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Sample records for leg ulcer

  1. [Leg ulcers].

    PubMed

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

    2013-11-01

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

  2. Multidimensional leg ulcer assessment.

    PubMed

    Anderson, Irene

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

  3. [Etiological diagnosis of leg ulcers].

    PubMed

    Debure, Clélia

    2010-09-20

    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

  4. FAQs on leg ulcer care.

    PubMed

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

    In a webchat on leg ulcer management issues, hosted by Nursing Times, participants raised three key areas of care: the role of healthcare assistants in compression bandaging; reporting and investigating damage caused by compression therapy; and recommendations for dressings to be used under compression. This article discusses each of these in turn. PMID:23495505

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

    PubMed

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

    2016-04-01

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

  6. Venous Leg Ulcer in a Sarcoidosis Patient: A Case Report

    PubMed Central

    Ohn, Jungyoon; Byun, Sang Young; Kim, In Su

    2015-01-01

    Venous leg ulcers, the most common form of leg ulcers, are relevant to the pathogenicity of pericapillary fibrin cuff. Sarcoidosis, a multiorgan granulomatous disease, causes fibrin deposition in tissues. We report a case of a 50-year-old man with venous leg ulcers coexisting with sarcoidosis. On the basis of the histologic findings, we propose the hypothesis that sarcoidosis patients are prone to the development of venous leg ulcers. PMID:26719645

  7. [Update on current care guidelines: chronic leg ulcers].

    PubMed

    2014-01-01

    Chronic leg ulcer is a common disorder affecting 1.3-3.6 % of people at some time of their life. The etiology of the ulcer can often be identified through careful clinical examination. The majority of leg ulcers are caused by venous or arterial insufficiency. The target of ulcer treatment should always be directed to the cause of the ulcer. Correction of the circulatory disorder is essential for ulcer healing. Since the probability of ulcer healing reduces as the ulcer becomes chronic, effective treatment should be initiated immediately. Skin grafting should be considered for ulcers > 20 cm2 and > 6 months duration. PMID:24881146

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

    PubMed

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

    2016-04-01

    Leg ulcerations are a common problem, with an estimated prevalence of 1% to 2% in the adult population. Venous leg ulcers are primarily treated in outpatient settings and often are managed by dermatologists. Recent advances in the diagnosis and treatment of leg ulcers combined with available evidence-based data will provide an update on this topic. A systematized approach and the judicious use of expensive advanced therapeutics are critical. Specialized arterial and venous studies are most commonly noninvasive. The ankle brachial pressure index can be performed with a handheld Doppler unit at the bedside by most clinicians. The vascular laboratory results and duplex Doppler findings are used to identify segmental defects and potential operative candidates. Studies of the venous system can also predict a subset of patients who may benefit from surgery. Successful leg ulcer management requires an interdisciplinary team to make the correct diagnosis, assess the vascular supply, and identify other modifiable factors to optimize healing. The aim of this continuing medical education article is to provide an update on the management of venous leg ulcers. Part I is focused on the approach to venous ulcer diagnostic testing. PMID:26979354

  9. [Cellular therapy and leg ulcers: Future approaches].

    PubMed

    Senet, P

    2015-01-01

    The prevalence of leg ulcers, which are most commonly caused by venous insufficiency, is high in Europe. Current treatments are fairly unsatisfactory, with long healing times in many cases, as well as a high risk of relapse. Over the last 15 years, improved understanding of the cellular and molecular mechanisms at work in delayed wound healing has contributed to the development of cellular therapy in this field. The use of keratinocytes or cultured fibroblasts, whether autogenic or allogenic, has been of little value in terms of either healing times or rates of complete healing. For the moment, there are very few allogenic skin substitutes available; they are expensive and have been insufficiently studied in the indication of leg ulcers. Pluripotent mesenchymal adult stem cells have proved capable of accelerating wound healing in animal models and their study in chronic wounds in humans is currently awaited. PMID:26188963

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

    PubMed

    Spoljar, Sanja

    2014-10-01

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

  11. Compression therapy of leg ulcers with PAOD.

    PubMed

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

    2014-05-19

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

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

    PubMed

    Maillard, H

    2015-01-01

    Chronic wounds can take a long time to heal despite appropriate therapy based upon aetiology and use of suitable dressings. The success of electrostimulation is based upon the existence within the skin of the endogenous currents involved in the wound healing process. Where skin continuity is broken by a wound, these electrical potentials are short-circuited, resulting in leakage of electrical current. Woundel() therapy is the only such treatment currently available in France and is based on the use of continuous pulsed current that generates an electrical field near the endogenous electrical fields. It utilises a console to deliver the electrical impulses, a dressing electrode and a dispersion electrode. The electrode dressing is left on the wound for 3 days, and venous compression bandaging may be applied to the leg, taking care to leave the connector free. Negative polarity stimulates migration of fibroblasts, resulting in elimination of fibrin. Positive polarity causes keratinocyte migration, which in turn leads to epidermisation. Electrostimulation is of recognised utility in the healing of chronic wounds: it has been assigned a high-level recommendation in the European and American guidelines for the treatment of venous ulcers and bedsores with proof level of A. Further, the analgesic effect of electrostimulation has been demonstrated in several studies. Electrostimulation is already well developed in France among wound specialists, but prospective studies are planned so that it may be used at patients' homes. PMID:26188964

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

    PubMed

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

    2015-01-01

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

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

    PubMed

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

    2014-12-01

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

  15. Use of sugar in the treatment of infected leg ulcers.

    PubMed

    Lisle, Jackie

    2002-06-01

    Mrs R is an 84-year-old retired shop-keeper with a 17-year history of recurrent leg ulceration. She has received treatment in both primary and secondary care settings, including specialist dermatology and vascular clinics. Mrs R has a long history of non-compliance to treatment regime, removing bandages and rucking them down causing compression injuries that almost resulted in amputation of her right leg. On assessment by the author, she had two partial thickness ulcers to each leg, signs of venous insufficiency and malnutrition, and swabs cultured positive for a range of bacteria. Resistance to topical antimicrobials and allergy to systemic antibiotics meant that another solution had to be tried to relieve the bacterial load on Mrs R's wounds. PMID:12066080

  16. Leg ulcer plastic surgery descent by laser therapy

    NASA Astrophysics Data System (ADS)

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

    1994-02-01

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

  17. Disturbed blood flow regulation in venous leg ulcers.

    PubMed

    Jnger, M; Klyscz, T; Hahn, M; Rassner, G

    1996-01-01

    Microangiopathy of the skin has been recognized as an important factor in the development of skin diseases connected with chronic venous insufficiency (CVI). Here the relationship between postcapillary transmural pressure and precapillary vaso-constriction - we call it the postural feedback system - was examined in venous ulcers (n = 12) and compared to blood flow regulation in the inner ankle area of healthy controls (n = 12). Blood flow changes were measured by laser Doppler fluxmetry. Changes in the laser Doppler flux (LDF) minus the biological zero value were measured after 3 min of arterial occlusion, during 3 min of venous occlusion, while the leg was elevated and while it was lowered and expressed relative to the pretest resting value. In venous ulcers the LDF remained nearly unchanged after arterial occlusion (3 vs. 190%, p < 0.001), leg elevation caused an LDF decrease contrary to what was seen in the controls (-17 vs. +80%, p < 0.001), in the lowered leg an LDF decrease was found (-51 vs. -65%) and venous occlusion led to a profound reduction of flux (-78 vs. -84%). In severe CVI the precapillary arterioles seem to be dilated even with the leg at heart level. This finding means that the postural feedback system under resting conditions is upregulated, and 'luxus' hyperperfusion results. The upregulated postural feedback system contributes to the cutaneous microangiopathy due to chronic venous congestion. PMID:8951524

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-01-01

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

  20. Chronic leg ulcer: does a patient always get a correct diagnosis and adequate treatment?

    PubMed

    Mooij, Michael C; Huisman, Laurens C

    2016-03-01

    Patients with chronic leg ulcers have severely impaired quality of life and account for a high percentage of annual healthcare costs. To establish the cause of a chronic leg ulcer, referral to a center with a multidisciplinary team of professionals is often necessary. Treating the underlying cause diminishes healing time and reduces costs. In venous leg ulcers adequate compression therapy is still a problem. It can be improved by training the professionals with pressure measuring devices. A perfect fitting of elastic stockings is important to prevent venous leg ulcer recurrence. In most cases, custom-made stockings are the best choice for this purpose. PMID:26916772

  1. Therapy-resistant skin ulcers on hypoplastic leg associated with neurofibromatosis type 1.

    PubMed

    Fujimura, Taku; Okuyama, Ryuhei; Aiba, Setsuya

    2008-02-01

    We describe a case of therapy-resistant skin ulcers in sporadic neurofibromatosis type 1. A 40-year-old woman had suffered from neurofibromata on her trunk and extremities since 30 years prior. She suffered from hypoplasia of her right leg from a young age and had a 1-year history of therapy-resistant skin ulcers on the leg and inguinal region. Magnetic resonance angiography disclosed a narrowed femoral artery at the level of the upper thigh with poor root in the inner side corresponding to the ulcerated lesions. The vascular changes were thought to be the cause of the skin ulcers. PMID:18271810

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

    PubMed Central

    Lucas, Antoine; Pirard, Grald E.; Hermanns-L, Trinh; De Paepe, Anne; Dupuy, Alain

    2013-01-01

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

  3. Chronic leg ulcers as a rare cause for the first diagnosis of epidermolysis bullosa dystrophica.

    PubMed

    Bafaraj, Mazin G; Cesko, Elvir; Weindorf, Maren; Dissemond, Joachim

    2014-06-01

    Chronic leg ulcers occur most frequently in the elderly population as a result of an underlying vascular disease especially chronic venous insufficiency. But it also occurs less commonly in younger people due to other aetiologies, for example, infections, vasculitis, neoplasia or genetic diseases. The following case report presents chronic leg ulcers as a rare cause for the first diagnosis of dystrophic epidermolysis bullosa. We report about a 21-year-old man with painful chronic leg ulcers resistant to different wound treatments for 4 months. After exclusion of the more common vascular aetiologies and reviewing the patient's family history, we considered an epidermolysis bullosa dystrophica which could be confirmed by genetic analyses. We treated the patient with debridement, modified negative pressure therapy with non-adhesive foil and skin grafting. The chronic leg ulcers healed completely. This case report demonstrates that the family history and genetic diseases should be considered as rare causes for therapy-refractory chronic leg ulcers, especially in young patients. PMID:22974048

  4. Cohesive short-stretch vs four-layer bandages for venous leg ulcers.

    PubMed

    Puffett, Nick; Martin, Lisa; Chow, Meng Kiew

    2006-06-01

    Nurses today are employing more and more evidence base within their practice. This must be carefully balanced with their ability to offer patients choice about treatment options for venous leg ulceration. Knowledge of only one particular compression bandage system is inadequate for nurses working within this area. This article aims to examine the evidence base for the use of compression bandaging in the treatment of leg ulceration. It explores results of current randomised controlled trials in this area pertaining to four-later bandage (4LB) and cohesive short-stretch bandage (CSSB) systems. The advantages and disadvantages of the 4LB and CSSB are explored and application method of CSSB is explained. Concordance is and important issue that affects successful leg ulcer management (Moffatt, 2004a): if this can be achieved through offering patients choice of treatment bandages, then more successful treatment will be achieved for patients. PMID:16835569

  5. Cross-contamination: Comparison of Nasal and Chronic Leg Ulcer Staphylococcus aureus Strains Isolated from the Same Patient.

    PubMed

    Gjdsbl, Kristine; Skindersoe, Mette Elena; Skov, Robert Leo; Krogfelt, Karen Angeliki

    2013-01-01

    The aim of this study was to investigate the occurrence of bacterial cross-contamination between the nasal cavity and leg ulcers. Sixteen patients were included in the study. Staphylococcus aureus was isolated from the leg ulcer of 13 patients and 6 of these patients also harboured S. aureus in the nasal cavity. Klebsiella oxytoca was found in the ulcer and the nasal cavity of one patient. PFGE analysis revealed that patients harbouring S. aureus both in the nasal cavity and the leg ulcer had the same bacterial type at both sites. None of the S. aureus isolates were methicillin resistant. PMID:23459213

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

    PubMed Central

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

    2007-01-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

    Biguet, Gabriele; Elfving, Britt

    2011-01-01

    Objective: To identify and describe the qualitative variations in how physical activity is perceived and understood by individuals with current or previous venous leg ulcer. Design: A qualitative study using semi-structured interviews. Method: Twenty-two individuals aged 60–85 years were interviewed. The interviews were recorded, transcribed verbatim and analysed by three researchers using a phenomenographic research approach. A set of categories of descriptions and their internal relationships were constructed based on the essential features of the variation in patients’ perceptions of physical activity. Results: Four categories of descriptions were identified: (i) ‘self-management’, (ii) ‘instructions and support’, (iii) ‘fear of injury’ and (iv) ‘a wish to stay normal’. The categories could be interpreted by a two-dimensional construct: (1) perception of venous leg ulcer as a chronic or acute condition and (2) engagement or avoidance behaviour toward physical activity. Chronicity and behaviour combined together formed a 2 × 2 square housing the four qualitatively different categories. Irrespective of category, the participants reported that information given by caregivers regarding leg ulcer and physical activity was insufficient or contradictory. Written information or exercise programmes were not obtained regularly and not at all in primary care. Conclusion: A dichotomous view emerged from participants’ experiences of physical activity based on (1) perception of venous leg ulcer as a chronic or acute condition and (2) engagement or avoidance behaviour toward physical activity. PMID:21148268

  9. Draft Genome Sequence of Kerstersia gyiorum CG1, Isolated from a Leg Ulcer

    PubMed Central

    Greninger, Alexander L.; Kozyreva, Varvara; Truong, Chau-Linda; Longoria, Rose

    2015-01-01

    We report the first draft genome sequence of Kerstersia gyiorum from a leg ulcer of a patient with diabetes and osteomyelitis. The 3.94-Mb genome assembly included 3,428 annotated coding sequences with an N50 of 223,310bp and a plasmid encoding a type IV secretion system gene and two antitoxin genes. PMID:26358603

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

    PubMed Central

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

    2015-01-01

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

  11. A comparative clinical study on five types of compression therapy in patients with venous leg ulcers.

    PubMed

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

    2014-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  13. Knowledge, Attitude, and Practice in the Management of Mixed Arteriovenous Leg Ulcers.

    PubMed

    Woo, Kevin Y; Sears, Kim

    2016-03-01

    Leg ulceration is a chronic health condition that constitutes a significant disease burden. In this cross-sectional descriptive study, a sample of wound care clinicians were asked to respond to a web-based survey. Based on a review of literature and recommended best practices in the management of mixed arteriovenous (AV) ulcers, a questionnaire was developed to examine the knowledge, attitude, and practice pattern in the management of AV ulcers. A total of 436 clinicians participated in the survey. A number of assessment techniques were perceived to be relevant for the assessment of AV ulcers; medical history and the appearance of ulcers were the most commonly used methods in clinical practice. While over 80% of the participants conceded that compression should be used to promote wound healing, half of them would consider using compression for AV ulcers if ankle brachial index was less than 0.8. Half of the participants considered an ankle brachial index of 0.8 or higher as the optimal cutoff value for safe compression. The majority of respondents disagreed with the perception that caring for people with AV ulcers was unrewarding. However, challenges to promote treatment adherence, address psychosocial concerns, and optimize symptom management are common. PMID:26811376

  14. Infection in Venous Leg Ulcers: Considerations for Optimal Management in the Elderly.

    PubMed

    Pugliese, Douglas J

    2016-02-01

    Venous leg ulcers are the most common cause of chronic leg wounds, accounting for up to 70 % of all chronic leg ulcers and carrying with them a significant morbidity, especially for elderly patients. Among people aged 65 years and older, the annual prevalence is 1.7 %. Billions of dollars per year are spent caring for patients with these often difficult-to-heal and sometimes recurrent chronic wounds. Chronic non-healing wounds of the lower extremities are susceptible to microbial invasion and can lead to serious complications, such as delayed healing, cellulitis, enlargement of wound size, debilitating pain, and deeper wound infections causing systemic illness. Recognition and treatment of the infected venous leg ulcer is an essential skill set for any physician caring for geriatric patients. Most physicians rely on subjective clinical signs and patient-reported symptoms in the evaluation of infected chronic wounds. The conventional bacterial culture is a widely available tool for the diagnosis of bacterial infection but can have limitations. Systemic antibiotics, as well as topical antiseptics and antibiotics, can be employed to treat and control infection and critical colonization. Better understanding of microbial biofilms in the wound environment have caused them to emerge as an important reason for non-healing and infection due to their increased resistance to antimicrobial, immunological, and chemical attack. A sound understanding of the microbial-host environment and its complexities, as well as the pathophysiology of venous hypertension, must be appreciated to understand the need for a multimodality approach to treating an infected venous leg ulcer. Other treatment measures are often required, in addition to systemic and topical antibiotics, such as the application of wound bandages, compression therapy, and wound debridement, which can hasten clearance of the infection and help to promote healing. PMID:26833351

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

    PubMed Central

    2014-01-01

    Background Drug users suffer harm from the injecting process, and clinical services are reporting increasing numbers presenting with skin-related problems such as abscesses and leg ulcers. Skin breakdown can lead to long-term health problems and increased service costs and is often the first indication of serious systemic ill health. The extent of skin problems in injecting drug users has not previously been quantified empirically, and there is a dearth of robust topical literature. Where skin problems have been reported, this is often without clear definition and generic terms such as soft tissue infection are used which lack specificity. The aim of this study was to identify the range and extent of skin problems including leg ulceration in a sample of injecting drug users. Definitions of skin problems were developed and applied to descriptions from drug users to improve rigour. Methods Data were collected in needle exchanges and methadone clinics across Glasgow, Scotland, from both current and former drug injectors using face-to-face interviews. Results Two hundred participants were recruited, of which 74% (n?=?148) were males and 26% (n?=?52) were females. The age range was 2144 years (mean 35 years). Just under two thirds (64%, n?=?127) were currently injecting or had injected within the last 6 months, and 36% (n?=?73) had previously injected and had not injected for more than 6 months. Sixty per cent (n?=?120) of the sample had experienced a skin problem, and the majority reported more than one problem. Most common were abscesses, lumps, track marks and leg ulcers. Fifteen per cent (n?=?30) of all participants reported having had a leg ulcer. Conclusions This is an original empirical study which demonstrated unique findings of a high prevalence of skin disease (60%) and surprisingly high rates of leg ulceration (15%). Skin disease in injecting drug users is clearly widespread. Leg ulceration in particular is a chronic recurring condition that is costly to treat and has long-term implications for drug users and services caring for current or former injectors long after illicit drug use has ceased. PMID:25119472

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2014-01-01

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

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

    PubMed

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

    2014-05-25

    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

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

    PubMed

    Martin, Fiona

    2014-06-01

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

  20. Effectiveness of an acellular synthetic matrix in the treatment of hard-to-heal leg ulcers.

    PubMed

    Harding, Keith; Aldons, Pat; Edwards, Helen; Stacey, Michael; Finlayson, Kathleen; Gibb, Michelle; Jenkins, Liz; Shooter, Gary; Lonkhuyzen, Derek Van; Lynam, Emily; Heinrichs, Eva-Lisa; Upton, Zee

    2014-04-01

    Hard-to-heal leg ulcers are a major cause of morbidity in the elderly population. Despite improvements in wound care, some wounds will not heal and they present a significant challenge for patients and health care providers. A multi-centre cohort study was conducted to evaluate the effectiveness and safety of a synthetic, extracellular matrix protein as an adjunct to standard care in the treatment of hard-to-heal venous or mixed leg ulcers. Primary effectiveness criteria were (i) reduction in wound size evaluated by percentage change in wound area and (ii) healing assessed by number of patients healed by end of the 12?week study. Pain reduction was assessed as a secondary effectiveness criteria using VAS. A total of 45 patients completed the study and no difference was observed between cohorts for treatment frequency. Healing was achieved in 356% and wound size decreased in 933% of patients. Median wound area percentage reduction was 708%. Over 50% of patients reported pain on first visit and 870% of these reported no pain at the end of the study. Median time to first reporting of no pain was 14?days after treatment initiation. The authors consider the extracellular synthetic matrix protein an effective and safe adjunct to standard care in the treatment of hard-to-heal leg ulcers. PMID:23834253

