidised supports, alternating-pressure surfaces (including mattresses), alternative foam mattresses, constant low-pressure supports, debridement, electric profiling beds, electrotherapy, hydrocellular heel supports, low-air-loss beds (including hydrotherapy beds), low-level laser therapy, low-tech constant-low-pressure supports, medical sheepskin overlays, nutritional supplements, orthopaedic wool padding, pressure-relieving overlays on operating tables, pressure-relieving surfaces, repositioning (regular "turning"), seat cushions, standard beds, standard care, standard foam mattresses, standard tables, surgery, therapeutic ultrasound, topical lotions and dressings, topical negative pressure, and topical phenytoin. PMID:21524319

2011-01-01

114

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 ...

115

Differential diagnosis of ulcerative lesions in fish.  

PubMed Central

Tissues such as skin and muscle have a limited repertoire of morphological response to injury. The two most important phenomena that determine the outcome of cell injury appear to be a) critical cell membrane damage, with associated fluid and ionic imbalances; and b) inability of mitochondria, the powerhouse of the cell, to restart ATP synthesis. In fish, skin ulcers can have many different etiologies, including infectious agents, toxins, physical causes, immunologic causes, and nutritional and metabolic perturbations. This article is concerned primarily with the possible pathways of disease involved in ulcerative lesions of fish. In particular, the high prevalence of ulcerative lesions in Atlantic menhaden found along the mid-Atlantic coast, especially in North Carolina estuarine waters, has received much recent attention. These ulcerative lesions are likely to be initiated by a series of factors that lead ultimately to a breach of the normal barrier function of the skin. Bioassays that attempt to define the role of individual etiologic agents such as fungi (oomycetes) or putative Pfiesteria toxin(s) should recognize this multiplicity of factors and should include appropriate quality control measures for water quality parameters (temperature, dissolved oxygen, nitrogenous wastes, etc.) as well as bacterial and other contaminants that may confound bioassay results and their interpretation. Consideration of these factors along with the whole animal in the context of its environment can only advance the science, perhaps provide clues to the causative pathways of skin ulcers in fish, and give us keener insight into the health of the aquatic environment. PMID:11677175

Law, M

2001-01-01

116

[Etiology of adult insomnia].  

PubMed

In the article, the author develops an analysis of external and intrapsychic factors related to adults' insomnia. First she undertakes a literature review to describe semiological, evolutive and etiological levels of insomnia. From a semiological point of view, it is usual to differenciate initial insomnia (associated to the first phase of sleeping), intermittent insomnia (related to frequent awakenings) and final insomnia (related to early morning awakenings). From an evolutive point of view, we can identify transitory insomnia (characterized by frequent awakenings) and chronic insomnia. On the other hand, we are allowed to distinguish organic insomnia (disorder where an organic cerebral injury is demonstrated or suspected) from insomnias related to psychiatric or somatic disease or idiopathic one. Then, the author makes a literary review to identify various insomnia causes and points out. Social factors: insomnia rates are higher by divorced, separated or widowed people. Percentages are higher when scholastic level is weak, domestic income is less then 915 O a month, or by unemployed people. Besides, sleep quality is deteriorated by ageing. Sleeping and waking rhythm is able to loose its synchronization. Complaints about insomnia occur far frequently from women than men. Environmental factors: working constraints increase sleep disorders. It is possible to make the same conclusion when we have to face overcharge of external events, deep intrapsychic conflicts (related to grief, unemployment, damage or hospitalization) or interpersonal conflicts' situations where we are confronted to stress related to socio-affective environment, lack of social support or conjugal difficulties. Medical and physiologic causes: legs impatience syndrome, recurrent limbs shakings syndrome, breathe stop during sleep, narcolepsy, excessive medicine or hypnotic drugs use, some central nervous system injuries, every nocturnal awakening (related to aches.), surgical operation. Chronobiological factors: night working or day-night shift produce insomnia by desynchronization. It is the same for time lag related to jet-lag flights. Significant gaps between the internal biological clock and environmental synchronizators, such as phase delay sleep, phase advance sleep, sleep-waking cycle longer than 24 (25) hours, or variations in sleep-awakening cycle, are of less importance. Toxic factors are numerous: amphetamines, antidepressors, medication against anorexia and tubercular disease, caffeine and alcohol excessive use, chronic alcoholism. Behavioral factors: enduring insomnias are related to poor nightroutines (to go to sleep too early, to read or to look at T.V. when going to bed). The same effect is produced by regular intellectual activities close to bedtime or by a late meal in the evening, by an noisy or unhealthy environment, by physical hyperactivity or sleeping after each lunch. Psychiatric factors: insomnia often appears with psychiatric disorders such as a major depressive episode, an anxiety disorder or schizophrenia. Insomnia also is able to open a delirious disorganization or a manic access. Psychological factors: overstimulation of waking system (related to stress overdose or intellectual hyperactivity), conditioning phenomena, fear of not falling asleep, intrapsychic and interpersonal conflicts. Third, the author put hypothesis about psychodynamic etiology of chronic insomnia. Following a first assumption, insomnia should be a result of anguish excess related to intrapsychic (and not interpersonal) conflicts which can't lead to a mental elaboration. These conflicts run over dream protective function, generating a breakdown of dream symbolization function. At a clinical level, we are in some cases in front of people enduring sleeping insomnia but more often, we are confronted with an intermittent or early waking insomnia sometimes associated with nightmares. Following a second assumption, insomnia should be a result of psychic functioning invalidation. Here, failure of dream protective and symbolization function is related to anguish ex

Dollander, M

2002-01-01

117

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.

118

[GASTRODUODENAL ULCER IN PEDIATRICS  

PubMed

476 endoscopic reports of 435 children under 15 years old of both sexes were reviewed to determine the morbility of gastroduodenal peptic ulcer. Endoscopy was performed because they had symptoms referred to the upper gastrointestinal tract between December 1989 and December 1994. Gastroduodenal ulcer was diagnosed in forty five children (10,3%). Primary ulcer was diagnosed in twenty four patients (55%) and secondary ulcers in twenty one (45%), being the administration of ulcerogenic drugs the main factor involved. Primary ulcer was more frequently diagnosed in older children and teenagers and localized mainly in the duodenum. Male sex was predominant in both types of ulcers. 42% of children with primary ulcers had familiar ocurrence of ulcer disease. Thirty three patients (73%) had complications, being gastrointestinal bleeding the most frequent. Ulcer disease is not rare in children and must be suspected in patients with recurrent abdominal pain. PMID:12219102

Trujillo T, María; García, Rosario; Sagaró G, Eduardo; Fragoso A, Trini; Lazo D, Odalys; Borbolla, Elvira; Rodríguez G, Nancy

1997-01-01

119

[Etiopathogenesis and therapy of ulcers of the lower limbs].  

PubMed

The authors assess the pathogenic causes of leg-ulcers which all have as a common denominator chronic venous incompetence. It is vital to have a correct identification of prevention of frequent relapse as well as cure. The authors suggest their strategy of topic treatment which, despite its simplicity and economy, has never proved unsuccessful. PMID:4023087

Berta, V; Russo, R; Pellegrino, R

1985-01-01

120

Skin zinc concentrations in patients with varicose ulcers  

SciTech Connect

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.

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

1990-06-01

121

Peripheral Ulcerative Keratitis  

MedlinePLUS

... developing peripheral ulcerative keratitis unless they are treated. Rheumatoid arthritis is what causes peripheral ulcerative keratitis and death due to a heart attack. Treatment with drugs that suppress the immune system, such ...

122

Preventing pressure ulcers  

MedlinePLUS

Pressure ulcers are also called bedsores and pressure sores. They can form when muscles and soft tissue press ... this area to die. When this happens, a pressure ulcer may form. You have a risk of developing ...

123

NSAIDs and Peptic Ulcers  

MedlinePLUS

... a printable PDF: Peptic Ulcer Disease and H. pylori (PDF, 465 KB) Spanish Version? (PDF, 276 KB)? ... term or are infected with the bacteria H. pylori are most likely to develop peptic ulcers. Symptoms & ...

124

Stomach and Intestinal Ulcers  

Microsoft Academic Search

Intestinal ulcers can be a painful and dangerous situation. Ulcers are associated not only with pain and discomfort, but may also be a source of significant blood loss. Ulcers are treatable but may require several medications and sometimes multiple rounds of these medications. It is important to know that there are several nutrimental factors that may help improve the success

Steve Windley

125

Leg 192 Preliminary Report72 Leg 192 Preliminary Report  

E-print Network

Leg 192 Preliminary Report72 Figure 21 cm 70 75 80 65 60 #12;Leg 192 Preliminary Report Figure 22 73 Basalt C D E F A B #12;Leg 192 Preliminary Report74 Figure 23 #12;Leg192PreliminaryReport Figure207002120021300 21100 21000 20900 20800 Shotpoints #12;Leg192PreliminaryReport76 Figure 25 Nannofossils

126

Oral ulcers produced by mycophenolate mofetil in two liver transplant patients.  

PubMed

Oral ulcers are a frequent problem in transplant medicine. It is important to consider infectious etiologies, exacerbated by the immunosuppressive treatment, but other etiologies are also possible, like adverse drug reactions. Mycophenolate mofetil (MMF) is an immunosuppressive medication that has been used in combination with calcineurin inhibitors and steroids. Reports of renal transplant patients with oral ulcers related to MMF have appeared lately and herein we have described 2 cases in liver transplant patients. Their oral ulcers resolved quickly after suspension of the medication. Our 2 cases in liver transplant patients represented a unique setting for this type of complication. PMID:17445557

Naranjo, J; Poniachik, J; Cisco, D; Contreras, J; Oksenberg, D; Valera, J M; Díaz, J C; Rojas, J; Cardemil, G; Mena, S; Castillo, J; Rencoret, G; Godoy, J; Escobar, J; Rodríguez, J; Leyton, P; Fica, A; Toledo, C

2007-04-01

127

Etiology of sarcoidosis.  

PubMed

Research over the past decade has advanced our understanding of the pathogenesis of sarcoidosis and provided new insights into potential causes of this disease. It is important to remember that any etiologic agent of sarcoidosis must be capable of causing the pathologic hallmark of systemic noncaseating granulomas and the heterogeneous clinical features of sarcoidosis. In addition, etiologic agents must be compatible with immunologic features, including polarized T-helper 1 cytokine profiles and oligoclonal T cell expansions consistent with antigen driven processes. Yet, even with studies conducted in this disease, there remains a lack of consensus on the etiology of sarcoidosis. This challenge is likely to be overcome only with additional research that incorporates clinical, genetic, immunologic, environmental, and microbiologic profiles in groups of patients, supplemented with testing of candidate pathogenic agents in experimental models that recapitulate critical features of this disease. PMID:18539232

Chen, Edward S; Moller, David R

2008-09-01

128

Retrograde mechanochemical ablation of the small saphenous vein for the treatment of a venous ulcer.  

PubMed

We present the first case of retrograde ablation of the small saphenous vein to treat active venous ulceration. A 73-year-old gentleman with complicated varicose veins of the left leg and a non-healing venous ulcer despite previous successful endovenous treatment to his left great saphenous vein underwent mechanochemical ablation of his small saphenous vein with the ClariVein® system, under local anaesthetic, using a retrograde cannulation technique. Post-operatively the patient had improved symptomatically and the ulcer size had reduced. This report highlights that patients with small saphenous vein incompetence and active ulceration can be treated successfully with retrograde mechanochemical ablation. PMID:24347131

Moore, Hayley M; Lane, Tristan Ra; Franklin, Ian J; Davies, Alun H

2014-10-01

129

Ulcerative Colitis in Kuwait: A Review of 90 Cases  

Microsoft Academic Search

Background: Chronic ulcerative colitis is a disease of unknown etiology. Its incidence is on the rise in various developing countries as has been reported in studies from South-East Asia and the Middle East. There seems to be significant differences in the pattern and the clinical course of this disease in our patient population. The aim of our study is to

Mohammed A. Al-Shamali; Maher Kalaoui; Istivan Patty; Fuad Hasan; Abdulkareem Khajah; Basil Al-Nakib

2003-01-01

130

Diabetic foot ulcers: Part I. Pathophysiology and prevention.  

PubMed

Diabetes mellitus is a serious, life-long condition that is the sixth leading cause of death in North America. Dermatologists frequently encounter patients with diabetes mellitus. Up to 25% of patients with diabetes mellitus will develop diabetic foot ulcers. Foot ulcer patients have an increased risk of amputation and increased mortality rate. The high-risk diabetic foot can be identified with a simplified screening, and subsequent foot ulcers can be prevented. Early recognition of the high-risk foot and timely treatment will save legs and improve patients' quality of life. Peripheral arterial disease, neuropathy, deformity, previous amputation, and infection are the main factors contributing to the development of diabetic foot ulcers. Early recognition of the high-risk foot is imperative to decrease the rates of mortality and morbidity. An interprofessional approach (ie, physicians, nurses, and foot care specialists) is often needed to support patients' needs. PMID:24355275

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

2014-01-01

131

The etiology of thrombocytopenia.  

PubMed

Hemostasis depends on an adequate number of well-functioning platelets in the circulating blood; decreasing platelet levels raise the risk for bleeding. Thrombocytopenia is a laboratory finding, not a diagnosis, and once identified, a detailed history, physical examination, and further laboratory tests are used to establish an etiology. This article reviews the assessment, diagnosis, and treatment of thrombocytopenia. PMID:22076454

Horrell, C J; Rothman, J

2001-01-01

132

The Etiology of Giftedness  

ERIC Educational Resources Information Center

Many theories of giftedness either explicitly or implicitly acknowledge the role of genetic influences; yet, empirical work has not been able to establish the impact that genes have specifically on gifted behavior. In contrast, a great deal of research has been targeted at understanding the etiology of individual differences in general and…

Thompson, Lee Anne; Oehlert, Jeremy

2010-01-01

133

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.

134

An integrated approach in the treatment of varicose ulcer  

PubMed Central

Venous ulcers (stasis ulcers, varicose ulcers) are the wounds occurring due to inappropriate functioning of venous valves, usually of the legs. It is one of the most serious chronic venous insufficiency complications. The overall incidence rate is 0.76% in men and 1.42% in women. When a venous valve gets damaged, it prevents the backflow of blood, which causes pressure in the veins that leads to hypertension and, in turn, venous ulcers. These are mostly along the medial distal leg, which is often very painful, can bleed, and get infected. Treating varicose ulcers is a difficult task to the physician and a nightmare to the suffering patients, though a good number of the treatment principles are mentioned and practiced in allied sciences. In Ayurveda, this condition is considered as du??a vra?a. It can be managed with the specific s’odhana therapy. So, the same treatment protocol was used to treat the case discussed here, i.e. with Nitya virecana and by Basti karma. The wound was successfully treated and, therefore, is discussed in detail. PMID:24501445

Patil, Deepa; Jahagirdhar, Sangeeta H.; Toshikhane, Hemant D.

2013-01-01

135

An integrated approach in the treatment of varicose ulcer.  

PubMed

Venous ulcers (stasis ulcers, varicose ulcers) are the wounds occurring due to inappropriate functioning of venous valves, usually of the legs. It is one of the most serious chronic venous insufficiency complications. The overall incidence rate is 0.76% in men and 1.42% in women. When a venous valve gets damaged, it prevents the backflow of blood, which causes pressure in the veins that leads to hypertension and, in turn, venous ulcers. These are mostly along the medial distal leg, which is often very painful, can bleed, and get infected. Treating varicose ulcers is a difficult task to the physician and a nightmare to the suffering patients, though a good number of the treatment principles are mentioned and practiced in allied sciences. In Ayurveda, this condition is considered as du??a vra?a. It can be managed with the specific s'odhana therapy. So, the same treatment protocol was used to treat the case discussed here, i.e. with Nitya virecana and by Basti karma. The wound was successfully treated and, therefore, is discussed in detail. PMID:24501445

Patil, Deepa; Jahagirdhar, Sangeeta H; Toshikhane, Hemant D

2013-01-01

136

Acute duodenal ulcer.  

PubMed Central

A series of 31 infants and children with acute duodenal ulcer verified by endoscopy was studied over an eight year period. Eighteen (58%) of them were under 2 years of age. The most common symptom was upper gastrointestinal bleeding (n = 27, 87%). Twenty nine patients (94%) had a preceding illness characterised by diarrhoea, upper respiratory tract infection, or fever, which was not necessarily treated with antipyretic drugs. Initial endoscopy showed that ulcer lesions were solitary in 14 patients and present on the anterior wall (n = 11), posterior wall (n = 2), or both (n = 1). Multiple ulcers were found in 17 patients, and present in the bulb with (n = 6) or without (n = 11) extension into the second part of duodenum. The most conspicuous finding was the irregularly shaped ulcers seen in eight young children with similar clinical and endoscopic features. Sixteen patients were re-endoscoped one to two weeks after the initial examination; the ulcers had entirely disappeared in 13, and there were only small residual ulcers in three. Thirty patients were treated medically and only one (with uncontrollable haemorrhage) required operation. Most patients were symptom free two to six years after the initial diagnosis. Our results suggest that young children may develop acute duodenal ulcers after viral illnesses whether or not they are treated with drugs, mainly antipyretics. This kind of acute duodenal ulcer usually heals quickly irrespective of the morphology, site, and number of ulcers. Images Figure PMID:2774612

Hsu, H Y; Chang, M H; Wang, T H; Hsu, J Y; Wang, C Y; Lin, M I; Wu, M H

1989-01-01

137

On the etiology of Crohn disease.  

PubMed Central

Crohn disease (CD) is a chronic, panenteric intestinal inflammatory disease. Its etiology is unknown. Analogous to the tuberculoid and lepromatous forms of leprosy, CD may have two clinical manifestations. One is aggressive and fistulizing (perforating), and the other is contained, indolent, and obstructive (nonperforating) [Gi]-berts, E. C. A. M., Greenstein, A. J., Katsel, P., Harpaz, N. & Greenstein, R. J. (1994) Proc. Natl. Acad. Sci. USA 91, 12721-127241. The etiology, if infections, may be due to Mycobacterium paratuberculosis. We employed reverse transcription PCR using M. paratuberculosis subspecies-specific primers (IS 900) on total RNA from 12 ileal mucosal specimens (CD, n = 8; controls, n = 4, 2 with ulcerative colitis and 2 with colonic cancer). As a negative control, we used Myobacterium avium DNA, originally cultured from the drinking water of a major city in the United States. cDNA sequence analysis shows that all eight cases of Crohn's disease and both samples from the patients with ulcerative colitis contained M. paratuberculosis RNA. Additionally, the M. avium control has the DNA sequence of M. paratuberculosis. We demonstrate the DNA sequence of M. paratuberculosis from mucosal specimens from humans with CD. The potable water supply may be a reservoir of infection. Although M. paratuberculosis signal in CD has been previously reported, a cause and effect relationship has not been established. In part, this is due to conflicting data from studies with empirical antimycobacterial therapy. We conclude that clinical trials with anti-M. paratuberculosis therapy are indicated in patients with CD who have been stratified into the aggressive (perforating) and contained (nonperforating) forms. Images Fig. 1 Fig. 3 PMID:8790414

Mishina, D; Katsel, P; Brown, S T; Gilberts, E C; Greenstein, R J

1996-01-01

138

Temporal Comorbidity of Mental Disorder and Ulcerative Colitis  

PubMed Central

Objectives: Ulcerative colitis is an inflammatory bowel disease that rarely exists in isolation in affected patients. We examined the association of ulcerative colitis and International Classification of Diseases mental disorder, as well as the temporal comorbidity of three broad International Classification of Diseases groupings of mental disorders in patients with ulcerative colitis to determine if mental disorder is more likely to occur before or after ulcerative colitis. Methods: We used physician diagnoses from the regional health zone of Calgary, Alberta, for patient visits from fiscal years 1994 to 2009 for treatment of any presenting concern in that Calgary health zone (763,449 patients) to identify 5113 patients age younger than 1 year to age 92 years (2120 males, average age = 47 years; 2993 females, average age = 48 years) with a diagnosis of ulcerative colitis. Results: The 16-year cumulative prevalence of ulcerative colitis was 0.0058%, or 58 cases per 10,000 persons (95% confidence interval = 56–60 per 10,000). Although the cumulative prevalence of mental disorder in the overall sample was 5390 per 10,000 (53.9%), we found that 4192 patients with ulcerative colitis (82%) also had a diagnosis of a mental disorder. By annual rate of ulcerative colitis, patients with mental disorder had a significantly higher annual prevalence. The mental disorder grouping neuroses/depressive disorders was most likely to arise before ulcerative colitis (odds ratio = 1.87 for males; 2.24 for females). Conclusions: A temporal association was observed between specific groups of International Classification of Diseases mental disorder and ulcerative colitis, indicating a possible etiologic relationship between the disorders or their treatments, or both. PMID:25663206

Cawthorpe, David; Davidson, Marta

2015-01-01

139

Ulcerative Lupus Vulgaris Over Nose, Leading to Cosmetic Deformity  

PubMed Central

Lupus vulgaris (LV), is a chronic and progressive form of secondary cutaneous tuberculosis. In India, it is commonly seen over buttocks, thighs, and legs whereas involvement of nose is quite rare. Ulcerative variant particularly over nose causes destruction of cartilage, leading to irreversible deformities and contracture. High-index of suspicion is required for early diagnosis and prevention of cosmetic deformity. A case of LV over nose in a young male with ulceration is reported who responded well to anti-tubercular therapy, but left with scarring of nose, which could have been prevented if adequate awareness regarding extra-pulmonary cases would have been practiced. PMID:25657427

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

2015-01-01

140

Restless Legs Syndrome  

MedlinePLUS

... reduce twitching and restless sensations. Cut back on alcohol, caffeine and tobacco. Try taking a hot bath and massaging your legs before bedtime to help you relax. Relaxation techniques, such as meditation and yoga, can help you ...

141

Legs of Mesolimulus  

NSDL National Science Digital Library

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).

2001-03-01

142

Restless Legs Syndrome  

MedlinePLUS

Table of Contents (click to jump to sections) What is restless legs syndrome? What are common signs ... also experience a more common condition known as periodic limb movement of sleep (PLMS). PLMS is characterized ...

143

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....

2009-07-23

144

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

PubMed Central

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

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

2014-01-01

145

[Ulcers of lower limb veins: venous ulcers].  

PubMed

The lower extremity vascular ulcers currently represent a major public health problem, particularly because of different situations: the chronic nature of the injury, a poor response to treatment, recurrence rates, high absenteeism, poor training in some cases of the health staff that treats, etc. Lower extremity ulcers mean a serious personal, family, health and social problem, with a significant expenditure of human and material resources. Since the prevalence and incidence of lower extremity vascular ulcers is high worldwide, it is necessary to go into detail about the knowledge of the epidemiology and to favour, in different countries, the creation of interdisciplinary research groups that addresses issues related to risk factors, pathogenesis, treatment, health care costs, quality of life and, above all, specialized training aimed at health professionals. PMID:24984301

López Herranz, Marta; Bas Caro, Pedro; Moraleja Millán, Tania; Mateos García, Marina; García Jábega, Rosa Ma; López Corral, Juan Carlos

2014-05-01

146

Pressure Ulcer Prevention  

PubMed Central

Executive Summary In April 2008, the Medical Advisory Secretariat began an evidence-based review of the literature concerning pressure ulcers. Please visit the Medical Advisory Secretariat Web site, 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

2009-01-01

147

Severe cutaneous ulceration following treatment with thalidomide for GVHD.  

PubMed

We report two cases of severe leg ulcerations in patients being treated with thalidomide for graft-versus-host disease following bone marrow transplantation. Local wound care and debridement were attempted, but one patient required skin grafting to ensure healing. We propose that this complication may be due to the antiangiogenic properties of thalidomide and urge careful attention to skin breakdown in patients being treated with this compound. PMID:11281398

Schlossberg, H; Klumpp, T; Sabol, P; Herman, J; Mangan, K

2001-01-01

148

Ulcerative disease outbreak in crayfish Orconectes propinquus linked to Saprolegnia australis in big Muskellunge Lake, Wisconsin.  

PubMed

Crayfish populations in the area of the North Temperate Lakes Long Term Ecological Research (LTER) project, Wisconsin, USA, have been monitored for >25 yr. In 2005, native crayfish Orconectes propinquus from Big Muskellunge Lake were found with ulcerated lesions in the cuticle. In 2006, lesions occurred in 9.5% of sampled crayfish from the lake (n=3146). Ulcers generally occurred on the appendages of affected individuals but varied in location and severity. The prevalence of ulcers varied widely among sites, sample depths, and sampling dates, ranging from < 2% to >20%. The prevalence of ulcers in crayfish increased from a minimum in early June to a maximum in late July and August. In aquarium trials, healthy crayfish representing either O. propinquus or O. rusticus co-housed with ulcerated crayfish did not develop ulcers within 4 wk of exposure. Gross and histopathologic analyses of ulcerated crayfish revealed the presence of filamentous hyphae in the lesions while hemocytic infiltrates, melanotic reactions and silver-stained sections indicated that the ulcers had an oomycete etiology. Excised samples of ulcerated crayfish cuticle grown in culture developed an oomycete that was identified as Saprolegnia australis by PCR amplification and sequence analysis of 2 different DNA fragments. This is the first report of the occurrence of ulcers in wild crayfish associated with S. australis infection in the U.S.A. The advent of the outbreak and its underlying ecological causes are still under investigation. PMID:20853742

Krugner-Higby, Lisa; Haak, Danielle; Johnson, Pieter T J; Shields, Jeffery D; Jones, William M; Reece, Kimberly S; Meinke, Tim; Gendron, Annette; Rusak, James A

2010-07-26

149

Pyoderma Gangrenosum: A Commonly Overlooked Ulcerative Condition  

PubMed Central

Background: Pyoderma ga ngrenosum (PG) is a rare, inflammatory, destructive neutrophilic dermatosis, which mimics other ulcerative conditions. Materials and Methods: In a retrospective study based on patients diagnosed with PG over a 3-year period (2010–2013), we evaluated demographics, anatomical sites, number of lesions, subtypes, histopathology, associated conditions, treatment regimens, healing time, and recurrence. Results: Of our five patients, there were three males and two females, age ranging between 19 and 58 years (mean age 38 years). Four had single lesions localized to the lower limbs while one had multiple lesions (more than five) over bilateral hands and legs. Ulcerative subtype was observed in all the patients. One exhibited pathergy. Skin biopsies were done in four patients, revealing dense neutrophilic infiltrates in three cases and leukocytoclastic vasculitis in one. Associated systemic diseases were observed in all patients, four having inflammatory bowel disease and one having both systemic lupus erythematosus and anti-phospholipid syndrome. The patients were all treated with systemic corticosteroids either alone or in combination with immunosuppressants (e.g., azathioprine, mycophenolate mofetil, tacrolimus), and wound dressing. Split-thickness skin graft was done in one patient. Complete healing was achieved in all patients, ranging from one to 3 months after diagnosis. No recurrence was reported. Conclusions: Systemic corticosteroids, either alone or in combination with steroid-sparing agents are the mainstay of treatment. Should family physicians encounter a rapidly progressing ulcer that has poor response to usual wound management, timely referral to dermatology should be made. PMID:25657946

Tay, Daniel Zunsheng; Tan, Ki-Wei; Tay, Yong-Kwang

2014-01-01

150

Ulcer healing time and antibiotic treatment before and after the introduction of the Registry of Ulcer Treatment: an improvement project in a national quality registry in Sweden  

PubMed Central

Objectives To investigate changes in ulcer healing time and antibiotic treatment in Sweden following the introduction of the Registry of Ulcer Treatment (RUT), a national quality registry, in 2009. Design A statistical analysis of RUT data concerning the healing time and antibiotic treatment for patients with hard-to-heal ulcers in Sweden between 2009 and 2012. Setting RUT is a national web-based quality registry used to capture areas of improvement in ulcer care and to structure wound management by registering patients with hard-to-heal leg, foot and pressure ulcers. Registration includes variables such as gender, age, diagnosis, healing time, antibiotic treatment, and ulcer duration and size. Population Every patient with a hard-to-heal ulcer registered with RUT between 2009 and 2012 (n=1417) was included. Main outcome measures Statistical analyses were performed using Stata V.12.1. Healing time was assessed with the Kaplan-Meier analysis and adjustment was made for ulcer size. A log-rank test was used for equality of survivor functions. Results According to the adjusted registry in December 2012, patients’ median age was 80?years (mean 77.5?years, range 11–103?years). The median healing time for all ulcers, adjusted for ulcer size, was 146?days (21?weeks) in 2009 and 63?days (9?weeks) in 2012 (p=0.001). Considering all years between 2009 and 2012, antibiotic treatment for patients with hard-to-heal ulcers was reduced from 71% before registration to 29% after registration of ulcer healing (p=0.001). Conclusions Healing time and antibiotic treatment decreased significantly during 3?years after launch of RUT. PMID:23959752

Öien, Rut F; Forssell, Henrik W

2013-01-01

151

Canker Sore (Aphthous Ulcer)  

MedlinePLUS

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

152

Chancroid or Chancroidal Ulcers  

Microsoft Academic Search

1532 cases with genital ulcers were investigated, of whom 610 presented with features suggestive of chancroid; classic, multiple lesions of chancroid were observed in 312, while its other variants, i.e. dwarf, giant and phagedaenic chancroid were also seen. In addition, 162 cases had a conspicuous morphology characterised by a single ulcer which was well-defined, soft, tender, non-indurated and had weakening

V. N. Sehgal; Shyam Prasad

1985-01-01

153

Capsaicin and Gastric Ulcers  

Microsoft Academic Search

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

M. N. Satyanarayana

2006-01-01

154

Ulcerative Colitis: A Challenge to Surgeons  

PubMed Central

Ulcerative colitis is a chronic disease that specifically affects the mucosa of the rectum and colon. Although the etiology of this recurring inflammatory disorder remains essentially unknown, there have been significant advances in identifying the likely genetic and environmental factors that contribute to its pathogenesis. The clinical course of the disease typically manifests with remissions and exacerbations characterized by rectal bleeding and diarrhea. Since ulcerative colitis most commonly affects patients in their youth or early middle age, the disease can have serious long-term local and systemic consequences. There is no specific medical therapy that is curative. Although medical therapy can ameliorate the inflammatory process and control most symptomatic flares, it provides no definitive treatment for the disease. Proctocolectomy or total removal of the colon and rectum provides the only complete cure; however, innovative surgical alternatives have eliminated the need for a permanent ileostomy. The aim of this review is to provide a detailed account of the surgical management of ulcerative colitis. PMID:23189226

Parray, Fazl Q; Wani, Mohd L; Malik, Ajaz A; Wani, Shadab N; Bijli, Akram H; Irshad, Ifat; Nayeem-Ul-Hassan

2012-01-01

155

The etiology of osteosarcoma.  

PubMed

Studies to determine the etiology of osteosarcoma involve epidemiologic and environmental factors and genetic impairments. Factors related to patient characteristics include age, gender, ethnicity, growth and height, genetic and familial factors, and preexisting bone abnormalities. Rapidly proliferating cells may be particularly susceptible to oncogenic agents and mitotic errors which lead to neoplastic transformation. Genetic aberrations that accompany osteosarcoma have received increasing recognition as an important factor in its etiology. Osteosarcoma tumor cells exhibit karyotypes with a high degree of complexity which has made it difficult to determine whether any recurrent chromosomal aberrations characterize osteosarcoma. Although extremely rare, osteosarcoma has occasionally been observed in several members of the same family. No other clinical abnormalities in the proband or the affected members were reported. Pathologic examination of the tumors revealed no unusual features. Genetic testing was not available in most of these reports. The patients generally responded to conventional therapy. A genetic predisposition to osteosarcoma is found in patients with hereditary retinoblastoma, characterized by mutation of the retinoblastoma gene RB1 on chromosome 13q14. The Rothmund-Thomson syndrome is an autosomal recessive disorder with a heterogeneous clinical profile. Patients may have a few or multiple clinical features including skin rash, small stature, skeletal dysplasias, sparse or absent scalp hair, eyebrows or eyelashes, juvenile cataracts, and gastrointestinal disturbance including chronic emesis and diarrhea; its molecular basis is the mutation in the RECQL4 gene in a subset of cases. The Li-Fraumeni syndrome is an autosomal dominant disorder characterized by a high risk of developing osteosarcoma and has been found in up to 3% of children with osteosarcoma. It is associated with a germline mutation of the p53, a suppressor gene. The following three criteria must be met for a diagnosis of Li-Fraumeni syndrome: (1) A proband diagnosed with sarcoma when younger than 45 years; (2) A first-degree relative with any cancer diagnosed when younger than 45 years; (3) Another first- or second-degree relative of the same genetic lineage with any cancer diagnosed when younger than 45 years or sarcoma diagnosed at any age. A second recessive p53 oncogene on chromosome 17p13.1 may also play a role in the development and progression of osteosarcoma. Osteosarcoma has also been associated with solitary or multiple osteochondroma, solitary enchondroma or enchondromatosis (Ollier's disease), multiple hereditary exostoses, fibrous dysplasia, chronic osteomyelitis, sites of bone infarcts, sites of metallic prostheses and sites of prior internal fixation. Ionizing radiation is a well-documented etiologic factor. Osteosarcoma has also been associated with the use of intravenous radium and Thorotrast. Exposure to alkylating agents may also contribute to its development ,and it is apparently independent of the administration of radiotherapy. PMID:20213384

Ottaviani, Giulia; Jaffe, Norman

2009-01-01

156

Mycotic corneal ulcers in upper Assam  

PubMed Central

Purpose: To study the association of various risk factors and epidemiological variables of mycotic keratitis treated at a tertiary referral hospital of upper Assam. Materials and Methods: In this hospital-based prospective study a total of 310 consecutive corneal ulcer cases attending the ophthalmology outpatient department of Assam Medical College were enrolled between April 2007 and March 2009. After clinical and slit-lamp biomicroscopic examination in all suspected cases, smears and culture examination for fungus was done to establish the etiology. Demographic information and associated probable risk factors of individual cases were noted in a predesigned questionnaire. Results: In 188 (60.6%) cases fungal etiology could be established. Out of them 67.6% were males. The most commonly affected age group was 41-50 years (25.5%). The maximum (23.4%) cases were reported during the paddy harvesting season in Assam (January and February). Fungal element could be demonstrated in 65.2% cases in direct potassium hydroxide (KOH) mount. The commonest predisposing factor was corneal injury (74.5%). While diabetes was a significant systemic predisposing factor in mixed bacterial and fungal infections in 11.1% cases, blocked naso-lacrimal duct was the local predisposing factor in 11.1% of cases. Fusarium solani (25%) was the commonest isolate followed by Aspergillus species (19%), Curvularia species (18.5%) and Penicillium species (15.2%). Yeasts were isolated in 2.7% (n=5) cases. Conclusions: Ocular trauma was the commonest cause of fungal corneal ulcer in Assam and Fusarium solani was the commonest species responsible for it. Most of the mycotic ulcer cases come from rural areas including the tea gardens. PMID:21836342

Nath, Reema; Baruah, Syamanta; Saikia, Lahari; Devi, Bhanu; Borthakur, A K; Mahanta, J

2011-01-01

157

Metastable legged-robot locomotion  

E-print Network

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 ...