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

    PubMed

    Minniti, Caterina P; Kato, Gregory J

    2016-01-01

    The past five decades have seen an improvement in the mortality and morbidity of sickle cell disease (SCD) because of prophylaxis against infectious complications, improved and expanded red cell transfusions, implementation of hydroxyurea therapy, and advances in supportive care. Now that the majority of patients in the western hemisphere reaches adulthood, end organ diseases are frequent, which include vasculopathic complications such as chronic leg ulcers. The management of patients with leg ulcers requires the hematologist to lead a team of health care professionals, and investigates the presence of associated, but potentially still occult signs of vasculopathy, such as pulmonary hypertension, renal disease, priapism and retinopathy. These complications may be asynchronous, and long term careful screening is indicated, in order to ensure early diagnosis and intervention. It is crucial to address both the immediate consequences of pain, infection and disability, and long term effects on quality of life, employment and stigma associated with chronic ulceration. Recent insights into their pathophysiology may have practical implications. We propose a holistic approach to the management of patients' physical and emotional problems and mechanisms of ulcers formation and delayed healing. An overview of topical and systemic therapies for chronic ulcers is given, with the understanding that wound care therapy is best left to the wound specialists, medical and surgical, with whom the hematologist must keep an open line of communication. In the absence of evidence-based guidelines, our opinion is based on both a critical review of the literature and our personal clinical and research experience. Am. J. Hematol. 00:000-000, 2015. 2015 Wiley Periodicals, Inc. Am. J. Hematol. 91:22-30, 2016. 2015 Wiley Periodicals, Inc. PMID:26257201

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2011-01-01

    Background: In Germany, cost calculations on the financial burden of wound treatment are scarce. Studies for attributable costs in hospitalized patients estimate for pressure ulcer additional costs of 6,135.50 per patient, a calculation based on the assumption that pressure ulcers will lead to prolonged hospitalization averaging 2 months. The scant data available in this field prompted us to conduct a prospective economical study assessing the direct costs of treatment of chronic ulcers in hospitalized patients. Study design: The study was designed and conducted as an observational, prospective, multi-centre economical study over a period of 8 months in three community hospitals in Germany. Patients: Direct treatment costs for leg ulcer (n=77) and pressure ulcer (n=35) were determined observing 67 patients (average age: 7512 years). 109 treatments representing 111 in-ward admissions and 62 outpatient visits were observed. During a total of 3,331 hospitalized and 867 outpatient wound therapies, 4,198 wound dressing changes were documented. Main outcome measure: Costs of material were calculated on a per item base. Direct costs of care and treatment, including materials used, surgical interventions, and personnel costs were determined. Results: An average of 1,342 per patient ( 48/d) was spent for treatment of leg ulcer (staff costs 581, consumables 458, surgical procedures 189, and diagnostic procedures 114). On average, each wound dressing change caused additional costs of 15. For pressure ulcer, 991 per patient ( 52/d) was spent on average (staff costs 313, consumables 618, and for surgical procedures 60). Each wound dressing change resulted in additional costs of 20 on average. Conclusion: When direct costs of chronic wounds are calculated on a prospective case-by-case basis for a treatment period over 3 months, these costs are lower than estimated to date. While reduction in prevalence of chronic wounds along with optimised patient care will result in substantial cost saving, this saving might be lower than expected. Our results, however, do not serve as basis for making any conclusions on cost-benefit analysis for both, the affected individual, as well as for the society. PMID:22242088

  4. Evaluation of the use of prognostic information for the care of individuals with venous leg ulcers or diabetic neuropathic foot ulcers.

    PubMed

    Kurd, Shanu K; Hoffstad, Ole J; Bilker, Warren B; Margolis, David J

    2009-01-01

    This is a randomized factorial design clinical trial that investigates the efficacy and feasibility of providing prognostic information on wound healing. Prognostic information was provided based on baseline or 4-week wound characteristics. Healing rates were then determined at 24 weeks for venous leg ulcers and 20 weeks for diabetic neuropathic foot ulcers. Centers that had access to baseline information for venous leg ulcer prognosis had an odds ratio (OR) of healing of 1.42 (95% confidence interval [CI]: 1.03, 1.95) while centers that had access to information at 4 weeks had an OR of healing of 1.43 (95% CI: 1.05, 1.95) compared with controls. Diabetic neuropathic foot ulcer patients treated in centers that had been randomized to receive only 4-week prognostic information were more likely to heal than individuals seen in centers randomized to receive no intervention (OR 1.50, 95% CI: 1.05, 2.14). Our study found that it is feasible and efficacious to provide prognostic information on venous leg ulcers and diabetic neuropathic foot ulcers in a wound care setting using an existing administrative database. This intervention was easy to administer and likely had low associated costs. This method of dispersing prognostic information to healthcare providers should be expanded to include recently published treatment algorithms. PMID:19660039

  5. EFFECTS OF LOW-FREQUENCY ULTRASOUND ON MICROCIRCULATION IN VENOUS LEG ULCERS

    PubMed Central

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

    2011-01-01

    Background: Therapeutic low-frequency ultrasound (US) has been used for many years to improve wound healing in chronic wounds like venous leg ulcers. No human data are available for the possible effects of single US applications on microcirculation and their frequency-dependency. Aims: To investigated the role of therapeutic low-frequency US on microcirculation of venous leg ulcers in vivo. Patients and Methods: This is a pilot study on an inpatient basis. We use a newly developed low-frequency continuous-wave US-equipment composed of a US transducer based on piezo-fiber composites that allow the change of frequency. In this study, we apply US of 34 kHz, 53.5 kHz, and 75 kHz respectively. Twelve patients with chronic venous leg ulcers are analyzed. As an adjunct to good ulcer care, therapeutic US is applied, non-contacting, once a day, in a subaqual position for 10 minutes. Microcirculation is assessed in the ulcers adjacent to skin before US-therapy, immediately after the treatment and 30 minutes later. We use a micro-light guide spectrophotometer (O2C, LEA Medizintechnik GmbH, Gieίen, Germany) for calculation of blood flow velocity, hemoglobin oxygen saturation (SCO2) and relative hemoglobin concentration (rHb) in 2 and 8 mm depth. Contact-free remission spectroscopy (SkinREM3, Color Control Chemnitz GmbH, Chemnitz, Germany) allows contact free measurements in the VIS-NIR range of the spectrum (400 ± 1600 nm). Results: It is seen that therapeutic US is well tolerated. One patient dropped out from a treatment series since he developed erysipelas responding to standard antibiotic. Effects were seen at 34 kHz only. The SO2 values increased after single US application. The values for rHb were higher in the superficial layer of the wound bed (depth 2 mm) compared to deeper parts (8 mm depth). US treatment did not result in significant changes of rHb and blood cell velocity. The data obtained by remission spectroscopy disclose an increase of oxygenized hemoglobin. Conclusions: The major findings are that continuous-wave low-frequency US of 34 kHz, but not, 53.5 kHz or 75 kHz, has a temporary stimulatory effect on microcirculation mainly due to an improved oxygenation. Further studies with treatment series are necessary. PMID:21716543

  6. Chronic venous disease and venous leg ulcers: An evidence-based update.

    PubMed

    Kelechi, Teresa J; Johnson, Jan J; Yates, Stephanie

    2015-06-01

    Chronic venous disease (CVD) is a complex chronic vascular condition with multifaceted primary and secondary etiologies leading to structural and functional changes in veins and valves and blood flow of the lower legs. As a consequence, a spectrum of clinical manifestations arise, ranging from symptoms of mild leg heaviness and achiness to debilitating pain, and signs of skin changes, such as eczema and hemosiderosis, to nonhealing, heavily draining venous leg ulcers (VLUs). Triggers such as trauma to the skin are responsible for a large majority of VLU recurrences. Diagnostic testing for venous reflux includes ultrasound imaging; unfortunately, there are no diagnostic tests to predict VLUs. The hallmark of treatment of both CVD and VLUs is compression. Leg elevation, exercise, and wound management with dressings and advanced healing technologies that provide an environment conducive to healing should focus on reducing pain, necrotic debris, drainage, and odor, as well as preventing infection. VLUs that become chronic without evidence of healing over a 4-week period respond best to multidisciplinary wound experts within a framework of patient-centered care. Nurses are in key positions to provide early recognition of the signs and symptoms as well as initiate prompt diagnostic and promote early treatment to offset the progression of the disease and improve quality of life. PMID:26025146

  7. A new option for endovascular treatment of leg ulcers caused by venous insufficiency with fluoroscopically guided sclerotherapy

    PubMed Central

    Garcarek, Jerzy; Falkowski, Aleksander; Rybak, Zbigniew; Jargiello, Tomasz; Łokaj, Marek; Czapla, Norbert

    2015-01-01

    Introduction Ulcers of lower legs are the most bothersome complication of chronic venous insufficiency (CVI). Aim To assess the effectiveness of endovascular fluoroscopically guided sclerotherapy for the treatment of venous ulcers. Material and methods Thirty-eight limbs in 35 patients with crural venous ulcers were treated with guided sclerotherapy under the control of fluoroscopy. Patients with non-healing ulcers in the course of chronic venous insufficiency, with and without features of past deep vein thrombosis, were qualified for the study. Doppler ultrasound and dynamic venography with mapping of venous flow were performed. Ambulatory venous pressure measurements, leg circumference and varicography were performed just before and following the procedure. Results In 84% of cases, ulcers were treated successfully and healed. Patients with post-thrombotic syndrome (n = 17) healed in 13 (76.5%) cases, whereas patients without post-thrombotic syndrome (n = 21) healed in 19 (90.5%) cases. The mean time of healing of an ulcer for all patients was 83 days (in the first group it was 121 days and in the second group 67 days). Recurrence of an ulcer was observed in 10 limbs: 6 cases in the first group and 4 cases in the second group. Occurrence of deep vein thrombosis associated with the procedure was not observed. Temporary complications were reported but none giving a serious clinical outcome. Conclusions Endovascular fluoroscopically guided sclerotherapy can be an alternative method of treatment of venous ulcers, especially in situations when surgical procedures or other options of treatment are impossible. PMID:26649090

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

    PubMed

    Day, Julie

    2015-12-01

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

  9. QUALITY OF LIFE AND PERCEPTION OF DISEASE IN PATIENTS WITH CHRONIC LEG ULCER.

    PubMed

    Brtan Romi?, Renata; Brtan, An?elka; Romi?, Ivan; Cvitanovi?, Hrvoje; Duvan?i?, Tomislav?; Lugovi?-Mihi?, Liborija

    2015-09-01

    Chronic wounds on lower extremities most commonly result from chronic venous insufficiency. Chronic leg ulcer impacts the quality of life in a number of ways such as reduced mobility, pain, unpleasant odor, sleep disturbances, social isolation, etc. This study included 100 patients with chronic wounds/lower leg ulcer (59% of women and 41% of men, aged 31 to 89) treated locally with special wound dressings for moist wound healing. Study results showed no age and sex correlation with the quality of life, and all participants evaluated their quality of life and health satisfaction as neither good nor bad, but it was found that the disease mostly affected social relationships and to a lesser extent patient satisfaction with their physical and mental health, and the environment. Results on the disease perception showed that the participants considered their disease to have a significant effect on their life and would last for a relatively long time, but they also believed they had good control of their disease. Also, they considered the disease to have many symptoms affecting them; they were worried about their disease which they understood relatively well; they were aware that treatment could be very helpful; and that the disease had moderate effect on their emotional health. According to sex, the disease was found to have greater effect on women (especially on their emotional condition) and women had more faith in successful treatment, while correlation with age was nonsignificant. This study confirmed the importance of the patient psychological condition and the need of due care of their psychological reactions to and facing with the disease. PMID:26666100

  10. Pathophysiology of wound healing and alterations in venous leg ulcers-review.

    PubMed

    Raffetto, Joseph D

    2016-03-01

    Venous leg ulcer (VLU) is one of the most common lower extremity ulcerated wound, and is a significant healthcare problem with implications that affect social, economic, and the well-being of a patient. VLU can have debilitating related problems which require weekly medical care and may take months to years to heal. The pathophysiology of VLU is complex, and healing is delayed in many patients due to a persistent inflammatory condition. Patient genetic and environmental factors predispose individuals to chronic venous diseases including VLU. Changes in shear stress affecting the glycocalyx are likely initiating events, leading to activation of adhesion molecules on endothelial cells, and leukocyte activation with attachment and migration into vein wall, microcirculation, and in the interstitial space. Multiple chemokines, cytokines, growth factors, proteases and matrix metalloproteinases are produced. The pathology of VLU involves an imbalance of inflammation, inflammatory modulators, oxidative stress, and proteinase activity. Understanding the cellular and biochemical events that lead to the progression of VLU is critical. With further understanding of inflammatory pathways and potential mechanisms, certain biomarkers could be revealed and studied as both involvement in the pathophysiology of VLU but also as therapeutic targets for VLU healing. PMID:26916770

  11. Human Skin Allograft for Patients With Diabetic Foot Ulcers, Venous Leg Ulcers, or Surgical/Traumatic Wounds Retrospective, Descriptive Study.

    PubMed

    Desman, Eric; Bartow, William; Anderson, Louise H

    2015-07-01

    Chronic wounds such as diabetic foot ulcers (DFU) and venous leg ulcers (VLU) may take a long time to heal and increase the risk of complications. Previous studies have suggested human skin allograft may facilitate healing of these chronic wounds. A retrospective, descriptive study was conducted among outpatients with nonhealing DFU, VLU, surgical, or traumatic wounds managed with a meshed, partial-thickness, cryopreserved human skin allograft. Charts of all patients who received an allograft from 2011 to 2013 were abstracted if the wound was >1 cm2, had a duration>30 days, was adequately debrided, and was free of infection before the first allograft application. Primary outcome was percentage of wounds healed (ie, 100% epithelialized) at 12 and 20 weeks. Secondary outcome was the number of recorded adverse events. Wound measurements (area--calculated as width x length in cm2), wound type and duration, number of allograft applications, number of adverse events, and race, smoking status, and body mass index were abstracted. Of the 49 patients (average age 64.3 [SD 15.0]; 64% male) who met the inclusion criteria, 13 did not have medical follow-up through the primary outcomes at 12 and 20 weeks, leaving 36 patients (average age 65.1 [SD 15.4]; 67% male) available for analysis. The most common diagnoses were VLU (18 patients, 50%) and traumatic wounds (9 patients, 25%). Average wound size was 19.4 cm2 (SD 29.3, range 1.2-156, median 9.5), and average wound duration at initial treatment was 17.2 (SD 17.0, range 4-72, excluding outlier) weeks. Seventeen (17) wounds (47%) healed by 12 weeks, and 21 (58%) were healed by week 20 with an average of 3.3 (SD 2.0) allograft applications. No serious adverse events occurred. The results of this study are encouraging and add to the currently available literature on the use of allograft skin for chronic wounds, but the study design and sample size limit the ability to interpret the observations. Prospective, controlled clinical studies are needed to compare the efficacy, effectiveness, and cost-effectiveness of human skin allograft to standard care and to other advanced care modalities. PMID:26185972

  12. VenUS IV (Venous leg Ulcer Study IV) - compression hosiery compared with compression bandaging in the treatment of venous leg ulcers: a randomised controlled trial, mixed-treatment comparison and decision-analytic model.

    PubMed Central

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

    2014-01-01

    BACKGROUND Compression is an effective and recommended treatment for venous leg ulcers. Although the four-layer bandage (4LB) is regarded as the gold standard compression system, it is recognised that the amount of compression delivered might be compromised by poor application technique. Also the bulky nature of the bandages might reduce ankle or leg mobility and make the wearing of shoes difficult. Two-layer compression hosiery systems are now available for the treatment of venous leg ulcers. Two-layer hosiery (HH) may be advantageous, as it has reduced bulk, which might enhance ankle or leg mobility and patient adherence. Some patients can also remove and reapply two-layer hosiery, which may encourage self-management and could reduce costs. However, little robust evidence exists about the effectiveness of two-layer hosiery for ulcer healing and no previous trials have compared two-layer hosiery delivering 'high' compression with the 4LB. OBJECTIVES Part I To compare the clinical effectiveness and cost-effectiveness of HH and 4LB in terms of time to complete healing of venous leg ulcers. Part II To synthesise the relative effectiveness evidence (for ulcer healing) of high-compression treatments for venous leg ulcers using a mixed-treatment comparison (MTC). Part III To construct a decision-analytic model to assess the cost-effectiveness of high-compression treatments for venous leg ulcers. DESIGN Part I A multicentred, pragmatic, two-arm, parallel, open randomised controlled trial (RCT) with an economic evaluation. Part II MTC using all relevant RCT data - including Venous leg Ulcer Study IV (VenUS IV). Part III A decision-analytic Markov model. SETTINGS Part I Community nurse teams or services, general practitioner practices, leg ulcer clinics, tissue viability clinics or services and wound clinics within England and Northern Ireland. PARTICIPANTS Part I Patients aged ≥ 18 years with a venous leg ulcer, who were willing and able to tolerate high compression. INTERVENTIONS Part I Participants in the intervention group received HH. The control group received the 4LB, which was applied according to standard practice. Both treatments are designed to deliver 40 mmHg of compression at the ankle. Part II and III All relevant high-compression treatments including HH, the 4LB and the two-layer bandage (2LB). MAIN OUTCOME MEASURES Part I The primary outcome measure was time to healing of the reference ulcer (blinded assessment). Part II Time to ulcer healing. Part III Quality-adjusted life-years (QALYs) and costs. RESULTS Part I A total of 457 participants were recruited. There was no evidence of a difference in time to healing of the reference ulcer between groups in an adjusted analysis [hazard ratio (HR) 0.99, 95% confidence interval (CI) 0.79 to 1.25; p = 0.96]. Time to ulcer recurrence was significantly shorter in the 4LB group (HR = 0.56, 95% CI 0.33 to 0.94; p = 0.026). In terms of cost-effectiveness, using QALYs as the measure of benefit, HH had a > 95% probability of being the most cost-effective treatment based on the within-trial analysis. Part II The MTC suggests that the 2LB has the highest probability of ulcer healing compared with other high-compression treatments. However, this evidence is categorised as low to very low quality. Part III Results suggested that the 2LB had the highest probability of being the most cost-effective high-compression treatment for venous leg ulcers. CONCLUSIONS Trial data from VenUS IV found no evidence of a difference in venous ulcer healing between HH and the 4LB. HH may reduce ulcer recurrence rates compared with the 4LB and be a cost-effective treatment. When all available high-compression treatments were considered, the 2LB had the highest probability of being clinically effective and cost-effective. However, the underpinning evidence was sparse and more research is needed. Further research should thus focus on establishing, in a high-quality trial, the effectiveness of this compression system in particular. TRIAL REGISTRATION Current Controlled Trials ISRCTN49373072. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 57. See the NIHR Journals Library website for further project information. PMID:25242076

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

    PubMed Central

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

    2015-01-01

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

  14. Nasal-type extranodal natural killer/T-cell lymphoma presenting as a solitary non-healing lower leg ulcer.

    PubMed

    Liaw, Tse-Yuan; Hu, Stephen Chu-Sung

    2016-02-01

    Nasal-type extranodal natural killer/T-cell lymphoma (ENTCL) is an aggressive form of non-Hodgkin's lymphoma with a poor prognosis. Primary cutaneous lesions of ENTCL usually present as nodules or infiltrative plaques. The presentation of ENTCL as a solitary ulcer, in the absence of other cutaneous lesions and systemic symptoms and signs, is extremely rare and may be easily misdiagnosed. In this report, we describe an unusual case of ENTCL with a diagnostically challenging clinical presentation as a solitary non-healing leg ulcer in an elderly woman. PMID:25496526

  15. Medical grade honey in the management of chronic venous leg ulcers.

    PubMed

    Holland, Luke C; Norris, Joseph M

    2015-08-01

    A best evidence topic in vascular surgery was written according to a structured protocol. The question addressed was: In patients with chronic venous leg ulcers (CVLU), does the use of medical grade honey as compared to standard wound therapy improve clinical outcomes? A total of 299 papers were identified using the search protocol described, of which five represented the best evidence available to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Two randomised controlled trials arrived at contradictory conclusions: one showing better outcomes for CVLU healing with use of honey over standard wound therapy and the other showing equivalent outcomes but more adverse effects. A third randomised controlled trial showed a non-significant reduction in bacterial colonisation of CVLU with honey compared to standard therapy. Two further studies--a prospective cohort study and a case series--supported the use of honey, but these were of lower grade evidence and had numerous methodological faults. Therefore, the clinical bottom line is that there is no conclusive evidence that honey improves outcome in patients with CVLU, and until more robust trials are conducted, its benefit should be considered unproven. PMID:26050953

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

    PubMed

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

    2015-01-01

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

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

    PubMed

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

    2015-10-01

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

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

    PubMed Central

    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

    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

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

    PubMed Central

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

    2008-01-01

    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

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

    PubMed

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

    2014-12-01

    Biatain and Biatain-Ag are two identical wound dressings except the fact that Biatain-Ag releases silver. In the present multinational double-blinded randomised controlled trial the effect of the two dressings were compared for treatment of venous leg ulcers. A total of 181 patients were treated for 6 weeks with either Biatain or Biatain-Ag followed by 4 weeks treatment with Biatain. Biatain-Ag showed superior performance in relative wound area reduction after 6 weeks treatment and the estimated treatment difference increased after 10 weeks indicating that the effect of silver continues at least for 4 weeks after treatment. A subgroup of the patients differed significantly from the others with respect to parameters associated with a poor healing prognosis; patients were older, had significant history of venous thrombosis, larger ulcers with longer duration and more often recurrent. For this subgroup of patients Biatain-Ag showed significant (P < 005) 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

  1. [Nutrition and chronic wound healing. A clinical case of a patient with a hard to heal venous leg ulcers].

    PubMed

    Lozano, Sandra Alexandre; Bonet, Carme Marquilles; Bou, Joan-Enric Torra I; Llobet Burgus, Marta

    2014-05-01

    The cronicity of a wound can be produced by the alteration of several factors. One of the agents that can produce a delay in the wound healing process is malnutrition. According with the evidence, nutrition is an important factor in chronic wound prevention and treatment. The prevalence of low extremity wounds increases in population aged 65 or more. As we became older, malnutrition risk is more relevant due to physiological changes related to ageing. We describe a clinical case of a torpid venous leg ulcer in an elder patient centering on nutrition assessment and management. PMID:24984303

  2. Ulcers

    MedlinePLUS

    ... have something to do with the combination of H. pylori infection and the level of acid in the stomach. continue How Ulcers Form When H. pylori bacteria do cause ulcers, here's how doctors think ...

  3. Refractory sickle cell leg ulcer: is heparan sulphate a new hope?

    PubMed

    Hayek, Shady; Dibo, Saad; Baroud, Joe; Ibrahim, Amir; Barritault, Denis

    2016-02-01

    Patients with sickle cell disease are known to have recurrent lower extremity ulcers that have a high pain score and are resistant to conventional means of wound therapy. This study reports the successful use of synthetic heparan sulphate (Cacipliq20() , OTR3, Paris, France) in the treatment of a sickle cell ulcer that had failed to respond to several other means of treatment. Therapeutic success was assessed by complete wound coverage and vast improvement in pain score. This is the first study to report use of heparan sulphate in sickle cell ulcers. PMID:24618185

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

    PubMed

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

    2016-02-01

    Chronic venous ulcer (CVU) represents a dreaded complication of chronic venous disease (CVD). The onset of infection may further delay the already precarious healing process in such lesions. Some evidences have shown that matrix metalloproteinases (MMPs) are involved and play a central role in both CVUs and infectious diseases. Two groups of patients were enrolled to evaluate the expression of MMPs in infected ulcers and the levels of inflammatory cytokines as well as their prevalence. Group I comprised 63 patients (36 females and 27 males with a median age of 68·7 years) with infected CVUs, and group II (control group) comprised 66 patients (38 females and 28 males with a median age of 61·2 years) with non-infected venous ulcers. MMP evaluation and dosage of inflammatory cytokines in plasma and wound fluid was performed by means of enzyme-linked immunosorbent assay test; protein extraction and immunoblot analysis were performed on biopsied wounds. The first three most common agents involved in CVUs were Staphylococcus aureus (38·09%), Corynebacterium striatum (19·05%) and Pseudomonas aeruginosa (12·7%). In this study, we documented overall higher levels of MMP-1 and MMP-8 in patients with infected ulcers compared to those with uninfected ulcers that showed higher levels of MMP-2 and MMP-9. We also documented higher levels of interleukin (IL)-1, IL-6, IL-8, vascular endothelial growth factor and tumour necrosis factor-alpha in patients with infected ulcers with respect to those with uninfected ulcers, documenting a possible association between infection, MMP activation, cytokine secretions and symptoms. The present results could represent the basis for further studies on drug use that mimic the action of tissue inhibitors of metalloproteinases in order to make infected CVU more manageable. PMID:24618232

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

    PubMed Central

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

    2015-01-01

    Background For intervention studies that require the use of participant self-reports, the quality and accuracy of recorded data and variability in participant adherence rates to the treatment can cause significant outcome bias. Purpose To assess the quality and accuracy of participant documentation of daily self-monitoring of leg skin temperature, adherence to a graduated cooling treatment protocol to prevent venous leg ulcers, and the potential for bias in treatment effect in a randomized controlled trial that included a population with chronic venous disease. Methods Individuals were randomized to a leg cooling intervention or placebo treatment group to daily self-monitor and record lower leg skin temperature over a 9-month period on monthly paper study logs. Returned study logs for the first 100 completed participants (n=54 cooling intervention, n=46 control) were reviewed for quality and accuracy. Adherence was determined from evaluating the accuracy of participant documentation. To examine potential outcome bias in treatment effect, mean between group and within group comparisons of the before and after treatment differences were conducted using an intention-to-treat (ITT) versus a modified intention-to-treat (mITT) analysis approach with an 85% accuracy cut-off rate. Data were collected in 2011–2014. Results Of the expected 900 study logs, 91.8% (826/900) were returned and 8.2% (74/900) were not. Non-mutually exclusive main error types in returned documentation included: 59.2% (489/826) white-outs, cross-off and/or overwrites, 34.9% (288/826) entries omitted, 29.4% (243/826) no performance of daily self-monitoring, 28.7% (237/826) no performance of the treatment intervention per the prescribed protocol regime, 26.8% (221/826) extraneous data, 8.6% (71/826) suspected fabrication, and 7.6% (63/826) questionable validity. Under ITT analysis, 38.4% (346/900) of all returned logs were <85% accurate, 25.0% (225/900) were 85%–99% accurate, and 36.6% (329/900) were 100% accurate. Mean overall participant adherence rates were: 22.0% at <85% accuracy, 53.0% at 85%–99% accuracy, and 25.0% at 100% accuracy. Under the mITT analysis, 54.0% (483/900) of returned logs were deemed adherent with ≥85% accuracy. Conclusion This study found good rates of adherence. Under ITT analysis, 78.0% of participants were deemed adherent to the study protocol with ≥85% accuracy in documenting daily self-monitoring of skin temperatures in response to a topically applied experimental cooling cuff intervention for the prevention of venous leg ulcers. PMID:26719678

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

    PubMed Central

    2014-01-01

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

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

    PubMed

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

    2016-02-01

    Although chronic wounds have a high socio-economic impact, data on comparative effectiveness of treatments are rare. UrgoStart(®) is a hydroactive dressing containing a nano-oligosaccharide factor (NOSF). This study aimed at evaluating the cost-effectiveness of this NOSF-containing wound dressing in vascular leg ulcers compared with a similar neutral foam dressing (UrgoCell(®) Contact) without NOSF. Cost-effectiveness analysis from the perspective of the German statutory health care system was performed using a decision tree model for a period of 8 weeks. Cost and outcome data were derived from the clinical study 'Challenge' suggesting a response rate (≥40% wound size reduction) of UrgoStart(®) of 65·6% versus 39·4% for the comparator. In the treatment model, effect-adjusted costs of €849·86 were generated after 8 weeks for treatment with UrgoStart(®) versus €1335·51 for the comparator resulting in an effect-adjusted cost advantage of €485·64 for UrgoStart(®) . In linear sensitivity analyses, the outcomes were stable for varying assumptions on prices and response rates. In an 8-week period of treatment for vascular leg ulcers, UrgoStart(®) shows superior cost-effectiveness when compared with the similar neutral foam dressing without any active component (NOSF). As demonstrated within a randomised, double-blind clinical trial, UrgoStart(®) is also more effective in wound area reduction than the neutral foam dressing. Wound healing was not addressed in this clinical trial. Follow-up data of 12 months to allow for reulceration assessment were not generated. PMID:24618370

  8. Ulcers

    MedlinePLUS

    ... and cause ulcers. Anti-inflammatory drugs include aspirin, ibuprofen (one brand name: Motrin), naproxen (brand name: Aleve), ... Avoid anti-inflammatory drugs such as aspirin and ibuprofen. Avoid caffeine and alcohol (or have them only ...

  9. Low-grade elastic compression regimen for venous leg ulcers--an effective compromise for patients requiring daily dressing changes.

    PubMed

    Dabiri, Ganary; Hammerman, Scott; Carson, Polly; Falanga, Vincent

    2015-12-01

    Venous leg ulcers (VLUs) affect millions of patients worldwide and are a tremendous financial burden on our health care system. The hallmark of venous disease of the lower extremities is venous hypertension, and compression is the current mainstay of treatment. However, many patients are non-compliant, partly because of the complexity of the dressings and the difficulties with application and removal. The aim of our study was to test an effective compression dressing regimen for patients with VLUs who require changing the ulcer primary dressing twice daily. We used two layers of a latex-free tubular elastic bandage for compression. The primary endpoint of our study was increased wound-healing rate and our secondary endpoint was complete wound closure. All active study subjects had positive healing rates at week 4 and week 8. Two subjects achieved complete wound closure by week 8. We conclude that compression with a latex-free tubular elastic bandage can be safely used in patients with VLUs requiring frequent dressing changes. This type of compression allows for daily inspection of wounds, dressing changes at home, flexibility in the context of clinical trials, and is a compromise for patients who are intolerant to compression dressings. PMID:24267477

  10. Wireless micro current stimulation - an innovative electrical stimulation method for the treatment of patients with leg and diabetic foot ulcers.

    PubMed

    Wirsing, Peter G; Habrom, Alexander D; Zehnder, Thomas M; Friedli, Sandra; Blatti, Marlise

    2015-12-01

    Clinical experience with a new electrical stimulation (ES) technique, the wireless micro current stimulation (WMCS), for the treatment of chronic wounds is described. WMCS transfers the current to any surface wound from a distance, by using oxygen's and nitrogen's ability to exchange electrons. We studied 47 patients with hard-to-heal wounds. Patients with venous, arterial and mixed leg ulcers were predominant; other aetiologies such as diabetic foot lesions, pressure ulcers, vasculitis and pyoderma were also included. WMCS treatment protocol specified treatment twice or thrice per week, for 45-60 minutes per session, with 15 ?A current intensity. Standard wound care was applied to all patients, including compression bandages, if necessary. Clear progress of wound healing, even after 2 weeks, was observed in all cases. The mean reduction of the wound surface after WMCS treatment was 95% in 8 weeks. Complete healing was achieved within 3 months for the majority of the cases. No clinical side effects were observed. WMCS technology significantly accelerated wound healing for patients with hard-to-heal wounds of different aetiologies. This new therapy offers multiple advantages compared with the previous methods of ES, as it is contactless, free of pain and very easy to use. PMID:24373098

  11. "Toothbrush" the Feet: A Periodic Mechanical Stimulus for Healing of a Severe Chronic Leg Ulcer.

    PubMed

    Vounotrypidis, Periklis; Pappas, Periklis; Vrangalas, Vasilios; Pehlivanidis, Anthimos

    2015-09-01

    Chronic wounds develop when the sequence of healing events are disrupted, usually in patients with underlying diseases such as diabetes mellitus, venous insufficiency, peripheral artery disease, and neuropathies and they affect most often the lower extremities. We present a 68-year-old woman with plantar ulceration, lasting for approximately 18 months, resistant to healing with conventional therapy and various modalities we used. The patient had a long history of seronegative enteropathic arthritis, Crohn's disease, secondary fibrillar amyloidosis, multiplex neuropathy, and small vessel vasculitis, the latter being the trigger event for the ulceration of her right foot. Before the decision for a final surgical intervention, we implemented a mechanical periodic stimulus using a soft toothbrush, which resulted in the gradual and complete healing of the ulcer within a period of 6 weeks. Patient's history and previous treatments are presented along with the procedures that led to the healing of the chronic wound. This report supports the idea that periodic mechanical stimulus is of great importance for the healing process and this could be the mechanism of action of some other methods that have been described in the medical literature. PMID:25845912

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

    PubMed Central

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

    2015-01-01

    Objective: This study compares two different negative pressure wound therapy (NPWT) modalities in the treatment of venous leg ulcers (VLUs), the ultraportable mechanically powered (MP) Smart Negative Pressure (SNaP®) Wound Care System to the electrically powered (EP) Vacuum-Assisted Closure (V.A.C.®) System. Approach: Patients with VLUs from 13 centers participated in this prospective randomized controlled trial. Each subject was randomly assigned to treatment with either MP NPWT or EP NPWT and evaluated for 16 weeks or complete wound closure. Results: Forty patients (n=19 MP NPWT and n=21 EP NPWT) completed the study. Primary endpoint analysis of wound size reduction found wounds in the MP NPWT group had significantly greater wound size reduction than those in the EP NPWT group at 4, 8, 12, and 16 weeks (p-value=0.0039, 0.0086, 0.0002, and 0.0005, respectively). Kaplan–Meier analyses showed greater acceleration in complete wound closure in the MP NPWT group. At 30 days, 50% wound closure was achieved in 52.6% (10/19) of patients treated with MP NPWT and 23.8% (5/21) of patients treated with EP NPWT. At 90 days, complete wound closure was achieved in 57.9% (11/19) of patients treated with MP NPWT and 38.15% (8/21) of patients treated with EP NPWT. Innovation: These data support the use of MP-NPWT for the treatment of VLUs. Conclusions: In this group of venous ulcers, wounds treated with MP NPWT demonstrated greater improvement and a higher likelihood of complete wound closure than those treated with EP NPWT. PMID:25713749

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

    PubMed Central

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

    2010-01-01

    PURPOSE To describe the strategies and costs associated with recruiting African American and white adults into a randomized controlled pilot trial. DESIGN Cryotherapy for Venous Disorders: A Pilot Study is a randomized controlled trial designed to determine the effects of a cool gel wrap and leg elevation intervention versus a leg elevation alone intervention on skin temperature, skin microcirculation, quality of life, and pain in adults with stages 4 and 5 chronic venous disorders. We sought to recruit 60 participants (21 African Americans, 37 whites, and 2 Hispanic or Latino) to complete the study. These enrollment targets reflect the demographic distribution of the community in which the study was conducted (33% African American, 66% white, and 2% Latino). Proactive and reactive recruitment strategies were implemented to recruit subjects. RESULTS Seventy-three individuals (9 African American men, 29 African American women, 11 white men, 22 white women, 1 Asian woman, and 1 Hispanic woman) were screened, and of those, 67 were randomized (9 African American men, 25 African American women, 9 white men, 22 white women, 1 Asian woman, and 1 Hispanic women). Fifty-eight completed the study, yielding an overall 11% attrition rate. An additional 8 subjects canceled or did not show up for a first appointment. Reactive recruitment strategies were most successful for recruiting men, women, African American, and white participants. The 3 most successful reactive strategies were referrals from providers/clinics (34%), flyers posted in the hospital elevators (22%), and targeted mailings from a business (16%). Of the healthcare provider referrals (19), wound care nurses referred 12 completed participants. The amount budgeted for advertisement was $5,000 (2% of the total grant award). The amount spent on recruitment including labor was $5,978, which averaged $103 per participant who completed the study (N = 58). Reactive strategies per participant completer proved more cost-efficient than proactive strategies ($83 vs $215). However, the time spent by the principal investigator (approximately 100 hours or 2.5 hours per week 40 weeks) on recruitment, particularly maintaining frequent face-to-face contact with providers, increased success in the area of healthcare provider referrals. CONCLUSION A variety of recruitment strategies are needed to ensure a diverse participant response to clinical research studies. As nurses become more involved in research activities, and particularly in recruitment, it is important to understand the most effective types of strategies and costs associated with these activities. PMID:20075691

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

    PubMed

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

    2013-08-01

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

  15. Topical sodium nitrite for chronic leg ulcers in patients with sickle cell anaemia: a phase 1 dose-finding safety and tolerability trial

    PubMed Central

    Minniti, Caterina P; Gorbach, Alexander M; Xu, Dihua; Hon, Yuen Yi; Delaney, Kara-Marie; Seidel, Miles; Malik, Nitin; Peters-Lawrence, Marlene; Cantilena, Carly; Nichols, James S; Mendelsohn, Laurel; Conrey, Anna; Grimes, George; Kato, Gregory J

    2015-01-01

    Summary Background Well-tolerated and effective treatments are needed for chronic leg ulcers in sickle cell anaemia. Topical sodium nitrite, a known nitric oxide donor, enhances blood flow in ulcers and has known bacteriostatic effects. We aimed to assess the safety, tolerability, and pharmacokinetics of topical sodium nitrite in patients with sickle cell disease and chronic leg ulcers. Methods We enrolled adult patients from an ambulatory clinic at the National Institutes of Health (Bethesda, MD, USA) with sickle cell anaemia with leg ulcers (with a surface area of 2.5100 cm2) persisting for at least 4 weeks into a safety and tolerability phase 1 dose-escalation trial of topical sodium nitrite. Increasing concentrations of sodium nitrite cream were applied twice weekly for 4 weeks to one ulcer per patient at five dose levels (0.5%, 1%, 1.5%, 1.8%, and 2%). The primary endpoints were safety and tolerability, with secondary endpoints of pharmacokinetics, blood flow, and wound healing. Pain relief was analysed post hoc. Endpoints were analysed over time for the whole study population and according to dose level. This study is registered with ClinicalTrials.gov, number NCT01316796. Findings Between April 4, 2011, and March 19, 2013, we enrolled 18 adult patients with sickle cell anaemia and leg ulcers into our trial. We assigned three patients into each cohort, and each cohort was treated with a different concentration of sodium nitrite cream (cohort 1: 0.5%, cohort 2: 1.0%, cohort 3: 1.5%, and cohort 4: 2.0%). Patients were not enrolled into the next cohort dose until we were able to establish that no dose-limiting toxicities were observed. An additional six patients were enrolled to cohort 3a: 1.8%, after two patients in cohort 4 had asymptomatic drops in diastolic blood pressure. No grade 34 adverse events were observed, and there were no serious adverse events or dose-limiting side-effects. Pharmacokinetic analysis showed that systemic absorption of sodium nitrite was very low. Application of topical sodium nitrite was associated with a significant increase in peri-wound cutaneous blood flow measured by laser speckle contrast imaging (p=0.0002), corroborated by increased peri-wound skin temperature by infrared thermography (p=0.0119). We recorded a dose-dependent decrease in leg ulcer size (p=0.0012) and pain (p<0.0001). Ulcers healed completely in three patients who received the highest concentrations of topical sodium nitrite (the 1.8% and 2% cream). In our post-hoc analysis of pain, brief pain inventory scores improved in pain severity (p=0.0048) and pain interference (p=0.0013). Interpretation Our results indicate that topical sodium nitrite 2% cream is suitable for additional clinical trials in adults with sickle cell anaemia to promote healing of leg ulcers. Funding National Heart, Lung and Blood Institute Division of Intramural Research (National Institutes of Health). PMID:25938131

  16. Use of the sensory nerve stimulator to accelerate healing of a venous leg ulcer with sensory nerve dysfunction: a case study.