Byl, Katie

2008-01-01

158

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

PubMed

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

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

2008-01-01

159

[Genital artefact ulcers appearing simultaneously in a couple].  

PubMed

Genital ulcers may be due to a number of causes, with the most frequent ones being of infectious, tumorous and physical etiology. The coexistence of genital lesions in a couple makes it necessary to rule out sexual transmission as a first option, as it is not always the cause. We present the case of a 78 and 73-year-old couple, both of whom presented with genital ulcers which had been developing for months and which began to manifest simultaneously. The negative results in the tests performed, the exclusion of other likely causes and the favorable evolution of the lesions suggest self-inflicted ulcers as a probable diagnosis, an infrequent form of presentation of "folie à deux". Despite its infrequent occurrence, dermatitis artefacta is a cause that should always be included in the differential diagnosis of any skin lesion, as it often goes unnoticed because of its many clinical presentations. PMID:16595114

Hernández-Gil, Jesús; Guiote, María Victoria; Vilanova, Anna; Mendoza, Francisco; Linares, Juan; Naranjo, Ramón

2006-03-01

160

Quality of ulcer healing in gastrointestinal tract: its pathophysiology and clinical relevance.  

PubMed

In this paper, we review the concept of quality of ulcer healing (QOUH) in the gastrointestinal tract and its role in the ulcer recurrence. In the past, peptic ulcer disease (PUD) has been a chronic disease with a cycle of repeated healing/remission and recurrence. The main etiological factor of PUD is Helicobacter pylori (H. pylori), which is also the cause of ulcer recurrence. However, H. pylori-negative ulcers are present in 12%-20% of patients; they also recur and are on occasion intractable. QOUH focuses on the fact that mucosal and submucosal structures within ulcer scars are incompletely regenerated. Within the scars of healed ulcers, regenerated tissue is immature and with distorted architecture, suggesting poor QOUH. The abnormalities in mucosal regeneration can be the basis for ulcer recurrence. Our studies have shown that persistence of macrophages in the regenerated area plays a key role in ulcer recurrence. Our studies in a rat model of ulcer recurrence have indicated that proinflammatory cytokines trigger activation of macrophages, which in turn produce increased amounts of cytokines and chemokines, which attract neutrophils to the regenerated area. Neutrophils release proteolytic enzymes that destroy the tissue, resulting in ulcer recurrence. Another important factor in poor QOUH can be deficiency of endogenous prostaglandins and a deficiency and/or an imbalance of endogenous growth factors. Topically active mucosal protective and antiulcer drugs promote high QOUH and reduce inflammatory cell infiltration in the ulcer scar. In addition to PUD, the concept of QOUH is likely applicable to inflammatory bowel diseases including Crohn's disease and ulcerative colitis. PMID:23002355

Arakawa, Tetsuo; Watanabe, Toshio; Tanigawa, Tetsuya; Tominaga, Kazunari; Fujiwara, Yasuhiro; Morimoto, Ken'ichi

2012-09-21

161

Foot ulcers in the diabetic patient, prevention and treatment  

PubMed Central

Lower extremity complications in persons with diabetes have become an increasingly significant public health concern in both the developed and developing world. These complications, beginning with neuropathy and subsequent diabetic foot wounds frequently lead to infection and lower extremity amputation even in the absence of critical limb ischemia. In order to diminish the detrimental consequences associated with diabetic foot ulcers, a com-mon-sense-based treatment approach must be implemented. Many of the etiological factors contributing to the formation of diabetic foot ulceration may be identified using simple, inexpensive equipment in a clinical setting. Prevention of diabetic foot ulcers can be accomplished in a primary care setting with a brief history and screening for loss of protective sensation via the Semmes-Weinstein monofilament. Specialist clinics may quantify neuropathy, plantar foot pressure, and assess vascular status with Doppler ultrasound and ankle-brachial blood pressure indices. These measurements, in conjunction with other findings from the history and physical examination, may enable clinicians to stratify patients based on risk and help determine the type of intervention. Other effective clinical interventions may include patient education, optimizing glycemic control, smoking cessation, and diligent foot care. Recent technological advanced combined with better understanding of the wound healing process have resulted in a myriad of advanced wound healing modalities in the treatment of diabetic foot ulcers. However, it is imperative to remember the fundamental basics in the healing of diabetic foot ulcers: adequate perfusion, debridement, infection control, and pressure mitigation. Early recognition of the etiological factors along with prompt management of diabetic foot ulcers is essential for successful outcome. PMID:17583176

Wu, Stephanie C; Driver, Vickie R; Wrobel, James S; Armstrong, David G

2007-01-01

162

Pedicled Fillet of Leg Flap for Extensive Pressure Sore Coverage  

PubMed Central

Objective: Multiple large decubitus ulcers present a reconstructive challenge to the plastic surgeon. When stage IV pressure sores become recurrent or extensive, traditional flaps either have already been exhausted or would not be sufficient to cover the defect. Methods: A retrospective review was performed on all paraplegic patients who had chronic, extensive, and stage IV decubitus ulcers, and underwent reconstruction using a pedicled continuous musculocutaneous flap of the entire leg between 1998 and 2007. The extent and size of the debrided pressure sores, number of previous flap reconstructions, intraoperative blood loss, postoperative complications, and years of follow-up were all recorded. A description of the operative technique is also given. Results: Four patients underwent a total leg fillet flap in the study period, with follow-up ranging from 2 to 7 years. Indications included extensive and bilateral trochanteric, sacral, and ischial pressure sores. Complications included intraoperative blood loss and postoperative heterotopic calcification. Conclusions: The total leg fillet flap is a very large and robust flap that offers paraplegic patients coverage of extensive stage IV pressure sores of the trochanteric, sacral, and ischial areas. PMID:19946358

Jandali, Shareef; Low, David W.

2009-01-01

163

A Case of Intranasal Hemangioma and Concurrent Tetracycline-induced Ulcerative Gastritis in Dogs  

PubMed Central

Incidence of drug-induced gastritis and ulceration in human medicine is well established. Besides, unilateral hemangioma, a unique concurrent case of tetracycline induced gastric toxicity in a dog, characterized by gastritis and ulceration is being reported here. Grossly, the appearance of gastric ulcers mimicked the appearance of Italian pizza. Histological examination further supported drug-induced etiology in this case. This is probably the one of the few cases in the annals of veterinary medicine to be documented as drug-induced gastric toxicity in dog. PMID:21042472

Banga, H. S.; Deshmukh, S.; Brar, R. S.; Gadhave, P. D.; Chavhan, S. G.; Sandhu, H. S.

2010-01-01

164

JAMA Patient Page: Diabetic Foot Ulcers  

MedlinePLUS

... of the American Medical Association JAMA PATIENT PAGE Diabetic Foot Ulcers D iabetic foot ulcers are sores ... article about preventing diabetic foot ulcers. WHAT CAUSES DIABETIC FOOT ULCERS? FOR MORE INFORMATION • National Diabetes Information ...

165

The papilla of Vater just below the pylorus presenting as recurrent duodenal ulcer bleeding.  

PubMed

The papilla of Vater emptying into the duodenal bulb site is extremely rare and considered an aberrant condition. We report here a case with recurrent duodenal ulcer bleeding associated with this anomaly. A 42-year-old man was admitted to St. Mary Hospital because of tarry stool for three days. Despite no documented etiology to explain recurrent ulceration, the patient had about ten episodes of ulcer bleeding since 1995. On duodenoscopy, 1.0 x 0.6 cm sized active stage duodenal ulcer with oozing was observed at the posterior wall side below the pylorus. The papilla of Vater was bulging just below the pylorus. Bile juice was excreted from its opening. Pancreatic duct and common bile duct, which drained into the bulb site, were observed on ERCP. In this report, we show that recurrent duodenal ulcer can be associated with the papilla of Vater just below the pylorus. PMID:18025767

Sung, Hye Young; Kim, Jin Il; Park, Yong Bum; Cheung, Dae Young; Cho, Se Hyun; Park, Soo-Heon; Han, Joon-Yeol; Kim, Jae Kwang

2007-01-01

166

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

PubMed

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

Chatterjee, Sasanka S

2012-05-01

167

Traumatic purpuric penile ulcer.  

PubMed

A 33-year-old man presented with a history of a penile ulcer of four days' duration. He was immediately treated with 2.4 million IU of benzathine penicillin IM and tested for syphilis, but subsequently proved non-reactive. He was already receiving doxycycline BID from another physician for this nonspecific genital ulcer and minocycline for acne. Past medical history revealed periodic flares of hidradenitis suppurativa, limited to the buttocks and inguinal region; acne, involving the face and back; and angiokeratoma of the scrotum. He had no known drug allergies, nor had he admitted to taking any other medicaments. Examination revealed an 8 x 15 mm irregularly shaped, shallow, tender ulcer over a larger purpuric base and involving part of the corona and the distal portion of the shaft. No inguinal adenopathy or buboes could be found on palpation. The patient was placed on a cream containing 3% iodochlorhydroxyquin 1% hydrocortisone. By the end of two weeks of therapy, the lesion had healed with no residual discoloration. Subsequently, the patient revealed that he masturbated daily, rubbing his penis back and forth on the bed sheet while lying prone on the bed. Eleven months later, he consulted us again for a new purpuric penile ulcer, because he had begun to masturbate in his usual fashion. The ulcer healed within several days, and there were no sequellae. PMID:15075044

Witkowski, Joseph A; Parish, Jennifer L; Parish, Lawrence Ch

2004-01-01

168

ORTHOPEDIC LEG BRACE  

NASA Technical Reports Server (NTRS)

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.

Myers, William Neil (Inventor)

2005-01-01

169

Restless Legs Syndrome: A Unique Case and Essentials of Diagnosis and Treatment  

PubMed Central

Restless legs syndrome (RLS) is a common, poorly understood movement disorder that can cause significant sleep disruption. RLS is characterized by uncomfortable sensations deep in the legs, relieved only by voluntary movement. Differential diagnosis includes peripheral neuropathy, leg cramps, and akathesia. Although RLS is familial in 50% of cases, secondary etiologies can be medically important, such as iron deficiency anemia and renal failure. We report a rare case of RLS associated with hyperparathyroidism. To our knowledge, only 1 other case of hyperparathyroid-related RLS has been described. PMID:19242602

Agarwal, Pinky; Griffith, Alida

2008-01-01

170

Understanding non ulcer dyspepsia.  

PubMed

Non ulcer dyspepsia is one of the most common problems encountered in primary care practice. The underlying pathophysiology of non ulcer dyspepsia is not fully understood, but it is known that this condition is associated with H. pylori infection and motility disorder. The presenting abdominal symptoms are non specific: they include bloating, belching, flatulence, excessive fullness after eating and nausea. Psychological condition such as anxiety, depression and stress do play a role in the recurrence of symptoms. Upper GI endoscopy is necessary in patients who presents with alarm symptoms suggestive of possible underlying organic condition before one makes the diagnosis of non ulcer dyspepsia. Pharmacological therapy using H2 receptor antagonist and proton pump inhibitors are effective for symptom relief. Patient's education and supportive care should be part of the management strategy in recurrent chronic dyspepsia. PMID:18942314

Loh, K Y; Siang, T K

2008-06-01

171

A randomized controlled trial of solcoseryl and duoderm in chronic sickle-cell ulcers.  

PubMed

A randomized controlled trial of Solcoseryl, DuoDerm and conventional conservative therapy with Eusol has been performed in 32 patients with homozygous sickle-cell (SS) disease. After 12 weeks' baseline observation, patients were randomized to one of three therapies and monitored for a further 12 weeks. Of 44 ulcerated legs, 20 received control treatment, 12 Solcoseryl and 12 DuoDerm. DuoDerm was generally unacceptable, and two-thirds of the patients defaulted from this treatment. Solcoseryl increased ulcer healing compared to the controls but the difference was not significant. Solcoseryl was well tolerated and may have a role in the treatment of chronic leg ulcers of sickle-cell disease. PMID:8273321

La Grenade, L; Thomas, P W; Serjeant, G R

1993-09-01

172

[Lasik after corneal ulcer].  

PubMed

Our case report presents successful treatment of corneal ulcer caused by the most common pathogen of infectious keratitis--Pseudomonas aeruginosa. Treatment was followed by LASIK as a final refractive error solution. 20 year old patient (contact lens wearer) was admitted for acute infectious corneal ulcer in her left eye. Her visual acuity was 0.5 partial with full correction. Intensive local treatment with Tobramycin, Ofloxacin and Scopolamin was started. After healing of infectious focuses, local steroids (Fluorometholonin acetas) were used to clear residual stromal haze. Refractive error was corrected after stabilisation using LASIK. Longstanding visual acuity is thanks to the early and intensive therapy 1.0 bilaterally. PMID:22132646

Procházková, S; Netuková, M; Klecka, D; Novák, P

2011-08-01

173

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

SciTech Connect

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.

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

1983-12-01

174

Chancroid or chancroidal ulcers.  

PubMed

1532 cases with genital ulcers were investigated, of whom 610 presented with features suggestive of chancroid; classic, multiple lesions of chancroid were observed in 312, while its other variants, i.e. dwarf, giant and phagedaenic chancroid were also seen. In addition, 162 cases had a conspicuous morphology characterised by a single ulcer which was well-defined, soft, tender, non-indurated and had weakening edges. These were termed chancroidal ulcers. The latter had a longer incubation period of 8-11 days. Absence of lymphadenopathy was prominent in these cases. The male/female ratio was 27/1. Persons of low socio-economic status in the sexually vulnerable age-group were predominantly affected. The prepuce, coronal sulcus and glans penis were the common sites of affliction in males, while the labia minora was frequently involved in females. Due to the limited value of gram-stained smears for the detection of H. ducreyi and lack of good culture media, chancroid and chancroidal ulcers should be differentiated clinically. PMID:3979640

Sehgal, V N; Shyam Prasad, A L

1985-01-01

175

Ulcers and gastritis.  

PubMed

Significant advances continue to be made in the area of gastritis and ulcer disease. Studies to identify the most appropriate use of capsule endoscopy have now confirmed that it is superior to other methods for identifying small-bowel mucosal pathology and sites of obscure gastrointestinal bleeding. It has increasingly been recognized that the complications of ulcer disease are secondary to the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and to interactions between NSAIDs and Helicobacter pylori. Effective prophylaxis for NSAID ulcers in H. pylori-negative individuals continues to be a challenge, as it has become clear that conclusions from studies focusing on "endoscopic ulcers" in patients whose H. pylori status was unknown provided a false sense of security. The concept of multifocal atrophic gastritis has been challenged. The precursor lesion to gastric cancer now appears to be a sheet of pseudopyloric metaplasia advancing into the gastric body with islands of intestinal metaplasia embedded within it. Multifactorial models such as those proposed for understanding periodontal disease, including the organism, environmental factors, and host factors, appear particularly applicable to understanding the pathogenesis of H. pylori-associated gastric cancer. PMID:14722854

Dore, M P; Graham, D Y

2004-01-01

176

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

PubMed

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

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

177

Spiders Have 8 Legs  

NSDL National Science Digital Library

In this three-day (or three-part) math lesson, learners represent the number eight in writing and with a variety of manipulatives related to spiders. Learners construct sets of eight by cutting eight strips of paper and counting eight pretzel sticks that represent spider legs. Learners also use eight plastic spiders to show eight with a ten frame and count on from a given number to make eight. This lesson guide includes questions for learners, assessment options, extensions, and reflection questions. Note: The snack activity involves peanut butter, but any other creamy food can be used instead.

Golden, Deeanna D.

2010-01-01

178

Review and clinical perspectives for the use of infliximab in ulcerative colitis  

Microsoft Academic Search

Infliximab is a chimeric, monoclonal anti-tumour necrosis factor- alpha antibody. It has been previously demonstrated to be an effec- tive treatment for patients with Crohn's disease who do not achieve the desired response with conventional treatments. Although the etiology of ulcerative colitis (UC) differs from that of Crohn's dis- ease, randomized controlled trials have demonstrated that inflix- imab is also

Remo Panaccione; Richard N Fedorak; Guy Aumais; Edmond-Jean Bernard; Charles N Bernstein; Alain Bitton; Ken Croitoru; Robert Enns; Denis Franchimont; Gordon R Greenberg; Anne-Marie Griffiths; John K Marshall; Sunil Patel; Robert Penner; Craig Render; Ernest Seidman; A Hillary Steinhart

179

The red hearing: swollen ear in a patient with ulcerative colitis  

PubMed Central

Relapsing polychondritis is a rare connective tissue disease of unknown etiology characterized by recurrent inflammation, degeneration and deformity of auricular cartilage. The autoimmune inflammation may also affect cartilage at other sites including nose, larynx, trachea and bronchi. Here, we present a case of relapsing polychondritis in a patient with ulcerative colitis. We also review the presentation, diagnosis and management of this condition. PMID:25147631

Karmacharya, Paras; Pathak, Ranjan; Shrestha, Pragya; Alweis, Richard

2014-01-01

180

The red hearing: swollen ear in a patient with ulcerative colitis.  

PubMed

Relapsing polychondritis is a rare connective tissue disease of unknown etiology characterized by recurrent inflammation, degeneration and deformity of auricular cartilage. The autoimmune inflammation may also affect cartilage at other sites including nose, larynx, trachea and bronchi. Here, we present a case of relapsing polychondritis in a patient with ulcerative colitis. We also review the presentation, diagnosis and management of this condition. PMID:25147631

Karmacharya, Paras; Pathak, Ranjan; Shrestha, Pragya; Alweis, Richard

2014-01-01

181

Measurement of body fat using leg to leg bioimpedance  

Microsoft Academic Search

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

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

2001-01-01

182

Management of Chronic Pressure Ulcers  

PubMed Central

Executive Summary In April 2008, the Medical Advisory Secretariat began an evidence-based review of the literature concerning pressure ulcers. Please visit the Medical Advisory Secretariat Web site, 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

2009-01-01

183

Macular lymphocytic arteritis: first clinical presentation with ulcers.  

PubMed

Macular lymphocytic arteritis describes a recently reported entity, clinically characterized by asymptomatic hyperpigmented macules on the lower limbs, without association of systemic diseases. Histopathologically it is characterized by a lymphocytic arteritis with a hyalinized fibrin ring. We report a new case presenting with ulceration, a finding not previously described. A 25-year-old Hispanic woman was evaluated for a 1-year history of a gradually progressive, asymptomatic eruption that begins at level of both knees and progressively affects both legs and feet. She also referred recently appeared ulcers on inner right ankle without previous traumatism. Physical examination revealed multiple fairly well-defined light brown and faint pink patches with petechiae on as well as retiform crusts and livedoid lesions on inner right ankle. Both types of lesions were biopsied showing lymphocytic arteritis with fibrinoid necrosis and thrombus. There were no relevant laboratory alterations. The clinical peculiarity of our case is the clinical image of the lesions mimicking a pigmented purpuric dermatosis and the presence of a non-traumatic ulcer which could be explained because chronic lymphocytic damage may cause ischemic damage. Ulceration in our case supports consideration of macular arteritis as a latent form of cutaneous polyarteritis nodosa. PMID:23384039

Llamas-Velasco, M; García-Martín, P; Sánchez-Pérez, J; Sotomayor, E; Fraga, J; García-Diez, A

2013-04-01

184

Another ‘Cushing ulcer  

PubMed Central

The authors describe the case of a 39-year-old man who presented to our hospital with easy fatigability and malaise. On physical examination, hypertension was noted without any cushingoid appearance. Laboratory testing revealed normochromic-normocytic anaemia with positive results of occult blood in the stool, hyperglycaemia and hypokalemia. Upper endoscopy revealed active gastric ulcer with Helicobacter pylori infection, likely causing gastrointestinal bleeding. Endocrine examinations showed that both serum adrenocorticotropic hormone and cortisol were elevated with loss of diurnal variation. A diagnosis of Cushing’s disease secondary to pituitary adenoma was made as results of brain MRI and blood sampling from inferior petrosal sinus. In a patient with peptic ulcer disease, physician should be alert to the possible endocrine background. PMID:22700935

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

2011-01-01

185

Venous Ulcers: New Options in Treatment: Minimally Invasive Vein Surgery  

PubMed Central

Venous disease has a spectrum of presentations. The most advanced state of chronic venous insufficiency (CVI) managed by wound care specialists being ulceration of the lower extremity. The goal of all treatments for advanced venous disease is to decrease ambulatory venous hypertension. Treatment can be divided into exogenous and endogenous methods. Exogenous methods include those applied externally such as compression, elevation, debridement and wound dressings. Endogenous methods treat the underlying venous pathology either due to venous valvular dysfunction or venous obstruction leading to venous hypertension. Recently, significant advances in endogenous methods have evolved. The development of a new concept, minimally invasive vein surgery (MIVS), has improved upon traditional, open, invasive treatments of venous disease. MIVS techniques are performed percutaneously, with minimal anesthesia, no incisions and rarely require hospital admission. This article summarizes the concept of MIVS, describes each method of MIVS and its complementary role in the management of venous leg ulcers patients. PMID:24527103

Poblete, Honesto; Elias, Steven

2009-01-01

186

[Restless legs syndrome].  

PubMed

Restless legs syndrome (RLS) is a chronic sensorimotor disorder, with a negative impact in the quality of life and sleep architecture. Despite its reported high prevalence, remains under-recognized and under-treated. The diagnosis is based on the presence of four essential criteria, three supportive clinical features, and other three associated features. The primary or idiopathic RLS is the most common presentation form, but it is very important to exclude other RLS secondary forms and other differential diagnosis. The physiopathology of the idiopathic RLS remains unclear, however changes in the dopamine pathway have been proposed, and justifies the use of dopaminergic agents as first line treatment. Iron therapy, opioids, anti-epileptics (gabapentin) and benzodiazepines are others non-dopaminergic options of treatment in selected patients. PMID:19094811

Santos, Bruno; Oliveira, Ana Sofia; Canhão, Cristina; Teixeira, Joana; Dias, Ana Rita; Pinto, Paula; Bárbara, Cristina

2008-01-01

187

A patient with foot ulcer and severe metabolic alkalosis.  

PubMed

We report a case of triple acid-base disorder with metabolic alkalosis as the primary disorder in a 65-year-old man due to ingestion and application to leg ulcers of baking soda (calcium bicarbonate). The blood pH was 7.65 with hypochloremia, hypokalemia, and prerenal azotemia. He was treated with isotonic saline with K replacement, and the patient improved without any adverse clinical consequences. We discuss the causes, mechanisms, and management of Cl-responsive (depletion) metabolic alkalosis. PMID:21185672

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

2012-01-01

188

Continuous automated pressure ulcer monitoring.  

PubMed

In the spring of 2002, the nurses working in a 300-bed Midwest care center embarked on a mission to decrease patient suffering from skin breakdown and pressure ulcers. A continuous automated pressure ulcer monitoring system was developed to improve decision making and identify educational needs. As a result, the nurses have changed the skin culture of the facility and positively affected the rate of hospital-acquired pressure ulcers and non-pressure-related breakdown. PMID:17538267

Dobbs, Nancy Ann; Spanbauer, Pam; Datz, David

2007-01-01

189

Etiology of Depression in Children  

ERIC Educational Resources Information Center

Major Depressive Disorder (MDD) is experienced by a significant proportion of youth today, occurring at an earlier age than found in previous generations. Major Depressive Disorder can produce long-lasting detrimental effects on a child's life, which raises the question of etiology. Three areas were examined for evidence identifying specific…

Watts, Shirley J.; Markham, Ramona A.

2005-01-01

190

Childhood Obesity: A Multifaceted Etiology  

Microsoft Academic Search

This paper presents a multifaceted etiology of childhood obesity regarding energy consumption, energy expenditure, behavioral factors, and psychosocial factors related to the disorder. Recommendations are presented for health educators to approach this problem from a holistic perspective involving assistance from parents and teachers and assisting children in making lifestyle changes. Also, challenges and future directions for research are given.

Kristine Stouffer; Steve M. Dorman

191

The rise of peptic ulcer, 1900-1950.  

PubMed

The seeming increase in the incidence of peptic ulcer after 1900 quickly occupied the attention of physicians. Their understanding and treatment of peptic ulcer was shaped not only by new diagnostic tools, but by differences between contesting medical specialties, broad concepts or paradigms current in the larger medical and scientific community, and prevailing social and ideological beliefs. Surgeons and internists, for example, were often at odds over appropriate therapies; each maintained that personal experiences demonstrated the efficacy of their therapies. Nor were etiological theories derived from empirical data. The claim that peptic ulcer resulted from focal infections was simply a reflection of the popularity of germ theory. Other explanations included the role of stress, race, constitutional makeup, psychosomatic factors, and the pressures of modern industrial society. Virtually all were derivative and reflected social and intellectual currents that were common in the larger society of which medicine was but a part. Thus, the history of peptic ulcer during the first half of the 20th century provides an instructive and in many ways a typical case study in the complexities posed by the emergence of modern medicine. PMID:14593223

Grob, Gerald N

2003-01-01

192

Etiologic role of infectious agents.  

PubMed

A consensus statement found in most peer-reviewed literature on sarcoidosis is that the etiology of sarcoidosis is unknown. It is timely to review whether this statement should be revised. Many infectious agents meet the basic requirements of inducing granulomatous inflammation and immunologic responses consistent with sarcoidosis including oligoclonal expansion of CD4+ T cells, polarized Th1 and possibly Th17 responses, and dysregulated regulatory T-cell function. Studies over the past decade provide increasing and complementary data to implicate a role for infectious agents in sarcoidosis etiology. These studies used different methodologies such as polymerase chain reaction and mass spectrometry to document microbial nucleic acids and proteins in sarcoidosis tissues. Multiple studies report antigen-specific immune responses to specific microbial proteins in sarcoidosis. In aggregate, these studies provide compelling evidence that mycobacteria play a major etiologic role in sarcoidosis in the United States and Europe. Studies from Japan support a role for Propionibacteria as a major etiologic agent in the country. There is controversy over how these (or other) infectious agents cause sarcoidosis. The hypothesis that chronic sarcoidosis is caused by a viable, replicating mycobacterial or other infection has no direct pathologic, microbiologic, or clinical evidence. A novel hypothesis links microbial triggers to a sarcoidosis outcome from the accumulation of aggregated proinflammatory serum amyloid A within granulomas, providing a mechanism for chronic disease in the absence of any viable tissue infection. Further studies are needed to provide more definitive evidence for these competing hypotheses before the statement that the etiology of sarcoidosis is unknown becomes obsolete. PMID:25007081

Chen, Edward S; Moller, David R

2014-06-01

193

Restless legs and periodic leg movements in sleep syndromes  

Microsoft Academic Search

Restless legs syndrome (RLS) is a common sensorimotor disorder with an estimated prevalence of between 1% and 5%. The symptomatology\\u000a is characterized by unpleasant sensations experienced predominantly in the legs and rerely in the arms. The symptoms occur\\u000a only at rest and become more pronounced in the evening or at night. In addition, the patients suffer from a strong urge

Thomas C. Wetter; Thomas Pollmächer

1997-01-01

194

Etiology, pathophysiology and classifications of the diabetic Charcot foot  

PubMed Central

In people with diabetes mellitus, the Charcot foot is a specific manifestation of peripheral neuropathy that may involve autonomic neuropathy with high blood flow to the foot, leading to increased bone resorption. It may also involve peripheral somatic polyneuropathy with loss of protective sensation and high risk of unrecognized acute or chronic minor trauma. In both cases, there is excess local inflammatory response to foot injury, resulting in local osteoporosis. In the Charcot foot, the acute and chronic phases have been described. The former is characterized by local erythema, edema, and marked temperature elevation, while pain is not a prominent symptom. In the latter, signs of inflammation gradually recede and deformities may develop, increasing the risk of foot ulceration. The most common anatomical classification describes five patterns, according to the localization of bone and joint pathology. This review article aims to provide a brief overview of the diabetic Charcot foot in terms of etiology, pathophysiology, and classification. PMID:23705058

Papanas, Nikolaos; Maltezos, Efstratios

2013-01-01

195

Ulcerative Colitis: Current Treatment Strategies and Future Prospects  

PubMed Central

Ulcerative colitis (UC) is a disease of unknown etiology characterized by inflammation of the mucosa and occasionally the submucosa of the colon. Conventional drug therapy for UC involves use of aminosalicylates, corticosteroids, azathioprine/6-mercaptopurine, cyclosporine and anti-tumor necrosis factor therapy. Alternative therapies include probiotics, nicotine and fish oil. Drugs like tacrolimus, rosiglitazone and Trichuris suis ova are being evaluated for use in UC patients. With the new biologic agents, new treatment options for UC continue to evolve. In this article we will discuss the conventional drugs, the alternative therapies and the management strategies according to the severity and extent of UC. PMID:21180538

Peppercorn, Mark A.

2009-01-01

196

Design of robotic quadruped legs  

E-print Network

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 ...

McKenzie, Jacob Elijah

2012-01-01

197

A metabolically efficient leg brace  

E-print Network

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 ...

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

2006-01-01

198

Chest neoplasms with infectious etiologies  

PubMed Central

A wide spectrum of thoracic tumors have known or suspected viral etiologies. Oncogenic viruses can be classified by the type of genomic material they contain. Neoplastic conditions found to have viral etiologies include post-transplant lymphoproliferative disease, lymphoid granulomatosis, Kaposi’s sarcoma, Castleman’s disease, recurrent respiratory papillomatosis, lung cancer, malignant mesothelioma, leukemia and lymphomas. Viruses involved in these conditions include Epstein-Barr virus, human herpes virus 8, human papillomavirus, Simian virus 40, human immunodeficiency virus, and Human T-lymphotropic virus. Imaging findings, epidemiology and mechanism of transmission for these diseases are reviewed in detail to gain a more thorough appreciation of disease pathophysiology for the chest radiologist. PMID:22224176

Restrepo, Carlos S; Chen, Melissa M; Martinez-Jimenez, Santiago; Carrillo, Jorge; Restrepo, Catalina

2011-01-01

199

Sustained compression and healing of chronic venous ulcers.  

PubMed Central

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

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

1988-01-01

200

Establishing the etiology of thrombocytopenia.  

PubMed

Hemostasis is dependent on an adequate number of well-functioning platelets in the circulating blood. As the number of circulating platelets decreases, the chance of bleeding increases. Thrombocytopenia, a platelet count of less than 150,000 per microliter, is a laboratory finding and not a diagnosis. Therefore, once thrombocytopenia is identified, a detailed history, physical examination, and further laboratory tests are used to establish an etiology. This article reviews the assessment, diagnosis, and treatment of thrombocytopenia. PMID:10884997

Horrell, C J; Rothman, J

2000-06-01

201

THE ETIOLOGY OF BACTERIAL VAGINOSIS  

PubMed Central

Bacterial vaginosis (BV) is the most common vaginal infection among women of childbearing age. This condition is notorious for causing severe complications related to the reproductive health of women. Five decades of intense research established many risk factors for acquisition of BV, however due to the complexity of BV and due to lack of a reliable animal model for this condition, its exact etiology remains elusive. In this manuscript we use a historical perspective to critically review the development of major theories on the etiology of BV, ultimately implicating BV-related pathogens, healthy vaginal microbiota, bacteriophages and the immune response of the host. None of these theories on their own can reliably explain the epidemiological data. Instead, BV is caused by a complex interaction of multiple factors, which include the numerous components of the vaginal microbial ecosystem and their human host. Many of these factors are yet to be characterized because a clear understanding of their relative contribution to the etiology of BV is pivotal to formulation of an effective treatment for and prophylaxis of this condition. PMID:21332897

Turovskiy, Yevgeniy; Noll, Katia Sutyak; Chikindas, Michael L.

2011-01-01

202

Myorhythmia: Phenomenology, etiology, and treatment.  

PubMed

Myorhythmia is defined as repetitive, rhythmic, slow (1-4 Hz) movement affecting chiefly cranial and limb muscles. When occurring in the limbs it may be oscillatory and jerky, whereas oculo-masticatory myorhythmia, typically associated with Whipple's disease, is a slow, repetitive, often asymmetrical, facial and ocular movement. Thus, myorhythmia overlaps phenomenologically with tremor and segmental myoclonus. Although often present at rest, it must be differentiated from parkinsonian or dystonic tremor. Recognition of this movement disorder is important because it is usually associated with lesions involving the brainstem, thalamus, or other diencephalic structures with potentially treatable etiologies. In addition to Whipple's disease, myorhythmia has been described in patients with cerebrovascular disease, listeria encephalitis, anti-N-methyl-d-aspartate receptor encephalitis, steroid-responsive encephalopathy associated with autoimmune thyroiditis, multiple sclerosis, and other disorders. In addition to our own experience, we have systematically reviewed the medical literature, focusing on the phenomenology, pathophysiology, and etiology of this poorly recognized movement disorder. In this review, we aim to highlight the clinical features that differentiate myorhythmia from other movement disorders. Treatment should be directed against the underlying etiology. © 2014 International Parkinson and Movement Disorder Society. PMID:25487777

Baizabal-Carvallo, José Fidel; Cardoso, Francisco; Jankovic, Joseph

2014-12-01

203

Microbial Diversity of Genital Ulcer Disease in Men Enrolled in a Randomized Trial of Male Circumcision in Kisumu, Kenya  

PubMed Central

Background Medical male circumcision (MMC) reduces the risk of genital ulcer disease (GUD) in men by 50%. In Ugandan and Kenyan trials, a sexually transmissible agent was not identified in 50–60% of GUD specimens by polymerase chain reaction (PCR) assay. We sought to better define the etiology of GUD in men participating in the Kenyan trial and examine how MMC affects GUD etiology. Methods We defined GUD of unknown etiology as negative for HSV (type 1 and type 2), T. pallidum, and H. ducreyi by PCR, and negative for HSV-2 and T. pallidum by serology. We identified bacterial microbiota in a subset of 59 GUD specimens using multitag pyrosequencing of the 16S rRNA gene, and compared results by unknown vs. STI-associated etiology. Statistical analysis employed Bray-Curtis similarity measure of bacterial community by etiology, hierarchical clustering and logistic regression. Results In 59 GUD specimens from 59 men, 23 (39%) had unknown etiology. Bacterial diversity was greater in GUD of unknown than STI etiology (p?=?0.01). Fusobacteria (Fusobacterium spp. and Sneathia spp.) were more commonly detected in men with GUD of unknown etiology [adjusted OR?=?5.67; 95% CI: 1.63–19.8] as were Oxobacter spp. and Anaerovorax spp. [adjusted OR?=?3.12; 95% CI: 0.83–11.7]. Sequences from these four anaerobic bacterial taxa were more often detected in uncircumcised men than circumcised men (p<0.05). Conclusions Anaerobic bacteria are more common in genital ulcers of uncircumcised men. The specific anaerobic bacteria associated with GUD of unknown etiology have cytotoxic properties that can exacerbate epithelial disruptions leading to ulcer-like appearance. MMC may reduce GUD through a reduction in these anaerobic bacteria. PMID:22848346

Mehta, Supriya D.; Green, Stefan J.; Maclean, Ian; Hu, Hong; Bailey, Robert C.; Gillevet, Patrick M.; Spear, Greg T.