    PubMed

    Ogrin, Rajna; Darzins, Peteris; Khalil, Zeinab

    2005-09-01

    A new therapy using sensory nerve stimulation [International Patent Application Number PCT/AU2004/001079: "nerve function and tissue healing" (Khalil, Z)] has been developed in our vascular physiology laboratory. This treatment has been found to improve the deficient sensory nerve function and associated deficient wound healing of older persons to levels seen in young people. An 82-year-old man with a small but persistent venous leg ulcer for 18 months, despite apparently appropriate wound dressings and compression therapy, was seen in a specialist wound management service. The patient's sensory and microvascular function was assessed in great detail using the vascular physiology laboratory techniques, and he was provided the sensory nerve stimulation therapy in addition to conventional therapy. His wound healed after 4 weeks. We report the case here. Prior to nerve stimulation therapy, cutaneous sensation, microvascular blood flow and oxygen tension were found to be reduced near the ulcer when compared with the opposite, non ulcerated leg. After therapy, oxygen tension and microvascular blood flow had improved. This case provides further evidence that sensory nerve stimulation therapy at the stipulated parameters improves wound healing. The observation that sensory nerve function improved provides support for the notion that improvement in healing is mediated by improved nerve function. PMID:16618329

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

    PubMed Central

    Langer, Astrid; Rogowski, Wolf

    2009-01-01

    Background Tissue engineering is an emerging field. Novel bioengineered skin substitutes and genetically derived growth factors offer innovative approaches to reduce the burden of diabetic foot and venous leg ulcers for both patients and health care systems. However, they frequently are very costly. Based on a systematic review of the literature, this study assesses the cost-effectiveness of these growth factors and tissue-engineered artificial skin for treating chronic wounds. Methods On the basis of an extensive explorative search, an appropriate algorithm for a systematic database search was developed. The following databases were searched: BIOSIS Previews, CRD databases, Cochrane Library, EconLit, Embase, Medline, and Web of Science. Only completed and published trial- or model-based studies which contained a full economic evaluation of growth factors and bioengineered skin substitutes for the treatment of chronic wounds were included. Two reviewers independently undertook the assessment of study quality. The relevant studies were assessed by a modified version of the Consensus on Health Economic Criteria (CHEC) list and a published checklist for evaluating model-based economic evaluations. Results Eleven health economic evaluations were included. Three biotechnology products were identified for which topical growth factors or bioengineered skin substitutes for the treatment of chronic leg ulceration were economically assessed: (1) Apligraf, a bilayered living human skin equivalent indicated for the treatment of diabetic foot and venous leg ulcers (five studies); (2) Dermagraft, a human fibroblast-derived dermal substitute, which is indicated only for use in the treatment of full-thickness diabetic foot ulcers (one study); (3) REGRANEX Gel, a human platelet-derived growth factor for the treatment of deep neuropathic diabetic foot ulcers (five studies). The studies considered in this review were of varying and partly low methodological quality. They calculated that due to shorter treatment periods, fewer complications and fewer inpatient episodes the initial cost of the novel biotechnology products may be offset, making the treatment cost-effective or even cost-saving. The results of most studies were sensitive to initial costs of the products and the evidence of effectiveness. Conclusion The study results suggest that some growth factors and tissue-engineered artificial skin products feature favourable cost-effectiveness ratios in selected patient groups with chronic wounds. Despite the limitations of the studies considered, it is evident that health care providers and coverage decision makers should take not only the high cost of the biotechnology product but the total cost of care into account when deciding about the appropriate allocation of their financial resources. However, not only the cost-effectiveness but first of all the effectiveness of these novel biotechnology products deserve further research. PMID:19591680

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

    PubMed

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

    2016-02-01

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

  19. Evaluation of the Essen Rotary as a new technique for bacterial swabs: results of a prospective controlled clinical investigation in 50 patients with chronic leg ulcers.

    PubMed

    Al Ghazal, Philipp; Krber, Andreas; Klode, Joachim; Schmid, Ernst N; Buer, Jan; Dissemond, Joachim

    2014-02-01

    Most chronic wounds are colonised with different microorganisms, especially problematic bacteria like methicillin-resistant Staphylococcus aureus (MRSA), which represent an increasing therapeutic challenge in the modern wound therapy regimen. Therefore, it is essential to specify the bacteria in wounds for an individual-specific treatment. In most patients, an exemplary bacterial swab is taken from the centre of the wound surface. This so-called Levine technique is propagated currently as the gold standard. The aim of our clinical investigation was to compare the results of different swab techniques to the new established Essen Rotary. In this monocentric prospective investigation, 50 patients with chronic leg ulcers were examined consecutively. The results of our clinical study show that bacteria are heterogeneously spread on wound surfaces. The analysis of the semiquantitative measured results showed that the Essen Rotary could detect significant more bacteria with a total amount of 111 bacteria (P = 0049) compared to usual swab techniques. Considerably, only the Essen Rotary identified five compared to three MRSA-patients detected by other techniques. The Essen Rotary is an efficient, economic and uncomplicated modification of bacteriological swab techniques which detects significant more bacteria compared to other conventional swab techniques. Therefore, the Essen Rotary may become the new gold standard in routinely taken bacteriological swabs especially for MRSA screenings in patients with chronic leg ulcers. PMID:22776565

  20. Efficacy and cost-effectiveness of octenidine wound gel in the treatment of chronic venous leg ulcers in comparison to modern wound dressings.

    PubMed

    Hmmerle, Gilbert; Strohal, Robert

    2016-04-01

    The aim of this study was to determine the efficacy, safety and cost-effectiveness of an octenidine-based wound gel in the treatment of chronic venous leg ulcers. For this purpose, 49 wounds were treated with either modern wound-phase-adapted dressings alone (treatment arm 1; n?=?17), octenidine wound gel plus modern wound-phase-adapted dressings (treatment arm 2; n?=?17) or octenidine wound gel alone (treatment arm 3; n?=?15). During the study period of 42?days with dressing changes every 3-5?days, wound healing characteristics and treatment costs of different dressings were analysed. Wound size reduction was significantly better (P?=?0028) in both octenidine wound gel treatment arms compared to modern dressings alone with total reductions of 146%, 641% and 962% in treatment arms 1-3. Early wound healing was merely observed under octenidine wound gel treatment (n?=?9), whereby lowest treatment costs were generated by octenidine wound gel alone (2034/dressing change). As a result, the octenidine wound gel is cost-effective and well suitable for the treatment of chronic venous leg ulcers, considering both safety and promotion of wound healing. PMID:24589044

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

    PubMed

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

    2015-03-01

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

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

    PubMed Central

    Romanelli, Marco; Macchia, Michela; Panduri, Salvatore; Paggi, Battistino; Saponati, Giorgio; Dini, Valentina

    2015-01-01

    This study was carried out to assess the efficacy and tolerability of the topical application of an aqueous extract of Triticum vulgare (TV) in different vehicles (cream, impregnated gauzes, foam, hydrogel, and dressing gel) for the treatment of venous lower leg ulcers. Fifty patients were randomized to receive one of the five investigational vehicles. Treatment was performed up to complete healing or to a maximum of 29 days. The wound size reduction from baseline was the primary efficacy variable, which was measured by means of a noninvasive laser scanner instrument for wound assessment. In all groups, apart from the foam group, a similar trend toward the reduction of the surface area was observed. The cream showed the greatest effect on the mean reduction of the lesion size. At last visit, six ulcers were healed: two in the cream group, three in the gauze group, and one in the dressing gel group. In the patients treated with the cream, the gauzes, the hydrogel, and the dressing gel, the reduction of lesion size was 40%50%; the reduction was smaller in the foam group. No impact in terms of age on the healing process was found. The Total Symptoms Score decreased in all groups during the study; a greater efficacy in terms of signs/symptoms was observed in the patients treated with the gauzes. In the dressing gel group, one patient had an infection of the wound after 3 weeks of treatment and 2 of colonization, leading to a systemic antibiotic treatment. The events were judged as nonrelated to the device used. On the basis of the results, it could be argued that the medical device may be useful in the treatment of chronic venous ulcers. PMID:26060395

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

    PubMed

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

    2014-01-01

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

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

    ClinicalTrials.gov

    2014-10-29

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

  5. Venous ulcers - self-care

    MedlinePLUS

    Risk factors for venous ulcers include: Varicose veins History of blood clots in the legs ( deep vein thrombosis ) Leg swelling Age Being female (related to levels of the hormone progesterone) Being tall Family history of venous insufficiency ...

  6. Low-frequency ultrasound for patients with lower leg ulcers due to chronic venous insufficiency: a report of two cases.

    PubMed

    Maher, Sara F; Halverson, Jessica; Misiewicz, Rob; Reckling, Trisha; Smart, Ojas; Benton, Carol; Schoenherr, Dawn

    2014-02-01

    Low-frequency ultrasound may facilitate debridement and healing of chronic wounds, including lower leg wounds in patients with chronic venous insufficiency (CVI). To evaluate the use of a low-frequency ultrasound (LFU) device with a curette, two patients with CVI and chronic wounds were treated for a period of 2 to 3 weeks. A 63-year-old woman with rheumatoid arthritis and two wounds, one on the right lower leg (250 cm) and one wound on the left medial leg (0.80 cm), present for 12 months; and a 77-year-old man with cardiopulmonary issues with seven wounds, three on the left medial calf (1.2 cm, 11.40 cm, and 0.72 cm), one on the left anterior calf (0.30 cm), two on the right posterior calf (0.90 cm, 0.30 cm), and one on the right anterior calf (0.14 cm), present for 3 months consented to participate in the study. Both patients received low-intensity (50-70 ?m), low-frequency (35 kHz) ultrasound at an intensity of 50% through a saline mist in addition to antimicrobial dressing with silver, a multilayer compression bandage system applied at every visit, and pain medication as needed. Both patients received treatments every 1 to 3 weeks that were not timed. Treatment continued until no additional slough or other necrotic tissue could be removed from the wound bed; the female patient received two treatment sessions and the male received three. Average wound volume did not change significantly from the first to last treatment session (t(8)-1.2, P = 0.26). Five wounds (56%) with initial measurements of 0.8 cm, 0.72 cm, 0.3 cm, 0.3 cm, and 0.14 cm reduced in volume by 100%. Mean wound characteristic scores changed significantly (P <0.05) for amount of fibrin, periwound skin, drainage amount, and color. In addition, the number of wounds filled with slough decreased from 89% at the first session to 22% at the final treatment session. The results of this study suggest LFU may have been beneficial for these patients with CVI. Additional studies using larger sample sizes are needed to evaluate the effect of this treatment on a variety of chronic wounds and to compare its effectiveness to other debridement methods. PMID:24515985

  7. Evaluation of CD4(+)CD25(+)FoxP3(+) T cell populations, IL-10 production, and their correlation with clinical and biochemical parameters in sickle cell anemia patients with leg ulcers.

    PubMed

    Rgo, Moacyr Jesus Barreto Melo; da Silva, Rafael Ramos; Pereira, Michelly Cristiny; da Silva Arajo, Aderson; Pitta, Ivan da Rocha; Falco, Diego Arruda; Bezerra, Marcos Andr Cavalcanti; Pitta, Maira Galdino da Rocha

    2015-10-01

    Leg ulcers (LUs) are a debilitating complication of sickle cell anemia (SCA), with inflammation known to play a crucial role in their pathogenesis. Many studies have described the roles of T helper type 1 (Th1) and Th2 pathways in SCA; however, defects in anti-inflammatory responses are poorly understood. We evaluated interleukin (IL)-10 levels in serum and peripheral blood mononuclear cells (PBMCs) in SCA patients with leg ulcers (SCALU) and without leg ulcers (SCAWH) in addition to CD4(+) CD25(+)FoxP3(+) T cell populations and their its IL-10 expression. In stimulated and unstimulated PBMC cultures, SCALU patients produced higher levels of IL-10 than those in the SCAWH group. Higher levels of IL-10 in SCALU patients correlated with a history of osteonecrosis in stimulated and unstimulated cultures when compared with those in SCAWH. Immunophenotyping revealed that SCALU patients had a higher proportion of CD4(+)CD25(+)FoxP3(+), Tr1 and CD4(+)CD25(+)FoxP3(+)IL-10(+) T cells than other groups. Our findings revealed that IL-10 levels were increased in unstimulated cells from the SCALU group, and that this group also presented with a predominant CD4(+) CD25(+)FoxP3(+) cell population despite many of those cells being IL-10 negative. PMID:26210477

  8. Encouraging patients to self-care - the preliminary development and validation of the VeLUSET, a self-efficacy tool for venous leg ulcer patients, aged 60?years and over.

    PubMed

    Brown, Annemarie; Kendall, Sally; Flanagan, Madeleine; Cottee, Michaela

    2014-06-01

    Venous leg ulceration has a high recurrence rate. Patients with healed or frequently recurring venous ulceration are required to perform self-care behaviours to prevent recurrence or promote healing, but evidence suggests that many find these difficult to perform. Bandura's self-efficacy theory is a widely used and robust behaviour change model and underpins many interventions designed to promote self-care in a variety of chronic conditions. By identifying areas where patients may experience difficulty in performing self-care, interventions can be developed to strengthen their self-efficacy beliefs in performing these activities successfully. There are currently a variety of self-efficacy scales available to measure self-efficacy in a variety of conditions; but not a disease-specific scale for use with venous ulcer patients. The aim of this study, therefore, was to develop and validate a disease-specific, patient-focused self-efficacy scale for patients with healed venous leg ulceration. This scale will need further validation studies; however, it is ready for use in clinical practice and will enable practitioners to identify those patients who may need additional support in performing self-care activities to prevent recurrence. PMID:24373556

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

    PubMed Central

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

    2008-01-01

    Background: Water-filtered infrared-A (wIRA) is a special form of heat radiation with a high tissue-penetration and with a low thermal burden to the surface of the skin. wIRA is able to improve essential and energetically meaningful factors of wound healing by thermal and non-thermal effects. Aim of the study: prospective study (primarily planned randomised, controlled, blinded, de facto with one exception only one cohort possible) using wIRA in the treatment of patients with recalcitrant chronic venous stasis ulcers of the lower legs with thermographic follow-up. Methods: 10 patients (5 males, 5 females, median age 62 years) with 11 recalcitrant chronic venous stasis ulcers of the lower legs were treated with water-filtered infrared-A and visible light irradiation (wIRA(+VIS), Hydrosun radiator type 501, 10 mm water cuvette, water-filtered spectrum 5501400 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, patients 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 4.5C 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 wounds and wound infections can be explained by the improvement of both the energy supply and the oxygen supply (e.g. for the granulocyte function). wIRA causes as a thermal effect in the tissue an improvement in three decisive factors: tissue oxygen partial pressure, tissue temperature and tissue blood flow. Besides this non-thermal effects of infrared-A by direct stimulation of cells and cellular structures with reactions of the cells have also been described. It is concluded that wIRA can be used to improve wound healing, to reduce pain, exudation, and inflammation and to increase quality of life. PMID:19675738

  10. [Leg discoloration].

    PubMed

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

    2013-11-01

    Many patients present with discolouration of the legs or with non-ulcerating skin lesions, the most frequent causes being chronic venous insufficiency or other chronic or acute states of congestion. Erysipelas (cellulitis) is also a frequent example of a bacterial skin infection. A complex differential diagnosis arises from all types of immune-mediated skin lesions, opening up the broad spectrum of inflammatory systemic disease, such as vasculitis and sarcoidosis. Livedo like lesions and skin involvement in borreliosis are challenging to classify but of considerable clinical importance. The present review focuses on the description of underlying diseases as well as on diagnosis and differential diagnosis. Therapeutic considerations are discussed in less detail. PMID:24026790

  11. Ulcerative Colitis

    MedlinePLUS

    ... complication of ulcerative colitis. [ Top ] Ulcerative Colitis and Colon Cancer People with ulcerative colitis may be more likely to develop colon cancer when ulcerative colitis affects the entire colon a ...

  12. A randomized, controlled clinical pilot study comparing three types of compression therapy to treat venous leg ulcers in patients with superficial and/or segmental deep venous reflux ?.

    PubMed

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

    2013-08-01

    Compression therapy--including inelastic, elastic, and intermittent pneumatic compression--is the standard of care for venous ulcers (VLUs) and chronic venous insufficiency, but there is no consensus in the literature regarding the most effective type of compression therapy. A prospective, randomized, clinical pilot study was conducted among 70 patients with unilateral VLUs treated in a hospital dermatology department in Poland to compare three types of compression therapy (intermittent pneumatic compression, stockings, and short-stretch bandages) in persons with superficial deep venous reflux alone or combined with the segmental variety. Study endpoints were change in ulcer dimensions and proportions healed. Patients with superficial or combined superficial and deep vein insufficiency were randomly allocated to receive one of the three therapies (one of each vein type for each treatment option, six groups total). All patients received saline-soaked gauze dressings along with micronized purified flavonoid fraction, diosmin, hesperidin, and Daflon 500 once daily. Compression treatments were changed or pneumatic compression provided daily for 15 days. Wound size reduction and percentage of wounds healed were significantly higher in groups receiving intermittent pneumatic compression or stockings than in groups using short-stretch bandages (for percentage change of ulcer surface area, P = 0.02; for healing rates P = 0.01). These results warrant additional randomized controlled clinical studies with a larger sample size and longer patient follow-up. PMID:23934375

  13. 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

    Barnikol, Wolfgang K. R.; Ptzschke, Harald

    2012-01-01

    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

  14. Ulcerative colitis

    MedlinePLUS

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

  15. [Oral ulcers].

    PubMed

    Bascones-Martnez, Antonio; Figuero-Ruiz, Elena; Esparza-Gmez, Germn Carlos

    2005-10-29

    Ulcers commonly occur in the oral cavity, their main symptom being pain. There are different ways to classify oral ulcers. The most widely accepted form divides them into acute ulcers--sudden onset and short lasting--and chronic ulcers--insidious onset and long lasting. Commonest acute oral ulcers include traumatic ulcer, recurrent aphthous stomatitis, viral and bacterial infections and necrotizing sialometaplasia. On the other hand, oral lichen planus, oral cancer, benign mucous membrane pemphigoid, pemphigus and drug-induced ulcers belong to the group of chronic oral ulcers. It is very important to make a proper differential diagnosis in order to establish the appropriate treatment for each pathology. PMID:16277953

  16. Leg pain

    MedlinePLUS

    ... usually seen in boys and overweight children between ages 11 and 15 ... as much as possible. Elevate your leg. Apply ice for up to 15 minutes. ... Other homecare will depend on the cause of your leg pain.

  17. [Aphthous ulcers and oral ulcerations].

    PubMed

    Vaillant, Loïc; Samimi, Mahtab

    2016-02-01

    Aphthous ulcers are painful ulcerations located on the mucous membrane, generally in the mouth, less often in the genital area. Three clinical forms of aphthous ulcers have been described: minor aphthous ulcers, herpetiform aphthous ulcers and major aphthous ulcers. Many other conditions presenting with oral bullous or vesiculous lesions orulcerations and erosions can be mistaken for aphthous ulcers. Currently, treatment of aphthous ulcers is palliative and symptomatic. Topical treatments (topical anesthetics, topical steroids and sucralfate) are the first line therapy. Recurrent aphthous stomatitis (RAS) is defined by the recurrence of oral aphthous ulcers at least 4 times per year. RAS is often idiopathic but can be associated with gastro-intestinal diseases (i.e. celiac disease, inflammatory bowel diseases), nutritional deficiencies (iron, folates…), immune disorders (HIV infection, neutropenia) and rare syndromes. Behçet's disease is a chronic, inflammatory, disease whose main clinical feature is recurrent bipolar aphthosis. Colchicine associated with topical treatments constitutes a suitable treatment of most RAS. Thalidomide is the most effective treatment of RAS but its use is limited by frequent adverse effects. Oral ulcers can be related to a wide range of conditions that constitute the differential diagnoses of aphthous ulcers. Oral ulcers are classified into three main groups: acute ulcers with abrupt onset and short duration, recurrent ulcers (mainly due to postherpetic erythema multiforme) and chronic ulcers (with slow onset and insidious progression). Acute oral ulcers are due to trauma, bacterial infections (including acute necrotizing ulcerative gingivitis), deep fungal infection, gastro-intestinal (namely inflammatory bowel disease) or systemic diseases. Chronic oral ulcers may be drug-induced, or due to benign or malignant tumors. Every oral solitary chronic ulcer should be biopsied to rule out squamous cell carcinoma. A solitary palatal ulcer can be related with necrotizing sialometaplasia. PMID:26880080

  18. Peptic ulcer

    MedlinePLUS

    ... If you have a peptic ulcer with an H. pylori infection, the standard treatment uses different combinations of the ... bacteria If you have an ulcer without an H. pylori infection, or one that is caused by taking aspirin ...

  19. Stomach ulcer

    MedlinePLUS Videos and Cool Tools

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

  20. Ulcerative Colitis

    MedlinePLUS

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

  1. 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 For a child with peptic ulcer disease, ...

  2. Pressure ulcer

    MedlinePLUS

    Bedsore; Decubitus ulcer ... form. You are more likely to get a pressure ulcer if you: Use a wheelchair or stay in ... Symptoms of a pressure ulcer are: Red skin that gets worse over time The area forms a blister, then an open sore Pressure sores ...

  3. Medical management of venous ulcers.

    PubMed

    Pascarella, Luigi; Shortell, Cynthia K

    2015-03-01

    Venous disease is the most common cause of chronic leg ulceration and represents an advanced clinical manifestation of venous insufficiency. Due to their frequency and chronicity, venous ulcers have a high socioeconomic impact, with treatment costs accounting for 1% of the health care budget in Western countries. The evaluation of patients with venous ulcers should include a thorough medical history for prior deep venous thrombosis, assessment for an hypercoagulable state, and a physical examination. Use of the CEAP (clinical, etiology, anatomy, pathophysiology) Classification System and the revised Venous Clinical Severity Scoring System is strongly recommended to characterize disease severity and assess response to treatment. This venous condition requires lifestyle modification, with affected individuals performing daily intervals of leg elevation to control edema; use of elastic compression garments; and moderate physical activity, such as walking wearing below-knee elastic stockings. Meticulous skin care, treatment of dermatitis, and prompt treatment of cellulitis are important aspects of medical management. The pharmacology of chronic venous insufficiency and venous ulcers include essentially two medications: pentoxifylline and phlebotropic agents. The micronized purified flavonoid fraction is an effective adjunct to compression therapy in patients with large, chronic ulceration. PMID:26358306

  4. Atypical ulcers.

    PubMed

    Hoffman, Mark D

    2013-01-01

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

  5. Leg Problems

    MedlinePLUS

    ... See your doctor or go to the emergency room right away. A blood clot in the legs could break away and block an artery in the lungs, causing pulmonary embolism. No 7. Do you have twisted dark blue or purple veins near the surface of ...

  6. Restless Legs

    MedlinePLUS

    ... also have a condition called periodic limb movement disorder (PLMD). PLMD is a condition in which a person's legs twitch or jerk uncontrollably, usually during sleep. PLMD and RLS can also affect the arms. NIH: National Heart, Lung, and Blood Institute

  7. Venogram - leg

    MedlinePLUS

    ... elderly or people with diabetes who take the medicine metformin (Glucophage) Worsening of a clot in the leg vein There is low radiation exposure; however, most experts feel that the risk of most x-rays is smaller than other daily risks. Pregnant women ...

  8. Management of venous ulcers.

    PubMed

    Kolluri, Raghu

    2014-06-01

    Chronic venous insufficiency (CVI) results from venous hypertension secondary to superficial or deep venous valvular reflux, as well as venous obstruction. The most severe clinical manifestation of CVI is venous leg ulceration that can result in significant morbidity, including venous gangrene and amputation, albeit rare. Treatment modalities are aimed at reducing venous hypertension. Diuretic therapy, although widely used, only provides short-term improvement of the edema but provides no long-term benefit. Compression therapy is the cornerstone in the management of CVI. Compression can be achieved using compression bandaging, compression pumps, or graduated compression stockings. Topical steroid creams may reduce inflammation, venous eczema, and pain in the short term, but they can be detrimental in the long run. Apligraf (a living, bilayered, cell-based product) in conjunction with compression therapy was noted to be more effective in healing venous leg ulcerations, when compared with treatment with compression therapy and zinc paste. Endovascular and surgical techniques that minimize valvular reflux and relieve venous obstruction improve venous hemodynamics, promoting wound healing. PMID:24840970

  9. Venous ulcer infection caused by Arcanobacterium haemolyticum.

    PubMed

    Pânzaru, C; Tăranu, T

    2001-01-01

    A. haemolyticum has been described as an unusual pathogen causing pharyngotonsillitis and extra pharyngeal infections like ulcerative lesions infection mainly in patients with underlying condition (peripheral vascular disease, diabetes, alcoholism). A case of A. haemolyticum venous leg ulcer infection is reported in a 66 year-old diabetic male patient. Bacteriological diagnosis is based on conventional culture technique. But, due to its coryneform appearance and time growing, it is probably underreported. PMID:12561674

  10. Venous ulcers.

    PubMed

    Reichenberg, Jason; Davis, Mark

    2005-12-01

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

  11. Cutaneous Ulcer as Leading Symptom of Systemic Cytomegalovirus Infection

    PubMed Central

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

    2015-01-01

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

  12. Ugh! Ulcers

    MedlinePLUS

    ... sores, or ulcers, are caused. continue Who Has H. Pylori Infection? By testing someone's blood or bowel movements (poop), ... H. pylori . When tested, lots of people have H. pylori infections. Almost 2 out of every 10 people younger ...

  13. Peptic Ulcers

    MedlinePLUS

    ... can irritate the lining and cause an ulcer. H. pylori infection is usually contracted in childhood (perhaps through food, ... have any symptoms until they're older. Although H. pylori infection usually doesn't cause problems in childhood, it ...

  14. Ugh! Ulcers

    MedlinePLUS

    ... sores, or ulcers, are caused. continue Who Has H. Pylori Infection? By testing someone's blood or bowel ... she has been exposed to and might have H. pylori . When tested, lots of people have H. ...

  15. Leg CT scan

    MedlinePLUS

    CAT scan - leg; Computed axial tomography scan - leg; Computed tomography scan - leg; CT scan - leg ... 2012:chap 11. Shaw AS, Prokop M. Computed tomography. In: Adam A, Dixon AK, Gillard JH, Schaefer- ...

  16. Persistent dyspnea and leg edema.

    PubMed

    Nguyen, Khoi Duc; Frieri, Marianne

    2007-01-01

    This case illustrates a complexity of confounding and overlapping symptoms that can masquerade as another diagnosis. A 56-year-old African American man with persistent dyspnea and leg edema was hospitalized three times in a period of 6 months. The patient was treated for asthma, chronic obstructive pulmonary disease, and congestive heart failure. Hypertension and peptic ulcer disease were treated also. Complete clinical improvement was not observed. A careful review of his last admission and current admission clinical presentation and laboratory evaluation revealed a systemic manifestation and laboratory findings consistent with atypical systemic lupus erythematosus. PMID:17883922

  17. Peptic Ulcer

    MedlinePLUS

    ... them worse. To see if you have an H. pylori infection, your doctor will test your blood, breath, or stool. Your doctor also may look inside your stomach and duodenum by doing an ... antibiotics to kill H. pylori. Antacids and milk can't heal peptic ulcers. ...

  18. Bacterial skin contamination before and after surgical preparation of the foot, ankle, and lower leg in patients with diabetes and intact skin versus patients with diabetes and ulceration: a prospective controlled therapeutic study.

    PubMed

    Roukis, Thomas S

    2010-01-01

    Eradication of bacterial flora from the foot, especially the nailfolds and toe webspaces, through surgical preparation remains a challenge. All previous studies have involved healthy patients undergoing elective foot and ankle surgery or healthy volunteers. However, the patient with diabetes is considered an immunocompromised host with decreased ability to combat invasive bacterial infections. The use of an efficacious surgical preparation is therefore of paramount importance. The author conducted a prospective study involving patients with diabetes with and without ulceration who underwent the current "best evidence available" surgical preparation (i.e., chlorhexidine gluconate [4%] scrub followed by alcohol impregnated with iodine [1%] solution). Qualitative aerobic cultures before and after completion of this surgical preparation technique were obtained from the hallux nailfold; second, third, and fourth toe webspaces (as one culture); and distal anterior tibia. A total of 120 organisms were cultured before surgical preparation with 64 in the elective group and 56 in the ulcerated group. The most commonly isolated organism was methicillin-resistant Staphylococcus epidermidis, which was identified in 46 pre-preparation cultures (38.3%). This was followed by methicillin-sensitive S. epidermidis (16.7%) and "other" organisms (10.0%). There was a significant reduction for both numbers of organisms identified and positive cultures for the 3 most commonly isolated organisms after surgical preparation. Based on the results of this study, the surgical preparation used here appears to be an efficacious surgical preparation technique for eradicating aerobic bacterial pathogens from the foot in patients with diabetes both with and without ulceration. The high incidence of methicillin-sensitive and methicillin-resistant S. epidermidis found in this patient population is a cause for concern, especially when metallic fixation is intended to be implanted. PMID:20610202

  19. Leg lengthening - series (image)

    MedlinePLUS

    ... procedures are the bones of the leg, the tibia and the femur. Surgical treatment may be recommended ... to be lengthened; usually the lower leg bone (tibia) or upper leg bone (femur). Metal pins or ...

  20. Leg MRI scan

    MedlinePLUS

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

  1. Leg Injuries and Disorders

    MedlinePLUS

    ... can damage your legs. Common leg injuries include sprains and strains, joint dislocations, and fractures. These injuries can affect the entire leg, or just the foot, ankle, knee, or hip. Certain diseases also lead to ...

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

    PubMed

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

    2016-02-01

    An observational study of 2 years was promoted by the Italian Association for Cutaneous Ulcers (AIUC) in order to monitor the epidemiology of leg ulcers, the trend of healing and the more frequent therapeutic approaches in lower limb ulcers. Fifty-nine sites in 14 different Italian regions involved in the study, with 1333 enrolled patients (1163 patients fully evaluated and followed up for 9 months). A prevalence of females (62%) was observed with a mean age of 70 years and a high rate of hypertension (62%), diabetes (38%) and obesity (29%). Venous ulcer was most frequent (55%), followed by mixed (25%) and diabetic (8·3%) ulcers. Basically, all patients received a local therapy (LT) (compression and advanced local therapies), while 63% of patients have an associated systemic pharmaceutical treatment. Ulcer healing rates progressively increased throughout the study and despite the type of observational study does not allow conclusions on the treatment, it was observed that the patients receiving additional systemic drugs were associated with a more rapid acceleration of healing rates of ulcers compared to LT alone (3 months: 39·7% versus 29·2%; 6 months: 62·0% versus 47·0%; 9 months: 74·7% versus 63·8%). In particular, the Studio Ulcere Vascolari (SUV) study showed that a combination treatment with sulodexide and compression therapy allows for a greater increase in the healing rates in venous ulcers. PMID:24618175

  3. Leg lengthening.

    PubMed

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

    1993-04-01

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

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

    PubMed

    Laursen, M V; Boelling, D; Mark, T

    2009-04-01

    The purpose of this study was to estimate the genetic correlations among claw and leg health and potential indicator traits. Claw health was defined as absence of heel horn erosion, interdigital dermatitis, interdigital phlegmon, interdigital hyperplasia, laminitis, and sole ulcer. Leg health was defined as absence of hock infection, swollen hock, and bruising. The potential indicators were locomotion and foot and leg conformation, represented by rear leg side view, rear leg rear view, foot angle, and apparent hock quality and bone structure. The study was conducted using records from 429,877 Danish Holstein cows in first lactation. Binary health traits were divided into 3 subcategories: claw health, leg health, and absence of all claw and leg disorders. Genetic (r(g)) and phenotypic correlations were estimated using a bivariate linear sire model and REML. Estimated heritabilities were 0.01 for all 3 combined claw and leg health traits (on the observed binary scale), 0.09 for locomotion, 0.14 for rear leg rear view, 0.19 for rear leg side view, 0.13 for foot angle, 0.22 for apparent hock quality, and 0.27 for apparent bone structure. Heritabilities were 0.06 and 0.01 for claw health and leg health, respectively, when transformed to the underlying continuous scale. Claw and leg disorders are an increasing problem for Danish Holsteins, but genetic improvement of claw and leg health is challenging because the traits have low heritabilities. Claw and leg health were separate but correlated traits (r(g) = 0.35). Locomotion and rear leg rear view were useful indicator traits for claw health (r(g) = 0.46 and r(g) = 0.21, respectively), whereas hock quality and bone structure were useful indicators for leg health (r(g) = 0.42 and 0.26, respectively). Claw and leg health should be considered as separate traits in genetic evaluations that also include the useful indicator traits to compensate for low heritability of the health traits. PMID:19307660

  5. Stasis ulcers: the role of compliance in healing.

    PubMed

    Dickey, J W

    1991-05-01

    The goal in treating a stasis ulcer is rapid and permanent reepithelialization of the ulcer bed. The patient can reach this goal by strict compliance with a program taught and continually reinforced by the physician. The program teaches about the effects of the force of gravity on the flow of blood and lymph in the lower extremities in various positions. The program consists of three rules for the patient to follow: (1) Never sit with legs below heart level. (2) Never stand still. Walk in place or even while sitting (if sitting is necessary). (3) Always wear compressive stockings or pneumatic leggings when walking. I present four case histories demonstrating the different rates of healing of stasis ulcers during noncompliance and during compliance with the physiologic methods of controlling edema and venous stasis in the legs. PMID:2035072

  6. Stasis dermatitis and ulcers

    MedlinePLUS

    ... the leg At first, the skin of the ankles and lower legs may look thin or tissue- ... hardening of the skin on the legs and ankles (lipodermatosclerosis) A bumpy or cobblestone appearance of the ...

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

    PubMed

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

    2013-10-01

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

  8. Restless legs syndrome

    MedlinePLUS

    Restless legs syndrome (RLS) is a nervous system problem that causes you to feel an unstoppable urge to get ... DA, Bista SR, et al. The treatment of restless legs syndrome and periodic limb movement disorder in adults-an ...

  9. When an ulcer is not ‘just an ulcer’: pyoderma gangrenosum

    PubMed Central

    Anderson, Michelle Louise; Mackenzie, Graeme

    2014-01-01

    A 94-year-old man presented with painful leg ulcers that were affecting his mobility. No clear history of these ulcers was obtained on admission or during his initial 7 days of admission and there was no examination made of the ulcer by medical staff during this time. On day 8, a clear history was obtained. It was established that this was a rapidly deteriorating and painful ulcer developing within a 2-week period in previously normal skin. On examination, he had an ulcer clinically consistent with pyoderma gangrenosum which had further enlarged since admission with evidence of newly developing lesions on the legs. He was started on oral and topical therapies and the ulcer improved symptomatically and aesthetically. He was discharged a few weeks later and the patient was followed up by the Dermatology department to ensure continued improvement and eventual resolution. PMID:24614779

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

    PubMed

    Huband, M S; Carr, J B

    1993-02-01

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

  11. 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 when the person also: Is overweight Has a blood clot in the leg Is older Has ...

  12. Nocturnal leg cramps.

    PubMed

    Allen, Richard E; Kirby, Karl A

    2012-08-15

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

  13. Noninfectious genital ulcers.

    PubMed

    Kirshen, Carly; Edwards, Libby

    2015-12-01

    Noninfectious genital ulcers are much more common than ulcers arising from infections. Still, it is important to take a thorough history of sexual activity and a sexual abuse screen. A physical exam should include skin, oral mucosa, nails, hair, vulva, and vaginal mucosa if needed. The differential diagnosis of noninfectious genital ulcers includes: lipschütz ulcers, complex aphthosis, Behçet's syndrome, vulvar metastatic Crohn's disease, hidradenitis suppurativa, pyoderma gangrenosum, pressure ulcers, and malignancies. It is important to come to the correct diagnosis to avoid undue testing, stress, and anxiety in patients experiencing genital ulcerations. PMID:26650697

  14. Peptic ulcer disease - discharge

    MedlinePLUS

    ... standard treatment for a peptic ulcer and an H. pylori infection uses a combination of medicines that you take ... first. If you have an ulcer without an H. pylori infection, or one that is caused by taking aspirin ...

  15. Acute genital ulcers

    PubMed Central

    Delgado-Garca, Silvia; Palacios-Marqus, Ana; Martnez-Escoriza, Juan Carlos; Martn-Bayn, Tina-Aurora

    2014-01-01

    Acute genital ulcers, also known as acute vulvar ulcers, ulcus vulvae acutum or Lipschtz ulcers, refer to an ulceration of the vulva or lower vagina of non-venereal origin that usually presents in young women, predominantly virgins. Although its incidence is unknown, it seems a rare entity, with few cases reported in the literature. Their aetiology and pathogenesis are still unknown. The disease is characterised by an acute onset of flu-like symptoms with single or multiple painful ulcers on the vulva. Diagnosis is mainly clinical, after exclusion of other causes of vulvar ulcers. The treatment is mainly symptomatic, with spontaneous resolution in 2?weeks and without recurrences in most cases. We present a case report of a 13-year-old girl with two episodes of acute ulcers that fit the clinical criteria for Lipschtz ulcers. PMID:24473429

  16. Acute genital ulcers.

    PubMed

    Delgado-Garca, Silvia; Palacios-Marqus, Ana; Martnez-Escoriza, Juan Carlos; Martn-Bayn, Tina-Aurora

    2014-01-01

    Acute genital ulcers, also known as acute vulvar ulcers, ulcus vulvae acutum or Lipschtz ulcers, refer to an ulceration of the vulva or lower vagina of non-venereal origin that usually presents in young women, predominantly virgins. Although its incidence is unknown, it seems a rare entity, with few cases reported in the literature. Their aetiology and pathogenesis are still unknown. The disease is characterised by an acute onset of flu-like symptoms with single or multiple painful ulcers on the vulva. Diagnosis is mainly clinical, after exclusion of other causes of vulvar ulcers. The treatment is mainly symptomatic, with spontaneous resolution in 2 weeks and without recurrences in most cases. We present a case report of a 13-year-old girl with two episodes of acute ulcers that fit the clinical criteria for Lipschtz ulcers. PMID:24473429

  17. Leg Length Inequality

    PubMed Central

    Sharpe, Colin R.

    1983-01-01

    Leg length inequality, a common abnormality, can cause musculoskeletal pain, scoliosis, and osteoarthritis of the hip. Seven percent of the asymptomatic population has a leg length inequality greater than 12 mm; the incidence is considerably higher (13%-22%) in individuals complaining of low back pain. Correction can usually be accomplished by shoe modification, and can result in dramatic relief of pain. Leg length inequality of more than half an inch is considered clinically significant. Leg length measurement should be routine in all patients complaining of low back pain, hip pain, and atypical flank and lower quadrant pain. Correction might prove very cost-effective. PMID:21283327

  18. Leg amputation - discharge

    MedlinePLUS

    Amputation - leg - discharge; Below knee amputation - discharge; BK amputation - discharge; Above knee - discharge; AK - discharge; Trans-femoral amputation - discharge; Trans-tibial amputation - discharge

  19. Restless Legs Syndrome

    MedlinePLUS

    ... legs before bedtime to help you relax. Relaxation techniques, such as meditation and yoga, can help you relax before bed. Apply warm or cool packs, which can help relieve sensations in your legs. Try to distract your mind by reading or doing a crossword puzzle while you wait ...

  20. Acute duodenal ulcer.

    PubMed Central

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

    1989-01-01

    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

  1. Evaluation of treatment with carboxymethylcellulose on chronic venous ulcers*

    PubMed Central

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

    2016-01-01

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

  2. Restless Legs Syndrome

    MedlinePLUS

    ... trips, sitting in a movie theater, long-distance flights, immobilization in a cast, or relaxation exercises. Many ... restless legs syndrome diagnosed? There is no specific test for RLS. The four basic criteria for diagnosing ...

  3. Restless Legs Syndrome

    MedlinePLUS

    ... NINDS Funding Information Research Programs Training & Career Awards Enhancing Diversity Find People About NINDS NINDS Restless Legs ... Funding | News From NINDS | Find People | Training | Research | Enhancing Diversity Careers@NINDS | FOIA | Accessibility Policy | Contact Us | ...

  4. Leg lengthening and shortening

    MedlinePLUS

    ... to very unequal leg lengths. They include: Poliomyelitis Cerebral palsy Small, weak muscles or short, tight (spastic) muscles, ... 4 weeks. Healing is complete in 8 to 12 weeks. The child can go back to regular ...

  5. 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....

  6. Leg venography (image)

    MedlinePLUS

    Leg venography is a procedure where contrast material is injected through a catheter in a vein to help visualize the internal structures by using x-rays. The test is used to identify and locate thrombi (blood ...

  7. An integrated approach in the treatment of varicose ulcer.

    PubMed

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

    2013-01-01

    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

  8. An integrated approach in the treatment of varicose ulcer

    PubMed Central

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

    2013-01-01

    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 sodhana 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

  9. Ulcerative Lupus Vulgaris Over Nose, Leading to Cosmetic Deformity

    PubMed Central

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

    2015-01-01

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

  10. [Cutaneous polyarteritis nodosa: A rare cause of chronic ulcers].