2012-01-01

204

Ulcerative penile leishmaniasis in a child.  

PubMed

Penile ulcers may be caused by several different agents. Rarely, cutaneous leishmaniasis may also be accompanied by penile ulcers. We report a five-year-old boy with who had an ulcer on the glans penis. Smears from the ulcer demonstrated amastigotes, biopsy showed histopathological features of leishmaniasis and Leishmania was grown in culture. Treatment with meglumine antimoniate injections led to improvement. PMID:24823403

Yesilova, Yavuz; Turan, Enver; Sürücü, Hacer Altun; Kocarslan, Sezen; Tanrikulu, Osman; Eroglu, Naime

2014-01-01

205

Dysfunctions of the stomach with gastric ulceration  

Microsoft Academic Search

Factors implicated in the pathogenesis of gastric ulcer were studied simultaneously in seven patients with strictly defined type 1 gastric ulcer (single benign ulcer above the incisura of the stomach) and in six healthy controls. After ingestion of an ordinary solid-liquid meal, patients with gastric ulcer demonstrated gastric hyposecretion of acid, pepsin, and water; delayed gastric emptying of solids with

Laurence J. Miller; Juan-R. Malagelada; George F. Longstreth; Vayliang W. Go

1980-01-01

206

Pipe crawler with extendable legs  

DOEpatents

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

Zollinger, W.T.

1992-06-16

207

Translational Control in Cancer Etiology  

PubMed Central

The link between perturbations in translational control and cancer etiology is becoming a primary focus in cancer research. It has now been established that genetic alterations in several components of the translational apparatus underlie spontaneous cancers as well as an entire class of inherited syndromes known as “ribosomopathies” associated with increased cancer susceptibility. These discoveries have illuminated the importance of deregulations in translational control to very specific cellular processes that contribute to cancer etiology. In addition, a growing body of evidence supports the view that deregulation of translational control is a common mechanism by which diverse oncogenic pathways promote cellular transformation and tumor development. Indeed, activation of these key oncogenic pathways induces rapid and dramatic translational reprogramming both by increasing overall protein synthesis and by modulating specific mRNA networks. These translational changes promote cellular transformation, impacting almost every phase of tumor development. This paradigm represents a new frontier in the multihit model of cancer formation and offers significant promise for innovative cancer therapies. Current research, in conjunction with cutting edge technologies, will further enable us to explore novel mechanisms of translational control, functionally identify translationally controlled mRNA groups, and unravel their impact on cellular transformation and tumorigenesis. PMID:22767671

Ruggero, Davide

2013-01-01

208

[Pedophilia: etiology, diagnostics and therapy].  

PubMed

Child sexual abuse is one of the most destructive events for healthy child development. Following psychiatric classification systems, pedophilia must be distinguished from child sexual abuse. Approximately only one half of all child abusers fulfill the diagnostic criteria for pedophilia which is defined as a persistent or dominating sexual preference for prepubescent children characterized by persistent thoughts, fantasies, urges, sexual arousal or behavior. This article describes the diagnostic criteria and potential differential diagnoses as well as epidemiological and etiological findings. From an etiological point of view multifactorial mechanisms are currently considered to be responsible especially genetic factors, learning theoretical and neurobiological factors. Psychotherapeutic and pharmaceutical treatment options will be discussed. According to the current state of knowledge cognitive-behavioral psychotherapy is the method of choice in the treatment of pedophilia and has demonstrated positive treatment effects in meta-analyses regarding relapse prevention. Medicinal treatment of pedophilia is only indicated for severe forms of pedophilia. Important aspects of risk management in the treatment of pedophilia and aspects which must be considered in the forensic psychiatric assessment are presented. PMID:23793393

Fromberger, P; Jordan, K; Müller, J L

2013-09-01

209

Prometheus Hot Leg Piping Concept  

SciTech Connect

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

Gribik, Anastasia M. [Bechtel Bettis, Inc., Bettis Atomic Power Laboratory, West Mifflin, PA 15122 (United States); DiLorenzo, Peter A. [KAPL, Inc., Knolls Atomic Power Laboratory, Schenectady, NY 12301 (United States)

2007-01-30

210

JAMA Patient Page: Pressure Ulcers  

MedlinePLUS

... www.npuap.org • Association for the Advancement of Wound Care www.aawcone.org/patientresources .shtml INFORM YOURSELF To ... Ulcer Advisory Board, Association for the Advancement of Wound Care, American Academy of Family Physicians The JAMA Patient ...

211

Laparoscopic Surgery for Ulcerative Colitis  

PubMed Central

Laparoscopic techniques have become increasingly used in the treatment of ulcerative colitis: in experienced hands, they are safe and feasible. Recovery advantages have not been consistently demonstrated and functional results have been comparable to open surgery. Other possible benefits and costs issues have also been inconsistent. Further investigation on the role of laparoscopic surgery for ulcerative colitis with larger populations and longer follow-up with a focus on recovery parameters, quality of life, and costs are needed. PMID:22131895

Stocchi, Luca

2010-01-01

212

Inflammatory Nodules of the Leg  

PubMed Central

There is a group of diseases characterized by inflammatory nodules which generally located on the lower leg. They have certain clinical appearances in common, which often makes a differential diagnosis difficult or impossible on clinical grounds alone. There is a great variation in histopathologic appearance, which depends on the duration of the lesions and sites from specimens are obtained for biopsy. Therefore, separating and subclassifying inflammatory nodule lesions of the legs, based on the subtle clinical and histological variation, is not easy. Despite all these difficulties, a specific diagnosis can be made with an adequate clinic-pathologic correlation. PMID:23197902

2012-01-01

213

Treatment of Chronic Posttraumatic Leg Injury Using Autologous Fat Graft  

PubMed Central

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

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

2012-01-01

214

Environmental factors in the etiology of endemic elephantiasis of the lower legs in tropical Africa.  

PubMed

The environmental factors including geography, geology and soil have been reviewed in areas of high prevalence of non-filariasis endemic elephantiasis surveyed in tropical Africa. These areas occur at altitudes above 1000 m where rainfall is seasonal and exceeds 1000 mm annually. The soil is a red clay, very slippery when wet and very adhesive if allowed to dry on the skin. These are also areas of past or present alkalic volcanism, the prevalence being highest in proximity to the volcanoes. The derived soils are notable for the high proportion of alumino-silicate particles of colloid size in the clays. The significance of these findings suggests that the number and small size of the clays. The significance of these findings suggests that the number and small size of the particles facilitates entry through the skin into the lymphatic tissues, where they exert the known irritant and fibrosing effects of silica and alumina. PMID:6328708

Price, E W; Bailey, D

1984-03-01

215

[Long-term normovolemic hemodilution in refractory postphlebitic ulcers].  

PubMed

Thrombo-embolic complications are still amongst the most serious encountered in surgery and in certain medical afflictions, despite the different forms of prophylaxis, and in particular subcutaneous heparin. Thus, in 1983, an investigation by Salleras in Barcelona based on 37,400 cases, assessed the incidence of these complications after surgery at a rate of 2.5%. That is why post-phlebitic syndromes, the results of late diagnosis at the acute stage and/or inappropriate treatment, are disorders which are still very widespread, chronic, and more or less incapacitating. At the root of tissue modifications and trophic disorders which are seen in the post-phlebitic illness, a state of venous stasis at the periphery of the limbs is very often encountered; it depends on the following processes: the obstruction of a large venous collector (obstructive syndrome), the size of the stasis depending on the functional value of the anastomotic channels; the insufficiency of the superficial network; orthostatic reflux in the repermeabilized deep veins whose valvular system has broken down. The main trophic complications are: oedema, hypodermatitis and leg ulceration, which is the most formidable complication and which still occurs very frequently. Most post-phlebitic ulcers heal after a well-executed phlebological treatment on an ambulatory basis. A certain number of these ulcers prove, however, to respond badly to ambulatory treatment; they are called resistant post-phlebitic ulcers. By definition, they are difficult to cure; however, it has recently been apparent that the classical treatments associated with long-term isovolaemic haemodilution are more effective and enable healing to take place by treating the venous stasis and the increased blood viscosity. PMID:3777547

Duruble, M; Ouvry, P; Guenneguez, H

1986-01-01

216

[Total contact cast for management of neuropathic ulceration of the foot].  

PubMed

Neuropathic foot ulcers are common in diabetic patients. One etiological factor is neural dysfunction. These ulcers are a major cause leading to limb loss and exist in 85% of diabetic patients undergoing amputations. A treatment modality of neuropathic ulcers is by weight-bearing relief of the affected area, which facilitates natural healing. The best way of providing such treatment is by the application of a total contact healing plaster cast which dissipates the pressure over the entire sole and shin. The method is successful in more than 70% of the cases. The major drawbacks of this process are the frequent need to change the plaster cast, which is extremely time consuming, and the need for a skilled artisan. This treatment protocol is dependent on the availability of conditions that will permit the artisan to create these total contact casts. PMID:16509423

Tamir, Eran; Heim, Michael; Siev-Ner, Itzhak

2006-02-01

217

Leg 187 Preliminary Report Alterationhalo  

E-print Network

Indian-type MORB A3 PRT andesitic lava B5 axis B5 off-axis A B #12;Leg 187 Preliminary Report Figure 26 andesitic basalt propagating rift tip lavas Indian-type MORB Zone A fractionated Zone A primitive Zone A PRT

218

Why Dont Whales Have Legs?  

NSDL National Science Digital Library

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.

Bedell, S.

219

Animation of dynamic legged locomotion  

Microsoft Academic Search

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

Marc H. Raibert; Jessica K. Hodgins

1991-01-01

220

Non-ulcer dyspepsia.  

PubMed

Non-ulcer dyspepsia (NUD) includes functional forms, related to secretory and/or motor disorders, but also refers to forms with gastritis and/or duodenitis (erosive or not, Helicobacter pylori positive or not), as well as to idiopathic forms. NUD pathophysiology is multifactorial. Secretory abnormalities, H. pylori infection and in particular digestive and interdigestive disorders of gastrointestinal motility are often detected in NUD patients, but psychological, social and environmental factors can be also involved in NUD pathogenesis. With regard to symptom genesis, there is still no convincing evidence as to whether and to what extent pathogenetic factors have a causal relationship with dyspeptic symptoms. Upper gastro-intestinal endoscopy with biopsies and abdominal ultrasonography must be performed in patients over 45 years complaining of sudden symptoms, in patients under 45 years suffering from symptoms suggestive of severe organic disease and in patients with unexplained worsening of chronic symptoms. Ex adjuvantibus therapy may be employed in the remainder of dyspeptics. Oligosymptomatic dyspepsia needs no pharmacological treatment and in most cases it is enough to advise modifications of dietary habits and life style. Many drugs are usually employed in the pharmacological treatment of severe NUD but only H2-antagonists, pirenzepine and prokinetics are reported to be more effective than placebo. Efficacy of therapy should be checked after 4 weeks of treatment. If no improvement occurs, combined or different therapy might be employed. Treatment should be checked again after 8 weeks: therapeutic failure at this time indicates the need for endoscopic examination. PMID:1840814

Blasi, A; Mangiameli, A

1991-01-01

221

OCEAN DRILLING PROGRAM LEG 159 SCIENTIFIC PROSPECTUS  

E-print Network

OCEAN DRILLING PROGRAM LEG 159 SCIENTIFIC PROSPECTUS THE COTE D'IVOIRE - GHANA TRANSFORM MARGIN on the sedimentary records. Leg 159 will investigate the Cote dlvoire-Ghana (CIG) Margin in the eastern equatorial

222

Peptic ulcer as a risk factor for postherpetic neuralgia in adult patients with herpes zoster.  

PubMed

Postherpetic neuralgia is the most common complication of herpes zoster. Identifying predictors for postherpetic neuralgia may help physicians screen herpes zoster patients at risk of postherpetic neuralgia and undertake preventive strategies. Peptic ulcer has been linked to immunological dysfunctions and malnutrition, both of which are predictors of postherpetic neuralgia. The aim of this retrospective case-control study was to determine whether adult herpes zoster patients with peptic ulcer were at greater risk of postherpetic neuralgia. Adult zoster patients without postherpetic neuralgia and postherpetic neuralgia patients were automatically selected from a medical center's electronic database using herpes zoster/postherpetic neuralgia ICD-9 codes supported with inclusion and exclusion criteria. Consequently, medical record review was performed to validate the diagnostic codes and all pertaining data including peptic ulcer, Helicobacter pylori (H. pylori) infection and ulcerogenic medications. Because no standard pain intensity measurement exists, opioid usage was used as a proxy measurement for moderate to severe pain. In total, 410 zoster patients without postherpetic neuralgia and 115 postherpetic neuralgia patients were included. Multivariate logistic regressions identified 60 years of age and older, peptic ulcer and greater acute herpetic pain as independent predictors for postherpetic neuralgia. Among etiologies of peptic ulcer, H. pylori infection and usage of non-selective nonsteroidal anti-inflammatory drugs were significantly associated with the increased risk of postherpetic neuralgia; conversely, other etiologies were not significantly associated with the postherpetic neuralgia risk. In conclusion, 60 years of age and older, peptic ulcer and greater acute herpetic pain are independent predictors for postherpetic neuralgia in adult herpes zoster patients. PMID:25156435

Chen, Jen-Yin; Lan, Kuo-Mao; Sheu, Ming-Jen; Tseng, Su-Feng; Weng, Shih-Feng; Hu, Miao-Lin

2015-02-01

223

Intelligent ballistic control of a jointed leg  

Microsoft Academic Search

In order to perform a wide range of locomotive tasks, a legged robot should be able to autonomously adjust its stride and properly move its legs so as to fit the current locomotion requirement. We develop an adaptive intelligent system that controls the movement of a jointed leg during a running stride. This paper focuses on the ballistic controller, which

P. Israel Doerschuk; V. Nguyen; W. Simon; F. Kwong

1996-01-01

224

The first leg video endoscopic groin lymphadenectomy in vulvar cancer: A case report  

PubMed Central

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

Naldini, Angelica; Rossitto, Cristiano; Morciano, Andrea; Panico, Giovanni; Campagna, Giuseppe; Paparella, Pierluigi; Scambia, Giovanni

2014-01-01

225

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 ... become damaged or die. When this happens, a pressure ulcer may form. Below are some questions you may ...

226

38 CFR 4.110 - Ulcers.  

Code of Federal Regulations, 2011 CFR

...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...

2011-07-01

227

38 CFR 4.110 - Ulcers.  

Code of Federal Regulations, 2012 CFR

...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...

2012-07-01

228

38 CFR 4.110 - Ulcers.  

Code of Federal Regulations, 2010 CFR

...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...

2010-07-01

229

38 CFR 4.110 - Ulcers.  

Code of Federal Regulations, 2013 CFR

...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...

2013-07-01

230

38 CFR 4.110 - Ulcers.  

...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...

2014-07-01

231

Family Studies, Cancer Etiology, and Telomere Biology  

Cancer.gov

Dr. Sharon Savage of the National Cancer Institute speaks about Family Studies, Cancer Etiology, and Telomere Biology. Presentation was part of “Cancer Epidemiology: From Pedigrees to Populations,” a scientific symposium honoring 50 years of visionary leadership by Dr. Joseph F. Fraumeni, Jr., hosted by NCI’s Division of Cancer Epidemiology and Genetics (DCEG).Family Studies, Cancer Etiology, and Telomere Biology.

232

Syncope: epidemiology, etiology, and prognosis  

PubMed Central

Syncope is a common medical problem, with a frequency between 15% and 39%. In the general population, the annual number episodes are 18.1–39.7 per 1000 patients, with similar incidence between genders. The first report of the incidence of syncope is 6.2 per 1000 person-years. However, there is a significant increase in the incidence of syncope after 70 years of age with rate annual 19.5 per thousand individuals after 80 years. It presents a recurrence rate of 35% and 29% of physical injury. Among the causes of syncope, the mediated neural reflex, known as neurocardiogenic or vasovagal syncope, is the most frequent. The others are of cardiac origin, orthostatic hypotension, carotid sinus hypersensitivity, neurological and endocrinological causes and psychiatric disorders. The diagnosis of syncope can be made by clinical method associated with the electrocardiogram in up 50% of patients. Its prognosis is determined by the underlying etiology specifically the presence and severity of cardiac disease. The annual mortality can reach between 18 and 33% if cardiac cause, and between 0 and 12% if the non-cardiac cause. Thus, it is imperative to identify its cause and risk stratification for positive impact in reducing morbidity and mortality. PMID:25538626

da Silva, Rose M. F. L.

2014-01-01

233

On the etiology of epididymitis.  

PubMed

An exceptionally high frequency of acute epididymitis has been observed among military recruits in basic training. 28 soldiers presenting with an episode of acute tender swelling of the epididymis were evaluated. Average age was 21 years. 8 patients reported gonorrheal infection within the preceding 2 months. None had a recent history of trauma or prior operation, and no systemic symptoms or upper respiratory infections were noted. Acute tubular destruction with some micro abscesses in the tubules and some degree of interstitial inflammation was observed in 13 of the 24 cases for which laboratory specimens were adequate. Polymorphonuclear leukocytes were the predominant cells and some cases showed vasculitis. In 8 of the specimens with no tubular involvement, a chronic type of interstitial inflammation was noted. Lymphocytes were the main cells found in these cases. Testicular tissue was normal in 8 patients. Depressed spermatogenesis was noted in 20 patients, 9 of whom manifested inflammation. All viral and culture studies were negative. It was concluded that acute epididymitis is not caused by any culturable bacteria or virus; however, a chemical etiology is possible. Epididymitis appears to be mainly a disease of people who have extended periods of unaccumstomed strenuous physical exertion. Reflux up the vas deferens, induced by the physical strain of basic training, may be a major cause of the high rate of acute epididymitis observed among military recruits. Gonorrhea may also be a contributing factor. Antibiotic use is recommended in such cases to prevent secondary testicular atrophy. PMID:5556701

Wolin, L H

1971-04-01

234

Chronic villitis of unknown etiology.  

PubMed

The diagnosis of chronic villitis of unknown etiology (CVUE), characterized by focal areas of inflammation with mononuclear cells and areas of fibrinoid necrosis in chorionic villi, can only be set-up after exclusion of a latent maternal-fetal transmission of infectious agents by sophisticated techniques such as polymerase chain reaction. Significant associations of CVUE with maternal body mass index, multigravidity and ethnicity were reported. While a fetal origin of the inflammatory cells has been evoked, there are many more arguments drawn from histopathology and immunohistology for a maternal immune response against the foreign fetal allograft. CVUE is detected in 7-33% of placentas, mainly after idiopathic intrauterine growth retardation, unexplained prematurity, preeclampsia, perinatal asphyxia and intrauterine fetal death. CVUE is also more frequent in pregnancies affected by autoimmune or alloimmune diseases. Considering the high rate of recurrences after an index case of CVUE, we would suggest to associate aspirine and corticosteroids in further pregnancies, a regimen that was successful in our experience but must be confirmed by other studies. The same is true for the alleviated inflammatory immunologic response recently obtained by a weekly use of maternal intravenous immunoglobulins. PMID:17683846

Boog, Georges

2008-01-01

235

Kayexalate-induced colonic ulcer.  

PubMed

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

Albeldawi, Mazen; Gaur, Varun; Weber, Luke

2014-08-01

236

Kayexalate-induced colonic ulcer  

PubMed Central

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

Albeldawi, Mazen; Gaur, Varun; Weber, Luke

2014-01-01

237

Assessing Children's Legs and Feet  

PubMed Central

Shoes are necessary for protection and warmth. Normal children do not require shoes for support. There is no scientific evidence that shoes—‘orthopedic’ or otherwise—influence or alter the growth or shape of the normal child's foot except, perhaps, adversely if they fit poorly. Family physicians must understand common variations of normal foot and leg development if they are to effectively advise and reassure parents about appropriate footwear. Flat feet, knock knees, bow legs, in-toeing, and out-toeing in otherwise normal children can easily be distinguished from similar but more serious deformities associated with disease or congenital anomaly. ImagesFig. 1AFig. 1BFig. 2AFig. 2B PMID:21274231

Wedge, John H.

1985-01-01

238

Genital ulcers: it is not always simplex?….  

PubMed

Patients with vulval aphthae, also termed Lipschütz ulcers, often present to genitourinary medicine clinics. Typically, these ulcers present as acute, painful, vulval ulcers in young women and adolescents. The aetiology is unknown, and often these ulcers are accompanied by flu-like symptoms. Previous case reports have linked such lesions to acute viral infections such as Epstein-Barr virus, cytomegalovirus and influenza A. We report the first case of influenza B virus and adenovirus infections associated with this presentation. PMID:24970475

Haidari, G; MacMahon, E; Tong, Cyw; White, Ja

2015-01-01

239

Acupuncture treatment for duodenal ulcer.  

PubMed

The effect of acupuncture therapy for duodenal ulcer was investigated in 21 male and female patients. The diagnosis and healing were verified by gastroscopy. It was found that the needle therapy for 3 weeks led to complete recovery in 76 percent of the patients. Diet, alcohol and cigarette abstinency were necessary for healing. Cuti-visceral reflex activation eliciting the improvement of the secretory and motor function of the gastrointestinal tract and effects in the CNS leading to analgesia and tranquilization may play a role in the mechanism of action. Our conclusion is that acupuncture can be satisfactory method to cure duodenal ulcer. PMID:2904207

Debreceni, L; Denes, L

1988-01-01

240

Occupational mortality from gastric and duodenal ulcer.  

PubMed Central

The pronounced geographical and temporal variations in gastric and duodenal ulcer suggest that important environmental factors must play a part in their aetiology. To determine the nature of possible factors, the Registrar General's decennial supplement and the vital statistics special reports of the United States Department of Health, Education, and Welfare on occupational mortality were analysed for occupation-specific mortality from peptic ulcer. The data disclose a high mortality from both types of ulcer among manual workers and a low mortality among sedentary occupations. This general pattern runs parallel to a low mortality from gastric and duodenal ulcer among the high social classes and a high mortality in the low social classes. Married women displayed a gradient of gastric ulcer mortality increasing from social class 1 to social class 5 but gave no evidence of social class correlation with respect to duodenal ulcer. The significant correlation between mortality from gastric and duodenal ulcer among different occupations could suggest that both types of ulcer hold some of the precipitating environmental risks in common. In duodenal ulcer the varying extent of energy expenditure among different occupations may be responsible for the different risk of contracting duodenal ulcer and dying from it. The association between energy expenditure and peptic ulcer mortality seems to be less important for gastric ulcer where additional factors associated with social class may also be operating. PMID:3947561

Sonnenberg, A; Sonnenberg, G S

1986-01-01

241

Risk indicators for pressure ulcers during surgery  

Microsoft Academic Search

Patients undergoing surgery are prone to develop pressure ulcers during surgery. The aim of this study was to identify pressure ulcer risk indicators in patients undergoing surgery which lasted more than four hours. A prospective follow-up study was conducted in 208 patients. Data on presence or absence of pressure ulcers and risk indicators were collected preoperatively, during surgery, and postoperatively.

Lisette Schoonhoven; Tom Defloor; Ingeborg van der Tweel; Erik Buskens; Maria H. F. Grypdonck

2002-01-01

242

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...

243

Molecular assays for detecting Aphanomyces invadans in ulcerative mycotic fish lesions.  

PubMed

The pathogenic oomycete Aphanomyces invadans is the primary etiological agent in ulcerative mycosis, an ulcerative skin disease caused by a fungus-like agent of wild and cultured fish. We developed sensitive PCR and fluorescent peptide nucleic acid in situ hybridization (FISH) assays to detect A. invadans. Laboratory-challenged killifish (Fundulus heteroclitus) were first tested to optimize and validate the assays. Skin ulcers of Atlantic menhaden (Brevoortia tyrannus) from populations found in the Pamlico and Neuse River estuaries in North Carolina were then surveyed. Results from both assays indicated that all of the lesioned menhaden (n = 50) collected in September 2004 were positive for A. invadans. Neither the FISH assay nor the PCR assay cross-reacted with other closely related oomycetes. These results provided strong evidence that A. invadans is the primary oomycete pathogen in ulcerative mycosis and demonstrated the utility of the assays. The FISH assay is the first molecular assay to provide unambiguous visual confirmation that hyphae in the ulcerated lesions were exclusively A. invadans. PMID:16461710

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

2006-02-01

244

Molecular Assays for Detecting Aphanomyces invadans in Ulcerative Mycotic Fish Lesions  

PubMed Central

The pathogenic oomycete Aphanomyces invadans is the primary etiological agent in ulcerative mycosis, an ulcerative skin disease caused by a fungus-like agent of wild and cultured fish. We developed sensitive PCR and fluorescent peptide nucleic acid in situ hybridization (FISH) assays to detect A. invadans. Laboratory-challenged killifish (Fundulus heteroclitus) were first tested to optimize and validate the assays. Skin ulcers of Atlantic menhaden (Brevoortia tyrannus) from populations found in the Pamlico and Neuse River estuaries in North Carolina were then surveyed. Results from both assays indicated that all of the lesioned menhaden (n = 50) collected in September 2004 were positive for A. invadans. Neither the FISH assay nor the PCR assay cross-reacted with other closely related oomycetes. These results provided strong evidence that A. invadans is the primary oomycete pathogen in ulcerative mycosis and demonstrated the utility of the assays. The FISH assay is the first molecular assay to provide unambiguous visual confirmation that hyphae in the ulcerated lesions were exclusively A. invadans. PMID:16461710

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

2006-01-01

245

Healing refractory venous ulcers: new treatments offer hope.  

PubMed

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

Kirsner, Robert S; Baquerizo Nole, Katherine L; Fox, Joshua D; Liu, Sophia N

2015-01-01

246

Refractory restless legs syndrome likely caused by olanzapine.  

PubMed

We report a case of severe restless legs syndrome (RLS) that occurred as a side effect of olanzapine therapy. It was refractory to treatment with 2 mg of clonazepam and 3 mg ropinirole. There was partial relief with propoxyphene, however, it was stopped because of side effects. The symptoms disappeared once olanzapine was switched to another antipsychotic medication. Only two prior published reports associate olanzapine usage with development of RLS. In one report, low-dose benzodiazepines and ropinirole were associated with resolution of RLS symptoms stating dopamine depletion as the likely etiology. In our patient, however, RLS due to olanzapine was refractory to the trial of both high-dose benzodiazepine and ropinirole. This suggests that RLS occurring as a side effect of olanzapine therapy may have additional causative mechanisms beyond simple dopamine depletion as postulated before. High-dose narcotics, if tolerated, may be an alternative in such refractory cases. PMID:19317385

Khalid, Imran; Rana, Lopa; Khalid, Tabindeh J; Roehrs, Timothy

2009-02-15

247

Etiology and pathogenesis of obesity.  

PubMed

Obesity results from a greater consumption of energy than is used by the body. As this energy is stored, fat cells enlarge, producing the characteristic pathology of obesity. The pathologic enlargement of fat cells, in turn, produces altered levels of many peptide and nutrient signals that are responsible for the disease we call "obesity." The genetic makeup of human beings, which reflects a long history of relative scarcity of foodstuffs, has run into an age of surfeit, and many people cannot readily adapt. Thus, the increased intake of food does not signal satiety, and there is a gradual increase in energy stores as intake of energy outpaces need as we grow older. Against this background of struggle between nature and nurture, it is possible to identify an increasing number of defects or etiologies that produce obesity. For most patients, however, it is not possible to connect obesity to a specific cause. Leptin deficiency and defects in the leptin receptor both produce human obesity. Defects in the pro-opiomelanocortin receptor system, the peroxisome proliferator-activated receptor-gamma, the agouti-related peptide, and a few other rare genetic syndromes are also associated with human obesity. Of the genetic causes, Prader-Willi syndrome is the most common. Hypothalamic injury following craniopharyngioma is the most common neuroendocrine cause. Endocrine disorders such as Cushing's disease, polycystic ovary disease, and growth-hormone deficiency can lead to increased body fat. In the modern world, exposure to a high-fat diet predisposes many people to obesity, and this problem is compounded by the low levels of activity now required for daily living. Treatment strategies must be developed against this background. PMID:10696281

Bray, G A

1999-01-01

248

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

PubMed Central

A case involving a retired, elderly male war veteran with a symptomatic peroneus brevis muscle hernia causing superficial peroneal nerve compression with chosen surgical management is presented. Symptomatic muscle hernias of the extremities occur most commonly in the leg and are a rare cause of chronic leg pain. Historically, treating military surgeons pioneered the early documentation of leg hernias observed in active military recruits. A focal fascial defect can cause a muscle to herniate, forming a variable palpable subcutaneous mass, and causing pain and potentially neuropathic symptoms with nerve involvement. While the true incidence is not known, the etiology has been classified as secondary to a congenital (or constitutional) fascial weakness, or acquired fascial defect, usually secondary to direct or indirect trauma. The highest occurrence is believed to be in young, physically active males. Involvement of the tibialis anterior is most common, although other muscles have been reported. Dynamic ultrasonography or magnetic resonance imaging is often used to confirm diagnosis and guide treatment. Most symptomatic cases respond successfully to conservative treatment, with surgery reserved for refractory cases. A variety of surgical techniques have been described, ranging from fasciotomy to anatomical repair of the fascial defect, with no consensus on optimal treatment. Clinicians must remember to consider muscle hernias in their repertoire of differential diagnoses for chronic leg pain or neuropathy. A comprehensive review of muscle hernias of the leg is presented to highlight their history, occurrence, presentation, diagnosis and treatment. PMID:24497767

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

2013-01-01

249

Isthmic tubal occlusion: etiology and histology.  

PubMed

Twenty five patients were operated on for isthmic tubal occlusion. In 15 cases (60%) the etiology of this lesion was salpingitis isthmica nodosa. Of the other 10 cases, three showed tubal endometriosis and another three isthmic fibrosis. In two patients the histologic examination showed chronic inflammation. In one case etiology was tubal tuberculosis and in one case a cyst of calcified Gartner 's duct was seen. Inflammatory etiology seems to be important in isthmic tubal occlusion. In many cases chlamydial infection may be the chronic irritant which also cause the muscular hypertrophy leading to salpingitis isthmica nodosa. PMID:6730864

Punnonen, R; Söderström, K O; Alanen, A

1984-01-01

250

[Comprehensive surgical treatment of mixed crural ulcers with femoropopliteal distal bypass and endoscopic elimination of Cockett's perforating veins].  

PubMed

The authors present an account on a successful cure of a mixed crural ulcer using combined therapy by a classical vascular surgical method and endoscopic surgery of the venous perforators of the leg. In the described case this combined treatment is the method of choice because it was not possible to use the classical Linton operation and also to protect a vascular prosthesis from infection. PMID:9828659

Stádler, P; Netuka, I; Sebesta, P

1998-08-01

251

Effect of Rebamipide on Gastric Ulcer Healing Caused by Helicobacter pylori and\\/or NSAIDs or Non NSAIDs-Non H. pylori  

Microsoft Academic Search

etiologies. Material and Method: Thirty patients with gastric ulcer underwent gastric antral and body biopsies for histopathology. Group classifications depended on H. pylori status using CLO test, histology or urea breath test and history of NSAIDs taking. All patients received rebamipide 100 mg, three times a day, for 8 weeks. The symptoms and adverse effects were assessed in 4 weeks

Duangporn Thong-Ngam; Maneerat Chayanupatkul

252

Chronic parastomal ulcers: spectrum of dermatoses.  

PubMed

Parastomal ulcers that develop after stoma surgery have reportedly been associated with recurrent inflammatory bowel disease and chronic infection. We report 13 patients with refractory parastomal ulcers, which occurred at a mean of 11 years after surgery. Parastomal ulcers in eight patients were the result of dermatologic conditions (e.g., contact dermatitis, bullous pemphigoid, lichen sclerosus et atrophicus, eczema, or psoriasis) or contact ulcers from dermatitis of the skin around the stoma and faceplate pressure. These ulcers healed after treatment with topical medications at a mean of 4 weeks. Five patients with inflammatory bowel disease had pyoderma gangrenosum ulcerations, which healed with systemic treatment at a mean of 25 weeks. Thus nonpyoderma gangrenosum parastomal ulcerations that occur late after stoma surgery require early enterostomal therapy nursing intervention and dermatologic evaluation, since they respond rapidly to appropriate local therapy. PMID:1350739

Ng, C S; Wolfsen, H C; Kozarek, R A; Brubacher, L L; Kayne, A L

1992-01-01

253

Rapid Progression of Primary Sclerosing Cholangitis Complicated with Ulcerative Colitis  

PubMed Central

Primary sclerosing cholangitis is a cholestatic condition with unknown etiology and long-standing, progressive course, leading to cirrhosis and requiring orthotropic liver transplant. In approximately 80%, primary sclerosing cholangitis is accompanied by inflammatory bowel disease, and in most cases the recognition of bowel disease precedes the diagnosis of primary sclerosing cholangitis. We describe a case of 22-year-old male diagnosed simultaneously with primary sclerosing cholangitis and ulcerative colitis, with a medical history suggesting uncommon prior development of the liver disease. Five months after the initial diagnosis, we observed advanced lesions of bile tree due to progression of primary sclerosing cholangitis, which led to the unusually fast necessity for the orthotopic liver transplant.