    PubMed

    Jansen, T M; Hoff, N-Ph

    2015-10-01

    Cutaneous polyarteritis nodosa, a special form of polyarteritis nodosa (PAN) without systemic involvement, is classified as one of the ANCA-negative vasculitides of small and medium-sized vessels. It is a very rare disease with unknown etiology and occurs more commonly in women over the age of 40. Typical skin lesions are subcutaneous nodules, livedo racemosa, and ulcerations. We report the case of a 46-year-old woman presenting to our outpatient department who reported having very painful ulcerations of the lower legs with unknown origin for 6 months. PMID:26311032

  11. PEPTIC ULCER DISEASE

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

  12. Actuator device for artificial leg

    NASA Technical Reports Server (NTRS)

    Burch, J. L. (Inventor)

    1976-01-01

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

  13. Venous ulceration contaminated by multi-resistant organisms: larval therapy and debridement.

    PubMed

    McInnes, W; Ruzehaji, N; Wright, N; Cowin, A J; Fitridge, R

    2013-10-01

    A 72-year-old female with venous insufficiency presented to a hospital-based multidisciplinary wound clinic after 20 years of recurrent episodes of venous leg ulcers. Examination showed bilateral leg ulcers with no evidence of arterial insufficiency, but complicated by considerable devitalised tissue, abnormally high bacterial load and the presence of multi-resistant organisms. The ulcers were initially treated with larvae to aid debridement and reduce the bacterial load, prior to skin grafting. Although ulcer free for a period of 4 months, further debridement was required when the skin condition deteriorated. Surgical intervention was chosen as the preferred method by the surgeons for a second acute care admission using hydrosugery, along with supplementary skin grafts and compression. Ongoing management, consisting of regular debridement, skin care and compression therapy, continues. PMID:24142139

  14. Pressure Ulcer Prevention

    PubMed Central

    2009-01-01

    Executive Summary In April 2008, the Medical Advisory Secretariat began an evidence-based review of the literature concerning pressure ulcers. Please visit the Medical Advisory Secretariat Web site, http://www.health.gov.on.ca/english/providers/program/mas/tech/tech_mn.html to review these titles that are currently available within the Pressure Ulcers series. Pressure ulcer prevention: an evidence based analysis The cost-effectiveness of prevention strategies for pressure ulcers in long-term care homes in Ontario: projections of the Ontario Pressure Ulcer Model (field evaluation) Management of chronic pressure ulcers: an evidence-based analysis (anticipated pubicstion date - mid-2009) Purpose A pressure ulcer, also known as a pressure sore, decubitus ulcer, or bedsore, is defined as a localized injury to the skin/and or underlying tissue occurring most often over a bony prominence and caused by pressure, shear, or friction, alone or in combination. (1) Those at risk for developing pressure ulcers include the elderly and critically ill as well as persons with neurological impairments and those who suffer conditions associated with immobility. Pressure ulcers are graded or staged with a 4-point classification system denoting severity. Stage I represents the beginnings of a pressure ulcer and stage IV, the severest grade, consists of full thickness tissue loss with exposed bone, tendon, and or muscle. (1) In a 2004 survey of Canadian health care settings, Woodbury and Houghton (2) estimated that the prevalence of pressure ulcers at a stage 1 or greater in Ontario ranged between 13.1% and 53% with nonacute health care settings having the highest prevalence rate (Table 1). Executive Summary Table 1: Prevalence of Pressure Ulcers* Setting Canadian Prevalence,% (95% CI) Ontario Prevalence,Range % (n) Acute care 25 (23.826.3) 23.929.7 (3418) Nonacute care 30 (29.331.4) 30.053.3 (1165) Community care 15 (13.416.8) 13.2 (91) Mixed health care 22 (20.923.4) 13.125.7 (3100) All health care settings 26 (25.226.8) 13.153.3 (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 1.42.1 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

  15. Athletes' leg pains.

    PubMed Central

    Orava, S.; Puranen, J.

    1979-01-01

    The frequency and nature of exertion pains of the leg in athletes were studied in 2,750 cases of overuse injuries treated at the Sports Clinic of the Deaconess Institute of Oulu, Finland, during the years 1972-1977. 465 cases of exertion pain (18%) were located in the shin. The medial tibial syndrome was the most common overuse injury among these athletes, comprising 9.5% of all exertion injuries and 60% of the leg exertion pains. Together with stress fracture of the tibia, the second most common exertion pain of the leg, it accounted for 75% of the total leg pains. There are certain difficulties in differentiating between the medial tibial syndrome and stress fracture of the tibia. They both occur at the same site with similar symptoms. Radiological examination and isotope scanning are needed. The medial tibial syndrome is an overuse injury at the medial tibial border caused by running exercises. The pain is elicited by exertional ischaemia. The pathogenesis is explained by increased pressure in the fascial compartment of the deep flexor muscles due to prolonged exercise. Similar chronic ischaemic pains from exercise are also found in other fascial compartments of the leg, especially in the anterior compartment. The only treatment needed for stress fractures is rest from training. Fascial compartment pains also usually subside. If chronic fascial syndromes prevent training, fasciotomy is recommended as a reliable method to restore the athlete to normal training without pains. PMID:486888

  16. Connective Tissue Ulcers

    PubMed Central

    Dabiri, Ganary; Falanga, Vincent

    2013-01-01

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

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

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

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

  18. UNUSUAL CAUSES OF CUTANEOUS ULCERATION

    PubMed Central

    Panuncialman, Jaymie; Falanga, Vincent

    2010-01-01

    Synopsis Skin ulceration is a major source of morbidity and is often difficult to manage. Ulcers due to an inflammatory etiology or microvascular occlusion are particularly challenging in terms of diagnosis and treatment. The management of such ulcers requires careful assessment of associated systemic conditions and a thorough analysis of the ulcer's clinical and histologic findings. In this report, we discuss several examples of inflammatory ulcers and the approach to their diagnosis and treatment. PMID:21074034

  19. Legged locomotion on sand

    NASA Astrophysics Data System (ADS)

    Li, Chen; Umbanhowar, Paul; Komsuoglu, Haldun; Koditschek, Daniel; Goldman, Daniel

    2009-11-01

    To understand how and why animals modulate foot kinematics to achieve effective locomotion on granular media, we study the speed of a six-legged robot with c-shaped legs, SandBot, moving on granular media for varying volume fraction, ?, limb frequency, f, and gait timing parameters.footnotetextLi et. al, PNAS, 106, 3029, 2009 Speed is determined by step length which in turn depends on limb penetration. At low f and high ? penetration is small, step length is large, and SandBot advances with a rotary walking gait in which c-legs rotate about their centers by slipping relative to stationary grains. In the opposite extreme, grains cannot support the robot; its underside always contacts the ground and it advances slowly via thrust generated as the c-legs translate through the grains. For varied gait parameters, high speeds are only observed in a small area of parameter space. A yield stress based model predicts the speed and reveals that performance is maximized when gait parameters minimize limb acceleration and interference, and limbs utilize the solidification properties of the media.

  20. Legged locomotion on sand

    NASA Astrophysics Data System (ADS)

    Li, Chen; Umbanhowar, Paul; Komsuoglu, Haldun; Koditschek, Daniel; Goldman, Daniel

    2009-11-01

    To understand how and why animals modulate foot kinematics to achieve effective locomotion on granular media, we study the speed of a six-legged robot with c-shaped legs, SandBot, moving on granular media for varying volume fraction, ?, limb frequency, f, and gait timing parametersfootnotetextLi et. al, PNAS, 106, 3029, 2009. Speed is determined by step length which in turn depends on limb penetration. At low f and high ? penetration is small, step length is large, and SandBot advances with a rotary walking gait in which c-legs rotate about their centers by slipping relative to stationary grains. In the opposite extreme, grains cannot support the robot; its underside always contacts the ground and it advances slowly via thrust generated as the c-legs translate through the grains. For varied gait parameters, high speeds are only observed in a small area of parameter space. A yield stress based model predicts the speed and reveals that performance is maximized when gait parameters minimize limb acceleration and interference, and limbs utilize the solidification properties of the media.

  1. Venous ulceration, fibrinogen and fibrinolysis.

    PubMed Central

    Leach, R. D.

    1984-01-01

    The effect of long and short-term venous hypertension upon lymph fibrinogen concentrations was studied in an attempt to explain the peri-capillary deposition of fibrin reported in patients with post-phlebitic syndromes. The clearance of radioactive fibrinogen/thrombin clots from the subcutaneous tissues of rats and human volunteers was also studied. Both long- and short-term venous hypertension were found to increase fibrinogen transport across the interstitial space by more than 600%. Not only was there evidence of fibrinolytic activity in the lymph but after long-term venous hypertension alpha 2 antiplasmin activity was also detectable. Skin biopsies from the venous hypertensive ankles showed deposition of interstitial fibrin. The clearance of radioactive fibrinogen/thrombin clots from the subcutaneous tissues of the rat was found to be delayed if the rats were given epsilon amino caproic acid but it could not be increased with stanozolol. In human subjects it was found that patients with lipodermatosclerosis had delayed clot clearance and retarded blood fibrinolytic activity when compared with normal volunteers and patients with uncomplicated varicose veins. The principle cause why tall men are more subject to ulcers than short men, Dr Young conceived to be then length of the column of blood in their veins; which by its pressure, renders the legs less able to recover when hurt by any violence. Images Fig. 1 Fig. 2 Fig. 5 PMID:6742738

  2. Cushing's ulcer: Further reflections

    PubMed Central

    Kemp, William J.; Bashir, Asif; Dababneh, Haitham; Cohen-Gadol, Aaron A.

    2015-01-01

    Background: Brain tumors, traumatic head injury, and other intracranial processes including infections, can cause increased intracranial pressure and lead to overstimulation of the vagus nerve. As a result, increased secretion of gastric acid may occur which leads to gastro-duodenal ulcer formation known as Cushing's ulcer. Methods: A review of original records of Dr. Harvey Cushing's patients suffering from gastro-duodenal ulcers was performed followed by a discussion of the available literature. We also reviewed the clinical records of the patients never reported by Cushing to gain his perspective in describing this phenomenon. Dr. Cushing was intrigued to investigate gastro-duodenal ulcers as he lost patients to acute gastrointestinal perforations following successful brain tumor operations. It is indeed ironic that Harvey Cushing developed a gastro-duodenal ulcer in his later years with failing health. Results: Clinically shown by Cushing's Yale Registry, a tumor or lesion can disrupt this circuitry, leading to gastroduodenal ulceration. Cushing said that it was “reasonable to believe that the perforations following posterior fossa cerebellar operations were produced in like fashion by an irritative disturbance either of fiber tracts or vagal centers in the brain stem.” Conclusion: Harvey Cushing's pioneering work depicted in his Yale registry serves as a milestone for continuing research that can further discern this pathway. PMID:25972936

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

    PubMed

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

    2011-09-01

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

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

    PubMed

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

    2006-01-01

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

  5. ORTHOPEDIC LEG BRACE

    NASA Technical Reports Server (NTRS)

    Myers, William Neil (Inventor)

    2005-01-01

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

  6. Pedicled Fillet of Leg Flap for Extensive Pressure Sore Coverage

    PubMed Central

    Jandali, Shareef; Low, David W.

    2009-01-01

    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

  7. Bedsores (Pressure Ulcers)

    MedlinePLUS

    ... usually the tailbone (coccyx) or buttocks area, shoulder blades, spine, or backs of the arms or legs. ... on the back of the head, ears, shoulder blades, hips, lower back, tailbone, or the backs or ...

  8. A case of HIV ulcer

    PubMed Central

    2015-01-01

    HIV-associated ulcers must be distinguished from idiopathic anal fissures in HIV-positive patients and from other sexually transmitted diseases that cause anogenital ulcers as the treatments differ. PMID:26266040

  9. Influence of healing on the disturbed blood flow regulation in venous ulcers.

    PubMed

    Jnger, M; Hahn, M; Klyscz, T; Rassner, G

    1996-01-01

    Cutaneous blood flow regulation is disturbed in severe chronic venous insufficiency (CVI). The feedback system between the transmural pressure in the postcapillary venules and the precapillary resistance regulating arterioles has gone awry. The upregulated control system causes "luxus"-hyperperfusion. In this study laser Doppler fluxmetry was performed in 6 patients' florid venous ulcers (U) and later in the former ulcer area after healing (H) and in the inner ankle area of 12 healthy volunteers (C). Laser Doppler flux (LDF) changes were measured with the leg elevated and lowered as well as after arterial and during venous occlusion. The results proved a diminished (p < 0.01) flux increase with the leg elevated (U: LDF = -9%, H: LDF = 3.1%, C: LDF = 80%) and after arterial occlusion (U: LDF = 1.3%, H: LDF = 0%; C: 189.6%) in severe CVI both in florid ulcers and after healing. The ability to reduce flux when transmural pressures were increased remained. Leg lowering reduced flux by 46.4% in ulcers and by 36.8% after healing. This postural response to high transmural pressures, however, seemed weakened compared to controls, where LDF decreased by 65.8%. Our findings suggest that the postural feedback system remains disturbed and upregulated even after a venous ulcer has healed. PMID:8956551

  10. Leg size and muscle functions associated with leg compliance

    NASA Technical Reports Server (NTRS)

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

    1988-01-01

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

  11. Omics profiles in chronic venous ulcer wound fluid: innovative applications for translational medicine.

    PubMed

    Mannello, Ferdinando; Ligi, Daniela; Canale, Matteo; Raffetto, Joseph D

    2014-07-01

    Chronic venous disease represents a healthcare problem due to high prevalence and recurrence rates. Studies on chronic venous ulcer wound fluid (CVUWF) have demonstrated increased inflammation and proteolysis which can cause tissue destruction and delayed healing. This review discusses: nearly all known metabolites discovered in the past 25 years in CVUWF studies; the omics approaches characterizing the microenvironment of human venous leg ulcers; and the use of biocompounds as prognostic biomarkers and as possible targets for therapeutic approaches. A biomarker is a biological compound that can be functional or non-functional, specific or non-specific in the diagnosis/prognosis to a disease state and may be quantified to determine progression or regression of disease. Omics studies in CVUWF provide the impetus for future identification of biomarkers within the intricate network in chronic venous disease and set the basis for determining the appropriate combination of molecules that are expressed with the healing status of venous leg ulcers. PMID:24918119

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

    PubMed

    Silva, Marcelo Henrique da; Jesus, Maria Cristina Pinto de; Merighi, Miriam Aparecida Barbosa; Oliveira, Dese Moura de

    2014-08-01

    Objective To understand the experiences and expectations of nurses in the treatment of women with chronic venous ulcers. Method Phenomenological research was based on Alfred Schtz, whose statements were obtained in January, 2012, through semi-structured interviews with seven nurses. Results The nurse reveals the difficulties presented by the woman in performing self-care, the perceived limitations in the treatment anchored in motivation, and the values and beliefs of women. It showed professional frustration because venous leg ulcer recurrence, lack of inputs, interdisciplinary work and training of nursing staff. There was an expected adherence to the treatment of women, and it emphasized the need for ongoing care, supported self-care and standard practices in treatment. Conclusion That treatment of chronic venous leg ulcers constitutes a challenge that requires collective investment, involving women, professionals, managers and health institutions. PMID:25517835

  13. Exertional Leg Pain.

    PubMed

    Rajasekaran, Sathish; Finnoff, Jonathan T

    2016-02-01

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

  14. [Managing perilesional pressure ulcers].

    PubMed

    Perceau, Géraldine

    2013-01-01

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

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

    SciTech Connect

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

    1983-12-01

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

  16. Biomechanics of Counterweighted One-Legged Cycling.

    PubMed

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

    2016-02-01

    One-legged cycling has served as a valuable research tool and as a training and rehabilitation modality. Biomechanics of one-legged cycling are unnatural because the individual must actively lift the leg during flexion, which can be difficult to coordinate and cause premature fatigue. We compared ankle, knee, and hip biomechanics between two-legged, one-legged, and counterweighted (11.64 kg) one-legged cycling. Ten cyclists performed two-legged (240 W), one-legged (120 W), and counterweighted one-legged (120 W) cycling (80 rpm). Pedal forces and limb kinematics were recorded to determine work during extension and flexion. During counterweighted one-legged cycling relative ankle dorsiflexion, knee flexion, and hip flexion work were less than one-legged but greater than two-legged cycling (all P < .05). Relative ankle plantar flexion and hip extension work for counterweighted one-legged cycling were greater than one-legged but less than two-legged cycling (all P < .05). Relative knee extension work did not differ across conditions. Counterweighted one-legged cycling reduced but did not eliminate differences in joint flexion and extension actions between one- and two-legged cycling. Even with these differences, counterweighted one-legged cycling seemed to have advantages over one-legged cycling. These results, along with previous work highlighting physiological characteristics and training adaptations to counterweighted one-legged cycling, demonstrate that this exercise is a viable alternative to one-legged cycling. PMID:26398962

  17. Maneuvers during legged locomotion.

    PubMed

    Jindrich, Devin L; Qiao, Mu

    2009-06-01

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

  18. [Restless-legs syndrome].

    PubMed

    Karroum, E; Konofal, E; Arnulf, I

    2008-01-01

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

  19. Maneuvers during legged locomotion

    NASA Astrophysics Data System (ADS)

    Jindrich, Devin L.; Qiao, Mu

    2009-06-01

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

  20. Progressive and extensive ulcerations in a girl since 4 months of age: the difficulty in diagnosis of pyoderma gangrenosum.

    PubMed

    Sarma, Nilendu; Bandyopadhyay, Syamal Kumar; Boler, Anup Kumar; Barman, Medhatithi

    2012-01-01

    A female child developed multiple, progressive, therapy-resistant, painful large ulcers, vesicles, and pustules since her 4 months of age. The ulcers were large, some even measured more than 8 cm; most had violaceous undermined margin with surrounding erythematous halo, raw and crusted surface and were distributed extensively over scalp, face, ear, trunk, buttocks, thigh, legs, dorsum of hands, and feet without any mucosal involvement. After detail clinical examination and investigation, it was diagnosed as a case of pyoderma gangrenosum. Extensive search did not reveal any systemic abnormality or detect any infective etiology. The case highlights the problems of diagnosis of multiple ulcers at very early age. PMID:22470210

  1. Management of radiation ulcers

    SciTech Connect

    Shack, R.B.

    1982-12-01

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

  2. The FDA and designing clinical trials for chronic cutaneous ulcers.

    PubMed

    Maderal, Andrea D; Vivas, Alejandra C; Eaglstein, William H; Kirsner, Robert S

    2012-12-01

    Treatment of chronic wounds can present a challenge, with many patients remaining refractory to available advanced therapies. As such, there is a strong need for the development of new products. Unfortunately, despite this demand, few new wound-related drugs have been approved over the past decade. This is in part due to unsuccessful clinical trials and subsequent lack of Food and Drug Administration (FDA) approval. In this article, we discuss the FDA approval process, how it relates to chronic wound trials, common issues that arise, and how best to manage them. Additionally, problems encountered specific to diabetic foot ulcers (DFU) and venous leg ulcers (VLU) are addressed. Careful construction of a clinical trial is necessary in order to achieve the best possible efficacy outcomes and thereby, gain FDA approval. How to design an optimal trial is outlined. PMID:23063664

  3. Persistent nicorandil induced oral ulceration

    PubMed Central

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

    2004-01-01

    Four patients with nicorandil induced ulceration are described, and the literature on the subject is reviewed. Nicorandil induced ulcers are very painful and distressing for patients. Clinically they appear as large, deep, persistent ulcers that have punched out edges. They are poorly responsive to topical steroids and usually require alteration of nicorandil treatment. The ulceration tends to occur at high doses of nicorandil and all four cases reported here were on doses of 40 mg per day or greater. In these situations reduction of nicorandil dose may be sufficient to promote ulcer healing and prevent further recurrence. However, nicorandil induced ulcers have been reported at doses as low as 10 mg daily and complete cessation of nicorandil may be required. PMID:15201264

  4. [Prevalence of ulcer disease complications].

    PubMed

    Za?tsev, O V; Tarasenko, S V; Kope?kin, A A; Kariukhin, I V; Larionova, A A

    2011-01-01

    The epidemiology of complications of a peptic ulcer is studied: bleedings, perforations and pylorodudenal stenoses. 1799 patients are included in research that were on hospitalisation in 1995-2009. A frequency of all the complications has declined. Middle age of patients with the complicated ulcer enlarged: in case of an ulcerative bleeding--at the expense of reduction of a share of male at the age of 36-60 years, in case of a perforated ulcer--because of appreciable reduction of a percentage of male at the age of 21-35 years. PMID:22629752

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

    PubMed Central

    Carducci, Mauro; Bozzetti, Marcella; Spezia, Marco; Ripamonti, Giorgio; Saglietti, Giuseppe

    2016-01-01

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

  6. [Treatment of skin ulcer using oil of mosqueta rose].

    PubMed

    Moreno Gimenez, J C; Bueno, J; Navas, J; Camacho, F

    1990-01-01

    Oil rose of mosqueta (Rosa aff. Rubiginosa L.) is a concentrated solution in linoleic (41%) and linolenic acid (39%), that offers benefit therapeutic effects in the wound healing. Ten patients affected of leg ulcers and post-surgical wounds were treated by 26% oil concentrated rose of mosqueta with very notable improvement on its healing compared with the control group. Due to the lack of side effects, we believe rose of mosqueta oil is very usefull to these conditions. Mechanism of actions and others indications are discussed. PMID:2214931

  7. A patient with foot ulcer and severe metabolic alkalosis.

    PubMed

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

    2012-01-01

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

  8. Getting Your Sea Legs

    PubMed Central

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

    2013-01-01

    Sea travel mandates changes in the control of the body. The process by which we adapt bodily control to life at sea is known as getting one's sea legs. We conducted the first experimental study of bodily control as maritime novices adapted to motion of a ship at sea. We evaluated postural activity (stance width, stance angle, and the kinematics of body sway) before and during a sea voyage. In addition, we evaluated the role of the visible horizon in the control of body sway. Finally, we related data on postural activity to two subjective experiences that are associated with sea travel; seasickness, and mal de debarquement. Our results revealed rapid changes in postural activity among novices at sea. Before the beginning of the voyage, the temporal dynamics of body sway differed among participants as a function of their (subsequent) severity of seasickness. Body sway measured at sea differed among participants as a function of their (subsequent) experience of mal de debarquement. We discuss implications of these results for general theories of the perception and control of bodily orientation, for the etiology of motion sickness, and for general phenomena of perceptual-motor adaptation and learning. PMID:23840560

  9. Leg discomfort: beyond the joints.

    PubMed

    Berger, Douglas

    2014-05-01

    Although simple characterization of discomfort as cramps, heaviness, shooting pains, and so forth can be misleading, history and examination are key to accurate diagnosis. Absence of both dorsalis pedis and posterior tibial pulses strongly suggests peripheral arterial disease (PAD), and the presence of either pulse makes PAD less likely. Hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) are a common cause of lower extremity myalgias. Restless legs syndrome causes nocturnal discomfort but must be distinguished from confoundingmimics." Neurologic causes of leg symptoms include lumbar spinal stenosis, radiculopathy, distal symmetric polyneuropathy, and entrapment neuropathy. Many common causes of leg discomfort can be managed conservatively. PMID:24758955

  10. Athermal laser treatment of the diabetic leg

    NASA Astrophysics Data System (ADS)

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

    1995-03-01

    This work shows the result obtained in the medical clinic of the `Dr. I. Cantacuzino Hospital' on a lot of 43 diabetic patients using the `LASSIS' devices composed of a He-Ne laser and 4 semiconductor lasers. The 43 patients showed various clinic pictures of a diabetic leg (diabetic arteriopathy and neuropathy) 16 of the lot showed an arteriopathy with claudication and a decrease of pulses oscillometrically measurements, 15 had ulceration and a beginning of gangrene and the other 12 showed a plantary boring ill. There has been achieved an amelioration of the oscillometric index of the claudication while walking the amelioration of local circulation, together with the limitation of the necrosis. For the boring ill, there has been achieved the acceleration of the granulating and epithelization process avoiding surgeries, suppuration and cutaneous plasties. The response to the laser treatment was compared to the response to the classic treatment (vasodilatation surgery unstrapping, antibiotherapy) on a proving lot. We appreciated that the cicatrization and local vasodilatation with athermal laser treatment should be a hope for the treatment of patients suffering of diabetic arteriopathy and neuropathy.

  11. Revisiting Buruli ulcer.

    PubMed

    Yotsu, Rie R; Murase, Chiaki; Sugawara, Mariko; Suzuki, Koichi; Nakanaga, Kazue; Ishii, Norihisa; Asiedu, Kingsley

    2015-11-01

    Buruli ulcer (BU), or Mycobacterium ulcerans infection, is a new emerging infectious disease which has been reported in over 33 countries worldwide. It has been noted not only in tropical areas, such as West Africa where it is most endemic, but also in moderate non-tropical climate areas, including Australia and Japan. Clinical presentation starts with a papule, nodule, plaque or edematous form which eventually leads to extensive skin ulceration. It can affect all age groups, but especially children aged between 5 and 15years in West Africa. Multiple-antibiotic treatment has proven effective, and with surgical intervention at times of severity, it is curable. However, if diagnosis and treatment is delayed, those affected may be left with life-long disabilities. The disease is not yet fully understood, including its route of transmission and pathogenesis. However, due to recent research, several important features of the disease are now being elucidated. Notably, there may be undiagnosed cases in other parts of the world where BU has not yet been reported. Japan exemplifies the finding that awareness among dermatologists plays a key role in BU case detection. So, what about in other countries where a case of BU has never been diagnosed and there is no awareness of the disease among the population or, more importantly, among health professionals? This article will revisit BU, reviewing clinical features as well as the most recent epidemiological and scientific findings of the disease, to raise awareness of BU among dermatologists worldwide. PMID:26332541

  12. Restless Legs Syndrome and Leg Motor Restlessness in Parkinson's Disease

    PubMed Central

    Suzuki, Keisuke; Miyamoto, Masayuki; Miyamoto, Tomoyuki; Hirata, Koichi

    2015-01-01

    Sleep disturbances are important nonmotor symptoms in Parkinson's disease (PD) that are associated with a negative impact on quality of life. Restless legs syndrome (RLS), which is characterized by an urge to move the legs accompanied by abnormal leg sensations, can coexist with PD, although the pathophysiology of these disorders appears to be different. RLS and PD both respond favorably to dopaminergic treatment, and several investigators have reported a significant relationship between RLS and PD. Sensory symptoms, pain, motor restlessness, akathisia, and the wearing-off phenomenon observed in PD should be differentiated from RLS. RLS in PD may be confounded by chronic dopaminergic treatment; thus, more studies are needed to investigate RLS in drug-naïve patients with PD. Recently, leg motor restlessness (LMR), which is characterized by an urge to move the legs that does not fulfill the diagnostic criteria for RLS, has been reported to be observed more frequently in de novo patients with PD than in age-matched healthy controls, suggesting that LMR may be a part of sensorimotor symptoms intrinsic to PD. In this paper, we provide an overview of RLS, LMR, and PD and of the relationships among these disorders. PMID:26504610

  13. Assessing Ulcerative Pododermatitis of Breeding Rabbits

    PubMed Central

    Rosell, Joan M.; de la Fuente, L. Fernando

    2013-01-01

    Simple Summary Sore hocks are a health and welfare problem in rabbits housed in cages with mesh floors. Footrests are used to prevent them. They occupy part of the mesh floor of the cage but allow droppings to fall and also protect the rabbits feet. In this study we evaluated the use of footrests on 664 commercial farms visited in Spain and Portugal, and the rates of sick animals during 20012012; the attention given by producers to animal care was evident as 28% of farms with footrests in 2001 increased to 75% in 2012. Abstract Rabbits in conventional farms are housed in wire net cages with mesh floors to separate them from droppings. In time, lacerations appear on the legs of adult rabbits causing ulcerative pododermatitis or sore hocks, a severe health and welfare problem. Pain causes behavioral changes; productivity is reduced and the most seriously affected animals die or are culled. In this study we evaluated the attention producers have given to this problem and its prevention by installing footrests in cages. We made 2,331 visits to 664 commercial farms in Spain and Portugal between 2001 and 2012, and evaluated morbidity by examining 105,009 females and 10,722 males. The study highlights that the rate of farms with footrests increased from 27.8% in 2001 to 75.2% in 2012. Prevalence of sore hocks in does in 2001 was 11.4%, decreasing to 6.3% in 2012; prevention of ulcerative pododermatitis was associated (P < 0.001) with the presence of footrests. Overall, prevalence was 4.87 0.26 on farms with footrests and 13.71 0.32 without (P < 0.01). PMID:26487404

  14. Genetic correlations between claw health and feet and leg conformation in Norwegian Red cows.

    PubMed

    degrd, C; Svendsen, M; Heringstad, B

    2014-07-01

    The aim of this study was to estimate genetic correlations between claw disorders and feet and leg conformation traits in Norwegian Red cows. A total of 188,928 cows with claw health status recorded at claw trimming from 2004 to September 2013 and 210,789 first-lactation cows with feet and leg conformation scores from 2001 to September 2013 were included in the analyses. Traits describing claw health were corkscrew claw, infectious claw disorders (dermatitis, heel horn erosion, and interdigital phlegmon), and laminitis-related claw disorders (sole ulcer, white line disorder, and hemorrhage of sole and white line). The feet and leg conformation traits were rear leg rear view (new and old definition), rear leg side view, foot angle, and hoof quality. Feet and leg conformation traits were scored linearly from 1 to 9, with optimum scores depending on the trait. Claw disorders were defined as binary (0/1) traits for each lactation. Threshold sire models were used to model claw disorders, whereas the feet and leg conformation traits were described by linear sire models. Three multivariate analyses were performed, each including the 5 feet and leg conformation traits and 1 of the 3 claw disorders at a time. Posterior means of heritability of liability of claw disorders ranged from 0.10 to 0.20 and heritabilities of feet and leg conformation traits ranged from 0.04 to 0.11. Posterior standard deviation of heritability was ?0.01 for all traits. Genetic correlations between claw disorders and feet and leg conformation traits were all low or moderate, except between corkscrew claw and hoof quality (-0.86), which are supposed to measure the same trait. The genetic correlations between rear leg rear view (new) and infectious claw disorders (-0.20) and laminitis-related claw disorders (0.26), and between hoof quality and laminitis-related claw disorders (-0.33) were moderate. Eight of the 15 genetic correlations between claw disorders and feet and leg conformation traits had 0 included in the 95% highest posterior density interval. These results imply that selection for feet and leg conformation is not an efficient approach to genetically improve claw health in Norwegian Red cattle. PMID:24767887

  15. Common Questions About Pressure Ulcers.

    PubMed

    Raetz, Jaqueline G M; Wick, Keren H

    2015-11-15

    Patients with limited mobility due to physical or cognitive impairment are at risk of pressure ulcers. Primary care physicians should examine at-risk patients because pressure ulcers are often missed in inpatient, outpatient, and long-term care settings. High-risk patients should use advanced static support surfaces to prevent pressure ulcers and air-fluidized beds to treat pressure ulcers. Physicians should document the size and clinical features of ulcers. Cleansing should be done with saline or tap water, while avoiding caustic agents, such as hydrogen peroxide. Dressings should promote a moist, but not wet, wound healing environment. The presence of infection is determined through clinical judgment; if uncertain, a tissue biopsy should be performed. New or worsening pain may indicate infection of a pressure ulcer. When treating patients with pressure ulcers, it is important to keep in mind the patient's psychological, behavioral, and cognitive status. The patient's social, financial, and caregiver resources, as well as goals and long-term prognosis, should also be considered in the treatment plan. PMID:26554282

  16. Pipe crawler with extendable legs

    DOEpatents

    Zollinger, William T. (3927 Almon Dr., Martinez, GA 30907)

    1992-01-01

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

  17. Pipe crawler with extendable legs

    SciTech Connect

    Zollinger, W.T.

    1991-04-02

    This invention is comprised of 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 laying 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.

  18. Pipe crawler with extendable legs

    DOEpatents

    Zollinger, W.T.

    1992-06-16

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

  19. [THERAPEUTIC GUIDE IN VENOUS ULCERS].

    PubMed

    Lpez Herranz, Marta; Bas Caro, Pedro; Garca Jbega, Rosa Ma; Garca Carmona, Francisco Javier; Villalta Garca, Pedro; Postigo Mota, Salvador

    2014-11-01

    The treatment of venous ulcers and wounds in general, is a complex and important public health problem, with personal effects, family and health, without addressing the economic impact includes assistance, care of patients with ulcerative lesions. The increase in life expectancy, driven by improved socio-sanitary conditions that this aging population, facilitates the emergence of chronic diseases may be complicated by the presence of skin ulcers. There is no doubt that the best way to treat a skin ulcer is avoiding to occur, hence the importance of early diagnosis and risk factors act alone them. In relation to venous ulcers is crucial, provide local treatment, act on the cause, because if not, relapse is the norm in this type of injury. Currently, the moist wound healing, is an important step in solving earlier of these chronic wounds. This has meant that the pharmaceutical industry has been involved in researching and creating different types of dressings, having specific activity at different stages of venous ulcer healing, ie inflammatory phase, proliferative and remodeling. The proliferation of these products has been increasing over the years, not surprisingly, are described therapeutic 12 families that are applied in the management, care of these injuries. The fact of existing therapeutic options highlights the ineffectiveness of these products individually. Therefore, the nurse will not forget that the optimal treatment of venous ulcers, necessarily involves choosing the right product for every type and stage of the lesion. In this decision process, strongly influenced by the specific characteristics of each patient and injury, the nurse will take into account a lot of factors when choosing the product, not forgetting that an ulcer is not cured with a single therapeutic element, several products being used throughout the process to evolutionary venous ulcer until complete resolution. PMID:26118204

  20. Ulcerative Colitis: An Overview

    PubMed Central

    Archambault, Andre

    1990-01-01

    Idiopathic ulcerative colitis primarily affects young adults. Colonic symptoms are the most annoying. In severe colitis, systemic and extraintestinal inflammatory manifestations can be disabling. Proximal extension of colitis is demonstrated by double-contrast barium enema and total colonoscopy. Bacterial and parasitic colitis must be excluded by appropriate microbiological studies. Colonoscopy is recommended to screen for high-grade dysplasia or neoplasia in cases of chronic diffuse colitis (after seven years). Severe colitis can benefit from hospitalization, parenteral nutritional support, and high doses of corticosteroids that are progressively tapered. Mild or moderate cases or severe cases in remission respond well to rest, low-irritant diets, mild symptomatic medication, oral sulfasalazine, or more recent 5-acetylsalicylic derivatives. Long-term maintenance with reduced dosages will control more than 80% of cases. PMID:21234051

  1. Ulcerative Colitis in Infancy

    PubMed Central

    Rukunuzzaman, Md; Karim, A. S. M. Bazlul

    2011-01-01

    Ulcerative colitis (UC) is a chronic idiopathic inflammatory disorder of colon. Frequency of UC is gradually increasing over few years worldwide. Prevalence is 35 to 100/100 000 people in USA, 1% of them are infants. UC develops in a genetically predisposed individual with altered intestinal immune response. An eight-month-old girl presented with loose bloody stool, growth failure, and moderate pallor. The girl was diagnosed as a case of UC by colonoscopy and biopsy. Treatment was thereafter started with immunosuppressive drugs. After initial induction therapy with parenteral steroid and infliximab, the patient is now on remission with azathioprine and mesalamine. UC is rare in Bangladesh, especially in children, and it is rarer during infancy. Several conditions like infective colitis, allergic colitis, Meckel's diverticulitis, Crohn's disease, etc. may mimic the features of UC. So, if a child presents with recurrent bloody diarrhea, UC should be considered as differential diagnosis. PMID:22064342

  2. Mucocutaneous ulcerations secondary to methotrexate.

    PubMed

    Warner, Jennifer; Brown, Alissa; Whitmore, S Elizabeth; Cowan, David A

    2008-05-01

    Although methotrexate (MTX) is used in several medical specialties including dermatology, rheumatology, and oncology, drug-induced mucocutaneous ulcerations rarely are reported. We present a 36-year-old woman with plaque psoriasis and psoriatic arthritis being treated with oral MTX (12.5 mg weekly) and oral methoxsalen plus UVA. Following an increase in MTX dose, she developed erosions and ulcerations on her oral mucosa and within her psoriatic plaques. All erosions and ulcerations healed within 2 weeks upon discontinuation of MTX. PMID:18543592

  3. Golimumab Therapy in Ulcerative Colitis.

    PubMed

    Moon, Won

    2016-02-25

    Ulcerative colitis is a chronic inflammatory condition of the colon, characterized by diffuse mucosal inflammation and blood-mixed diarrhea. The main treatment has been 5-aminosalicylic acid, steroid, thiopurine, and anti-tumor necrosis factor alpha (TNF-?) antibodies including infliximab, adalimumab, and golimumab. Golimumab, a new anti-TNF-? agent has been recently approved for patients with moderate to severe ulcerative colitis. Its efficacy and safety has been demonstrated in line with infliximab and adalimumab in preclinical and clinical studies. This review will focus on golimumab therapy in ulcerative colitis. PMID:26907481

  4. [Psychological differences between ulcer and non-ulcer dyspeptic patients].

    PubMed

    Slepoy, V; Pezzotto, S; Pedrana, R; Gatto, A; Poletto, L

    1994-01-01

    The existence of differences in the psychological profile of 39 endoscopically evaluated patients with ulcer (U) and non ulcer (NU) dyspepsia were examined. There were 21 U and 18 NU subjects. Cigarette smoking, intake of alcohol, coffee, mate, aspirin and NSAID were recorded, but there were no significant differences between the two groups. Personality traits were determined by the Rorschach Test, considering psychological profile (introversive, extroversive, self-restrained), impulse and emotion control (do not allow their expression, impulsive, adequately conveyed) and level of social adaptation (low, normal, high). U and NU subjects experienced a similar number of potentially stressful life events. However, U patients perceived their events more negatively. Although no one type of "ulcer personality" was found consistently, ulcer patients tended to be more introversive and they had a better social adaptation than NU. PMID:7817698

  5. Promethus Hot Leg Piping Concept

    SciTech Connect

    AM Girbik; PA Dilorenzo

    2006-01-24

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

  6. Intramuscular pressures beneath elastic and inelastic leggings

    NASA Technical Reports Server (NTRS)

    Murthy, G.; Ballard, R. E.; Breit, G. A.; Watenpaugh, D. E.; Hargens, A. R.

    1994-01-01

    Leg compression devices have been used extensively by patients to combat chronic venous insufficiency and by astronauts to counteract orthostatic intolerance following spaceflight. However, the effects of elastic and inelastic leggings on the calf muscle pump have not been compared. The purpose of this study was to compare in normal subjects the effects of elastic and inelastic compression on leg intramuscular pressure (IMP), an objective index of calf muscle pump function. IMP in soleus and tibialis anterior muscles was measured with transducer-tipped catheters. Surface compression between each legging and the skin was recorded with an air bladder. Subjects were studied under three conditions: (1) control (no legging), (2) elastic legging, and (3) inelastic legging. Pressure data were recorded for each condition during recumbency, sitting, standing, walking, and running. Elastic leggings applied significantly greater surface compression during recumbency (20 +/- 1 mm Hg, mean +/- SE) than inelastic leggings (13 +/- 2 mm Hg). During recumbency, elastic leggings produced significantly higher soleus IMP of 25 +/- 1 mm Hg and tibialis anterior IMP of 28 +/- 1 mm Hg compared to 17 +/- 1 mm Hg and 20 +/- 2 mm Hg, respectively, generated by inelastic leggings and 8 +/- 1 mm Hg and 11 +/- 1 mm Hg, respectively, without leggings. During sitting, walking, and running, however, peak IMPs generated in the muscular compartments by elastic and inelastic leggings were similar. Our results suggest that elastic leg compression applied over a long period in the recumbent posture may impede microcirculation and jeopardize tissue viability.(ABSTRACT TRUNCATED AT 250 WORDS).

  7. Ischemic ulcers - self-care

    MedlinePLUS

    ... ischemic ulcers include: Dark red, yellow, gray, or black sores. Raised edges around the wound (looks punched ... Diabetes Diseases that cause inflammation, such as lupus High blood pressure Kidney failure Lymphedema, which causes fluid to build ...

  8. Genetics Home Reference: Ulcerative colitis

    MedlinePLUS

    ... of the colon and an overwhelming bacterial infection (sepsis). Ulcerative colitis also increases the risk of developing ... inflammation ; inheritance ; inheritance pattern ; intestine ; mucus ; prevalence ; rectum ; sepsis ; stool ; tissue ; toxic You may find definitions for ...