Pardak, Piotr; Walczak, Ewa; Filip, Rafa? S.

2015-01-01

254

Radiation of anginal pain to the legs.  

PubMed

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

Kolettis, M T; Kalogeropoulos, C K; Tzannetis, G C; Vitakis, S K; Xaplanteris, P P; Novas, I A

1986-02-01

255

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

PubMed Central

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

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

256

[Recurrent aphthous ulcerations: analysis of predisposing factors in 68 patients].  

PubMed

Recurrent aphthous ulcerations (RAU) are the most common oral ulcerative disease, affecting 10% to 20% of the population. Local, systemic, genetic, immunological and microbial factors may play a role in the etiology of RAU, but the pathogenesis of the disease still remains unknown. In this study we have investigated correlation between RAU and anemia, dispeptic difficulties, Helicobacter pylori infection and immunological disorders in 68 patients age range 5-73 years, mean age 38.8 years, from the Department of Oral Medicine, School of Dental Medicine, University of Zagreb with diagnosed RAU in the year 2003. The diagnosis of RAU was based on clinical criteria. Anemia was diagnosed using routine laboratory tests and the diagnosis of H. pylori infection was made based on serologic or urea breath test. The results of this study show that RAU are more frequent in women and that they often occur in patients with dispeptic difficulties. It should be emphasized that in patients with RAU after the exclusion of hematological deficiencies (iron, folic acid and vitamin B12) gastrointestinal examination and H. pylori testing should be performed, due to high percentage of RAU disappearance after H. pylori eradication therapy. PMID:17489510

Brailo, Vlaho; Boras, Vanja Vuci?evi?; Ceki?-Arambasin, Ana

2007-01-01

257

Management of ulcers in lymphoedematous limbs  

PubMed Central

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

Karnasula, Vishnu M.

2012-01-01

258

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

ERIC Educational Resources Information Center

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

Gettman, Larry R.; Huckel, Jack R.

259

Reliability of the European Pressure Ulcer Advisory Panel classification system  

Microsoft Academic Search

AIM: This paper reports a study examining the interrater and intrarater reliability of classifying pressure ulcers according to the European Pressure Ulcer Advisory Panel classification system when using photographs of pressure ulcers and incontinence lesions. BACKGROUND: Pressure ulcer classification is an essential tool for assessing ulcers and their severity and determining which preventive or therapeutic action is needed. Many classification

Tom Defloor; Lisette Schoonhoven; K. van der Wee; Jan Weststrate; Dries Myny

2006-01-01

260

Tracking quality over time: what do pressure ulcer data show?  

Microsoft Academic Search

Objective. To compare the prevalence of pressure ulcers and prevention before and after a quality improvement program; determine whether patient characteristics differed for those who did and did not develop pressure ulcers; identify pressure ulcer prevention implemented at admission and whether prevention and risk factors varied by pressure ulcer severity. Design. Descriptive comparative study based on two cross-sectional pressure ulcer

LENA GUNNINGBERG; NANCYA. STOTTS

2008-01-01

261

Cancer morbidity in ulcerative colitis  

Microsoft Academic Search

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

P Prior; S N Gyde; J C Macartney; H Thompson; J A Waterhouse; R N Allan

1982-01-01

262

Current treatment of ulcerative colitis  

PubMed Central

Ulcerative colitis (UC) is a chronic disease featuring recurrent inflammation of the colonic mucosa. The goal of medical treatment is to rapidly induce a steroid-free remission while at the same time preventing complications of the disease itself and its treatment. The choice of treatment depends on severity, localization and the course of the disease. For proctitis, topical therapy with 5-aminosalicylic acid (5-ASA) compounds is used. More extensive or severe disease should be treated with oral and local 5-ASA compounds and corticosteroids to induce remission. Patients who do not respond to this treatment require hospitalization. Intravenous steroids or, when refractory, calcineurin inhibitors (cyclosporine, tacrolimus), tumor necrosis factor-? antibodies (infliximab) or immunomodulators (azathioprine, 6-mercaptopurine) are then called for. Indications for emergency surgery include refractory toxic megacolon, perforation, and continuous severe colorectal bleeding. Close collaboration between gastroenterologist and surgeon is mandatory in order not to delay surgical therapy when needed. This article is intended to give a general, practice-orientated overview of the key issues in ulcerative colitis treatment. Recommendations are based on published consensus guidelines derived from national and international guidelines on the treatment of ulcerative colitis. PMID:21912469

Meier, Johannes; Sturm, Andreas

2011-01-01

263

Update on peripheral ulcerative keratitis  

PubMed Central

Ulcerative inflammation of the cornea occurs in the perilimbal cornea, and is associated with autoimmune collagen vascular and arthritic diseases. Rheumatoid arthritis is the most frequent underlying disease. The tendency for peripheral location is due to the distinct morphologic and immunologic characteristics of the limbal conjunctiva, which provides access for circulating immune complexes to the peripheral cornea via the capillary network. Deposition of immune complexes in the terminal ends of limbal vessels initiates immune-mediated vasculitis, and causes inflammatory cell and protein leakage due to vessel wall damage. Development of peripheral ulcerative keratitis associated with systemic disease may represent worsening of a potentially life-threatening disease. Accompanying scleritis, particularly the necrotizing form, is usually observed in severe cases, which may result in corneal perforation and loss of vision. Although first-line treatment with systemic corticosteroids is indicated for acute phases, immunosuppressive and cytotoxic agents are required for treatment of peripheral ulcerative keratitis associated with multisystem disorders. Recently, infliximab, a chimeric antibody against proinflammatory cytokine tumor necrosis factor-alpha, was reported to be effective in cases refractory to conventional immunomodulatory therapy. The potential side effects of these therapies require close follow-up and regular laboratory surveillance. PMID:22654502

Yagci, Ayse

2012-01-01

264

OCEAN DRILLING PROGRAM LEG 112 PRELIMINARY REPORT  

E-print Network

OCEAN DRILLING PROGRAM LEG 112 PRELIMINARY REPORT PERU CONTINENTAL MARGIN Roland von Huene Co Staff Scientist, Leg 112 Ocean Drilling Program Texas A&M University College Station, TX 77843 be obtained from the Director, Ocean Drilling Program, Texas A&M University, College Station, Texas 77843

265

[Treatment of severe ulcerative colitis flares].  

PubMed

The treatment of severe ulcerative colitis remains a challenge for gastroenterologists. A not inconsiderable number of patients will experience severe flares throughout their lives and will require hospitalization. Mortality in severe ulcerative colitis is still high and consequently treatment must be aggressive, avoiding delays in rescue therapies or even surgery. The aim of this review was to describe the medical treatment of severe ulcerative colitis, highlighting recent therapeutic advances. PMID:25015428

Montserrat, Aceituno; Yamile, Zabana; Maria, Esteve

2014-10-01

266

Antacids and peptic ulcer--a reappraisal.  

PubMed Central

Antacids can reduce gastroduodenal acidity for long periods if taken in substantial quantities after food. Their healing effect on gastric ulcer is minimal, if present at all, and easily overwhelmed by the benefit obtained from admission to hospital. Intensive antacid therapy appears effective in healing duodenal ulcer and preventing haemorrhage from stress ulcer, and is comparable in these respects with cimetidine but with a higher incidence of side-effects. Clinical impression strongly suggests that antacids relieve pain in peptic ulcer but objective confirmation is lacking. PMID:38192

Morris, T; Rhodes, J

1979-01-01

267

Gastric emptying abnormal in duodenal ulcer  

SciTech Connect

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.

Holt, S.; Heading, R.C.; Taylor, T.V.; Forrest, J.A.; Tothill, P.

1986-07-01

268

The Pneumonia Etiology Research for Child Health Project: A 21st Century Childhood Pneumonia Etiology Study  

PubMed Central

The Pneumonia Etiology Research for Child Health (PERCH) project is a 7-country, standardized, comprehensive evaluation of the etiologic agents causing severe pneumonia in children from developing countries. During previous etiology studies, between one-quarter and one-third of patients failed to yield an obvious etiology; PERCH will employ and evaluate previously unavailable innovative, more sensitive diagnostic techniques. Innovative and rigorous epidemiologic and analytic methods will be used to establish the causal association between presence of potential pathogens and pneumonia. By strategic selection of study sites that are broadly representative of regions with the greatest burden of childhood pneumonia, PERCH aims to provide data that reflect the epidemiologic situation in developing countries in 2015, using pneumococcal and Haemophilus influenzae type b vaccines. PERCH will also address differences in host, environmental, and/or geographic factors that might determine pneumonia etiology and, by preserving specimens, will generate a resource for future research and pathogen discovery. PMID:22403238

O’Brien, Katherine L.; Deloria-Knoll, Maria; Murdoch, David R.; Feikin, Daniel R.; DeLuca, Andrea N.; Driscoll, Amanda J.; Baggett, Henry C.; Brooks, W. Abdullah; Howie, Stephen R. C.; Kotloff, Karen L.; Madhi, Shabir A.; Maloney, Susan A.; Sow, Samba; Thea, Donald M.; Scott, J. Anthony

2012-01-01

269

The Most Common Detected Risk and Etiologic Factors of Pulmonary Thromboembolism  

PubMed Central

Introduction: Pulmonary thromboembolism (PTE) is the most serious manifestation of thromboembolic disease. Objective: To determine the most common risk and etiologic factors of pulmonary tromboembolism in patients treated in Intensive care unit of Clinic for Pulmonary Diseases and TB “Podhrastovi” in three-year- period from 2008. to 2010. Material and methods: We retrospectively analysed patients with PTE treated in Intensive care unit of Clinic for Pulmonary Diseases and TB “Podhrastovi” in three-year period from 2008. to 2010. PTE was diagnosed by high resolute computed tomography, in most of them ventilatory /perfusion scintigraphy (V/P SPECT) was made, with proper laboratory analyses (D-dimmer, platelets , fibrinogen, and if it was needed protein C, S and AT III factor were examined). In all of them echosonography of abdomen and pelvis was done, also the examination by angiologist, and in patients with indications echosonography of the heart and Color Doppler of leg veins was made. We analysed risk and etiologic factors for PTE in each patient. Results: In 222 treated patients with PTE risk factors were found in 124 or 55.86% patients, etiologic factors were found in 31 or 13.96%, and both risk and etiologic factors in one patient were found in 18 or 8.11% patients. Conclusion: PTE is very serious disease that very often has fatal prognosis, and can develop with previously entirely healthy people, and as soon as we become suspicious of its presence we have to made appropriate diagnostic procedures and include appropriate therapy. We can after look for risk and etiologic factors and try to influence them. PMID:23922531

Cukic, Vesna; Baljic, Rusmir

2012-01-01

270

Intravenous Iron Given prior to Pregnancy for Restless Legs Syndrome is Associated with Remission of Symptoms  

PubMed Central

Restless legs syndrome (RLS) is more common during pregnancy than in the general population, occurring at a 2-3 times higher prevalence. While iron, genetics, and central nervous system dopamine have been shown to play major roles in RLS unrelated to pregnancy, the etiology and treatment of RLS during pregnancy have not been adequately delineated. We describe a novel approach where a 23-year-old female was given intravenous iron prior to pregnancy, with complete remission of RLS symptoms until five months postpartum. Factors other than iron status that may have influenced the course of remission and relapse were oral contraceptive use, antidepressant use, and a strong family history of RLS. Citation: Picchietti DL; Wang VC; Picchietti MA. Intravenous iron given prior to pregnancy for restless legs syndrome is associated with remission of symptoms. J Clin Sleep Med 2012;8(5):585-586. PMID:23066374

Picchietti, Daniel L.; Wang, Victor C.; Picchietti, Matthew A.

2012-01-01

271

How diet and lifestyle affect duodenal ulcers. Review of the evidence.  

PubMed Central

OBJECTIVE: To demonstrate the role of diet in reducing or aggravating risk of duodenal ulcer (DU). QUALITY OF EVIDENCE: MEDLINE was searched from January 1966 to December 2001 for articles on the relationship between diet and lifestyle and DU using the key words duodenal ulcer and diet, fibre, or lifestyle. Evidence that these factors are associated with DU arose mainly from three case-control and three prospective studies (level II evidence) and from expert opinion (level III evidence). MAIN MESSAGE: A high-fibre diet appears to reduce risk of DU; soluble fibre might be associated with reduced risk also. Vitamin A intake is associated with lower risk of DU. Little evidence indicates that fat, type of fat, protein intake, or consumption of alcohol or caffeine affect the etiology of DU. CONCLUSION: A high-fibre diet, particularly if the fibre comes from fruit and vegetables, could reduce risk of DU; vitamin A might also be beneficial. PMID:15171675

Ryan-Harshman, Milly; Aldoori, Walid

2004-01-01

272

Steerable Hopping Six-Legged Robot  

NASA Technical Reports Server (NTRS)

The figure depicts selected aspects of a six-legged robot that moves by hopping and that can be steered in the sense that it can be launched into a hop in a controllable direction. This is a prototype of hopping robots being developed for use in scientific exploration of rough terrain on remote planets that have surface gravitation less than that of Earth. Hopping robots could also be used on Earth, albeit at diminished hopping distances associated with the greater Earth gravitation. The upper end of each leg is connected through two universal joints to an upper and a lower hexagonal frame, such that the tilt of the leg depends on the relative position of the two frames. Two non-back-driveable worm-gear motor drives are used to control the relative position of the two frames along two axes 120 apart, thereby controlling the common tilt of all six legs and thereby, further, controlling the direction of hopping. Each leg includes an upper and a lower aluminum frame segment with a joint between them. A fiberglass spring, connected via hinges to both segments, is used to store hopping energy prior to launch into a hop and to cushion the landing at the end of the hop. A cable for loading the spring is run into each leg through the center of the universal joints and then down along the center lines of the segments to the lower end of the leg. A central spool actuated by a motor with a harmonic drive and an electromagnetic clutch winds in all six cables to compress all six springs (thereby also flexing all six legs) simultaneously. To ensure that all the legs push off and land in the same direction, timing- belt pulley drives are attached to the leg segments, restricting the flexing and extension of all six legs to a common linear motion. In preparation for a hop, the spool can be driven to load the spring legs by an amount corresponding to a desired hop distance within range. The amount of compression can be computed from the reading of a shaft-angle encoder that indicates the amount by which the spool has been turned. When the robot is ready to hop, the electromagnetic clutch disengages the motor from the spool, thus releasing the cable restraints on the springs and allowing the springs to extend all six legs simultaneously.

Younse, Paulo; Aghazarian, Hrand

2010-01-01

273

Micropenis: etiology, diagnosis and treatment approaches.  

PubMed

Micropenis is a medical diagnosis based on correct measurement of length. If stretched penile length is below the value corresponding to - 2.5 standard deviation of the mean in a patient with normal internal and external male genitalia, a diagnosis of micropenis is considered. Micropenis can be caused by a variety of factors including structural or hormonal defects of the hypothalamic-pituitary-gonadal axis. It can also be a component of a number of congenital syndromes. For the etiological evaluation, endocrinologic tests are important. This article reviews the etiology, diagnosis, treatment and management of micropenis. PMID:24379029

Hatipo?lu, Nihal; Kurto?lu, Selim

2013-01-01

274

Advantages and pitfalls of the polymerase chain reaction in the diagnosis of esophageal ulcers in AIDS patients.  

PubMed

HIV-1-infected patients frequently have opportunistic esophageal infections which, when associated with severe immunodeficiency, can be attributed to unusual pathogens. The clinical presentation of several esophageal diseases is similar and the best method for a specific diagnosis of these patients has not been well defined. To evaluate the role of the polymerase chain reaction (PCR) in the etiologic definition of esophageal ulcers in HIV-1-infected patients, 96 esophageal biopsies from 79 HIV-1-infected patients were processed by PCR using specific primers for cytomegalovirus (CMV), herpes virus (HSV), human papilloma virus (HPV), HIV-1, Mycobacterium tuberculosis, Mycobacterium avium, Mycobacterium intracellulare, Treponema pallidum, and Haemophilus ducreyi. The PCR results were compared to the histopathologic results. Seventy-nine patients were studied (mean age: 34 years; 62% men; median CD4 + T cell = 103.59 cells/microl (range 1-795.2 cells/microl). The most common endoscopic findings were as follows: esophageal candidiasis (37.1%), esophageal ulcers (24.7%), esophagitis (11.2%), and lugol-negative areas (10.1%). The histopathologic findings in the esophageal ulcers (22 biopsies) were non-specific inflammation (31.8%), HSV (36.4%), Candida (13.6%), CMV (13.6%), or HPV disease (4.5%). In the esophageal ulcer biopsies, the PCR results were negative in 27.6% of cases, and positive for HIV (65.5%), CMV (31%), HPV (20.7%), HSV (10.3%), and H. ducreyi (6.9%). The histopathologic examination did not identify a pathogen or identified only Candida in 15 biopsies of esophageal ulcers. PCR was positive in ten (66.7%) and negative in five (33.3%) of these biopsies (idiopathic ulcers). PCR detected: HIV (53.3%), CMV (20%), HPV (13.3%), and H. ducreyi (6,7%). PCR detected more etiologic agents in esophageal ulcers than histopathology and was able to detect unusual pathogens. On the other hand, sometimes more than one pathogen was detected in the esophageal ulcers, making it difficult to reach an accurate diagnosis. This finding indicates the need for more studies to evaluate the benefit of this method in the routine evaluation of esophageal ulcer biopsies in HIV-1-infected patients. PMID:19051024

Borges, Marcos Carvalho; Colares, Jeová Keny Baima; Lima, Danielle Malta; Fonseca, Benedito Antônio Lopes

2009-09-01

275

Potential Infectious Etiology of Behçet's Disease.  

PubMed

Behçet's disease is a multisystem inflammatory disorder characterized by recurrent oral aphthous ulcers, genital ulcers, uveitis, and skin lesions. The cause of Behçet's disease remains unknown, but epidemiologic findings suggest that an autoimmune process is triggered by an environmental agent in a genetically predisposed individual. An infectious agent could operate through molecular mimicry, and subsequently the disease could be perpetuated by an abnormal immune response to an autoantigen in the absence of ongoing infection. Potentia bacterial are Saccharomyces cerevisiae, mycobacteria, Borrelia burgdorferi, Helicobacter pylori, Escherichia coli, Staphylococcus aureus, and Mycoplasma fermentans, but the most commonly investigated microorganism is Streptococcus sanguinis. The relationship between streptococcal infections and Behçet's disease is suggested by clinical observations that an unhygienic oral condition is frequently noted in the oral cavity of Behçet's disease patients. Several viral agents, including herpes simplex virus-1, hepatitis C virus, parvovirus B19, cytomegalovirus, Epstein-Barr virus and varicella zoster virus, may also have some role. PMID:22254152

Galeone, Massimiliano; Colucci, Roberta; D'Erme, Angelo Massimiliano; Moretti, Silvia; Lotti, Torello

2012-01-01

276

Does a crouched leg posture enhance running stability and robustness?  

PubMed

Humans and birds both walk and run bipedally on compliant legs. However, differences in leg architecture may result in species-specific leg control strategies as indicated by the observed gait patterns. In this work, control strategies for stable running are derived based on a conceptual model and compared with experimental data on running humans and pheasants (Phasianus colchicus). From a model perspective, running with compliant legs can be represented by the planar spring mass model and stabilized by applying swing leg control. Here, linear adaptations of the three leg parameters, leg angle, leg length and leg stiffness during late swing phase are assumed. Experimentally observed kinematic control parameters (leg rotation and leg length change) of human and avian running are compared, and interpreted within the context of this model, with specific focus on stability and robustness characteristics. The results suggest differences in stability characteristics and applied control strategies of human and avian running, which may relate to differences in leg posture (straight leg posture in humans, and crouched leg posture in birds). It has been suggested that crouched leg postures may improve stability. However, as the system of control strategies is overdetermined, our model findings suggest that a crouched leg posture does not necessarily enhance running stability. The model also predicts different leg stiffness adaptation rates for human and avian running, and suggests that a crouched avian leg posture, which is capable of both leg shortening and lengthening, allows for stable running without adjusting leg stiffness. In contrast, in straight-legged human running, the preparation of the ground contact seems to be more critical, requiring leg stiffness adjustment to remain stable. Finally, analysis of a simple robustness measure, the normalized maximum drop, suggests that the crouched leg posture may provide greater robustness to changes in terrain height. PMID:21569779

Blum, Yvonne; Birn-Jeffery, Aleksandra; Daley, Monica A; Seyfarth, Andre

2011-07-21

277

Colonoscopic evaluation in ulcerative colitis  

PubMed Central

Colonoscopic evaluation is an important tool in the evaluation of ulcerative colitis (UC). UC is divided by disease extent into proctitis, proctosigmoiditis, left-sided colitis, and pan-colitis. In addition, a cecal or peri-appendiceal patch and backwash ileitis are associated with UC. The extent and behavior of UC has been characterized further using various indices and scoring systems; among these systems is the Mayo Score, which is widely used in current clinical trials for new medications. As these medical therapies for UC have developed, achieving mucosal healing with medications has become an important therapeutic objective. PMID:24879406

Paine, Elizabeth R.

2014-01-01

278

Refractory parastomal ulcers: a multidisciplinary approach.  

PubMed

Chronic parastomal ulcers in patients with ileostomy or colostomy stomas are unusual. Previous reports have implicated infections, fistulas, recurrent inflammatory bowel disease (IBD), pyoderma gangrenosum, and trauma. Over the past 8 years we have evaluated 10 cases of such refractory parastomal ulcers that occurred at a mean of 11 years after stomal surgery. Eight patients had had an ileostomy for IBD while two had undergone colostomy for colon cancer. Five patients with IBD were diagnosed as having pyoderma gangrenosum ulcerations. They required systemic treatment for a mean of 25 weeks to effect ulcer healing. The other five patients had either parastomal ulcers on the basis of dermatoses (contact dermatitis, eczema, or bullous pemphigoid) or contact ulcers due to face-plate pressure and parastomal dermatitis. These patients received topical treatment with healing of ulcers in a mean of 4 weeks. We conclude that parastomal ulcers occurring in patients without IBD or IBD patients without classic pyoderma gangrenosum require early dermatologic evaluation as they respond relatively quickly to appropriate local therapy. PMID:1979985

Wolfsen, H C; Brubacher, L L; Ng, C S; Kayne, A L; Kozarek, R A

1990-12-01

279

Pressure ulcers: Back to the basics  

PubMed Central

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

Agrawal, Karoon; Chauhan, Neha

2012-01-01

280

Attention Deficit Disorder: Diagnosis, Etiology and Treatment.  

ERIC Educational Resources Information Center

Provides most recent information on attention deficit disorder including: (1) diagnostic considerations according to the latest behavioral criteria and breakthroughs using neurometric EEG assessment; (2) prevalence; (3) etiologies; (4) neurological basis; and (5) treatments. Evaluates alternatives to medication, behavior modification, cognitive…

Barabasz, Marianne; Barabasz, Arreed

1996-01-01

281

Etiology and Management of Aflatoxin Contamination  

E-print Network

25 Etiology and Management of Aflatoxin Contamination Peter J. Cotty*, Claudia Probst and Ramon Jaime-Garcia Abstract Aflatoxins are potent poisons that contaminate crops in warm regions worldwide of aflatoxin-producing and closely related fungi. Among these are atoxigenic strains that produce no aflatoxins

Cotty, Peter J.

282

Polycystic ovary syndrome—diagnosis and etiology  

Microsoft Academic Search

Polycystic ovary syndrome (PCOS) is a heterogenous condition with signs and symptoms including menstrual dysfunction, weight disorders, hirsutism, acne, endometrial hyperplasia, diabetes mellitus, metabolic syndrome and hyperlipidemia. As such, diagnosis is controversial and differs between countries and communities. By consensus, recent definitions highlight ovarian morphology, hyperandrogenism and menstrual dysfunction. Etiology is undetermined and may include genetic and environmental aspects, including

R. J Norman; T Hickey; L Moran; J Boyle; J Wang; M Davies

2004-01-01

283

Etiology and treatment of homosexuality: A review  

Microsoft Academic Search

The major causal theories of and treatment approaches to male and female homosexuality are critically reviewed. Neither biological, psychoanalytic, nor learning and social-learning theories are found to provide convincing evidence for the etiology of homosexuality. All of these accounts, however, are viewed as providing mixed empirical support for their predictions, with social-learning research presenting the most consistent evidence. It is

Frank X. Acosta

1975-01-01

284

Future Directions in ADHD Etiology Research  

ERIC Educational Resources Information Center

Reviews salient emerging themes in the scientific literature related to identifying etiology and pathophysiology of ADHD. While bypassing the need for new treatment research, the review highlights three themes. First, recognition of the epigenetic effects is expected to revitalize the search for and mapping of early environmental influences on the…

Nigg, Joel T.

2012-01-01

285

Pulmonary fibrosis: pathogenesis, etiology and regulation  

Microsoft Academic Search

Pulmonary fibrosis and architectural remodeling of tissues can severely disrupt lung function, often with fatal consequences. The etiology of pulmonary fibrotic diseases is varied, with an array of triggers including allergens, chemicals, radiation and environmental particles. However, the cause of one of the most common pulmonary fibrotic conditions, idiopathic pulmonary fibrosis (IPF), is still unclear. This review examines common mechanisms

M S Wilson; T A Wynn

2009-01-01

286

Oropharyngeal Dysphagia: neurogenic etiology and manifestation.  

PubMed

To determine the type, severity and manifestation of dysphagia in patients with neurogenic etiology. Clinical documentation was done on the different etiologies, its manifestation, assessment findings and management strategies taken for patients with neurogenic oropharyngeal dysphagia who were referred for assessment and management of dysphagia over a period of three months in a tertiary care teaching hospital. Flexible endoscopic examination was done in all the patients. The severity of dysphagia in these patients were graded based on Gugging Swallowing Screen (GUSS). A total of 53 patients with neurogenic oropharyngeal dysphagia were evaluated by an otolaryngologist and a speech language pathologist over a period of three months. The grading of severity based on GUSS for these patients were done. There were 30 patients with recurrent laryngeal nerve injury due to various etiologies, one patient with Neurofibroma-vestibular schwanoma who underwent surgical excision, 16 patients with stroke, two patients with traumatic brain injury, two patients with Parkinsonism and two patients with myasthenia gravis. The manifestation of dysphagia was mainly in the form of prolonged masticatory time, oral transit time, and increased number of swallows required for each bolus, cricopharyngeal spasms and aspiration. Among the dysphagia patients with neurogenic etiology, dysphagia is manifested with a gradual onset and is found to have a progressive course in degenerative disorders. Morbidity and mortality may be reduced with early identification and management of neurogenic dysphagia. PMID:25621266

Sebastian, Swapna; Nair, Prem G; Thomas, Philip; Tyagi, Amit Kumar

2015-03-01

287

Recent Research on the Etiologies of Autism.  

ERIC Educational Resources Information Center

Reviews recent research on the etiologies of autism, including genetic research, anatomic and neuroimaging studies, topics in neurophysiology research (including serotonin, dopamine, and opiods), immunologic research, studies of autism phenotype, and electroencephalographic studies. It concludes that, as of yet, research has found no clear…

Fisher, Eileen; Van Dyke, Don C.; Sears, Lonnie; Matzen, Jane; Lin-Dyken, Deborah; McBrien, Dianne M.

1999-01-01

288

Etiology of inflammatory bowel disease: A unified hypothesis  

PubMed Central

Inflammatory bowel disease (IBD), including both ulcerative colitis (UC) and Crohn’s disease (CD), emerged and dramatically increased for about a century. Despite extensive research, its cause remains regarded as unknown. About a decade ago, a series of findings made me suspect that saccharin may be a key causative factor for IBD, through its inhibition on gut bacteria and the resultant impaired inactivation of digestive proteases and over digestion of the mucus layer and gut barrier (the Bacteria-Protease-Mucus-Barrier hypothesis). It explained many puzzles in IBD such as its emergence and temporal changes in last century. Recently I further found evidence suggesting sucralose may be also linked to IBD through a similar mechanism as saccharin and have contributed to the recent worldwide increase of IBD. This new hypothesis suggests that UC and CD are just two symptoms of the same morbidity, rather than two different diseases. They are both caused by a weakening in gut barrier and only differ in that UC is mainly due to increased infiltration of gut bacteria and the resultant recruitment of neutrophils and formation of crypt abscess, while CD is mainly due to increased infiltration of antigens and particles from gut lumen and the resultant recruitment of macrophages and formation of granulomas. It explained the delayed appearance but accelerated increase of CD over UC and many other phenomena. This paper aims to provide a detailed description of a unified hypothesis regarding the etiology of IBD, including the cause and mechanism of IBD, as well as the relationship between UC and CD. PMID:22553395

Qin, Xiaofa

2012-01-01

289

Dragstedt, gastric acid and duodenal ulcer.  

PubMed Central

Dragstedt believed that basal hypersecretion of gastric acid was the root cause of duodenal ulcer, that the hypersecretion was due to an increased vagal stimulation, and that vagotomy would therefore cure duodenal ulcer. He introduced vagotomy and demonstrated that the operation was successful in curing most patients of their duodenal ulcers. This article reviews how further research in the succeeding half century has demonstrated that it is the effect of vagotomy on stimulated, rather than upon basal secretion that cures duodenal ulcer and that the apparent basal hypersecretion of patients with duodenal ulcer is due to an increased parietal cell mass. The article points out that there is no convincing explanation as yet of the mechanism whereby vagotomy reduces histamine-stimulated gastric secretion. PMID:7502527

Hobsley, M.

1994-01-01

290

Current and Emerging Biologics for Ulcerative Colitis  

PubMed Central

Conventional medical treatment for ulcerative colitis can have limited efficacy or severe adverse reactions requiring additional treatment or colectomy. Hence, different biological agents that target specific immunological pathways are being investigated for treating ulcerative colitis. Anti-tumor necrosis factor (TNF) agents were the first biologics to be used for treating inflammatory bowel disease. For example, infliximab and adalimumab, which are anti-TNF agents, are being used for treating ulcerative colitis. Recently, golimumab, another anti-TNF agent, and vedolizumab, an anti-adhesion therapy, have been approved for ulcerative colitis by the U.S. Food and Drug Administration. In addition, new medications such as tofacitinib, a Janus kinase inhibitor, and etrolizumab, another anti-adhesion therapy, are emerging as therapeutic agents. Therefore, there is a need for further studies to select appropriate patient groups for these biologics and to improve the outcomes of ulcerative colitis treatment through appropriate medical usage. PMID:25547087

Park, Sung Chul; Jeen, Yoon Tae

2015-01-01

291

Fecal lactate and ulcerative colitis.  

PubMed

Impaired metabolism of short-chain fatty acids, as well as a modified fecal ionogram, have been reported in ulcerative colitis. Fecal water samples from 62 patients with ulcerative colitis were analyzed in the present investigation to evaluate changes in SCFAs and lactic acid in relation to activity and severity of disease. Short-chain fatty acid levels were high in quiescent and mild disease (162.6 +/- 63.6 and 147.8 +/- 63.2 mM/L, respectively), but significantly decreased in the severe form (64.7 +/- 46.9 mM/L). Lactate showed a progressive increase from mild colitis (3.0 +/- 1.8 mM/L) to severe colitis (21.4 +/- 18.6 mM/L). It thus appears that mild colitis displayed a fecal pattern characterized by normal pH and bicarbonate, slightly impaired electrolyte handling, high short-chain fatty acid values, and only moderately increased lactate. Severe colitis, on the other hand, was characterized by low fecal pH, bicarbonate, and potassium, high sodium and chloride, low short-chain fatty acid levels, and very high lactate levels. A critical lowering of intraluminal pH, which shifts bacterial metabolism from short-chain fatty acid to lactate production, may be responsible for the intraluminal pooling of lactate. PMID:3181680

Vernia, P; Caprilli, R; Latella, G; Barbetti, F; Magliocca, F M; Cittadini, M

1988-12-01

292

Innervation of recurrent aphthous ulcers.  

PubMed

Specimens from nonkeratinized oral mucosa were obtained from diseased and clinically healthy mucosa from 7 patients with minor recurrent aphthous ulcers. The innervation of the specimens was visualized using antibodies to neuron-specific intermediate cytoskeletal neurofilament fiber, the cytoplasmic protein gene product 9.5 and a 38 kDa integral membrane protein of synaptic vesicles applied in avidin-biotin-peroxidase staining. Mapping with these 3 antibodies revealed dense and basically similar pattern of innervation in the specimens of the clinically healthy oral mucosa. In recurrent aphthous ulcers, all 3 general markers disclosed peripheral nerve fibers also in the lesions, apart from the necrotic area, among the inflammatory cells without signs of retraction from the diseased area. Synaptophysin staining suggested that these peripheral nerve fibers in the inflammatory areas still contained synaptic vesicles. Accordingly, they were shown to contain substance P and calcitonin gene-related peptide, which are known to be released upon stimulation of the nerve and can exert potent paracrine actions, possibly on the local inflammatory cells as suggested by a close spatial relationship between neuropeptide-containing nerves and inflammatory cells. PMID:7478757

Konttinen, Y T; Hayrinen-Immonen, R H; Nordstrom, D; Malmstrom, M J; Hukkanen, M; Sorsa, T; Polak, J

1994-02-01

293

Ulcerative colitis in Asian immigrants.  

PubMed Central

Forty-four Asian immigrants in Birmingham and 44 age- and sex-matched white Caucasians with ulcerative colitis were compared to investigate the existence of any ethnic differences in the pattern of disease. Asian immigrants demonstrated a male preponderance of 2:1, and compared to the matched Caucasians there was a higher incidence of presenting eosinophilia and a milder course of disease, with more patients experiencing only a single initial attack. In spite of this clinical difference, total or subtotal colitis was the commonest pathological type in both white Caucasians and Indians, whereas in Pakistanis localized distal disease predominated. All ethnic groups suffered the same overall complication rate (55%) which is at variance with the experience of low complication rates in India. The age of onset of ulcerative colitis was related to age at immigration with a mean interval of 11 years. Although in some respects Asian immigrants share the disease pattern of the indigenous population, the observed significant differences could be of importance with regard to pathogenesis. PMID:3422862

Benfield, G. F.; Montgomery, R. D.; Asquith, P.

1987-01-01

294

Skin ulcers in estuarine fishes: a comparative pathological evaluation of wild and laboratory-exposed fish.  

PubMed Central

The toxic dinoflagellate Pfiesteria piscicida Steidinger & Burkholder has recently been implicated as the etiologic agent of acute mass mortalities and skin ulcers in menhaden, Brevoortia tyrannus, and other fishes from mid-Atlantic U.S. estuaries. However, evidence for this association is largely circumstantial and controversial. We exposed tilapia (Oreochromis spp.) to Pfiesteria shumwayae Glasgow & Burkholder (identification based on scanning electron microscopy and molecular analyses) and compared the resulting pathology to the so-called Pfiesteria-specific lesions occurring in wild menhaden. The tilapia challenged by high concentrations (2,000-12,000 cells/mL) of P. shumwayaeexhibited loss of mucus coat and scales plus mild petecchial hemorrhage, but no deeply penetrating chronic ulcers like those in wild menhaden. Histologically, fish exhibited epidermal erosion with bacterial colonization but minimal associated inflammation. In moribund fish, loss of epidermis was widespread over large portions of the body. Similar erosion occurred in the mucosa lining the oral and branchial cavities. Gills exhibited epithelial lifting, loss of secondary lamellar structure, and infiltration by lymphoid cells. Epithelial lining of the lateral line canal (LLC) and olfactory organs exhibited severe necrosis. Visceral organs, kidney, and neural tissues (brain, spinal cord, ganglia, peripheral nerves) were histologically normal. An unexpected finding was the numerous P. shumwayae cells adhering to damaged skin, skin folds, scale pockets, LLC, and olfactory tissues. In contrast, histologic evaluation of skin ulcers in over 200 wild menhaden from Virginia and Maryland portions of the Chesapeake Bay and the Pamlico Estuary, North Carolina, revealed that all ulcers harbored a deeply invasive, highly pathogenic fungus now known to be Aphanomyces invadans. In menhaden the infection always elicited severe myonecrosis and intense granulomatous myositis. The consistent occurrence of this fungus and the nature and severity of the resulting inflammatory response indicate that these ulcers are chronic (age >1 week) and of an infectious etiology, not the direct result of an acute toxicosis initiated by Pfiesteria toxin(s) as recently hypothesized. The disease therefore is best called ulcerative mycosis (UM). This study indicates that the pathology of Pfiesteria laboratory exposure is fundamentally different from that of UM in menhaden; however, we cannot rule out Pfiesteria as one of many possible early initiators predisposing wild fishes to fungal infection in some circumstances. PMID:11677176

Vogelbein, W K; Shields, J D; Haas, L W; Reece, K S; Zwerner, D E

2001-01-01

295

Skin ulcers in estuarine fishes: a comparative pathological evaluation of wild and laboratory-exposed fish.  

PubMed

The toxic dinoflagellate Pfiesteria piscicida Steidinger & Burkholder has recently been implicated as the etiologic agent of acute mass mortalities and skin ulcers in menhaden, Brevoortia tyrannus, and other fishes from mid-Atlantic U.S. estuaries. However, evidence for this association is largely circumstantial and controversial. We exposed tilapia (Oreochromis spp.) to Pfiesteria shumwayae Glasgow & Burkholder (identification based on scanning electron microscopy and molecular analyses) and compared the resulting pathology to the so-called Pfiesteria-specific lesions occurring in wild menhaden. The tilapia challenged by high concentrations (2,000-12,000 cells/mL) of P. shumwayaeexhibited loss of mucus coat and scales plus mild petecchial hemorrhage, but no deeply penetrating chronic ulcers like those in wild menhaden. Histologically, fish exhibited epidermal erosion with bacterial colonization but minimal associated inflammation. In moribund fish, loss of epidermis was widespread over large portions of the body. Similar erosion occurred in the mucosa lining the oral and branchial cavities. Gills exhibited epithelial lifting, loss of secondary lamellar structure, and infiltration by lymphoid cells. Epithelial lining of the lateral line canal (LLC) and olfactory organs exhibited severe necrosis. Visceral organs, kidney, and neural tissues (brain, spinal cord, ganglia, peripheral nerves) were histologically normal. An unexpected finding was the numerous P. shumwayae cells adhering to damaged skin, skin folds, scale pockets, LLC, and olfactory tissues. In contrast, histologic evaluation of skin ulcers in over 200 wild menhaden from Virginia and Maryland portions of the Chesapeake Bay and the Pamlico Estuary, North Carolina, revealed that all ulcers harbored a deeply invasive, highly pathogenic fungus now known to be Aphanomyces invadans. In menhaden the infection always elicited severe myonecrosis and intense granulomatous myositis. The consistent occurrence of this fungus and the nature and severity of the resulting inflammatory response indicate that these ulcers are chronic (age >1 week) and of an infectious etiology, not the direct result of an acute toxicosis initiated by Pfiesteria toxin(s) as recently hypothesized. The disease therefore is best called ulcerative mycosis (UM). This study indicates that the pathology of Pfiesteria laboratory exposure is fundamentally different from that of UM in menhaden; however, we cannot rule out Pfiesteria as one of many possible early initiators predisposing wild fishes to fungal infection in some circumstances. PMID:11677176

Vogelbein, W K; Shields, J D; Haas, L W; Reece, K S; Zwerner, D E

2001-10-01

296

Restless Legs Syndrome -- Causes and Symptoms  

MedlinePLUS

... health issues or medication. This may include: Low iron levels This can cause problems with brain cell ... you have restless legs syndrome caused by low iron, talk with your physician and do not attempt ...

297

An Endangered Yellow-Legged Frog  

USGS Multimedia Gallery

USGS biologists are leading the monitoring and reintroduction effort of the Southern California mountain yellow-legged frog -- federally listed as endangered with only 200 wild adults remaining in the mountains surrounding Los Angeles County....

298

OCEAN DRILLING PROGRAM LEG 194 SCIENTIFIC PROSPECTUS  

E-print Network

K. Graber and Lori J. Cagle #12;Leg 194 Scientific Prospectus Page 3 ABSTRACT Cretaceous rifting in the western Coral Sea (offshore northeast Australia) formed continental fragments that are now capped

299

X-Ray Exam: Femur (Upper Leg)  

MedlinePLUS

KidsHealth > Parents > Doctors & Hospitals > Medical Tests & Exams > X-Ray Exam: Femur (Upper Leg) Print A A A Text Size What's in this article? What It Is Why It's Done Preparation Procedure What ...

300

OCEAN DRILLING PROGRAM LEG 102 SCIENTIFIC PROSPECTUS  

E-print Network

OCEAN DRILLING PROGRAM LEG 102 SCIENTIFIC PROSPECTUS DOWNHOLE MEASUREMENTS IN THE WESTERN ATLANTIC will depart Miami, Florida on March 19, and steam to Site 418 to conduct downhole geophysical studies

301

Assessing Sites for Yellow Legged Frog  

USGS Multimedia Gallery

Assessing suitable sites in southern California for reintroducing endangered southern mountain yellow-legged frogs, USGS scientists rediscovered a population in the San Jacinto Wilderness, 50 years since this frog was last seen there....

2009-07-23

302

Ipsilateral leg weakness associated with carotid stenosis.  

PubMed

Ipsilateral motor or sensory symptoms associated with carotid occlusive diseases are rare. We report a 52-year-old man who presented with aphasia, right hemiparesis, mild left leg weakness, and bilateral Babinski's signs. During the previous 10 days, he had experienced three episodes of left leg numbness and incoordination that occurred either alone or in association with right arm and leg weakness. Computed tomography showed infarcts in the right frontoparietal (parasagittal), left frontal, and left parietal lobes. Cerebral angiography revealed 60% stenosis of the right internal carotid artery, 80% stenosis of the left internal carotid artery, absence of the A1 segment of the right anterior cerebral artery, filling of the right anterior cerebral artery from the left carotid circulation only, and a normal vertebrobasilar system. This report illustrates that leg weakness may occur ipsilateral to carotid disease if the contralateral anterior cerebral artery is supplied by the ipsilateral carotid artery. PMID:2396275

Chimowitz, M I; Lafranchise, E F; Furlan, A J; Awad, I A

1990-09-01

303

Passive zero-gravity leg restraint  

NASA Technical Reports Server (NTRS)

A passive zero or microgravity leg restraint is described which includes a central support post with a top and a bottom. Extending from the central support post are a calf pad tab, to which calf pad is attached, and a foot pad tab, to which foot tab is attached. Also extending from central support post are knee pads. When the restraint is in use the user's legs are forced between pads by a user imposed scissors action of the legs. The user's body is then supported in a zero or microgravity neutral body posture by the leg restraint. The calf pad has semi-ridig elastic padding material covering structural stiffener. The foot pad has padding material and a structural stiffener. Knee pads have s structural tube stiffener at their core.

Miller, Christopher R. (inventor)

1989-01-01

304

Static Stability of Tension Leg Platforms  

E-print Network

The static stability of a Tension Leg Platform (TLP) with an intact tendon system is principally provided by its tendons and hence quite different from those of a conventional ship or even a floating structure positioned by its mooring system...

Xu, Ning

2010-07-14

305

LEG EXTENSION IS AN IMPORTANT PREDICTOR OF PARETIC LEG PROPULSION IN HEMIPARETIC WALKING  

PubMed Central

Forward propulsion is a central task of walking that depends on the generation of appropriate anterior-posterior ground reaction forces (AP GRFs). The AP impulse (i.e., time integral of the AP GRF) generated by the paretic relative to non-paretic leg is a quantitative measure of the paretic leg’s contribution to forward propulsion and is variable across hemiparetic subjects. The purpose of this study was to investigate the underlying mechanisms of propulsion generation in hemiparetic walking by identifying the biomechanical predictors of AP impulses. Three-dimensional kinematics and GRFs were recorded from 51 hemiparetic and 21 age-matched control subjects walking at similar speeds on an instrumented treadmill. Hierarchical regression models were generated for each leg to predict the AP impulse from independent biomechanical variables. Leg extension was a significant predictor and positively related to the propulsive impulse in the paretic, non-paretic and control legs. Secondarily, the hip flexor impulse was negatively related to the propulsive impulse. Also, the relationship of paretic and non-paretic ankle moments with the propulsive impulse depended on the paretic step ratio, suggesting the plantar flexor contribution to the propulsive impulse depends on leg angle. These results suggest that increasing paretic leg extension will increase propulsion. Increasing paretic leg plantar flexor output and decreasing paretic leg hip flexor output could also increase paretic leg propulsion. While increased pre-swing hip flexor output has been suggested to compensate for decreased plantar flexor output, such output may further impair propulsion by the paretic leg if it occurs too soon in the gait cycle. PMID:20656492

Peterson, Carrie L.; Cheng, Jing; Kautz, Steven A.; Neptune, Richard R.

2010-01-01

306

Microgravity, Mesh-Crawling Legged Robots  

NASA Technical Reports Server (NTRS)

The design, fabrication, and microgravity flight-testing are part of a continuing development of palm-sized mobile robots that resemble spiders (except that they have six legs apiece, whereas a spider has eight legs). Denoted SpiderBots (see figure), they are prototypes of proposed product line of relatively inexpensive walking robots that could be deployed in large numbers to function cooperatively in construction, repair, exploration, search, and rescue activities in connection with exploration of outer space and remote planets.

Behar, Alberto; Marzwell, Neville; Matthews, Jaret; Richardson, Krandalyn; Wall, Jonathan; Poole, Michael; Foor, David; Rodgers, Damian

2008-01-01

307

Ulcers  

MedlinePLUS

... gets through to the sensitive tissues lining the digestive system underneath. Acid and bacteria directly irritate this lining ... to other problems, such as bleeding in the digestive system or a hole in the wall of the ...

308

Passive legged, multi-segmented, robotic vehicle.  

SciTech Connect

The Passive-legged, Multi-segmented, Robotic Vehicle concept is a simple legged vehicle that is modular and scaleable, and can be sized to fit through confined areas that are slightly larger than the size of the vehicle. A specific goal of this project was to be able to fit through the opening in the fabric of a chain link fence. This terrain agile robotic platform will be composed of multiple segments that are each equipped with appendages (legs) that resemble oars extending from a boat. Motion is achieved by pushing with these legs that can also flex to fold next to the body when passing through a constricted area. Each segment is attached to another segment using an actuated joint. This joint represents the only actuation required for mobility. The major feature of this type of mobility is that the terrain agility advantage of legs can be attained without the complexity of the multiple-actuation normally required for the many joints of an active leg. The minimum number of segments is two, but some concepts require three or more segments. This report discusses several concepts for achieving this type of mobility, their design, and the results obtained for each.

Hayward, David R.

2003-11-01

309

THE EFFECT OF AGE ON VETERAN ATHLETES LEG ELASTICITY  

Microsoft Academic Search

INTRODUCTION: Farley & Morgenroth (1999) studied contributions to leg elasticity during maximal and sub maximal vertical jumping in a young population. Using a computer model for leg elasticity they found that ankle joint stiffness was the main contibutor to leg elasticity and showed that it was directly proportional to overall leg stiffness. The aim of this study was to track

Ceri Diss; David Kerwin

2006-01-01

310

Diabetic foot ulcers. Pathophysiology, assessment, and therapy.  

PubMed Central

OBJECTIVE: To review underlying causes of diabetic foot ulceration, provide a practical assessment of patients at risk, and outline an evidence-based approach to therapy for diabetic patients with foot ulcers. QUALITY OF EVIDENCE: A MEDLINE search was conducted for the period from 1979 to 1999 for articles relating to diabetic foot ulcers. Most studies found were case series or small controlled trials. MAIN MESSAGE: Foot ulcers in diabetic patients are common and frequently lead to lower limb amputation unless a prompt, rational, multidisciplinary approach to therapy is taken. Factors that affect development and healing of diabetic patients' foot ulcers include the degree of metabolic control, the presence of ischemia or infection, and continuing trauma to feet from excessive plantar pressure or poorly fitting shoes. Appropriate wound care for diabetic patients addresses these issues and provides optimal local ulcer therapy with débridement of necrotic tissue and provision of a moist wound-healing environment. Therapies that have no known therapeutic value, such as foot soaking and topical antiseptics, can actually be harmful and should be avoided. CONCLUSION: Family physicians are often primary medical contacts for patients with diabetes. Patients should be screened regularly for diabetic foot complications, and preventive measures should be initiated for those at risk of ulceration. PMID:11398715

Bowering, C. K.

2001-01-01

311

Corneal ulceration following measles in Nigerian children.  

PubMed Central

Acute corneal ulceration in malnourished children is the commonest cause of childhood blindness in Northern Nigeria and usually develops after measles. Other severe diseases in malnourished children rarely precipitate corneal ulceration. A survey in a school for blind children showed that 69% of the children were blind from corneal disease, and a survey of children with corneal scars showed that at least 42% were caused by ulceration after measles. The clinical appearance of the active ulcers was very varied. The serum retinol-binding protein and prealbumin levels in children with corneal ulcers following measles were below normal, but a group of malnourished children without eye complaints following measles were found to have even lower levels. Thus a specific deficiency of vitamin A does not appear to be the primary cause of these ulcers, though it may be a contributory one. A specific measles keratitis and secondary herpes simplex infectious may be local factors contributing to this ulceration, and there is nearly always a background of protein calorie malnutrition. Racial factors may also be of some significance. PMID:508686

Sandford-Smith, J H; Whittle, H C

1979-01-01

312

Future Directions in ADHD Etiology Research  

PubMed Central

Reviews salient emerging themes in the scientific literature related to identifying etiology and pathophysiology of ADHD. While bypassing the need for new treatment research, the review highlights three themes. First, recognition of the epigenetic effects is expected to revitalize the search for and mapping of early environmental influences on the development of ADHD. Second, neurobiological findings will have limited impact if not examined in the context of significant race and cultural variation in ADHD-related developmental processes, and in the context of rapidly changing social and technological contexts of children’s development worldwide. Third, further examination of the phenotype and characterization of its dimensional and categorical structure remains a major need. Overall, the coming decades of etiology research on ADHD will be expected to capitalize on new scientific tools. The hope in the field is that new insights into fundamental prevention can emerge. PMID:22642834

Nigg, Joel T.

2015-01-01

313

Facial Dysostoses: Etiology, Pathogenesis and Management  

PubMed Central

Approximately 1% of all live births exhibit a minor or major congenital anomaly. Of these approximately one-third display craniofacial abnormalities which are a significant cause of infant mortality and dramatically affect national health care budgets. To date, more than 700 distinct craniofacial syndromes have been described and in this review, we discuss the etiology, pathogenesis and management of facial dysostoses with a particular emphasis on Treacher Collins, Nager and Miller syndromes. As we continue to develop and improve medical and surgical care for the management of individual conditions, it is essential at the same time to better characterize their etiology and pathogenesis. Here we describe recent advances in our understanding of the development of facial dysostosis with a view towards early in-utero identification and intervention which could minimize the manifestation of anomalies prior to birth. The ultimate management for any craniofacial anomaly however, would be prevention and we discuss this possibility in relation to facial dysostosis. PMID:24123981

Trainor, Paul A.; Andrews, Brian T.

2013-01-01

314

The etiology of peripheral lymphadenopathy in children.  

PubMed

This prospective study evaluated 382 pediatric patients with peripheral lymphadenopathy (LA) presenting at the Pediatric Oncology and Hematology Departments of Social Security Children's Hospital and Gazi University Medical Faculty Hospital. The ages of the patients ranged between 2 months and 16 years (median 7 years); 72% of the patients were male. Of the 382 patients, 138 had localized LA (a single anatomic area involved), 171 had limited LA (two or three areas involved), and 73 had generalized LA (four or more anatomic areas involved). The specific etiology (either benign or malign) was defined in 79% of patients with generalized LA. However, in patients with localized LA and limited LA, specific etiology could be identified only in 43 and 53% of patients, respectively. Based on this study, BCG-LA and pyogenic infections are more frequently manifested by localized LA; LA of unknown origin, Hodgkin's disease, tuberculosis, nasopharyngeal carcinoma, and toxoplasmosis are frequently manifested by localized or limited LA; and cytomegalovirus infection (CMV), infectious mononucleous, rubella, acute leukemia, non-Hodgkin's lymphoma are frequently manifested by limited or generalized LA. Out of 382 patients, 196 patients had a maximum lymph node diameter of less than 2 cm. A benign etiology was shown in 159/196 of these patients. In 37/196 of these patients LA was due to a malignancy, and these cases almost invariably had some apparent additional diagnostic clinical and laboratory findings. Based on this observation a maximum lymph node size of 2 cm was considered an appropriate limit to distinguish malignant disease from benign causes except when there is other evidence of an underlying malignant disease. However, lymphadenopathies located at supraclavicular region (27 patients) either localized or as part of generalized LA had a specific benign or malignant disease in etiology (malignancy in 20, tuberculosis in 3, CMV in 2, sarcoidosis in 1, and lipoma in 1) even though they were less than 2 cm in diameter. PMID:10599092

Karadeniz, C; Oguz, A; Ezer, U; Oztürk, G; Dursun, A

1999-01-01

315

Methemoglobinemia: Etiology, Pharmacology, and Clinical Management  

Microsoft Academic Search

Methemoglobin (MHb) may arise from a variety of etiologies including genetic, dietary, idiopathic, and toxicologic sources. Symptoms vary from mild headache to coma\\/death and may not correlate with measured MHb concentrations. Toxin-induced MHb may be complicated by the drug’s effect on other organ systems such as the liver or lungs. The existence of underlying heart, lung, or blood disease may

Robert O Wright; William J Lewander; Alan D Woolf

1999-01-01

316

Actinomyces odontolyticus: Rare Etiology for Purulent Pericarditis  

PubMed Central

Purulent pericarditis is one of the most common causes of cardiac tamponade and if left untreated has a mortality of 100%. Staphylococcus aureus and Streptococcus pneumonia have been implicated as the main etiology of purulent pericardial effusion followed by fungi and anaerobic sources. Actinomyces odontolyticus pericardial involvement has been reported in the literature only once. To our knowledge, this is the first fatal case of A. odontolyticus purulent pericarditis in the absence of periodontal disease.

Mack, Ryan; Slicker, Kipp; Ghamande, Shekhar; Surani, Salim R.

2014-01-01

317

The Etiology of Osteoarthritis of the Hip  

Microsoft Academic Search

The etiology of osteoarthritis of the hip has long been considered secondary (eg, to congenital or developmental deformities)\\u000a or primary (presuming some underlying abnormality of articular cartilage). Recent information supports a hypothesis that so-called\\u000a primary osteoarthritis is also secondary to subtle developmental abnormalities and the mechanism in these cases is femoroacetabular\\u000a impingement rather than excessive contact stress. The most frequent

Reinhold Ganz; Michael Leunig; Katharina Leunig-Ganz; William H. Harris

2008-01-01

318

[Preterm birth--incidence and etiology].  

PubMed

Preterm birth is a major societal and economic problem. To him is accounting for 80 to 90% of neonatal morbidity and mortality worldwide. It is recognized as a complex multifactorial condition with different underlying etiologies. Paramount in the prevention of preterm birth is physician education regarding known risk factors, signs and symptoms of preterm labor and the role of close follow-up in the patients identified as high risk. PMID:24294755

Karamisheva, V; Ivanov, S; Nachev, A; Marinov, B; Jordanova, D; Basheva, S

2013-01-01

319

Etiology and treatment of postpartum depression  

Microsoft Academic Search

This article reviews the risk factors, pathogenesis, treatment, and prevention of postpartum depression. Postpartum depression\\u000a is common and occurs in up to 18% of newly delivered mothers. Though the hormonal changes occurring after childbirth are believed\\u000a to play a role in postpartum depression, no hormonal etiology has been identified. Estrogen appears somewhat helpful for postpartum\\u000a depression, but its use is

Deborah Lynne Flores; Victoria C. Hendrick

2002-01-01

320

Interstitial cystitis. Etiology, diagnosis, and treatment.  

PubMed Central

OBJECTIVE: To review current knowledge about the epidemiology, etiology, diagnosis, and treatment of interstitial cystitis, with special emphasis on management of this condition by family physicians. QUALITY OF EVIDENCE: Articles were identified through MEDLINE and review of abstracts presented at Urology and Interstitial Cystitis meetings during the last decade. Recent reviews were further searched for additional studies and trials. Data were summarized from large epidemiologic studies. Etiologic theories were extracted from current concepts and reviews of scientific studies. Diagnostic criteria described in this review are based on clinical interpretation of National Institutes of Health (NIH) research guidelines, interpretation of data from the NIH Interstitial Cystitis Cohort Study, and recent evidence on use of the potassium sensitivity test. Treatment suggestions are based on six randomized placebo-controlled clinical treatment trials and best available clinical data. MAIN MESSAGE: Interstitial cystitis affects about 0.01% to 0.5% of women. Its etiology is unknown, but might involve microbiologic, immunologic, mucosal, neurogenic, and other yet undefined agents. The diagnosis of interstitial cystitis is a diagnosis of exclusion. It is impossible to provide a purely evidence-based treatment strategy, but review of available evidence suggests that conservative supportive therapy (including diet modification); oral treatment with pentosan polysulfate, amitriptyline, or hydroxyzine; and intravesical treatments with heparinlike medications, dimethyl sulfoxide, or BCG vaccine could benefit some patients. CONCLUSION: Family physicians should have an understanding of interstitial cystitis and be able to make a diagnosis and formulate an evidence-based treatment strategy for their patients. PMID:11153410

Nickel, J. C.

2000-01-01

321

Diabetic foot ulcers: Part II. Management.  

PubMed

The management of diabetic foot ulcers can be optimized by using an interdisciplinary team approach addressing the correctable risk factors (ie, poor vascular supply, infection control and treatment, and plantar pressure redistribution) along with optimizing local wound care. Dermatologists can initiate diabetic foot care. The first step is recognizing that a loss of skin integrity (ie, a callus, blister, or ulcer) considerably increases the risk of preventable amputations. A holistic approach to wound assessment is required. Early detection and effective management of these ulcers can reduce complications, including preventable amputations and possible mortality. PMID:24355276

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

2014-01-01

322

Peripheral ulcerative keratitis in association with sarcoidosis.  

PubMed

Peripheral ulcerative keratitis (PUK) is a sight-threatening condition characterized by an epithelial defect, crescent-shaped stromal inflammation, and progressive stromal thinning. Peripheral ulcerative keratitis as a purely inflammatory entity is most commonly associated with collagen vascular diseases, including rheumatoid arthritis, polyarteritis nodosa, Wegener granulomatosis, systemic lupus erythematosus, and relapsing polychondritis. PUK can also be associated with infectious and inflammatory conditions such as hepatitis, syphilis, herpes simplex keratitis, fungal keratitis, Mooren ulcer, and marginal keratitis. We describe a case report of PUK associated with the inflammatory condition of sarcoidosis. PMID:23993305

Harthan, Jennifer S; Reeder, Renée E

2013-12-01

323

Anti-ulcer activity of Lucer against experimentally induced gastric ulcers in rats  

PubMed Central

The present study is designed to explore the mechanism of action of herbal formulation Lucer against experimentally induced gastric ulcers. The aqueous extract (120 and 180 mg/kg) of Lucer was tested against aspirin and ethanol-induced gastric ulcer model in rats. The drug has been found to be very effective in inhibiting gastric ulceration. This is evident from reduction in ulcer index parameters. Besides, significant reduction in acid secretory parameters such as total acidity, total acid output and volume of gastric secretion were also observed. It is concluded from this study that the drug possesses anti-ulcer activity in both the models. The anti-ulcer activity of the drug can be attributed to inhibition of acid secretary parameters and strengthening of gastric mucosal barrier. PMID:23559812

Shah, Jigna S.; Patel, Jetun R.

2012-01-01

324

Pressure ulcers: Development and psychometric evaluation of the Attitude towards Pressure ulcer Prevention instrument (APuP)  

Microsoft Academic Search

BackgroundPressure ulcers continue to be a significant problem in hospitals, nursing homes and community care settings. Pressure ulcer incidence is widely accepted as an indicator for the quality of care. Negative attitudes towards pressure ulcer prevention may result in suboptimal preventive care. A reliable and valid instrument to assess attitudes towards pressure ulcer prevention is lacking.

D. Beeckman; T. Defloor; L. Demarré; A. Van Hecke; K. Vanderwee

2010-01-01

325

Changes in leg volume during microgravity simulation  

NASA Technical Reports Server (NTRS)

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.

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

1992-01-01

326

Helicobacter pylori and Ulcers: A Paradigm Revised  

NSDL National Science Digital Library

FASEB Breakthroughs in Bioscience article. The story of the serendipitous discovery of the link between Helicobacter pylori and stomach ulcers. This story includes how this finding was applied to epidemiology, cancer research, and drug development.

PhD Nancy A. Lynch (University of Iowa College of Medicine)

2010-07-12

327

Peptic Ulcer Disease and H. pylori  

MedlinePLUS

... pain from a peptic ulcer is gone. Proton Pump Inhibitors Proton pump inhibitors are medications that reduce stomach acid, help ... suppress acid production by halting the mechanism that pumps acid into the stomach and can include • omeprazole ( ...

328

Tannins, Peptic Ulcers and Related Mechanisms  

PubMed Central

This review of the current literature aims to study correlations between the chemical structure and gastric anti-ulcer activity of tannins. Tannins are used in medicine primarily because of their astringent properties. These properties are due to the fact that tannins react with the tissue proteins with which they come into contact. In gastric ulcers, this tannin-protein complex layer protects the stomach by promoting greater resistance to chemical and mechanical injury or irritation. Moreover, in several experimental models of gastric ulcer, tannins have been shown to present antioxidant activity, promote tissue repair, exhibit anti Helicobacter pylori effects, and they are involved in gastrointestinal tract anti-inflammatory processes. The presence of tannins explains the anti-ulcer effects of many natural products. PMID:22489149

de Jesus, Neyres Zinia Taveira; de Souza Falcão, Heloina; Gomes, Isis Fernandes; de Almeida Leite, Thiago Jose; de Morais Lima, Gedson Rodrigues; Barbosa-Filho, Jose Maria; Tavares, Josean Fechine; da Silva, Marcelo Sobral; de Athayde-Filho, Petrônio Filgueiras; Batista, Leonia Maria

2012-01-01

329

Cutaneous leishmaniasis "chiclero's ulcer" in subtropical Ecuador.  

PubMed

An 18-year-old female presented with a severe ulcerative lesion on her right ear of 6 weeks duration. Her right ear was edematous and erythematous with a large, painless ulcerative lesion covering a third of the pinna and satellite papular lesions on the posterior. She was diagnosed with chiclero's ulcer. A skin smear stained with Diff-quik showed abundant Leishmania parasites. Chiclero's ulcer is a rare clinical presentation and is typically severe and difficult to treat. Physicians in Ecuador recommend administering prolonged intramuscular Glucantime. Side effects are common and can be severe resulting in low patient compliance. Because of preferences of the patient and the large volume needed for her weight, we recommended topical treatment with a lotion of Glucantime mixed half and half with white Merthiolate. After applying this lotion to the lesion 3 to 4 times a day for 6 weeks, the lesion healed. PMID:23926136

Calvopiña, Manuel; Martinez, Leonardo; Hashiguchi, Yoshihisa

2013-08-01

330

[Cycloferon in treating duodenal ulcers in rats].  

PubMed

The possibility of using cycloferon (interferon inductor) for a complex treatment (in combination with the main drug solcoseryl possessing pronounced therapeutic properties) of duodenum ulcers was experimentally studied in male rats. The experiments showed a considerable difference in the interferon status of animals with model duodenum ulcers treated with cycloferon, solcoseryl, their combination, and placebo (control). The healing effect of solcoseryl administered in combination with cycloferon exceeded that of each component administered separately. PMID:11871237

Bul'on, V V; Khnychenko, L K; Sapronov, N S; Kuznetsova, N N; Anikin, V B; arinenko, R Iu; Kovalenko, A L; Alekseeva, L E

2001-01-01

331

Marjolin's ulcers arising in burn scars.  

PubMed

Epidermoid carcinoma in nonhealing scar tissue, known as Marjolin's ulcer, is not uncommon and is thought to behave in a more aggressive fashion than those from other causes. Between 1982 and 1997, 56 patients with Marjolin's ulcer were treated at our center, Ege University Medical School, Izmir, Turkey. All lesions were secondary to various kinds of burns. Forty of these patients could be followed up 5 years or more. These 40 patients' medical records were reviewed retrospectively. PMID:11761388

Ozek, C; Cankayali, R; Bilkay, U; Guner, U; Gundogan, H; Songur, E; Akin, Y; Cagdas, A

2001-01-01

332

Not at risk — Nevertheless a pressure ulcer  

Microsoft Academic Search

When conducting prevalence surveys pressure ulcers were found in participants clearly identified not to be at risk. This article\\u000a determines and analyses persons in German hospitals and nursing homes who suffer from pressure ulcers but are not at risk.\\u000a In the years 2002, 2003 and 2004 there were 7,097 nursing home residents and 23,966 hospital patients examined in annual pressure

Nils A. Lahmann; Ruud J. G. Halfens; Theo Dassen

2006-01-01

333

[Treatment of patients with trophic ulcer].  

PubMed

The authors present the investigation of inpatient treatment of 137 patients with trophic ulcers of venous aethiology. All the patients were hospitalized in the "Road clinical hospital" on the Krasnoyarsk station. A comparative analysis of treatment results of the patients with trophic ulcers using different medical methods was made. The efficacy of combined use of low-frequency ultrasound and ozone therapy was proved. PMID:25306640

Karapetian, G É; Iakimov, S V; Mikitin, I L; Kochetova, L V; Pakhomova, R A

2014-01-01

334

Acute Marjolin's ulcers: a nebulous diagnosis.  

PubMed

Marjolin's ulcers are rare cutaneous malignancies that most commonly present as squamous cell carcinomas in previously injured, chronically inflamed, or scarred skin. Acute and chronic types have been distinguished by the length of latency; by definition, the acute type occurs within 12 months of injury whereas the chronic type appears over 12 months after injury. In this report, 3 cases of acute Marjolin's ulcers are described and questions are raised about the diagnosis of acute Marjolin's ulcer. Other than a discrepancy in lag time, it is unclear if there is any difference in clinical or histological characteristics or even prognosis between acute and chronic Marjolin's ulcers. In fact, the acute type may simply be a preemptive diagnosis that conveniently describes a carcinoma associated with a nonhealing wound and discovered within a short time span. Moreover, the rarity of the diagnosis and the relatively rapid rate of malignant degeneration from the inciting injury lead one to question whether the injury may have simply revealed or accelerated a previously existing occult cutaneous malignancy. With no definitive clinical, histological, or prognostic distinction between acute and chronic Marjolin's ulcers, the use of such terminology may not benefit a clinician's understanding or practice. In fact, it merely supports the clinical guideline that any nonhealing wound, acute or chronic, should be biopsied and sent for pathologic examination to ensure that it does not represent a Marjolin's ulcer. PMID:24691319

Chang, Jessica B; Kung, Theodore A; Cederna, Paul S

2014-05-01

335

Pressure ulcer prevention: utilizing unlicensed assistive personnel.  

PubMed

The purpose of this article is to provide education to the RN regarding pressure ulcer prevention and best practice interventions. This investigation focuses on the definition of a pressure ulcer, risk factors for pressure ulcers, and the benefits and importance of using unlicensed assistive personnel to help prevent pressure ulcers. A comprehensive literature review was completed using the Texas Woman's University Library, the Texas Christian University Library, and the World Wide Web. The search engine used was Google. The databases included were CINAHL, Academic Search Complete, Cochrane Library, MEDLINE, and ProQuest Nursing & Allied Health Source. The literature was current, defined as from the last 10 years, and the primary language searched was English. Full-text articles from these databases were included as well as print publications from the university collections. The key search terms from the literature review included (a) pressure ulcer, (b) prevention, (c) unlicensed assistive personnel, (d) nursing assistant, (e) theory of nursing knowledge, (f) incidence, (g) prevalence, (h) Braden scale, (i) moisture, and (j) repositioning. Best practice guidelines were reviewed via the Joanna Briggs database, National Guideline Clearinghouse, Cochrane Library, the Centers for Medicare & Medicaid Services, and the National Institutes of Health. Literature was synthesized to define evidence-based practices that would justify the use of unlicensed assistive personnel for the prevention and care of pressure ulcers. PMID:20827067

Walker Sewill, Danielle K; Van Sell, Sharon; Kindred, Chris

2010-01-01

336

Oxidative stress and cellular immunity in patients with recurrent aphthous ulcers  

PubMed Central

Recurrent aphthous ulcer (RAU) is an inflammatory condition of the oral mucosa characterized by painful, well-circumscribed, single or multiple round or ovoid ulcerations. The exact etiologic factor(s) of these ulcerations are not yet understood. The objective of this study was to evaluate inflammatory processes and free radical metabolism of 25 patients with RAUs compared to 25 healthy controls. The levels of malondialdehyde (MDA) and glutathione (GSH) were determined by high-performance liquid chromatography. Tumor necrosis factor-alpha (TNF-?), interleukin-2 (IL-2), IL-10, and IL-12 were determined by ELISA. Nitric oxide (NO), myeloperoxidase (MPO), total antioxidant status (TAS), and total oxidant status (TOS) levels were measured spectroscopically in serum. The levels of MDA, GSH, TNF-?, IL-2, IL-12, MPO, and TOS, and oxidative stress index (OSI) were higher, and the levels of NO, IL-10, and TAS were lower in patients with RAU than in controls. Statistical analysis showed that GSH, TNF-?, IL-2, IL-10, and OSI differed significantly in patients with RAU compared to controls. These parameters have important roles in oxidant/antioxidant defense. PMID:24760117

Avci, E.; Akarslan, Z.Z.; Erten, H.; Coskun-Cevher, S.

2014-01-01

337

Solitary rectal ulcer syndrome: Clinical features, pathophysiology, diagnosis and treatment strategies  

PubMed Central

Solitary rectal ulcer syndrome (SRUS) is an uncommon benign disease, characterized by a combination of symptoms, clinical findings and histological abnormalities. Ulcers are only found in 40% of the patients; 20% of the patients have a solitary ulcer, and the rest of the lesions vary in shape and size, from hyperemic mucosa to broad-based polypoid. Men and women are affected equally, with a small predominance in women. SRUS has also been described in children and in the geriatric population. Clinical features include rectal bleeding, copious mucus discharge, prolonged excessive straining, perineal and abdominal pain, feeling of incomplete defecation, constipation, and rarely, rectal prolapse. This disease has well-described histopathological features such as obliteration of the lamina propria by fibrosis and smooth muscle fibers extending from a thickened muscularis mucosa to the lumen. Diffuse collage deposition in the lamina propria and abnormal smooth muscle fiber extensions are sensitive markers for differentiating SRUS from other conditions. However, the etiology remains obscure, and the condition is frequently associated with pelvic floor disorders. SRUS is difficult to treat, and various treatment strategies have been advocated, ranging from conservative management to a variety of surgical procedures. The aim of the present review is to summarize the clinical features, pathophysiology, diagnostic methods and treatment strategies associated with SRUS. PMID:24574747

Zhu, Qing-Chao; Shen, Rong-Rong; Qin, Huan-Long; Wang, Yu

2014-01-01

338

Perforated duodenal ulcer presenting with massive hematochezia in a 30-month-old child  

PubMed Central

Peptic ulcer disease is uncommon in children and rarely suspected as a cause of abdominal complaints in this age group; the diagnosis is therefore made almost exclusively when complications develop. Peptic ulcer disease is usually not considered in the differential diagnosis of pediatric patients. We present the case of a 30-month-old boy with duodenal perforation due to a peptic ulcer without a known etiology. The patient was admitted through the emergency department due to severe hematochezia and ongoing anemia; he presented with neither abdominal pain nor abdominal distension. There were no medical problems, and no drugs, such as corticosteroids or nonsteroidal anti-inflammatory drugs, had been prescribed or administered recently. We tried to control the active bleeding by medical treatment including arterial embolization, but the active bleeding was not controlled. Finally, an exploratory laparotomy was performed. A discrete anterior perforation with active bleeding of the duodenal wall was found. After the operation, there were no complications and the patient recovered fully. PMID:19824124

Lee, Na Mi; Yun, Sin Weon; Chae, Soo Ahn; Yoo, Byoung Hoon; Cha, Seong Jae; Kwak, Byung Kook

2009-01-01

339

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

PubMed Central

Helicobacter pylori (H. pylori) infection underlies gastric ulcer disease, gastric cancer and duodenal ulcer disease. The disease expression reflects the pattern and extent of gastritis/gastric atrophy (i.e., duodenal ulcer with non-atrophic and gastric ulcer and gastric cancer with atrophic gastritis). Gastric and duodenal ulcers and gastric cancer have been known for thousands of years. Ulcers are generally non-fatal and until the 20th century were difficult to diagnose. However, the presence and pattern of gastritis in past civilizations can be deduced based on the diseases present. It has been suggested that gastric ulcer and duodenal ulcer both arose or became more frequent in Europe in the 19th century. Here, we show that gastric cancer and gastric ulcer were present throughout the 17th to 19th centuries consistent with atrophic gastritis being the predominant pattern, as it proved to be when it could be examined directly in the late 19th century. The environment before the 20th century favored acquisition of H. pylori infection and atrophic gastritis (e.g., poor sanitation and standards of living, seasonal diets poor in fresh fruits and vegetables, especially in winter, vitamin deficiencies, and frequent febrile infections in childhood). The latter part of the 19th century saw improvements in standards of living, sanitation, and diets with a corresponding decrease in rate of development of atrophic gastritis allowing duodenal ulcers to become more prominent. In the early 20th century physician’s believed they could diagnose ulcers clinically and that the diagnosis required hospitalization for “surgical disease” or for “Sippy” diets. We show that while H. pylori remained common and virulent in Europe and the United States, environmental changes resulted in changes of the pattern of gastritis producing a change in the manifestations of H. pylori infections and subsequently to a rapid decline in transmission and a rapid decline in all H. pylori-related diseases. PMID:24833849

Graham, David Y

2014-01-01

340

Probabilistic Mechanical Reliability Prediction of Thermoelectric Legs  

SciTech Connect

The probability of failure, Pf, for various square-arrayed thermoelectric device designs using bismuth telluride, lead telluride, or skutterudite thermoelectric materials were estimated. Only volume- or bulk-based Pf analysis was considered in this study. The effects of the choice of the thermoelectric material, the size of the leg array, the height of the thermoelectric legs, and the boundary conditions on the Pf of thermoelectric devices were investigated. Yielding of the solder contacts and mounting layer was taken into account. The modeling results showed that the use of longer legs, using skutterudites, allowing the thermoelectric device to freely deform while under a thermal gradient, and using smaller arrays promoted higher probabilities of survival.

Jadaan, Osama M. [University of Wisconsin, Platteville; Wereszczak, Andrew A [ORNL

2009-05-01

341

Conjoined legs: Sirenomelia or caudal regression syndrome?  

PubMed Central

Presence of single umbilical persistent vitelline artery distinguishes sirenomelia from caudal regression syndrome. We report a case of a12-year-old boy who had bilateral umbilical arteries presented with fusion of both legs in the lower one third of leg. Both feet were rudimentary. The right foot had a valgus rocker-bottom deformity. All toes were present but rudimentary. The left foot showed absence of all toes. Physical examination showed left tibia vara. The chest evaluation in sitting revealed pigeon chest and elevated right shoulder. Posterior examination of the trunk showed thoracic scoliosis with convexity to right. The patient was operated and at 1 year followup the boy had two separate legs with a good aesthetic and functional results. PMID:23960288

Das, Sakti Prasad; Ojha, Niranjan; Ganesh, G Shankar; Mohanty, Ram Narayan

2013-01-01

342

Sympathetic adaptations to one-legged training  

NASA Technical Reports Server (NTRS)

The purpose of the present study was to determine the effect of leg exercise training on sympathetic nerve responses at rest and during dynamic exercise. Six men were trained by using high-intensity interval and prolonged continuous one-legged cycling 4 day/wk, 40 min/day, for 6 wk. Heart rate, mean arterial pressure (MAP), and muscle sympathetic nerve activity (MSNA; peroneal nerve) were measured during 3 min of upright dynamic one-legged knee extensions at 40 W before and after training. After training, peak oxygen uptake in the trained leg increased 19 +/- 2% (P < 0.01). At rest, heart rate decreased from 77 +/- 3 to 71 +/- 6 beats/min (P < 0.01) with no significant changes in MAP (91 +/- 7 to 91 +/- 11 mmHg) and MSNA (29 +/- 3 to 28 +/- 1 bursts/min). During exercise, both heart rate and MAP were lower after training (108 +/- 5 to 96 +/- 5 beats/min and 132 +/- 8 to 119 +/- 4 mmHg, respectively, during the third minute of exercise; P < 0.01). MSNA decreased similarly from rest during the first 2 min of exercise both before and after training. However, MSNA was significantly less during the third minute of exercise after training (32 +/- 2 to 22 +/- 3 bursts/min; P < 0.01). This training effect on MSNA remained when MSNA was expressed as bursts per 100 heartbeats. Responses to exercise in five untrained control subjects were not different at 0 and 6 wk. These results demonstrate that exercise training prolongs the decrease in MSNA during upright leg exercise and indicates that attenuation of MSNA to exercise reported with forearm training also occurs with leg training.

Ray, C. A.

1999-01-01

343

Epidemiology and etiology of denture stomatitis.  

PubMed

Denture stomatitis, a common disorder affecting denture wearers, is characterized as inflammation and erythema of the oral mucosal areas covered by the denture. Despite its commonality, the etiology of denture stomatitis is not completely understood. A search of the literature was conducted in the PubMed electronic database (through November 2009) to identify relevant articles for inclusion in a review updating information on the epidemiology and etiology of denture stomatitis and the potential role of denture materials in this disorder. Epidemiological studies report prevalence of denture stomatitis among denture wearers to range from 15% to over 70%. Studies have been conducted among various population samples, and this appears to influence prevalence rates. In general, where reported, incidence of denture stomatitis is higher among elderly denture users and among women. Etiological factors include poor denture hygiene, continual and nighttime wearing of removable dentures, accumulation of denture plaque, and bacterial and yeast contamination of denture surface. In addition, poor-fitting dentures can increase mucosal trauma. All of these factors appear to increase the ability of Candida albicans to colonize both the denture and oral mucosal surfaces, where it acts as an opportunistic pathogen. Antifungal treatment can eradicate C. albicans contamination and relieve stomatitis symptoms, but unless dentures are decontaminated and their cleanliness maintained, stomatitis will recur when antifungal therapy is discontinued. New developments related to denture materials are focusing on means to reduce development of adherent biofilms. These may have value in reducing bacterial and yeast colonization, and could lead to reductions in denture stomatitis with appropriate denture hygiene. PMID:21463383

Gendreau, Linda; Loewy, Zvi G

2011-06-01

344

Recurrent pregnancy loss: etiology of thrombophilia.  

PubMed

Congenital and acquired thrombophilia are associated with an increased risk of pregnancy-associated venous thrombosis and fetal loss. Two hundred eighty-nine patients with a history of recurrent spontaneous abortion were subjected to screening examinations for the etiology of these abortions. Endocrine abnormality (28.0%), uterine abnormality (10.4%), autoimmune diseases (1.4%), antiphospholipid antibody syndrome (4.5%), and balanced type chromosome translocation (4.2%) were found as underlying causes of recurrent abortions, and the remaining 55.0% of the 289 patients were classified as having an unexplained etiology. Congenital thrombophilia such as protein C (PC) deficiency, protein S (PS) deficiency, antithrombin deficiency, and factor V Leiden mutation was not frequently detected; only one patient had PS deficiency. A reduced factor XII activity was found at a frequency of 4.2%. The frequency of methylene tetrahydrofolate reductase gene C677T mutation in recurrent aborters (0.38) was the same as that found in a fertile control group. Although the prevalence of anti-beta2-glycoprotein I antibody (abeta2-GPI) syndrome was very low (1.7%), patients with a high titer of immunoglobulin G (IgG) class abeta2-GPI, despite anticoagulation therapy, experienced severe fetomaternal complications in subsequent pregnancies. The rate (13.8%) of positive tests for serum IgA class abeta2-GPI in patients with unexplained etiology was higher than that in the controls (0%) (P < .05). We conclude that congenital thrombophilia is rare in Japanese patients who had experienced consecutive spontaneous abortions. PMID:11372765

Yamada, H; Kato, E H; Kobashi, G; Ebina, Y; Shimada, S; Morikawa, M; Yamada, T; Sakuragi, N; Fujimoto, S

2001-01-01

345

An Observational Study of the Etiology, clinical presentation and outcomes associated with peritonitis in Lilongwe, Malawi  

PubMed Central

Introduction Peritonitis is a life-threatening condition with a multitude of etiologies that can vary with geographic location. The aims of this study were to elucidate the etiology, clinical presentation and outcomes associated with peritonitis in Lilongwe, Malawi. Methods All patients admitted to Kamuzu Central Hospital (KCH) who underwent an operation for treatment of peritonitis during the calendar year 2008 were eligible. Peritonitis was defined as abdominal rigidity, rebound tenderness, and/or guarding in one or more abdominal quadrants. Subjects were identified from a review of the medical records for all patients admitted to the adult general surgical ward and the operative log book. Those who met the definition of peritonitis and underwent celiotomy were included. Results 190 subjects were identified. The most common etiologies were appendicitis (22%), intestinal volvulus (17%), perforated peptic ulcer (11%) and small bowel perforation (11%). The overall mortality rate associated with peritonitis was 15%, with the highest mortality rates observed in solid organ rupture (35%), perforated peptic ulcer (33%), primary/idiopathic peritonitis (27%), tubo-ovarian abscess (20%) and small bowel perforation (15%). Factors associated with death included abdominal rigidity, generalized (versus localized) peritonitis, hypotension, tachycardia and anemia (p < 0.05). Age, gender, symptoms (obstipation, vomiting) and symptom duration, tachypnea, abnormal temperature, leukocytosis, hemoconcentration, thrombocytopenia and thrombocytosis were not associated with mortality (p = NS). Conclusions There are several signs and laboratory findings predictive of poor outcome in Malawian patients with peritonitis. Tachycardia, hypotension, anemia, abdominal rigidity and generalized peritonitis are the most predictive of death (P < 0.05 for each). Similar to studies from other African countries, in our population the most common cause of peritonitis was appendicitis, and the overall mortality rate among all patients with peritonitis was 15%. Identified geographical differences included intestinal volvulus, rare in the US but the 2nd most common cause of peritonitis in Malawi and gallbladder disease, common in Ethiopia but not observed in Malawi. Future research should investigate whether correction of factors associated with mortality might improve outcomes. PMID:22067899

2011-01-01

346

Convergent mechanisms in etiologically-diverse dystonias  

PubMed Central

Introduction Dystonia is a neurological disorder associated with twisting motions and abnormal postures, which compromise normal movements and can be both painful and debilitating. It can affect a single body part (focal), several contiguous regions (segmental), or the entire body (generalized), and can arise as a result of numerous causes, both genetic and acquired. Despite the diversity of causes and manifestations, shared clinical features suggest that common mechanisms of pathogenesis may underlie many dystonias. Areas Covered This review identifies shared themes in etiologically-diverse dystonias on several biological levels. At the cellular level, abnormalities in the dopaminergic system, mitochondrial function, and calcium regulation are discussed. At the anatomical level, the roles of the basal ganglia and the cerebellum in dystonia are described. Global central nervous system dysfunction, with regard to aberrant neuronal plasticity, inhibition, and sensorimotor integration is also discussed. Using clinical data and data from animal models, this article seeks to highlight shared pathways that may be critical in understanding mechanisms and identifying novel therapeutic strategies in dystonia. Expert Opinion Identifying shared features of pathogenesis can provide insight into the biological processes that underlie etiologically-diverse dystonias, and can suggest novel targets for therapeutic intervention that may be effective in a broad group of affected individuals. PMID:22136648

Thompson, Valerie B.; Jinnah, H. A.

2012-01-01

347

Future etiologic research in occupational cancer.  

PubMed Central

Research focused on occupational exposure has been one of the cornerstones of epidemiological research into the etiology of cancer. It is appropriate to critically assess the contribution of this research effort and to assess the potential for making significant progress in the future in unraveling the etiology of cancer by studying the occupational environment. The study of the occupational environment has indeed been very fruitful. It is likely that there remain many more carcinogens to be discovered, but we have not deployed adequately sensitive study methods. The two major obstacles to quality research have been inadequate exposure assessment and insufficient sample sizes. Quality exposure assessment requires the participation of trained experts (industrial hygienists, chemists, etc.); it also requires an adequate information base on the exposures that occur in different workplaces. We need structures and career paths that facilitate the participation of exposure experts in epidemiological research. We need active large-scale industrial hygiene surveys to better characterize the U.S. workplace. This will be useful for epidemiological studies and for public health purposes. Community-based case-control studies will need to be much larger than they have been traditionally, with 1000 as a minimum number of cases and controls. PMID:8741785

Siemiatycki, J

1995-01-01

348

The epidemiology and etiology of azoospermia  

PubMed Central

The misconception that infertility is typically associated with the female is commonly faced in the management of infertile men. It is uncommon for a patient to present for an infertility evaluation with an abnormal semen analysis report before an extensive female partner workup has been performed. Additionally, a man is usually considered fertile based only on seminal parameters without a physical exam. This behavior may lead to a delay in both the exact diagnosis and in possible specific infertility treatment. Moreover, male factor infertility can result from an underlying medical condition that is often treatable but could possibly be life-threatening. The responsibility of male factor in couple's infertility has been exponentially rising in recent years due to a comprehensive evaluation of reproductive male function and improved diagnostic tools. Despite this improvement in diagnosis, azoospermia is always the most challenging topic associated with infertility treatment. Several conditions that interfere with spermatogenesis and reduce sperm production and quality can lead to azoospermia. Azoospermia may also occur because of a reproductive tract obstruction. Optimal management of patients with azoospermia requires a full understanding of the disease etiology. This review will discuss in detail the epidemiology and etiology of azoospermia. A thorough literature survey was performed using the Medline, EMBASE, BIOSIS, and Cochrane databases. We restricted the survey to clinical publications that were relevant to male infertility and azoospermia. Many of the recommendations included are not based on controlled studies. PMID:23503951

Cocuzza, Marcello; Alvarenga, Conrado; Pagani, Rodrigo

2013-01-01

349

Etiology, diagnosis, and clinical management of vulvodynia  

PubMed Central

Chronic vulvar pain or discomfort for which no obvious etiology can be found, ie, vulvodynia, can affect up to 16% of women. It may affect girls and women across all age groups and ethnicities. Vulvodynia is a significant burden to society, the health care system, the affected woman, and her intimate partner. The etiology is multifactorial and may involve local injury or inflammation, and peripheral and or central sensitization of the nervous system. An approach to the diagnosis and management of a woman presenting with chronic vulvar pain should address the biological, psychological, and social/interpersonal factors that contribute to her illness. The gynecologist has a key role in excluding other causes for vulvar pain, screening for psychosexual and pelvic floor dysfunction, and collaborating with other health care providers to manage a woman’s pain. An important component of treatment is patient education regarding the pathogenesis of the pain and the negative impact of experiencing pain on a woman’s overall quality of life. An individualized, holistic, and often multidisciplinary approach is needed to effectively manage the woman’s pain and pain-related distress. PMID:24833921

Sadownik, Leslie A

2014-01-01

350

Towards a balanced account of autism etiology  

PubMed Central

Drash and Tudor describe six sets of reinforcement contingencies which may be present in the environments of some children eventually diagnosed with autism and suggest that these contingencies account for the etiology of “autistic” behaviors. Nevertheless, merely observing such contingencies in the environments of these children is insufficient to establish a positive correlation between the contingencies and “autistic” behaviors, let alone a causal relationship. To demonstrate a positive correlation, it is necessary to present evidence that the relevant contingencies are present more often in the environments of children exhibiting these behaviors than in the environments of children not exhibiting these behaviors. This condition has not been met, since no evidence to the effect that such contingencies are absent in the environments of typical children or children with disabilities other than autism has been presented. In fact, the opposite appears to be true, as is argued in the present commentary. It appears that Drash and Tudor's account of autism etiology is incomplete in that it neglects the role of unlearned differences between children and their possible interactions with the social environment in shaping “autistic” behaviors. Despite the misconception held by some that behavior analysis is a radically environmental approach, unlearned differences may be discussed within a behavioral framework. A “completely behavioral” account may discuss such differences in terms of susceptibility to reinforcement or punishment, speed of conditioning, or other unlearned characteristics which are potentially testable. PMID:22477286

Hall, Genae A.

2004-01-01

351

Stress ulcers: their pathogenesis, diagnosis, and treatment.  

PubMed

Stress ulcers are multiple, superficial erosions which occur mainly in the fundus and body of the stomach. They develop after shock, sepsis, and trauma and are ofter found in patients with peritonitis and other chronic medical illness. Stress ulcers should be differentiated from reactivation of chronic duodenal or gastric ulcers. Cushing's ulcer following head injury, or drug-induced gastritis. Digestive symptoms are usually absent, hemorrhage is the most common manifestation, and perforation and obstruction are rare. The presence of luminal acid and ischemia are necessary for the production of stress ulcer, while disruption of the gastric mucosal barrier by refluxed duodenal content may contribute to the pathogenesis. Endoscopy is the mainstay of the diagnostic procedure, and angiography should be used if endoscopy fails to identify the bleeding lesions. Medical management should include volume replacement, nasogastric aspiration, and the use of antacid. Selective intraarterial infusion of pitressin has shown encouraging preliminary results. Surgical treatment is reserved only for those patients who continue to bleed despite all medical management. The operation of choice is open to question. We prefer vagotomy, pyloroplasty, and oversewing the ulcers as an initial operation. Since the result of all forms of therapy has been poor, it seems resonable to try to prevent ulcer development. The use of vitamin A, hyperalimentation, and growth hormones is still in an experimental stage. Large clinical studies with case control are necessary before recommendations can be made. The use of potent and frequent antacid to buffer the gastric content has shown promising results; however, these observations need to be confirmed in a properly controlled and randomized study. PMID:793064

Moody, F G; Cheung, L Y

1976-12-01

352

Leg 190 Preliminary Report58 Eurasian plate  

E-print Network

Seamounts 1173 1174 808 1177 1178 1176 1175 582 583 Figure 6 #12;Leg190PreliminaryReport64 VE = ~3x BSR LDR (LTS zone) Frontal out-of- sequence thrust zone (OOST) Imbricate thrust zone Protothrustzone 100 km BSR

353

OCEAN DRILLING PROGRAM LEG 137 SCIENTIFIC PROSPECTUS  

E-print Network

deepening through the dike/gabbro and/or Layer 2/3 transition(s). Located in 5.9-m.y.-old crust, Hole 504B and underlying gabbros in the context of a complete crustal section. The leg is scheduled for 21 March to 1 May

354

Get Your Legs Ready For Summer!  

E-print Network

Get Your Legs Ready For Summer! Free seminars: Treatments for spider veins The vascular program at UC Davis Health System is the most comprehensive in the Sacramento area for the treatment of varicose and spider veins. The UC Davis Vascular Center's vein program offers advanced cosmetic and therapeutic

Leistikow, Bruce N.

355

Force and motion management in legged locomotion  

Microsoft Academic Search

The control of a legged locomotion system over uneven terrain requires a new approach to coordination. The system has a high degree of static indeterminacy and, because of the stiffness of the structural and actuation systems, has stability problems if position-velocity control is used. The problem has many similarities to that of grasping and manipulating an object in a multi-fingered

Kenneth J. Waldron

1986-01-01

356

OCEAN DRILLING PROGRAM LEG 181 SCIENTIFIC PROSPECTUS  

E-print Network

of this publication may be obtained from the ODP Publications Home Page on the World Wide Web at http K. Graber #12;Leg 181 Scientific Prospectus Page 3 ABSTRACT The circulation of cold, deep Antarctic the world ocean through the Southwest Pacific Gateway as a thermohaline drive Deep Western Boundary Current

357

OCEAN DRILLING PROGRAM LEG 185 PRELIMINARY REPORT  

E-print Network

OCEAN DRILLING PROGRAM LEG 185 PRELIMINARY REPORT IZU-MARIANA MARGIN Dr. Terry Plank Co U.S.A. Internet: tplank@kuhub.cc.ukans.edu Work: (785) 864-2725 Fax: (785) 864-5276 John N. Ludden Internet: ludden@crpg.cnrs-nancy.fr Work: (33) 3-83-594213 Fax: (33) 3-83511798 Carlota Escutia Staff

358

Knee motion in a long leg cast  

Microsoft Academic Search

Five principles to reestablish static ligamentous sta bility are introduced, including secure, temporary, ti biofemoral fixation to protect against early postoper ative stretch or disruption. The necessity for empha sizing this point is demonstrated by a cadaver study. Knee motion in and out of long leg plaster casts was carefully studied in necropsy specimens. Casts ap plied over minimal or

Kenneth A. Krackow; William Laughlin Vetter

1981-01-01

359

Dynamic Analysis Tool for Legged Robots  

Microsoft Academic Search

The paper introduces a systematic approach for dealing with legged robot mechanism analysis. First, we briefly summarize basic mathematical tools for studying the dynamics of these multi-loop and parallel mechanisms using a unified spatial formulation which is useful for computer algorithms. The dynamic behavior analysis is based on two stages. The first one deals with establishing the equations of motion

F. B. Ouezdou; O. Bruneau; J. C. Guinot

1998-01-01

360

A colored leg banding technique for Amazona parrots  

USGS Publications Warehouse

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.

Meyers, J.M.

1995-01-01

361

Leg stiffness measures depend on computational method.  

PubMed

Leg stiffness is often computed from ground reaction force (GRF) registrations of vertical hops to estimate the force-resisting capacity of the lower-extremity during ground contact, with leg stiffness values incorporated in a spring-mass model to describe human motion. Individual biomechanical characteristics, including leg stiffness, were investigated in 40 healthy males. Our aim is to report and discuss the use of 13 different computational methods for evaluating leg stiffness from a double-legged repetitive hopping task, using only GRF registrations. Four approximations for the velocity integration constant were combined with three mathematical expressions, giving 12 methods for computing stiffness using double integrations. One frequency-based method that considered ground contact times was also trialled. The 13 methods thus defined were used to compute stiffness in four extreme cases, which were the stiffest, and most compliant, consistent and variable subjects. All methods provided different stiffness measures for a given individual, but the between-method variations in stiffness were consistent across the four atypical subjects. The frequency-based method apparently overestimated the actual stiffness values, whereas double integrations' measures were more consistent. In double integrations, the choice of the integration constant and mathematical expression considerably affected stiffness values, as variations during hopping were more or less emphasized. Stating a zero centre of mass position at take-off gave more consistent results, and taking a weighted-average of the force or displacement curve was more forgiving to variations in performance. In any case, stiffness values should always be accompanied by a detailed description of their evaluation methods, as our results demonstrated that computational methods affect calculated stiffness. PMID:24188972

Hébert-Losier, Kim; Eriksson, Anders

2014-01-01

362

Invasive mucormycosis in benign gastric ulcer.  

PubMed

Fungal elements are frequently noted overlying the base of chronic peptic ulcers of the stomach and it has been suggested that the fungi enhance the degree of necrosis and that these cases have protracted disease and deeper ulcers with more perforations. It has also been postulated that the number of fungal elements might be increased in the stomach of patients who are receiving potent medications such as H2-receptor antagonists to reduce gastric acidity, but there have not been adequate control studies, and the deleterious effects from the presence of the fungi in these cases have not been substantiated. We present a very rare case of invasive mucormycosis (phycomycosis) occurring in the base of a chronic gastric ulcer in a 55 years old diabetic male. This case was clinically and radiologically been mistaken for a gastric carcinoma. In addition, the ulcer was complicated by perforation and fungal septicemia with subsequent fatal outcome. The clinical, radiological and histopathological features are described together with a literature review of other reported fungal gastric ulcers. PMID:11533800

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

2000-03-01

363

Hydroxyurea and colonic ulcers: a case report  

PubMed Central

Background Hydroxyurea at a relatively low dose is frequently prescribed to induce hemoglobin F production in patients with sickle cell and ?-thalassemia diseases because of its good efficacy and safety profiles. However, a potentially fatal gastrointestinal ulceration was recently found and herein reported. Case presentation A thirty-seven-year-old man with transfusion dependent hemoglobin E/?-thalassemia disease was treated with hydroxyurea to induce hemoglobin F production since 2007 without incident. From 2008 to April 2010, episodes of hematochezia, mucous diarrhea and epigastric pain intermittently manifested. Four colonoscopies done during the period repeatedly showed ulcerative lesions from the terminal ileum to the ascending colon with a non-specific histo-pathologic finding. Subsequently, ulcerative lesions also developed at the pharynx, histo-pathologic findings of which were not different from those in the colon. These ulcerative lesions resolved within a month after discontinuing hydroxyurea in April 2010 and have not recurred since. Conclusion The findings suggested role of hydroxyurea in the pathogenesis of these ulcers, and that it must be immediately discontinued to prevent further damage to the digestive mucosa. PMID:25082414

2014-01-01

364

Current and emerging biologics for ulcerative colitis.  

PubMed

Conventional medical treatment for ulcerative colitis can have limited efficacy or severe adverse reactions requiring additional treatment or colectomy. Hence, different biological agents that target specific immunological pathways are be-ing investigated for treating ulcerative colitis. Anti-tumor ne-crosis factor (TNF) agents were the first biologics to be used for treating inflammatory bowel disease. For example, inflix-imab and adalimumab, which are anti-TNF agents, are be-ing used for treating ulcerative colitis. Recently, golimumab, another anti-TNF agent, and vedolizumab, an anti-adhesion therapy, have been approved for ulcerative colitis by the U.S. Food and Drug Administration. In addition, new medications such as tofacitinib, a Janus kinase inhibitor, and etrolizumab, another anti-adhesion therapy, are emerging as therapeu-tic agents. Therefore, there is a need for further studies to select appropriate patient groups for these biologics and to improve the outcomes of ulcerative colitis treatment through appropriate medical usage. (Gut Liver 2015;9:18-27). PMID:25547087

Park, Sung Chul; Jeen, Yoon Tae

2015-01-15

365

Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology  

Microsoft Academic Search

Background: Restless legs syndrome is a common yet frequently undiagnosed sensorimotor disorder. In 1995, the International Restless Legs Syndrome Study Group developed standardized criteria for the diagnosis of restless legs syndrome. Since that time, additional scientific scrutiny and clinical experience have led to a better understanding of the condition. Modification of the criteria is now necessary to better reflect that

Richard P Allen; Daniel Picchietti; Wayne A Hening; Claudia Trenkwalder; Arthur S Walters; Jacques Montplaisi

2003-01-01

366

[Rare etiology of multiple pulmonary lacunae].  

PubMed

Sarcoma of the common pulmonary artery are rare malignant tumors which can mimic pulmonary embolism. In the case presented here, the inaugural signs were particularly misleading: multiple pulmonary lacunae on computed tomography. The unusual aspect and asymmetric localizations at pulmonary angiography then suggested the doubtful nature of the embolism etiology. Magnetic resonance imaging findings suggested the diagnosis of sarcoma of the pulmonary artery. Certain diagnosis was obtained at pathology examination of the surgical specimen after thoracotomy. A malignant fibrous histiocytoma was identified. Curative resection was not possible and chemotherapy was performed. Unusual parenchymal lesions were then evidenced on the radiography. Better and better magnetic resonance imaging criteria are described in the literature and help distinguish between thromboembolism and sarcoma of the pulmonary artery. Follow-up of the clinical course is thus improved. It is nevertheless necessary to evaluate intravascular extension to determine whether curative surgery is possible. PMID:9033933

Nourdine, K; Nesme, P; Perol, M; Douek, P; De La Roche, E; Bejui-Thivolet, F; Loire, R; Champsaur, P; Guerin, J C

1996-01-01

367

Perspectives on the etiology of Alzheimer's disease  

SciTech Connect

There is a lack of consensus among investigators concerning the etiology of Alzheimer's disease. Clues are lacking, however, and the authors have assessed them in a broad biologic context. This inquiry has led us to regard Alzheimer's disease as a multifactorial disorder in which a putative infective agent is an essential element. Despite seeming competition among current hypotheses, there is overall unity. The concept that Down's syndrome is a congenital form of Alzheimer's disease and that both conditions are the result of a ubiquitous infective pathogen that affects genetically susceptible individuals offers the broadest unification. In both conditions slow infections develops against the background of aging. Indirect evidence involving immunologic and other biologic phenomena supports the postulated infectious origin. Overlapping pathologic and clinical features of Alzheimer's disease and the known transmissible encephalopathies suggest a similar pathogenesis.

Mozar, H.N.; Bal, D.G.; Howard, J.T.

1987-03-20

368

Microbial etiologies in community acquired pneumonia (CAP).  

PubMed

The objective of the study was determination of bacterial etiologic factors, including antibiotic atypical pathogens, of community acquired pneumonia (CAP) in adults and of sensitivity of isolated strains. The examined group comprised 50 patients with clinical and x-ray image of pneumonia. Patients' expectoration sputum was analyzed. Amongst all isolated bacteria, the most frequent were Staphylococcus aureus - 17.9%, Haemophilus parainfluenzae - 12.5% and H. influenzae - 8.9%. Identification of Corynebacterium pseudodiphtheriticum in 8.9% of CAP cases drew our particular attention. Staphylococcus aureus was the least antibiotic sensitive microorganism. In the majority of patients (26: 52%), serologic markers of chlamydial infection were determined. Pneumonia often results from mixed typical and atypical flora infection. High percentage of atypical pathogens in the examined material suggests the necessity to administer intracellularly acting antibiotics. PMID:15315033

Szmygin-Milanowska, Katarzyna; Kieszko, Robert; Chudnicka, Alina; Milanowski, Janusz

2003-01-01

369

Etiology, Pathogenesis, and Diagnosis of Interstitial Cystitis  

PubMed Central

Interstitial cystitis (IC) is a bladder syndrome of unknown etiology. The cause of IC is most likely multifactorial and includes genetic and environmental factors. Various pathophysiological changes in the bladder, pelvis, and peripheral and central nervous systems have been identified, and this has led to the emergence of biologically specific treatment modalities. Interstitial cystitis is being diagnosed with increasing frequency; however, current diagnostic criteria are non-uniform, and there is significant overlap between chronic pelvic pain syndromes in men and women, interstitial cystitis, recurrent “cystitis,” and the overactive bladder syndrome. The diagnosis of interstitial cystitis can be made clinically and by cystoscopy and hydrodistension. The sensitivity and specificity of urinary markers and the potassium sensitivity test have not been prospectively studied. PMID:16986036

Sant, Grannum R

2002-01-01

370

Gynecomastia: etiologies, clinical presentations, diagnosis, and management.  

PubMed

Gynecomastia is a common finding that is present in up to 57% of men. It is caused by proliferation of the mammary glands, which leads to the development of dense subareolar tissue. The condition results from both physiologic (eg, hypogonadism, altered estrogen-to-androgen ratio) and nonphysiologic (eg, drugs, herbal products) causes. Most cases are benign and resolve spontaneously. Treatment is usually unnecessary, although there are specific signs and symptoms that warrant further workup. Psychosocial effects also are of concern, particularly among adolescents. Knowledge of the possible causes of gynecomastia and a thoughtful approach to the patient presenting with this condition can lead to improved outcomes and patient satisfaction. This concise review of the common presentation, etiologies, diagnosis, and treatment of gynecomastia should aid healthcare professionals who may encounter these patients in their practices. PMID:24389786

Ladizinski, Barry; Lee, Kachiu Cecilia; Nutan, F N U; Higgins, H William; Federman, Daniel G

2014-01-01

371

Pathogenesis of foot ulcers and the need for offloading.  

PubMed

Diabetic foot ulceration represents a major medical, social and economic problem all over the world. While more than 5% of diabetic patients have a history of foot ulceration, the cumulative lifetime incidence may be as high as 15%. Ethnic differences exist in both ulcer and amputation incidences. Foot ulceration results from the interaction of several contributory factors, the most important of which is neuropathy. The use of the total-contact cast is demonstrated in the treatment of plantar neuropathic ulcers. Histological evidence suggests that pressure relief results in chronic foot ulcers changing their morphological appearance by displaying some features of an acute wound. Thus, repetitive stresses on the insensate foot appear to play a major role in maintaining ulcer chronicity. It is hoped that research activity in foot disease will ultimately result in fewer ulcers and less amputation in diabetes. PMID:15918113

Rathur, H M; Boulton, A J

2005-04-01

372

Validation of a leg-to-leg bioimpedance analysis system in assessing body composition in postmenopausal women  

Microsoft Academic Search

OBJECTIVES: To evaluate the validity of a leg-to-leg bioimpedance analysis (BIA) system in predicting body composition as measured by dual-energy X-ray absorptiometry (DXA) in postmenopausal women.SUBJECTS AND METHODS: Body fat mass (FM), %Fat and fat free mass (FFM) were measured in 124 postmenopausal women (age: 51–63 y, body mass index (BMI): 17–38 kg\\/m2) first by the leg-to-leg BIA system, and

X Xie; N Kolthoff; O Bärenholt; SP Nielsen

1999-01-01

373

A new pressure ulcer conceptual framework  

PubMed Central

Aim This paper discusses the critical determinants of pressure ulcer development and proposes a new pressure ulcer conceptual framework. Background Recent work to develop and validate a new evidence-based pressure ulcer risk assessment framework was undertaken. This formed part of a Pressure UlceR Programme Of reSEarch (RP-PG-0407-10056), funded by the National Institute for Health Research. The foundation for the risk assessment component incorporated a systematic review and a consensus study that highlighted the need to propose a new conceptual framework. Design Discussion Paper. Data Sources The new conceptual framework links evidence from biomechanical, physiological and epidemiological evidence, through use of data from a systematic review (search conducted March 2010), a consensus study (conducted December 2010–2011) and an international expert group meeting (conducted December 2011). Implications for Nursing A new pressure ulcer conceptual framework incorporating key physiological and biomechanical components and their impact on internal strains, stresses and damage thresholds is proposed. Direct and key indirect causal factors suggested in a theoretical causal pathway are mapped to the physiological and biomechanical components of the framework. The new proposed conceptual framework provides the basis for understanding the critical determinants of pressure ulcer development and has the potential to influence risk assessment guidance and practice. It could also be used to underpin future research to explore the role of individual risk factors conceptually and operationally. Conclusion By integrating existing knowledge from epidemiological, physiological and biomechanical evidence, a theoretical causal pathway and new conceptual framework are proposed with potential implications for practice and research. PMID:24684197

Coleman, Susanne; Nixon, Jane; Keen, Justin; Wilson, Lyn; McGinnis, Elizabeth; Dealey, Carol; Stubbs, Nikki; Farrin, Amanda; Dowding, Dawn; Schols, Jos MGA; Cuddigan, Janet; Berlowitz, Dan; Jude, Edward; Vowden, Peter; Schoonhoven, Lisette; Bader, Dan L; Gefen, Amit; Oomens, Cees WJ; Nelson, E Andrea

2014-01-01

374

Ulcerative Cheilitis in a Rhesus Macaque  

PubMed Central

A two-year-old, female, simian immunodeficiency virus E543-infected rhesus macaque (Macaca mulatta) was presented for necropsy following euthanasia due to a history of diarrhea, weight loss, and a small, round ulcer along the left labial commisure. Histopathologic examination of the ulcer revealed infiltration by large numbers of degenerate and non-degenerate neutrophils and macrophages admixed with syncytial epithelial cells. Rare epithelial cells contained herpetic inclusion bodies. These cells stained positive for Human herpesvirus 1 via immunohistochemistry and DNA sequencing confirmed the presence of closely related Macacine herpesvirus 1 (B virus). PMID:21383117

Bailey, C. C.; Miller, A. D.

2011-01-01

375

The isolation of fusobacteria from tropical ulcers.  

PubMed Central

Tropical ulcer is a disease found most commonly in the tropics, although the disease is not confined to those areas. Young children are affected most frequently and the disease is thought to be a polymicrobial infection with fusobacteria, aerobic microorganisms and spirochaetes each playing a role. The fusobacteria have been reported on smears but have not been cultured thus far. We report the isolation and culture of these organisms from 46 ulcers and have also demonstrated the same organisms in skin biopsies from these lesions. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 PMID:3678397

Adriaans, B.; Drasar, B. S.

1987-01-01

376

Recurrent myopericarditis with extensive ulcerative colitis  

PubMed Central

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

Freeman, Hugh James; Salh, Baljinder

2010-01-01

377

Elective Stoma Construction Improves Outcomes in Medically Intractable Pressure Ulcers  

Microsoft Academic Search

PURPOSE: Perineal pressure ulcers are a common and devastating complication for paralyzed or chronically bedridden patients. Controversy exists on the benefit of fecal diversion for the treatment and prevention of these ulcers. This study compared outcomes in bed-bound patients with pressure ulcers who electively underwent fecal diversion with those who did not. METHODS: A retrospective review was performed on all

Sebastian G. de la Fuente; L. Scott Levin; James D. Reynolds; Carmen Olivares; Theodore N. Pappas; Kirk A. Ludwig; Christopher R. Mantyh

2003-01-01

378

Ulcerated hemangiomas: Clinical characteristics and response to therapy  

Microsoft Academic Search

Background: Hemangiomas represent the most common benign tumor of infancy, with ulceration its most frequent complication. Objective: Our purpose was to review our experience with this challenging problem by evaluating the clinical features, management, and therapeutic responses of ulcerated hemangiomas. Methods: A retrospective analysis of ulcerated hemangiomas at the University of California, San Francisco outpatient pediatric dermatology clinics and Oakland

Ho Jin Kim; Mary Colombo; Ilona J. Frieden

2001-01-01

379

The bioavailability of morphine applied topically to cutaneous ulcers  

Microsoft Academic Search

A number of studies have reported the analgesic effect of morphine when applied topically to painful skin ulcers. It has been suggested that morphine may exert a local action, as opioid receptors have been demonstrated on peripheral nerve terminals. In this study, we investigated the bioavailability of topically applied morphine to cutaneous ulcers. Six hospice inpatients with skin ulcers were

Maria D. C. Ribeiro; Simon P. Joel; Giovambattista Zeppetella

2004-01-01

380

Pressure Ulcers Among Elderly Patients Early in the Hospital Stay  

Microsoft Academic Search

Background. Pressure ulcers among elderly hospital patients diminish quality of life and increase the cost of hospital care. Evidence suggests that pressure ulcers can arise after only a few hours of immobility. The goals of this study were to estimate the incidence of hospital-acquired pressure ulcers in the first 2 days of the hospital stay and to identify patient characteristics

Mona Baumgarten; David J. Margolis; A. Russell Localio; Sarah H. Kagan; Robert A. Lowe; Bruce Kinosian; John H. Holmes; Stephanie B. Abbuhl; William Kavesh; Althea Ruffin

2006-01-01

381

Patient Risk Factors for Pressure Ulcers During Cardiac Surgery  

Microsoft Academic Search

Patients undergoing cardiac surgery have increased risks for developing pressure ulcers. The researchers conducted this study to identify preoperative, intraoperative, and postoperative factors associated with the development of pressure ulcers among patients undergoing cardiac surgery at the Cleveland Clinic Foundation. The significant factors associated with pressure ulcer development in the study patients were presence of diabetes mellitus and other significant

Linda J. Lewicki; Lorraine Mion; Karen G. Splane; Doris Samstag; Michelle Secic

1997-01-01

382

Catastrophic Bleeding From a Marginal Ulcer After Gastric Bypass  

PubMed Central

Marginal ulceration at the gastrojejunal anastomosis is a common complication following Roux-Y gastric bypass (RYGB). Hemodynamically significant hemorrhagic marginal ulcers are usually treated either endoscopically or surgically. We describe a unique case of life-threatening hemorrhagic marginal ulcer eroding into the main splenic artery. This condition was initially managed with angiographic embolization, followed by surgical intervention. PMID:23743389

Sidani, Shafik; Akkary, Ehab

2013-01-01

383

Automated Pressure Ulcer Lesion Diagnosis for Telemedicine Systems  

E-print Network

Automated Pressure Ulcer Lesion Diagnosis for Telemedicine Systems Dimitrios I. Kosmopoulos dkosmo for automated pressure ulcer stage classification can be integrated into an asynchronous telemedicine system, telemedicine I. Introduction A pressure ulcer is a lesion caused by unrelieved pressure resulting in damage

Kosmopoulos, Dimitrios I.

384

Haemophilus ducreyi Associated with Skin Ulcers among Children, Solomon Islands  

PubMed Central

During a survey of yaws prevalence in the Solomon Islands, we collected samples from skin ulcers of 41 children. Using PCR, we identified Haemophilus ducreyi infection in 13 (32%) children. PCR-positive and PCR-negative ulcers were phenotypically indistinguishable. Emergence of H. ducreyi as a cause of nongenital ulcers may affect the World Health Organization’s yaws eradication program. PMID:25271477

Chi, Kai-Hua; Vahi, Ventis; Pillay, Allan; Sokana, Oliver; Pavluck, Alex; Mabey, David C.; Chen, Cheng Y.; Solomon, Anthony W.

2014-01-01

385

The Mycotic Ulcer Treatment Trial  

PubMed Central

Objective To compare topical natamycin vs voriconazole in the treatment of filamentous fungal keratitis. Methods This phase 3, double-masked, multicenter trial was designed to randomize 368 patients to voriconazole (1%) or natamycin (5%), applied topically every hour while awake until reepithelialization, then 4 times daily for at least 3 weeks. Eligibility included smear-positive filamentous fungal ulcer and visual acuity of 20/40 to 20/400. Main Outcome Measures The primary outcome was best spectacle-corrected visual acuity at 3 months; secondary outcomes included corneal perforation and/or therapeutic penetrating keratoplasty. Results A total of 940 patients were screened and 323 were enrolled. Causative organisms included Fusarium (128 patients [40%]), Aspergillus (54 patients [17%]), and other filamentous fungi (141 patients [43%]). Natamycin-treated cases had significantly better 3-month best spectacle-corrected visual acuity than voriconazole-treated cases (regression coefficient=?0.18 logMAR; 95% CI, ?0.30 to ?0.05; P=.006). Natamycin-treated cases were less likely to have perforation or require therapeutic penetrating keratoplasty (odds ratio=0.42; 95% CI, 0.22 to 0.80; P=.009). Fusarium cases fared better with natamycin than with voriconazole (regression coefficient=?0.41 logMAR; 95% CI, ?0.61 to ?0.20; P<.001; odds ratio for perforation=0.06; 95% CI, 0.01 to 0.28; P<.001), while non-Fusarium cases fared similarly (regression coefficient=?0.02 logMAR; 95% CI, ?0.17 to 0.13; P=.81; odds ratio for perforation=1.08; 95% CI, 0.48 to 2.43; P=.86). Conclusions Natamycin treatment was associated with significantly better clinical and microbiological outcomes than voriconazole treatment for smear-positive filamentous fungal keratitis, with much of the difference attributable to improved results in Fusarium cases. Application to Clinical Practice Voriconazole should not be used as monotherapy in filamentous keratitis. Trial Registration clinicaltrials.gov Identifier: NCT00996736 PMID:23710492

Prajna, N. Venkatesh; Krishnan, Tiruvengada; Mascarenhas, Jeena; Rajaraman, Revathi; Prajna, Lalitha; Srinivasan, Muthiah; Raghavan, Anita; Oldenburg, Catherine E.; Ray, Kathryn J.; Zegans, Michael E.; McLeod, Stephen D.; Porco, Travis C.; Acharya, Nisha R.; Lietman, Thomas M.

2013-01-01

386

Standard treatment of ulcerative colitis.  

PubMed

Ulcerative colitis (UC) is an idiopathic, chronic inflammation of the colon which may present with a range of mild to severe symptoms. The disease may be localized to the rectum or can be more extensive and involve the left side of the colon or the whole colon. Treatment in UC is directed towards inducing and maintaining remission of symptoms and mucosal inflammation. The key parameters to be assessed for the most appropriate treatment are the severity and extent of the inflammation. Meta-analyses of published trials have shown that topical treatment with 5-aminosalicylic acid (5-ASA) is the treatment of choice in active distal mild-to-moderate UC. Oral aminosalicylates are effective in both distal and extensive mild-to-moderate disease, but in distal disease, the rates of remission are lower than those obtained with topical 5-ASA. New steroids, such as budesonide and beclomethasone dipropionate (BDP), administered as enemas, constitute an alternative to 5-ASA therapy. In some studies, these have been shown to be as effective as conventional steroids but with significantly lower inhibition of plasma cortisol levels. Patients with unresponsive disease or those with more severe presentation will require oral corticosteroids and sometimes intravenous therapy. Approximately 10% of patients with unresponsive UC have severe attacks requiring hospitalization. Patients with severe disease should be managed jointly by a medical and surgical team, and intensive intravenous treatment should be started with high-dose steroids. Early recognition of failure of therapy will allow the introduction of immunosuppressive therapy with intravenous cyclosporine. Patients who respond are shifted to oral cyclosporine associated with azathioprine/6-mercaptopurine, whereas those who fail will require proctocolectomy. Oral aminosalicylates are the first-line therapy in maintenance of remission. Topical 5-ASA may play a role in distal disease. Patients who are steroid dependent can be started on azathioprine or 6-mercaptopurine although it may take up to 3 months for the treatment to become effective. They may have reversible immediate side effects, such as pancreatitis or bone marrow suppression, which disappear upon discontinuation of therapy. Close monitoring of these hematologic and biochemical parameters will improve safety. The use of biologic therapy with infliximab in more severe disease has not been established. PMID:14571113

Gionchetti, Paolo; Rizzello, Fernando; Habal, Flavio; Morselli, Claudia; Amadini, Cristina; Romagnoli, Rossella; Campieri, Massimo

2003-01-01

387

A young man with an ulcerated lesion on the right ankle.  

PubMed

We present a case of epitheloid sarcoma that was referred with a 2x3 cm ulcerated lesion on the right ankle and edema of the lower leg. Foot drop of the right side was present that had caused walking difficulty. After a few months, he developed several sporthricoidal nodular lesions on the medial aspect of right thigh, inguinal lymphadenopathy, weight loss, anorexia and respiratory symptoms. Chest x-ray and HRCT showed pulmonary metastasis. Histopathological evaluation and immunohistochemical profile of both skin lesion and involved inguinal lymph node were consistent with epitheloid sarcoma. The case is interesting because as far as we know there has been no report of epitheloid sarcoma in literature presenting with foot drop and edema prior to obvious skin involvement. PMID:21137674

Balighi, Kamran; Farsinejad, Khalil; Barzegar, Mohamadreza; Naraghi, Zahra; Mortazavizadeh, Seyed Mohammad Ali

2010-01-01

388

Complications of ascending phlebography of the leg.  

PubMed Central

Forty patients were studied prospectively for complications of ascending phlebography. The commonest immediate complication was pain at the site of injection and the commonest delayed complication pain in the foot or calf. Out of 30 patients with pain in the foot and calf, 15 had venous thrombosis. Review of 200 case notes disclosed only one recorded complication--namely, necrosis of the dorsal skin of the foot. Complications of the procedure reported by referring clinicians over 10 years comprised four cases of necrosis of the dorsum of the foot and two of gangrene of the foot, in one of which the gangrene spread to the leg. Major complications of ascending phlebography are rare, though when they occur may cause serious morbidity. If a scrupulous technique is used contrast phlebography remains the most accurate method of diagnosing venous disease of the leg. PMID:687897

Thomas, M L; MacDonald, L M

1978-01-01

389

Pathology Case Study: Leg Weakness and Numbness  

NSDL National Science Digital Library

The University of Pittsburgh School of Medicine's Department of Pathology has compiled a series of case studies to help both students and instructors. In this particular study, a 48 year-old man is admitted to the hospital with âÂÂa three week history of back pain, progressive right leg weakness and bilateral lower leg numbness.â A detailed patient history and account of the attending doctorâÂÂs examination is provided in the âÂÂPatient Historyâ section. MRI and CT images of the patient, as well as gross and microscopic descriptions of the condition are included as well. Clicking on the âÂÂFinal Diagnosisâ provides a thorough explanation of the diagnosis and treatment.

Goldberg, Herbert; Lavi, Ehud; Mourelatos, Zissimos; Quan, Dianna; Sinson, Grant

2009-08-28

390

Dynamic legged locomotion in robots and animals  

NASA Astrophysics Data System (ADS)

This report documents our study of active legged systems that balance actively and move dynamically. The purpose of this research is to build a foundation of knowledge that can lead both to the construction of useful legged vehicles and to a better understanding of how animal locomotion works. In this report we provide an update on progress during the past year. Here are the topics covered in this report: (1) Is cockroach locomotion dynamic? To address this question we created three models of cockroaches, each abstracted at a different level. We provided each model with a control system and computer simulation. One set of results suggests that 'Groucho Running,' a type of dynamic walking, seems feasible at cockroach scale. (2) How do bipeds shift weight between the legs? We built a simple planar biped robot specifically to explore this question. It shifts its weight from one curved foot to the other, using a toe-off and toe-on strategy, in conjunction with dynamic tipping. (3) 3D biped gymnastics: The 3D biped robot has done front somersaults in the laboratory. The robot changes its leg length in flight to control rotation rate. This in turn provides a mechanism for controlling the landing attitude of the robot once airborne. (4) Passively stabilized layout somersault: We have found that the passive structure of a gymnast, the configuration of masses and compliances, can stabilize inherently unstable maneuvers. This means that body biomechanics could play a larger role in controlling behavior than is generally thought. We used a physical 'doll' model and computer simulation to illustrate the point. (5) Twisting: Some gymnastic maneuvers require twisting. We are studying how to couple the biomechanics of the system to its control to produce efficient, stable twisting maneuvers.

Raibert, Marc; Playter, Robert; Ringrose, Robert; Bailey, Dave; Leeser, Karl

1995-01-01

391

An Instrument to Measure Healing in Pressure Ulcers: Development and Validation of the Pressure Ulcer Scale for Healing (PUSH)  

Microsoft Academic Search

Background. Currently, there is no instrument that provides an accurate and simple method of monitoring pressure ulcer healing in clinical practice. This article reports the two studies that were conducted to assess the validity of the Pressure Ulcer Scale for Healing (PUSH) as a tool to monitor healing of stage II-IV pressure ulcers. Methods. Subjects in both studies ( N

Nancy A. Stotts; George T. Rodeheaver; David R. Thomas; Rita A. Frantz; Alfred A. Bartolucci; Carrie Sussman; Bruce A. Ferrell; Janet Cuddigan

392

Free tissue transfer in treatment of the recalcitrant chronic venous ulcer.  

PubMed

We propose that a long-term cure for the recalcitrant chronic venous ulcer must involve a dual surgical approach including (1) wide excision of the ulcer and surrounding liposclerotic tissue bed, and (2) replacement by a free flap containing multiple, competent microvenous valves with a normal microcirculation. Advantages of free flaps over skin grafting include improvement of the underlying pathophysiology; increase in blood supply to the area; ability to cover exposed bone, joint, or tendon; and a lower incidence of recurrence. During the past 8 years, 20 consecutive muscle free flaps were performed in 18 patients for 19 recalcitrant venous ulcers (two "sequential" flaps to the ipsilateral leg in 1 patient and a repeat flap after initial failure in 1 patient). Twelve males and 6 females ranged in age from 17 to 76 years (mean, 44 years). Nontraumatic, nonosteomyelitic venous ulcers had been present for an average of 3.5 years (range, 1-10 years) and failed an average of 2.4 skin grafts (range, 0-6 grafts). Defects ranged from 100 to 600 cm2 (mean, 238 cm2). Donor tissues included rectus abdominis (N = 13), latissimus dorsi (N = 5), gracilis (N = 1), and serratus (N = 1) muscles. Recipient vessels included posterior tibial (N = 12), anterior tibial (N = 6), and peroneal (N = 2). In all instances except one, only one vein, usually one of the venae comitantes, was anastomosed in end-to-end fashion. Successful free tissue transfer was accomplished in 18 of 20 flaps (90%). Complications included infection with partial flap and/or skin graft loss (three flaps), and partial skin graft loss (two flaps). There were no recurrences within the flaps; however, breakdown occurred at the junction between the flap and residual adjacent liposclerotic skin in 1 patient. Follow-up average 32.7 months (range, 8-65 months); 3 patients were lost to follow-up. Free muscle transfer can provide a long-term cure for the recalcitrant venous ulcer by replacing the diseased tissue bed with healthy tissue containing multiple, competent microvenous valves and a normal microcirculation. This can be accomplished in one reconstructive procedure with excellent long-term results. PMID:9188977

Weinzweig, N; Schuler, J

1997-06-01

393

Multidrug resistance gene and its relationship to ulcerative colitis and immune status of ulcerative colitis.  

PubMed

We examined the relationship among the multidrug resistance (MDR1) gene product P-glycoprotein (P-gp), ulcerative colitis, and immune status under ulcerative colitis. MDR1 P-gp expression and interleukin-8 levels in ulcerative colitis were determined using immunohistochemistry and a double-antibody sandwich avidin-biotin complex-enzyme-linked immunosorbent assay, respectively. Nitric oxide content and nitric oxide synthase activity in the colonic mucosa were determined using a colorimetric method; CD4(+) and CD25(+) T cell subset percentages in the peripheral blood were determined by flow cytometry. The positive expression rate of P-gp in patients with ulcerative colitis (17.4%) was significantly lower than that in the control group (31.4%). The expression rate decreased to 10.1, 9.2, and 8.3% after 12, 18, and 24 months of treatment, respectively, which were significantly lower than the expression rate before treatment (17.4%). P-gp expression levels during the remission phase and active phase of ulcerative colitis were 15.2 and 17.1%, respectively, which were significantly lower than that in normal controls (31.4%). Compared with P-gp-negative patients, nitric oxide content, nitric oxide synthase activity, and interleukin-8 levels were significantly higher in P-gp-positive patients with moderately active, severely active, early onset, chronic relapsing, chronic persistent, and acute fulminant ulcerative colitis. CD4(+) and CD25(+) T cell subsets were significantly lower in the peripheral blood of patients with severely active and acute fulminant ulcerative colitis than in control subjects. Expression of the multidrug resistance gene and its product P-gp was observed in normal colon tissues and may be closely related to ulcerative colitis. PMID:25526204

Zhang, Y J; Xu, J J; Wang, P; Wang, J L

2014-01-01

394

Pressure ulcers: effectiveness of risk-assessment tools. A randomised controlled trial (the ULCER trial)  

Microsoft Academic Search

ObjectiveTo evaluate the effectiveness of two pressure-ulcer screening tools against clinical judgement in preventing pressure ulcers.DesignA single blind randomised controlled trial.SettingA large metropolitan tertiary hospital.Participants1231 patients admitted to internal medicine or oncology wards. Patients were excluded if their hospital stay was expected to be 2 days or less.InterventionsParticipants allocated to either a Waterlow (n=410) or Ramstadius (n=411) screening tool group

Joan Webster; Kerrie Coleman; Alison Mudge; Louise Marquart; Glenn Gardner; Monica Stankiewicz; Julie Kirby; Catherine Vellacott; Margaret Horton-Breshears; Alice McClymont

2011-01-01

395

Ulcerative Colitis Associated with Primary Biliary Cirrhosis  

Microsoft Academic Search

Primary biliary cirrhosis and ulcerative colitisare two diseases with many features of autoimmunity.Thirteen cases of coexistence of the two diseases havebeen reported in the literature so far. Patients are usually younger and more often males thanthe ordinary primary biliary cirrhosis patient, whilethe colitis is mild and easily controllable. In ahomogeneous population of 550,000 inhabitants of the island of Crete, 412

M. Koulentaki; I. E. Koutroubakis; E. Petinaki; M. Tzardi; H. Oekonomaki; I. Mouzas; E. A. Kouroumalis

1999-01-01

396

Treatment of Ulcerative Colitis in the Elderly  

Microsoft Academic Search

Ulcerative colitis (UC) has a bimodal age distribution, with the majority of patients being diagnosed between the second and fourth decades of life. However, a second peak in diagnosis occurs in older patients and an estimated 15% of patients present after age 65. Caring for older UC patients who have either presented later in life or who have carried an

Ashwin N. Ananthakrishnan; David G. Binion

2009-01-01

397

Cutaneous Ulcers: Treatment Protocols in the Home  

PubMed Central

When a systematic, coordinated treatment plan is used, many seemingly refractory ulcers can be treated in the home. Communication between the treatment team, which includes the patient, must be maintained. This article describes the various preventive measures, debriding, cleansing, granulating and epithelializing agents, their modes of action and their methods of application.

McNairn, Noreen

1979-01-01

398

A computerised guideline for pressure ulcer prevention  

Microsoft Academic Search

This paper illustrates the implementation of a computerised guideline for pressure ulcer prevention. In particular, it describes the aspects related to the site-specification of a guideline delivered by the Agency for Health Care Policy Research (AHCPR), to its integration with the electronic patient record, and to its implementation within the clinical routine. The primary goal of the system is both

S Quaglini; M Grandi; P Baiardi; M. C Mazzoleni; C Fassino; G Franchi; S Melino

2000-01-01

399

Failure of colonoscopic surveillance in ulcerative colitis  

Microsoft Academic Search

A prospective surveillance programme for patients with longstanding (> = 8 years), extensive (> = splenic flexure) ulcerative colitis was undertaken between 1978 and 1990. It comprised annual colonoscopy with pancolonic biopsy. One hundred and sixty patients were entered into the programme and had 739 colonoscopies (4.6 colonoscopies per patient; 709 patient years follow up). Eight eight per cent of

D A Lynch; A J Lobo; G M Sobala; M F Dixon; A T Axon

1993-01-01

400

Treatment of peptic ulcer disease with furazolidone.  

PubMed

Furazolidone (FZ) has been used in China as a treatment of peptic ulcer disease for about 20 years. Clinical and experimental studies suggest that it has good short-term and long-term effects on both human and animal ulcers. The ulcer healing rate is related to the dosage and course of treatment. The healing rate of a high dose, 2 week course is about 70-75% and the relapse rate after 3 years is 9.5%. The adverse reactions to FZ are not severe, and are well tolerated in most patients. However the mutagenic studies of several biological systems indicate that it has a mutagenic effect, but the mutagenic and carcinogenic effects on humans and animals remain questionable, because FZ has been biotransformed into other metabolites. The mechanisms of FZ in the treatment of peptic ulcer disease are not fully understood, perhaps partly due to the monoamine oxidase (MAO) inhibitory reaction and partly to the antibacterial activity to Helicobacter pylori (HP). The long-term effects of FZ are still not clear. PMID:1391736

Zheng, Z T; Wang, Y B

1992-01-01

401

Fibromyalgia Syndrome: Etiology, Pathogenesis, Diagnosis, and Treatment  

PubMed Central

Fibromyalgia syndrome is mainly characterized by pain, fatigue, and sleep disruption. The etiology of fibromyalgia is still unclear: if central sensitization is considered to be the main mechanism involved, then many other factors, genetic, immunological, and hormonal, may play an important role. The diagnosis is typically clinical (there are no laboratory abnormalities) and the physician must concentrate on pain and on its features. Additional symptoms (e.g., Raynaud's phenomenon, irritable bowel disease, and heat and cold intolerance) can be associated with this condition. A careful differential diagnosis is mandatory: fibromyalgia is not a diagnosis of exclusion. Since 1990, diagnosis has been principally based on the two major diagnostic criteria defined by the ACR. Recently, new criteria have been proposed. The main goals of the treatment are to alleviate pain, increase restorative sleep, and improve physical function. A multidisciplinary approach is optimal. While most nonsteroidal anti-inflammatory drugs and opioids have limited benefit, an important role is played by antidepressants and neuromodulating antiepileptics: currently duloxetine (NNT for a 30% pain reduction 7.2), milnacipran (NNT 19), and pregabalin (NNT 8.6) are the only drugs approved by the US Food and Drug Administration for the treatment of fibromyalgia. In addition, nonpharmacological treatments should be associated with drug therapy. PMID:23213512

Bellato, Enrico; Marini, Eleonora; Castoldi, Filippo; Barbasetti, Nicola; Mattei, Lorenzo; Bonasia, Davide Edoardo; Blonna, Davide

2012-01-01

402

Understanding and determining the etiology of autism.  

PubMed

Worldwide, the rate of autism has been steadily rising. There are several environmental factors in concert with genetic susceptibilities that are contributing to this rise. Impaired methylation and mutations of mecp2 have been associated with autistic spectrum disorders, and related Rett syndrome. Genetic polymorphisms of cytochrome P450 enzymes have also been linked to autism, specifically CYP27B1 that is essential for proper vitamin D metabolism. Vitamin D is important for neuronal growth and neurodevelopment, and defects in metabolism or deficiency have been implicated in autistic individuals. Other factors that have been considered include: maternally derived antibodies, maternal infection, heavy metal exposure, folic acid supplementation, epigenetics, measles, mumps, rubella vaccination, and even electromagnetic radiation. In each case, the consequences, whether direct or indirect, negatively affect the nervous system, neurodevelopment, and environmental responsive genes. The etiology of autism is a topic of controversial debate, while researchers strive to achieve a common objective. The goal is to identify the cause(s) of autism to understand the complex interplay between environment and gene regulation. There is optimism that specific causes and risk factors will be identified. The results of future investigations will facilitate enhanced screening, prevention, and therapy for "at risk" and autistic patients. PMID:19774457

Currenti, Salvatore A

2010-03-01

403

The etiology of maxillary canine impactions.  

PubMed

The etiology of tooth impactions has long been related to an arch-length deficiency. This is valid for most impactions, but not for palatal impaction of the maxillary canine. This study shows that 85 percent of the palatally impacted canines have sufficient space for eruption. The bud of the maxillary canine is wedged between the nasal cavity, the orbit, and the anterior wall of the maxillary sinus. The buds of the lateral incisor and the first premolar are located behind the canine's palatal surface. An arch-length deficiency will not allow the maxillary canine to "jump" the buds, the nasal cavity, or the sinus in order to reappear in the palate. A canine can be palatally impacted if an extra space is available in the maxillary bone. This space can be provided by (1) excessive growth in the base of the maxillary bone, (2) space created by agenesis or peg-shaped lateral incisors, or (3) stimulated eruption of the lateral incisor or the first premolar. In those conditions the canine is free to "dive" in the bone and to become palatally impacted. A dysplasia in the maxillary-premaxillary suture can also modify the direction of the maxillary canine's eruption. PMID:6576636

Jacoby, H

1983-08-01

404

Environmental contaminants as etiologic factors for diabetes.  

PubMed Central

For both type 1 and type 2 diabetes mellitus, the rates have been increasing in the United States and elsewhere; rates vary widely by country, and genetic factors account for less than half of new cases. These observations suggest environmental factors cause both type 1 and type 2 diabetes. Occupational exposures have been associated with increased risk of diabetes. In addition, recent data suggest that toxic substances in the environment, other than infectious agents or exposures that stimulate an immune response, are associated with the occurrence of these diseases. We reviewed the epidemiologic data that addressed whether environmental contaminants might cause type 1 or type 2 diabetes. For type 1 diabetes, higher intake of nitrates, nitrites, and N-nitroso compounds, as well as higher serum levels of polychlorinated biphenyls have been associated with increased risk. Overall, however, the data were limited or inconsistent. With respect to type 2 diabetes, data on arsenic and 2,3,7,8-tetrachlorodibenzo-p-dioxin relative to risk were suggestive of a direct association but were inconclusive. The occupational data suggested that more data on exposure to N-nitroso compounds, arsenic, dioxins, talc, and straight oil machining fluids in relation to diabetes would be useful. Although environmental factors other than contaminants may account for the majority of type 1 and type 2 diabetes, the etiologic role of several contaminants and occupational exposures deserves further study. PMID:11744505

Longnecker, M P; Daniels, J L

2001-01-01

405

Brain edema in diseases of different etiology.  

PubMed

Cerebral edema is a potentially life-threatening complication shared by diseases of different etiology, such as diabetic ketoacidosis, acute liver failure, high altitude exposure, dialysis disequilibrium syndrome, and salicylate intoxication. Pulmonary edema is also habitually present in these disorders, indicating that the microcirculatory disturbance causing edema is not confined to the brain. Both cerebral and pulmonary subclinical edema may be detected before it becomes clinically evident. Available evidence suggests that tissue hypoxia or intracellular acidosis is a commonality occurring in all of these disorders. Tissue ischemia induces physiological compensatory mechanisms to ensure cell oxygenation and carbon dioxide removal from tissues, including hyperventilation, elevation of red blood cell 2,3-bisphosphoglycerate content, and capillary vasodilatation. Clinical, laboratory, and necropsy findings in these diseases confirm the occurrence of low plasma carbon dioxide partial pressure, increased erythrocyte 2,3-bisphosphoglycerate concentration, and capillary vasodilatation with increased vascular permeability in all of them. Baseline tissue hypoxia or intracellular acidosis induced by the disease may further deteriorate when tissue oxygen requirement is no longer matched to oxygen delivery resulting in massive capillary vasodilatation with increased vascular permeability and plasma fluid leakage into the interstitial compartment leading to edema affecting the brain, lung, and other organs. Causative factors involved in the progression from physiological adaptation to devastating clinical edema are not well known and may include uncontrolled disease, malfunctioning adaptive responses, or unknown factors. The role of carbon monoxide and local nitric oxide production influencing tissue oxygenation is unclear. PMID:22579570

Adeva, María M; Souto, Gema; Donapetry, Cristóbal; Portals, Manuel; Rodriguez, Alberto; Lamas, David

2012-07-01

406

Acromegaly Update—Etiology, Diagnosis and Management  

PubMed Central

Acromegaly is a disease with unique clinical manifestations. Its confirmatory diagnosis, however, requires basal and dynamic tests of growth hormone secretion. The measurement of circulating levels of somatomedin C has been a valuable addition to the diagnostic armamentarium. We review the etiology of acromegaly, with particular reference to the different histochemical and ultrastructural forms of somatotropic adenomas and their respective clinical behaviors. Ectopic sources of growth hormone-releasing hormone and of growth hormone itself are now well-recognized, though unusual, causes of acromegaly. The treatment of acromegaly is often problematic and far from uniformly successful. Initial enthusiasm for the results of surgical treatment has now been tempered by reports of increasing rates of recurrence on long-term follow-up. The roles of irradiation and pharmacotherapy are reviewed with particular emphasis on the use of bromocriptine, which has added a new dimension to the control of the somatic and metabolic manifestations of hypersomatotropism. Studies have been done recently using a long-acting somatostatin analog with encouraging results. PMID:3554758

Melmed, Shlomo; Fagin, James A.

1987-01-01

407

Bladder Outlet Obstruction: Etiology and Evaluation  

PubMed Central

Numerous gender-specific etiologies are responsible for bladder outlet obstruction (BOO). BOO may be induced by specific functional and anatomic causes. The resulting obstruction frequently produces lower urinary tract symptoms (LUTS). Categorizing and understanding these entities is crucial when proceeding with a LUTS evaluation as specific diagnostic modalities may then be used to fully delineate the degree of BOO and any secondary issues. Although urodynamic evaluation and pressure flow evaluation is the gold standard diagnostic tool, other modalities may also be used, including post void residual analysis, urinary flow rates, cystoscopy, and selected radiologic ones. Patient self-appraisal of symptoms using various inventories such as the American Urologic Association Symptom Index or the International Prostate Symptom Score is relevant to the initial assessment and subsequent longitudinal follow up. Analysis of secondary symptoms of obstruction in women is often performed using a subjective symptom appraisal and is determined urodynamically, assessing the pressure-flow relation during voiding. The complete assessment of LUTS arising from BOO often includes several of these modalities to fully define the obstructive impact on the individual's urinary function and quality of life. PMID:16986027

Dmochowski, Roger R

2005-01-01

408

Etiological factors in space motion sickness.  

PubMed

We compared susceptibility to motion sickness during exposure to sudden-stop stimulation as a function of gravitoinertial force level. Our findings show that susceptibility is greatly enhanced, both with eyes-closed and eyes-open, for zero-g and 2-g conditions in parabolic flight compared with 1-g test conditions. The change in susceptibility is likely related to three factors: alterations in vestibulo-ocular function which result from variations in gravitoinertial force level (28,29); the altered pattern of otolithic activity resulting during variations in gravitoinertial force level; and the altered canal-otolith response synergies that result during exposure to gravitoinertial force levels greater or less than terrestrial levels. These factors are shown to be related to the etiology of space motion sickness and to the alterations in performance and vestibular function that are experienced by astronauts during reentry. An explanation is also proposed for the decrease in susceptibility to motion sickness exhibited by the Skylab astronauts inflight and for some period postflight during exposure to cross-coupled angular accelerations. PMID:6605145

Lackner, J R; Graybiel, A

1983-08-01

409

Advances in the Diagnosis of Etiologic Subtypes of Ischemic Stroke  

PubMed Central

A fundamental goal of etiologic stroke classification is to generate subgroups with discrete phenotypic, therapeutic, and prognostic features. Accurate stroke classification requires integration of multiple aspects of diagnostic stroke evaluation in a standardized manner. Diagnostic test findings can be simply organized into major etiologic groups to create a phenotypic subtype, or they can be reduced to a single causative subtype through a decision-making process. It is essential for a classification system to provide consistent results across different raters in different clinical settings. Comparability of subtype assignments is the key to valid communication of research results across the field. This article highlights important theoretical aspects of etiologic stroke classification and reviews major etiologic classification systems that have benefited from recent advances in etiologic stroke evaluation. PMID:20425221

2010-01-01

410

Pathology and diagnosis of proliferative and ulcerative dermatitis associated with Tunga penetrans infestation in cattle.  

PubMed

Tunga penetrans is the smallest biting flea known. In cattle, infestation by T. penetrans (tungiasis) typically affects the skin of the distal legs, udder, prepuce, and perianal area. A detailed clinical and pathologic description of bovine tungiasis, together with electron microscopy and molecular diagnostics to establish the identity of the parasite are described. Ninety percent of the cows and heifers and 80% of the bulls in a herd in northwest Argentina had proliferative and ulcerative skin lesions affecting the coronary band, interdigital space, heels, and rudimentary toes of the fore and/or rear limbs, teats, and/or prepuce. These proliferative lesions had multiple large cavities filled with hemorrhagic fluid, necrotic debris, and Tunga spp. parasites. Histologically, the skin showed diffuse papillary epithelial hyperplasia with severe orthokeratotic hyperkeratosis, and it was multifocally ulcerated and inflamed. Multifocally, sections of arthropod parasites were observed embedded in the epidermis and dermis with the posterior end toward the surface. Images of wet mounts and scanning electron microscopy of the parasite showed morphologic characteristics compatible with Tunga spp. Polymerase chain reaction followed by sequencing of the cytochrome c oxidase subunit II and the internal transcribed spacer region indicated 99% homology to published T. penetrans sequences. Tungiasis should be considered as a differential diagnosis for proliferative lesions in skin of cattle. PMID:25525141

Marin, Raul E; Houston, Robin; Omanska-Klusek, Alicja; Alcaraz, Ana; Garcia, Jorge P; Uzal, Francisco A

2015-01-01

411

[Weight loss and healing of ulcers - case report].  

PubMed

Diabetes mellitus type 2 is one of the most common diseases with a prevalence increasing with age. If blood sugar is not controlled, complications arise and diabetic foot ulcer occurs. Depending on the blood vessels involved, we distinguish venous and arterial ulcers. Venous ulcers respond very well to modern methods of treatment such as compression therapy and hydrocolloid dressings, but for arterial ulcer prevention is most significant, e.g. weight loss, dietary modification, etc. The aim of this study was to show that despite all the available therapeutic options, we cannot cure ulcers completely because the patient's readiness to change his lifestyle plays a decisive role. Therefore, we present a patient having suffered from venous ulcers for several years and arterial ulcer that healed only after the patient had lost about 20 pounds. PMID:24371990

Seremet, Jasmina; Laginja, Stanislava; Marinovi?, Marin

2013-10-01

412

Leg Muscle Activation and Distance Setting of the Leg Cycle Ergometer for Use by the Elderly  

PubMed Central

[Purpose] This study verified the leg muscle activities of elderly subjects performing leg cycle ergometer exercise. [Subjects] Forty-one elderly persons were the subjects of this study. [Methods] For the three distances corresponding to knee flexion angles of 15, 45, and 70, the muscle activities of the rectus femoris, biceps femoris, tibialis anterior and lateral gastrocnemius were measured while the subjects exercised on a cycle ergometer. [Results] The rectus femoris and biceps femoris showed statistically significant increases as the distance between the cycle ergometer and the body increased, and the lateral gastrocnemius muscle activation showed a statistically significant increase as the distance from the body to the cycle ergometer decreased. [Conclusion] When the elderly have limb muscle weakness, leg cycle ergometer distances should be adjusted. PMID:25364121

Kim, Seon-Chill; Lee, Sang-Yeol; Lee, Young-Ik

2014-01-01

413

Leg stiffness of sprinters using running-specific prostheses.  

PubMed

Running-specific prostheses (RSF) are designed to replicate the spring-like nature of biological legs (bioL) during running. However, it is not clear how these devices affect whole leg stiffness characteristics or running dynamics over a range of speeds. We used a simple spring-mass model to examine running mechanics across a range of speeds, in unilateral and bilateral transtibial amputees and performance-matched controls. We found significant differences between the affected leg (AL) of unilateral amputees and both ALs of bilateral amputees compared with the bioL of non-amputees for nearly every variable measured. Leg stiffness remained constant or increased with speed in bioL, but decreased with speed in legs with RSPs. The decrease in leg stiffness in legs with RSPs was mainly owing to a combination of lower peak ground reaction forces and increased leg compression with increasing speeds. Leg stiffness is an important parameter affecting contact time and the force exerted on the ground. It is likely that the fixed stiffness of the prosthesis coupled with differences in the limb posture required to run with the prosthesis limits the ability to modulate whole leg stiffness and the ability to apply high vertical ground reaction forces during sprinting. PMID:22337629

McGowan, Craig P; Grabowski, Alena M; McDermott, William J; Herr, Hugh M; Kram, Rodger

2012-08-01

414

Leg stiffness changes in athletes with Achilles tendinopathy.  

PubMed

Overuse injuries of the Achilles tendon cause impairment in lower leg muscle-tendon function. The purpose of this study was to evaluate leg stiffness in patients suffering unilateral Achilles tendinopathy. 51 athletes with unilateral Achilles tendinopathy underwent leg stiffness testing by modeling the vertical ground reaction force in a contact mat, measuring flight and contact time during hopping. Clinical status was estimated with a pain VAS and a validated questionnaire (VISA-A). The 'leg stiffness ratio' (LSR=stiffness of injured leg/stiffness of healthy leg) was calculated to determine the relative patient affectation and for intra-group comparison. 84 percent of subjects showed lower leg stiffness in the affected side during hopping. Leg stiffness was significantly lower in the limb affected by Achilles tendinopathy than in the healthy side (14.07±3.74 kN/m vs. 15.61±4.01 kN/m, p=0.047); overall LSR was 0.90±0.09. Intra-group comparison did not show significant differences related to patients' age, gender, sport level, and site of tendon injury (midportion or insertional). Leg stiffness was significantly reduced in patients with unilateral Achilles tendinopathy probably related to increasing ankle compliance. Regular leg stiffness assessment would be beneficial for athletes suffering Achilles tendon problems in terms of quantifying performance capabilities and providing objective data for a safer return to sport activity. PMID:22499572

Maquirriain, J

2012-07-01

415

Dietary agents and phytochemicals in the prevention and treatment of experimental ulcerative colitis.  

PubMed

Inflammatory bowel diseases (IBDs), consisting mainly of ulcerative colitis (UC) and Crohn's disease (CD), are important immune-mediated diseases of the gastrointestinal tract. The etiology of the disease includes environmental and genetic factors. Its management presents a constant challenge for gastroenterologists and conventional surgeon. 5-Amninosalicylates, antibiotics, steroids, and immune modulators have been used to reduce the symptoms and for maintenance of remission. Unfortunately, long-term usage of these agents has been found to lead to severe toxicities, which are deterrent to the users. Pre-clinical studies carried out in the recent past have shown that certain dietary agents, spices, oils, and dietary phytochemicals that are consumed regularly possess beneficial effects in preventing/ameliorating UC. For the first time, this review addresses the use of these dietary agents and spices in the treatment and prevention of IBD and also emphasizes on the mechanisms responsible for their effects. PMID:25379461

Saxena, Arpit; Kaur, Kamaljeet; Hegde, Shweta; Kalekhan, Faizan M; Baliga, Manjeshwar Shrinath; Fayad, Raja

2014-10-01

416

Dietary Agents and Phytochemicals in the Prevention and Treatment of Experimental Ulcerative Colitis  

PubMed Central

Inflammatory bowel diseases (IBDs), consisting mainly of ulcerative colitis (UC) and Crohn's disease (CD), are important immune-mediated diseases of the gastrointestinal tract. The etiology of the disease includes environmental and genetic factors. Its management presents a constant challenge for gastroenterologists and conventional surgeon. 5-Amninosalicylates, antibiotics, steroids, and immune modulators have been used to reduce the symptoms and for maintenance of remission. Unfortunately, long-term usage of these agents has been found to lead to severe toxicities, which are deterrent to the users. Pre-clinical studies carried out in the recent past have shown that certain dietary agents, spices, oils, and dietary phytochemicals that are consumed regularly possess beneficial effects in preventing/ameliorating UC. For the first time, this review addresses the use of these dietary agents and spices in the treatment and prevention of IBD and also emphasizes on the mechanisms responsible for their effects. PMID:25379461

Saxena, Arpit; Kaur, Kamaljeet; Hegde, Shweta; Kalekhan, Faizan M; Baliga, Manjeshwar Shrinath; Fayad, Raja

2014-01-01

417

Epizootic pneumonia of bighorn sheep is a devastating disease of uncertain etiology. To help clarify the etiology, we  

E-print Network

Epizootic pneumonia of bighorn sheep is a devastating disease of uncertain etiology. To help in the etiology of epizootic pneumonia of bighorn sheep. In North America, epizootic pneumonia is a devastating of all ages (1­ 3). During subsequent years or decades, sporadic cases of pneumonia in adult sheep

418

[Definition, etiology, classification and presentation forms].  

PubMed

Osteoarthritis is defined as a degenerative process affecting the joints as a result of mechanical and biological disorders that destabilize the balance between the synthesis and degradation of joint cartilage, stimulating the growth of subchondral bone; chronic synovitis is also present. Currently, the joint is considered as a functional unit that includes distinct tissues, mainly cartilage, the synovial membrane, and subchondral bone, all of which are involved in the pathogenesis of the disease. Distinct risk factors for the development of osteoarthritis have been described: general, unmodifiable risk factors (age, sex, and genetic makeup), general, modifiable risk factors (obesity and hormonal factors) and local risk factors (prior joint anomalies and joint overload). Notable among the main factors related to disease progression are joint alignment defects and generalized osteoarthritis. Several classifications of osteoarthritis have been proposed but none is particularly important for the primary care management of the disease. These classifications include etiological (primary or idiopathic forms and secondary forms) and topographical (typical and atypical localizations) classifications, the Kellgren and Lawrence classification (radiological repercussions) and that of the American College of Rheumatology for osteoarthritis of the hand, hip and knee. The prevalence of knee osteoarthritis is 10.2% in Spain and shows a marked discrepancy between clinical and radiological findings. Hand osteoarthritis, with a prevalence of symptomatic involvement of around 6.2%, has several forms of presentation (nodal osteoarthritis, generalized osteoarthritis, rhizarthrosis, and erosive osteoarthritis). Symptomatic osteoarthritis of the hip affects between 3.5% and 5.6% of persons older than 50 years and has different radiological patterns depending on femoral head migration. PMID:24467954

Mas Garriga, Xavier

2014-01-01

419

Restless Leg Syndrome: A Neglected Diagnosis  

PubMed Central

Context: Restless legs syndrome (RLS) is an irresistible urge to move legs that usually occur during inactivity and at night. This neurologic condition is associated with increased risk of nocturnal hypertension as well as cardiovascular events and affects patient’s sleep, which leads to anxiety, depression, and decreases quality of life. Presence of RLS in patients on hemodialysis is associated with higher mortality rate. Most of the times, patients have indescribable symptoms. The aim of this review was to provide physicians with information to be aware and turn their attention to the patient’s symptoms, which are the most important clue to diagnosis of RLS. Evidence Acquisition: For data extraction, we reviewed PubMed, Scopus, Google scholar, the Cochrane collaboration, and Up to Date databases with the keywords of restless legs syndrome, sleep disorders, and end-stage renal disease (ESRD). The most recent review articles, clinical trials, and cross-sectional studies with large sample sizes that had used International RLS Study Group criteria (IRLSSG) and had focused on demographic characteristics and renal function were included. This situation has described in primary and secondary forms. The former usually occurs in younger patients and seems to have genetic tendencies and the latter is due to the iron deficiency state, pregnancy, and ESRD. Results: Two major theories are developed regarding the pathophysiology of RLS. The first one concerns central nervous system dopamine imbalance and the second one concerns intracellular iron dysregulation. The most common used pharmacologic agents in treatment of RLS are dopamine agonists. Other used therapeutic agents include levodopa, Alpha-2-delta calcium channel ligands, opioids, anticonvulsants, benzodiazepines, clonidine, iron therapy in low levels of serum ferritin, and nonpharmacologic therapies. Conclusions: The most important factor in diagnosis is physician’s attention and clinical experience with this condition and using IRLSSG.

Einollahi, Behzad; Izadianmehr, Neda

2014-01-01

420

[Bow legged adjectives in ancient literature].  

PubMed

This article addresses the issue of capturing the medical entity called 'curved legs' in a terminologically exact way. In so doing, it refers to the long-lasting process of differentiation of exact nuances of meaning in Ancient Greek and Latin. In the chronological perusal of ancient Greek literature, it becomes evident that the various adjectives employed are often vague when looking at non-medical literature. By contrast, in the Hippocratic corpus these terms are for the first time annotated with explanations intended to lead to a more precise understanding of the described deformity. Further attempts of differentiation can be found in the writings of Galen, who not only distinguishes between outward and inward curvatures, but also between deformities of the thigh and lower leg as well as between pathological and natural curvatures. Latin literature also provides a series of adjectives that were initially often used in the meaning of 'curved' but it was not until Celsus that these were differentiated with respect to the type and direction of the curvature. When comparing Greek and Latin adjectives, it turns out that though the Latin term blaesus can be traced back etymologically to the Greek word beta lambda alpha iota sigma ó zeta, the meaning of beta lambda alpha iota sigma ó zeta does not fully correspond to that of the Latin word. It is not before the later common transliteration of Greek words that this adjective took on the meaning of beta lambda alpha iota sigma ó zeta; however, this was finally lost again. In summary, the article concludes that exact word meanings in ancient literature are often unclear and precise ascriptions of meanings are inconsistent. In the case of "curved legs," this has led to misunderstandings regarding the respective types and directions of the curvature. PMID:22352134

Simon, Frantisek; Steger, Florian

2011-01-01

421

Is leg compression beneficial for alpine skiers?  

PubMed Central

Background This study examined the effects of different levels of compression (0, 20 and 40 mmHg) produced by leg garments on selected psycho-physiological measures of performance while exposed to passive vibration (60 Hz, amplitude 4-6 mm) and performing 3-min of alpine skiing tuck position. Methods Prior to, during and following the experiment the electromygraphic (EMG) activity of different muscles, cardio-respiratory data, changes in total hemoglobin, tissue oxygenation and oscillatory movement of m. vastus lateralis, blood lactate and perceptual data of 12 highly trained alpine skiers were recorded. Maximal isometric knee extension and flexion strength, balance, and jumping performance were assessed before and after the experiment. Results The knee angle (?10°) and oscillatory movement (?20-25.5%) were lower with compression (P?leg compression, alpine skiers could maintain a deeper tuck position with less perceived exertion and greater deoxygenation of the vastus lateralis muscle, with no differences in whole-body oxygen consumption or blood lactate concentration. These changes occurred without compromising maximal leg strength, jumping performance or balance. Accordingly, our results indicate that the use of lower leg compression in the range of 20-40 mmHg may improve alpine skiing performance by allowing a deeper tuck position and lowering perceived exertion. PMID:24004479

2013-01-01

422

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

PubMed Central

Background Ghana is a Buruli ulcer (BU) endemic country yet there is paucity of socio-cultural research on BU. Examining distinctive experiences and meanings for pre-ulcers and ulcers of BU may clarify the disease burden, illness experience and local perceptions of causes and spread, and environmental features of BU, which are useful to guide public health programmes and future research. This study aimed to explain local meanings and experiences of BU for persons with pre-ulcers and ulcers in the Ga-West and Ga-South municipalities in Accra. Methods Semi-structured interviews based on the Explanatory Model Interview Catalogue framework were administered to 181 respondents comprising 15 respondents with pre-ulcers and 166 respondents with ulcers. The Wilcoxon rank-sum test was used to compare categories of illness experiences (PD) and perceived causes (PC) among respondents with pre-ulcer and ulcer conditions. The Fisher’s exact test was used to compare the most troubling PD and the most important PC variables. Qualitative phenomenological analysis of respondents’ narratives clarified illness experiences and meanings with reference to PC and PD variables. Results Families of respondents with pre-ulcers and the respondents themselves were often anxious about disease progression, while families of respondents with ulcers, who had to give care, worried about income loss and disruption of school attendance. Respondents with pre-ulcers frequently reported swimming in ponds and rivers as a perceived cause and considered it as the most important PC (53.3%). Respondents with ulcers frequently attributed their BU illness to witchcraft (64.5%) and respondents who claimed they had no water contact, questioned the credibility of health messages Conclusions Affected persons with pre-ulcers are likely to delay treatment because of social and financial constraints and the absence of pain. Scepticism on the role of water in disease contagion and prolonged healing is perceived to make ideas of witchcraft as a PC more credible, among respondents with ulcers. Health messages should address issues of locally perceived risk and vulnerability. Guided by study findings, further research on the role of environmental, socio-cultural and genetic factors in BU contagion, is also needed to clarify and formulate health messages and strengthen public health initiatives. PMID:22471884

2012-01-01

423

The CMTrio-98 Sony-Legged Robot Team  

Microsoft Academic Search

. Sony has provided a remarkable platform for research anddevelopment in robotic agents, namely fully autonomous legged robots.In this paper, we describe our work using Sony's legged robots to participatein the RoboCup'98 legged robot demonstration and competition.The robots are fully autonomous with on-board vision, control,and navigation. The challenges we addressed in this framework includethe color calibration of the vision hardware,

Manuela M. Veloso; William T. B. Uther

1998-01-01

424

Geometric axis compactness criteria for equal leg angles: horizontal leg compression  

Microsoft Academic Search

Single angle members are often used in applications requiring significant amounts of flexural ductility when subjected to bending in the plane of one of the angle legs. Such applications arise in the nuclear power and defense industries where angle members may serve as hangers for vital duct work and piping systems in reactor facilities. Lateral accelerations due to seismic loading

C. J. Earls

2001-01-01

425

Larval Legs of Mulberry Silkworm Bombyx mori Are Prototypes for the Adult Legs  

E-print Network

of the most closely related insect orders to Diptera (e.g., Drosophila melanogaster) (Common, 1975; Regier et harbored inside the larva. Bombyx mori (B. mori), a Lepidopteran insect, develops adult wings from larval wing imaginal discs. However, it has been debated whether the adult legs of B. mori arise from imaginal

Singh, Amit

426

MAGIC Leg0 CRUISE REPORT MAGIC Leg0 Cruise on the M/V Horizon Spirit  

E-print Network

Los Angeles to Hawaii (Leg00a), and Ernie Lewis and Mike Reynolds continued on the ship for the return Ernie Lewis Brookhaven National Laboratory Brad Orr Argonne National Laboratory Mike Reynolds Remote Angeles, CA February 16-23, 2012 Ernie Lewis (Brookhaven National Laboratory) Brad Orr (Argonne National

427

Tennis leg: mechanism of injury and radiographic presentation.  

PubMed

As summer is upon us, we thought a discussion of tennis leg would be beneficial to our fellow clinicians. Tennis leg is a relatively common clinical condition, classically manifesting as acute, sports-related pain in the mid-calf. First described in 1883, the pathogenesis has been debated--tennis leg was first attributed to rupture of the plantaris tendon, though more recent investigations have implicated rupture of the medial head of the gastrocnemius at its myotendinous junction. For simplicity, many authors use the term tennis leg to describe all such acute muscle injuries in the superficial calf. PMID:24195182

Pacheco, Rafael A; Stock, Harlan

2013-08-01

428

Ileal pouch surgery for ulcerative colitis  

PubMed Central

Ulcerative colitis (UC) is a relapsing and remitting disease characterised by chronic mucosal and submucosal inflammation of the colon and rectum. Treatment may vary depending upon the extent and severity of inflammation. Broadly speaking medical treatments aim to induce and then maintain remission. Surgery is indicated for inflammatory disease that is refractory to medical treatment or in cases of neoplastic transformation. Approximately 25% of patients with UC ultimately require colectomy. Ileal pouch-anal anastomosis (IPAA) has become the standard of care for patients with ulcerative colitis who ultimately require colectomy. This review will examine indications for IPAA, patient selection, technical aspects of surgery, management of complications and long term outcome following this procedure. PMID:17659667

Bach, Simon P; Mortensen, Neil J

2007-01-01

429

Aortoesophageal fistula due to esophageal ulcer.  

PubMed

Aortoesophageal fistula is a rare but fatal disease. Many such fistulas are caused by an aortic aneurysm, a previous operation, or esophageal disease. We report a case of aortoesophageal fistula due to an esophageal ulcer. A 66-year-old man suffered massive hematemesis; he was diagnosed as having an aortoesophageal fistula due to an esophageal ulcer after examination by upper endoscopy, computed tomography, and angiography. He had no aortic aneurysm, nor was there a history of a previous operation. An emergency operation was performed, but we could only accomplish closure because clamping of the aorta was impossible, and the source of the bleeding could not be established. He died 4 days later after sudden hemorrhage. Surgical outcome depends on early surgical intervention before massive hemorrhage occurs. PMID:19440823

Takano, Shinji; Katsuhara, Kazuhiro; Nobuhara, Kenji; Ueda, Shigeharu; Imura, Masato; Hohjo, Yoshihisa

2009-05-01

430

Techniques for targeting screening in ulcerative colitis  

PubMed Central

Patients with longstanding chronic ulcerative colitis are “at risk” of developing colorectal cancer. Approximately 1 in 6 patients will die as a result of colorectal malignancy, which can often be difficult to detect using conventional “white light” colonoscopy. New endoscopic techniques and technologies including the use of dye sprays, “chromoendoscopy”, high magnification chromoscopic colonoscopy and recently chromoscopic assisted confocal laser scanning in vivo endomicroscopy have now been introduced to improve the diagnostic yield of intraepithelial neoplasia at screening colonoscopy. This review details the true “risk” of colorectal cancer complicating ulcerative colitis, discusses the objective evidence to support current endoscopic screening guidelines, and describes the imminent technological paradigm shift about to occur in the endoscopic management and detection of intraepithelial neoplasia. PMID:17621613

Hurlstone, David Paul; Brown, Steve

2007-01-01

431

Large ulcerated cecal lipoma mimicking malignancy  

PubMed Central

Colonic lipomas are relatively uncommon tumors of mesenchymal origin, composed of well-differentiated adipose tissue supported by fibrous tissue, that usually occur in cecum and ascending colon. Colonic lipomas rarely cause symptoms and are usually detected incidentally. However, if the lesion is large, it may produce symptoms, such as abdominal pain, rectal bleeding, obstruction, intussusception, and even weight loss. Large colonic lipomas can be mistaken for malignancy, which may result in extensive surgical operations. We report a large broad-based ulcerated cecal lipoma in a 68-year-old woman, who presented with abdominal pain and weight loss. The ulcerated lesion was highly suspicious for malignancy radiologically and endoscopically. The patient underwent laparoscopic right-hemicolectomy, and the lesion was diagnosed as a cecal submucosal lipoma. The surgical approach remains the treatment of choice for large and complicated cases. PMID:21160661

Zhang, Xuchen; Ouyang, Jie; Kim, Yong-Doo

2010-01-01

432

Penile paraffinoma and ulcers of penis.  

PubMed

The authors describe a case of 33 year old Caucasian married man with an irregular 6 cm penile mass associated with multiple penile ulcers. He reluctantly admitted that 10 years ago he had multiple mineral oil (Vaseline) self injections into the penis, for penile enlargement purposes. The patient had a surgical intervention 10 years ago, but he has recurrent ulcers on his penis. We have administered an intravenous antibiotic therapy combined with local therapy. The term paraffinoma describes a distinct histopathological finding that results from the injection of foreign oily substances into the skin. Although such procedure may be considered rare, they are still performed in some countries. The major point we want emphasis is following: a lot of people seek penile augmentations, it is necessary to remind physicians and the public that nonscientific and inadequate procedure such as Vaseline may lead to debilitating and destructive consequences (Tab. 1, Ref. 12). PMID:22180996

Bobik, O; Bobik, O

2011-01-01

433

Review article: monitoring activity in ulcerative colitis.  

PubMed

The monitoring of patients with ulcerative colitis is easier than in patients with Crohn's disease for several reasons: the severity of symptoms and activity of inflammation tend to run parallel in ulcerative colitis when involvement of the large bowel is more extensive. The easy accessibility of the colonic mucosa by endoscopic and histologic examination provides further information concerning the degree of inflammation. In severe attacks, the patient must be admitted to hospital and monitored carefully. Clinical and laboratory parameters (such as daily stools, CRP, fever, haemoglobin, albumin, etc.) and plain abdominal X-ray are useful in monitoring the activity of the disease and to predict the outcome. In mild to moderate attacks, endoscopic and histologic evaluation are the best methods for choosing the appropriate treatment and for assessing response. PMID:12047252

Rizzello, F; Gionchetti, P; Venturi, A; Amadini, C; Romagnoli, R; Campieri, M

2002-07-01

434

Atypical presentation of oral tuberculosis ulcer.  

PubMed

Tuberculosis is a chronic infectious disease that can affect any part of the body, including the mouth. An upsurge in the number of tuberculosis cases, with a strong association with HIV infection, has been noted. We present a case of tuberculosis that clinically resembles a malignant chronic ulcer in the retromolar trigone-an uncommon site of occurrence. Histologically, the case demonstrated an atypical epitheloid granuloma with reduced lymphocyte count. The diagnosis of tuberculosis was confirmed following sputum culture of M tuberculosis. Antitubercular therapy improved the patient's condition. Although rare, tuberculosis must be considered as a differential diagnosis in chronic ulcers in the oral region; and its association with HIV must not be overlooked. PMID:18265771

Mahajan, Sumita; Srikant, Natarajan; George, Thomas

2007-11-01

435

Effects of Antiulcer Agents on Healing of Mepirizole-induced Duodenal Ulcers in Rats  

Microsoft Academic Search

Healing processes of duodenal ulcers induced by mepirizole and effects of several drugs on the ulcer healing were studied in rats. Mepirizole-induced duodenal ulcers, except for the perforated ones within 3 days after ulceration, gradually diminished in size and depth by the 15th day. Several ulcers persisted for up to 40 days, but complete healing in all rats occurred by

Y. Ishihara; S. Okabe

1983-01-01

436

Mechanisms of Ulcer Healing and Effects of Nonsteroidal Anti-inflammatory Drugs  

Microsoft Academic Search

Ulceration of the gastroduodenal mucosa occurs frequently in humans, particularly in patients with a history of peptic ulcer disease. In order for healing to occur, mucosal damage stimulates secretion of growth factors in the adjacent mucosa and ulcer bed. Peptic ulcer healing is accomplished by the filling of the mucosal defect with cells that migrate from the ulcer margin and

Adrian Schmassmann

1998-01-01

437

Role of Helicobacter pylori Eradication in the Prevention of Peptic Ulcer Bleeding Relapse  

Microsoft Academic Search

The objective of the present work was to determine the effect of treating Helicobacter pylori infection on the recurrence of peptic ulcer bleeding. We prospectively followed 66 out of 70 consecutive H. pylori-positive (histology and\\/ or culture) patients with conservatively and endoscopically managed peptic ulcer bleeding (duodenal ulcer; n = 39, gastric ulcer: n = 25, gastroduodenal double ulcer: n

Joachim Labenz; Gereon Borsch

1994-01-01

438

Management of pressure ulcers - What is new?  

PubMed Central

Pressure ulcers (PUs) are an important aspect of geriatrics and palliative care that amplifies morbidity of the chronically bed-ridden patients posing a threat to health-care economy and resources. PUs can interfere with functional recovery, may be complicated by pain and infection and can prolong hospital length of stay. Their presence may be a marker of poor overall prognosis and premature mortality. The pathogenesis and progress in the management of PUs is discussed. PMID:22408340

Gude, Dilip

2011-01-01

439

Intramedullary leg lengthening with a motorized nail  

PubMed Central

Background and purpose In the last decade, intramedullary limb lengthening has become a viable alternative to traditional external systems. We retrospectively analyzed the use of an intramedullary motorized nail (Fitbone) in a consecutive series of 32 patients. Patients and methods During the period September 2006 to December 2008, 32 consecutive patients with a median age of 17 (IQR: 15–19) years were treated with a fully implantable, motorized intramedullary lengthening device (Fitbone). The median leg length discrepancy was 35 (IQR: 30–44) mm at the femur (n = 21) and 28 (IQR: 25–30) mm at the tibia (n = 11). Results Leg lengthening was successful in 30 of 32 cases, with no residual relevant discrepancy (± 5 mm). No intraoperative complications were observed. The consolidation index was significantly different (p = 0.04) between femoral lengthening (mean 35 days/cm) and tibial lengthening (mean 48 days/cm) but did not depend on age older/younger than 16 or previous operations at the affected site. 3 problems, 3 obstacles, and 4 complications (3 minor, 1 major) were encountered in 8 patients, 5 of which were implant-associated. Interpretation This technique even allows correction in patients with multiplanar deformities. Compared to external devices, intramedullary systems provide comfort and reduce complication rates, give improved cosmetic results, and lead to fast rehabilitation since percutaneous, transmuscular fixation is prevented. This results in reasonable overall treatment costs despite the relatively high costs of implants. PMID:21561309

2011-01-01

440

Lower leg musculoskeletal geometry and sprint performance.  

PubMed

The purpose of this study was to investigate whether sprint performance is related to lower leg musculoskeletal geometry within a homogeneous group of highly trained 100-m sprinters. Using a cluster analysis, eighteen male sprinters were divided into two groups based on their personal best (fast: N=11, 10.30±0.07s; slow: N=7, 10.70±0.08s). Calf muscular fascicle arrangement and Achilles tendon moment arms (calculated by the gradient of tendon excursion versus ankle joint angle) were analyzed for each athlete using ultrasonography. Achilles tendon moment arm, foot and ankle skeletal geometry, fascicle arrangement as well as the ratio of fascicle length to Achilles tendon moment arm showed no significant (p>0.05) correlation with sprint performance, nor were there any differences in the analyzed musculoskeletal parameters between the fast and slow sprinter group. Our findings provide evidence that differences in sprint ability in world-class athletes are not a result of differences in the geometrical design of the lower leg even when considering both skeletal and muscular components. PMID:21474319

Karamanidis, Kiros; Albracht, Kirsten; Braunstein, Bjoern; Moreno Catala, Maria; Goldmann, Jan-Peter; Brüggemann, Gert-Peter

2011-05-01