  9. Pressure ulcer good practice published.

    PubMed

    2015-06-17

    Patients admitted to hospital or a nursing home should have a pressure ulcer risk assessment within six hours of admission, the National Institute for Health and Care Excellence has said. PMID:26080953

  10. Quality of life in patients with venous stasis ulcers and others with advanced venous insufficiency.

    PubMed

    Tracz, Edyta; Zamojska, Ewa; Modrzejewski, Andrzej; Zaborski, Daniel; Grzesiak, Wilhelm

    2015-01-01

    The quality of life (QoL) in patients with advanced venous insufficiency (including venous stasis ulcers, skin discoloration, stasis eczema, and lipodermatosclerosis) assessed using the Clinical Etiological Anatomical Pathophysiological (CEAP) and Venous Clinical Severity Score (VCSS) classifications is presented. Also, disease features such as: intensity of pain, edema and inflammatory response that exerted the most profound effect on different domains of QoL are reported. The global QoL in patients with lower leg venous ulcerations was relatively similar to that observed in other patients with chronic venous insufficiency. The presence of venous ulcerations was associated with lower QoL in a Physical domain. Significant correlations were found between pain intensity and the values of Physical, Physiological, Level of Independence and Environmental domains, between edema intensity and Social domain as well as between the intensity of inflammatory response and Physical and Spiritual domains. PMID:25658932

  11. Pyoderma GangrenosumLike Ulcer in a Patient With X-Linked Agammaglobulinemia

    PubMed Central

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

    2011-01-01

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

  12. Venous dynamics in leg lymphedema.

    PubMed

    Kim, D I; Huh, S; Hwang, J H; Kim, Y I; Lee, B B

    1999-03-01

    To determine whether there is anatomical and/or functional impairment to venous return in patients with lymphedema, we examined venous dynamics in 41 patients with unilateral leg lymphedema. A Volometer was used for computer analysis of leg volume, a color Duplex Doppler scanner was used to determine deep vein patency and skin thickness, and Air-plethysmography was used to assess ambulatory venous pressure, venous volume, venous filling index and the ejection fraction. In the lymphedematous leg, volume and skin thickness were uniformly increased (126.4 +/- 21.3% and 156.9 +/- 44.5%) (mean +/- S.D.), respectively. The ambulatory venous pressure was also increased (134 +/- 60.7%) as was the venous volume (124.5 +/- 37.5%), and the venous filling index (134.5 +/- 50.5%). The ejection fraction was decreased (94.9 +/- 26.1%). Greater leg volume correlated with increased venous volume and venous filling index (values = 0.327, 0.241, respectively) and decreased ejection fraction (r = -0.133). Increased subcutaneous thickness correlated with increased venous filling index and venous volume (r = 0.307, 0.126, respectively) and decreased ejection fraction (r = -0.202). These findings suggest that soft tissue edema from lymphatic stasis gradually impedes venous return which in turn aggravates the underlying lymphedema. PMID:10197322

  13. Other Causes of Leg Pain

    MedlinePLUS

    ... in the same position for a long time Injuries caused by: A torn or overstretched muscle (strain) Hairline crack in the bone (stress fracture) Inflamed tendon (tendinitis) Shin splints—pain in the front of your leg related to overuse or repetitive pounding Deep vein thrombosis (DVT) , which occurs when ...

  14. Rotational joint for prosthetic leg

    NASA Technical Reports Server (NTRS)

    Jones, W. C.; Owens, L. J.

    1977-01-01

    Device is installed in standard 30 millimeter tubing used for lower leg prosthetics. Unit allows proper rotation (about 3 degrees) of foot relative to the hip, during normal walking or running. Limited rotational movement with restoring force results in a more natural gait.

  15. Management of Chronic Pressure Ulcers

    PubMed Central

    2009-01-01

    Executive Summary In April 2008, the Medical Advisory Secretariat began an evidence-based review of the literature concerning pressure ulcers. Please visit the Medical Advisory Secretariat Web site, http://www.health.gov.on.ca/english/providers/program/mas/tech/tech_mn.html to review these titles that are currently available within the Pressure Ulcers series. Pressure ulcer prevention: an evidence based analysis The cost-effectiveness of prevention strategies for pressure ulcers in long-term care homes in Ontario: projections of the Ontario Pressure Ulcer Model (field evaluation) Management of chronic pressure ulcers: an evidence-based analysis Objective The Medical Advisory Secretariat (MAS) conducted a systematic review on interventions used to treat pressure ulcers in order to answer the following questions: Do currently available interventions for the treatment of pressure ulcers increase the healing rate of pressure ulcers compared with standard care, a placebo, or other similar interventions? Within each category of intervention, which one is most effective in promoting the healing of existing pressure ulcers? Background A pressure ulcer is a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in conjunction with shear and/or friction. Many areas of the body, especially the sacrum and the heel, are prone to the development of pressure ulcers. People with impaired mobility (e.g., stroke or spinal cord injury patients) are most vulnerable to pressure ulcers. Other factors that predispose people to pressure ulcer formation are poor nutrition, poor sensation, urinary and fecal incontinence, and poor overall physical and mental health. The prevalence of pressure ulcers in Ontario has been estimated to range from a median of 22.1% in community settings to a median of 29.9% in nonacute care facilities. Pressure ulcers have been shown to increase the risk of mortality among geriatric patients by as much as 400%, to increase the frequency and duration of hospitalization, and to decrease the quality of life of affected patients. The cost of treating pressure ulcers has been estimated at approximately $9,000 (Cdn) per patient per month in the community setting. Considering the high prevalence of pressure ulcers in the Ontario health care system, the total cost of treating pressure ulcers is substantial. Technology Wounds normally heal in 3 phases (inflammatory phase, a proliferative phase of new tissue and matrix formation, and a remodelling phase). However, pressure ulcers often fail to progress past the inflammatory stage. Current practice for treating pressure ulcers includes treating the underlying causes, debridement to remove necrotic tissues and contaminated tissues, dressings to provide a moist wound environment and to manage exudates, devices and frequent turning of patients to provide pressure relief, topical applications of biologic agents, and nutritional support to correct nutritional deficiencies. A variety of adjunctive physical therapies are also in use. Method Health technology assessment databases and medical databases were searched from 1996 (Medline), 1980 (EMBASE), and 1982 (CINAHL) systematically up to March 2008 to identify randomized controlled trials (RCTs) on the following treatments of pressure ulcers: cleansing, debridement, dressings, biological therapies, pressure-relieving devices, physical therapies, nutritional therapies, and multidisciplinary wound care teams. Full literature search strategies are reported in appendix 1. English-language studies in previous systematic reviews and studies published since the last systematic review were included if they had more than 10 subjects, were randomized, and provided objective outcome measures on the healing of pressure ulcers. In the absence of RCTs, studies of the highest level of evidence available were included. Studies on wounds other than pressure ulcers and on surgical treatment of pressure ulcers were excluded. A total of 18 systematic reviews, 104 RCTs, and 4 observational studies were included in this review. Data were extracted from studies using standardized forms. The quality of individual studies was assessed based on adequacy of randomization, concealment of treatment allocation, comparability of groups, blinded assessment, and intention-to-treat analysis. Meta-analysis to estimate the relative risk (RR) or weighted mean difference (WMD) for measures of healing was performed when appropriate. A descriptive synthesis was provided where pooled analysis was not appropriate or not feasible. The quality of the overall evidence on each intervention was assessed using the grading of recommendations assessment, development, and evaluation (GRADE) criteria. Findings Findings from the analysis of the included studies are summarized below: Cleansing There is no good trial evidence to support the use of any particular wound cleansing solution or technique for pressure ulcers. Debridement There was no evidence that debridement using collagenase, dextranomer, cadexomer iodine, or maggots significantly improved complete healing compared with placebo. There were no statistically significant differences between enzymatic or mechanical debridement agents with the following exceptions: Papain urea resulted in better debridement than collagenase. Calcium alginate resulted in a greater reduction in ulcer size compared to dextranomer. Adding streptokinase/streptodornase to hydrogel resulted in faster debridement. Maggot debridement resulted in more complete debridement than conventional treatment. There is limited evidence on the healing effects of debridement devices. Dressings Hydrocolloid dressing was associated with almost three-times more complete healing compared with saline gauze. There is evidence that hydrogel and hydropolymer may be associated with 50% to 70% more complete healing of pressure ulcers than hydrocolloid dressing. No statistically significant differences in complete healing were detected among other modern dressings. There is evidence that polyurethane foam dressings and hydrocellular dressings are more absorbent and easier to remove than hydrocolloid dressings in ulcers with moderate to high exudates. In deeper ulcers (stage III and IV), the use of alginate with hydrocolloid resulted in significantly greater reduction in the size of the ulcers compared to hydrocolloid alone. Studies on sustained silver-releasing dressing demonstrated a tendency for reducing the risk of infection and promoting faster healing, but the sample sizes were too small for statistical analysis or for drawing conclusions. Biological Therapies The efficacy of platelet-derived growth factors (PDGFs), fibroblast growth factor, and granulocyte-macrophage colony stimulating factor in improving complete healing of chronic pressure ulcers has not been established. Presently only Regranex, a recombinant PDGF, has been approved by Health Canada and only for treatment of diabetic ulcers in the lower extremities. A March 2008 US Food and Drug Administration (FDA) communication reported increased deaths from cancers in people given three or more prescriptions for Regranex. Limited low-quality evidence on skin matrix and engineered skin equivalent suggests a potential role for these products in healing refractory advanced chronic pressure ulcers, but the evidence is insufficient to draw a conclusion. Adjunctive Physical Therapy There is evidence that electrical stimulation may result in a significantly greater reduction in the surface area and more complete healing of stage II to IV ulcers compared with sham therapy. No conclusion on the efficacy of electrotherapy can be drawn because of significant statistical heterogeneity, small sample sizes, and methodological flaws. The efficacy of other adjunctive physical therapies [electromagnetic therapy, low-level laser (LLL) therapy, ultrasound therapy, ultraviolet light therapy, and negative pressure therapy] in improving complete closure of pressure ulcers has not been established. Nutrition Therapy Supplementation with 15 grams of hydrolyzed protein 3 times daily did not affect complete healing but resulted in a 2-fold improvement in Pressure Ulcer Scale for Healing (PUSH) score compared with placebo. Supplementation with 200 mg of zinc three times per day did not have any significant impact on the healing of pressure ulcers compared with a placebo. Supplementation of 500 mg ascorbic acid twice daily was associated with a significantly greater decrease in the size of the ulcer compared with a placebo but did not have any significant impact on healing when compared with supplementation of 10 mg ascorbic acid three times daily. A very high protein tube feeding (25% of energy as protein) resulted in a greater reduction in ulcer area in institutionalized tube-fed patients compared with a high protein tube feeding (16% of energy as protein). Multinutrient supplements that contain zinc, arginine, and vitamin C were associated with a greater reduction in the area of the ulcers compared with standard hospital diet or to a standard supplement without zinc, arginine, or vitamin C. Firm conclusions cannot be drawn because of methodological flaws and small sample sizes. Multidisciplinary Wound Care Teams The only RCT suggests that multidisciplinary wound care teams may significantly improve healing in the acute care setting in 8 weeks and may significantly shorten the length of hospitalization. However, since only an abstract is available, study biases cannot be assessed and no conclusions can be drawn on the quality of this evidence. PMID:23074533

  16. Genetics Home Reference: Restless legs syndrome

    MedlinePLUS

    ... restless legs syndrome. However, it is unclear how iron deficiency is related to abnormal dopamine signaling, or how ... legs syndrome? anemia ; arthritis ; autosomal ; autosomal dominant ; cell ; ... kidney ; nervous system ; neurological ; nicotine ; prevalence ; renal ; renal ...

  17. Gimbals in the insect leg.

    PubMed

    Frantsevich, Leonid; Wang, Weiying

    2009-01-01

    We studied the common kinematic features of the coxa and trochanter in cursorial and raptorial legs, which are the short size of the podomers, predominantly monoaxial joints, and the approximate orthogonality of adjacent joint axes. The chain coxa-trochanter with its short elements and serial orthogonality of joint axes resembles the gimbals which combine versatility and tolerance to external perturbations. The geometry of legs was studied in 23 insect species of 12 orders. Insects with monoaxial joints were selected. The joint between the trochanter and the femur (TFJ) is defined either by two vestigial condyles or by a straight anterior hinge. Direction of the joint axes in the two basal podomers was assessed by 3D measurements or by goniometry in two planes. Length of the coxa is <15% (mostly <8%) of the total length of the cursorial leg, that of the trochanter <10%. Angles between the proximal and distal joint axes in the middle coxa range from 124 to 84 degrees (mean 97+/-14 degrees ), in the trochanter (in all legs studied) from 125 to 72 degrees (mean 90+/-13 degrees ). Vectors of the distal axis in the coxa are concentrated about the normal to the plane defined by the proximal axis and the midpoint between the distal condyles. These vectors in the trochanter lie at various angles to the normal; angles are correlated with the direction of the TFJ relative to the femur. Range of reduction about the TFJ is over 60 degrees in the foreleg of Ranatra linearis, Mantispa lobata and the hind leg in Carabus coriaceus (confirming observations of previous authors), 40-60 degrees in the foreleg of Vespa crabro and in the middle one in Ammophila campestris, 10-30 degrees in other studied specimens. The special role of the trochanter in autotomy and in active propulsion in some insect groups is discussed. The majority of insects possess small trochanters and slightly movable TFJs with the joint axis laying in the femur-tibia plane. We pose the hypothesis that the TFJ damps external forces, the vectors of which lie off the femur-tibia plane, the reductor muscle acting as a spring. Thus the TFJ contributes to dynamic stability of legged locomotion. PMID:18765299

  18. Genetics of ulcerative colitis.

    PubMed

    Thompson, Alexandra I; Lees, Charlie W

    2011-03-01

    Ulcerative colitis (UC) and Crohn's disease (CD) are related polygenic inflammatory bowel diseases (IBDs), with distinct and overlapping susceptibility loci. Recently, hypothesis-free genome-wide association (GWA) studies have revolutionized the field of complex disease genetics. Substantial advances have been achieved in defining the genetic architecture of IBD. To date, over 60 published IBD susceptibility loci have been discovered and replicated, of which approximately a third are associated with both UC and CD, although 21 are specific to UC and 23 to CD. In CD, the breakthrough identification of NOD2 as a susceptibility gene was followed by a rapid phase of gene discovery from GWA studies between 2006 and 2008. Progress in UC was slower; however, by initially testing hits for CD in UC, and later scanning larger UC cohorts, significant new loci for UC have been discovered, with exciting novel insights into disease pathogenesis. Notably, genes implicated in mucosal barrier function (ECM1, CDH1, HNF4?, and laminin B1) confer risk of UC; furthermore, E-cadherin is the first genetic correlation between colorectal cancer and UC. Impaired IL10 signaling has reemerged as a key pathway in intestinal inflammation, and is perhaps the most amenable to therapeutic intervention in UC. Collaborative international efforts with large meta-analyses of GWA studies and replication will yield many new UC genes. Furthermore, a large effort is required to characterize the loci found. Fine-mapping, deep resequencing, and functional studies will be critical to translating these gene discoveries into pathogenic insights, and ultimately into clinical insights and novel therapeutics. PMID:21319274

  19. Nutritional care in peptic ulcer

    PubMed Central

    VOMERO, Nathália Dalcin; COLPO, Elisângela

    2014-01-01

    Introduction Peptic ulcer is a lesion of the mucosal lining of the upper gastrointestinal tract characterized by an imbalance between aggressive and protective factors of the mucosa, having H. pylori as the main etiologic factor. Dietotherapy is important in the prevention and treatment of this disease. Aim To update nutritional therapy in adults' peptic ulcer. Methods Exploratory review without restrictions with primary sources indexed in Scielo, PubMed, Medline, ISI, and Scopus databases. Results Dietotherapy, as well as caloric distribution, should be adjusted to the patient's needs aiming to normalize the nutritional status and promote healing. Recommended nutrients can be different in the acute phase and in the recovery phase, and there is a greater need of protein and some micronutrients, such as vitamin A, zinc, selenium, and vitamin C in the recovery phase. In addition, some studies have shown that vitamin C has a beneficial effect in eradication of H. pylori. Fibers and probiotics also play a important role in the treatment of peptic ulcer, because they reduce the side effects of antibiotics and help reduce treatment time. Conclusion A balanced diet is vital in the treatment of peptic ulcer, once food can prevent, treat or even alleviate the symptoms involving this pathology. However, there are few papers that innovate dietotherapy; so additional studies addressing more specifically the dietotherapy for treatment of peptic ulcer are necessary. PMID:25626944

  20. Assessing Children's Legs and Feet

    PubMed Central

    Wedge, John H.

    1985-01-01

    Shoes are necessary for protection and warmth. Normal children do not require shoes for support. There is no scientific evidence that shoesorthopedic or otherwiseinfluence 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

  1. Leg ischemia post-varicocelectomy

    PubMed Central

    Al-Wahbi, Abdullah M; Elmoukaied, Shaza

    2016-01-01

    Varicocelectomy is the most commonly performed operation for the treatment of male infertility. Many surgical approaches are used as each of them has advantages over the other and is preferred by surgeons. Vascular injury has never been reported as a complication of varicocelectomy apart from testicular artery injury. We present a 36-year-old male who developed leg ischemia post-varicocelectomy due to common femoral artery injury. He was successfully treated by using a vein graft.

  2. Painful legs and moving toes.

    PubMed

    Reich, Stephen G

    2011-01-01

    The syndrome of painful legs-moving toes (PLMT) is an adult-onset, rare disorder characterized by pain, typically of a neuropathic quality, in the feet or legs, associated with writhing movements of one or more toes. It is the pain which usually brings the patient to medical attention. The syndrome may be unilateral or bilateral. Identical toe movements may occur without pain, referred to as: "painless legs-moving toes," and a similar condition affects the upper limbs: "painful arms-moving fingers." The pathophysiology of PLMT and its variants is not known but most reports suggest an association with a peripheral lesion, usually at the level of the root or nerve, though in many cases no cause is found. It has been suggested that a peripheral lesion causes aberrant input leading to "central reorganization," probably at the level of the spinal cord, and that the latter is responsible for the pain and movement. Treatment is often unsatisfactory and many drugs commonly used for neuropathic pain have been reported anecdotally to help (e.g., gabapentin). Other anecdotal therapies include spinal blocks, spinal cord stimulation, and local injection of botulinum toxin. PMID:21496596

  3. Pradaxa-induced esophageal ulcer.

    PubMed

    Wood, Michele; Shaw, Paul

    2015-01-01

    Pradaxa (dabigatran) is a direct thrombin inhibitor approved for prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation. We describe a case of esophageal ulceration associated with Pradaxa administration in a 75-year-old man. The patient reported difficulty swallowing and a burning sensation after taking his first dose of Pradaxa. An esophagogastroduodenoscopy (EGD) revealed linear ulcerations in the mid-esophagus. Pradaxa was held beginning the day before the EGD. The patient reported that his pain and difficulty swallowing resolved on stopping Pradaxa. Pradaxa is formulated with a tartaric acid excipient to reduce variability in absorption. We hypothesise that the capsule lodged in the patient's esophagus and the tartaric acid may have caused local damage resulting in an esophageal ulcer. It is important to educate patients on proper administration of Pradaxa, to decrease the risk of this rare, but potentially serious adverse event. PMID:26452739

  4. Facial ulcer treated with olanzapine.

    PubMed

    Lowry, C L; Bewley, A; Taylor, R

    2013-07-01

    A 69-year-old woman presented with a nonhealing ulcer on her right cheek. On histological examination of a biopsy, no evidence of granuloma formation or malignancy was found, and the overall picture was felt to be consistent with dermatitis artefacta (DA). The patient was referred to a joint psychodermatology clinic, where treatment with risperidone was started. However, at follow-up the ulcer remained unchanged, and treatment was changed to olanzapine 2.5 mg twice daily. Within 10 months, the large facial ulcer, which had been refractory to treatment for several years, had completely healed. Anxiolytics, antidepressants and low-dose antipsychotics have been shown to be helpful in the management of DA. Successful treatment with olanzapine has been described. The good clinical response to olanzapine may be attributed to its anti-impulsive effect, antihistaminic properties and low risk of parkinsonian side-effects. PMID:23611260

  5. Peptic Ulcer Disease and H. pylori

    MedlinePLUS

    ... peptic ulcer? A person who has contracted an H. pylori infection is more likely to develop an H. pylori -induced peptic ulcer. Researchers are not certain how H. pylori infection spreads, although they think that contaminated food, water, ...

  6. Peptic Ulcer - Multiple Languages: MedlinePlus

    MedlinePLUS

    ... Are Here: Home → Multiple Languages → All Health Topics → Peptic Ulcer URL of this page: https://www.nlm.nih. ... V W XYZ List of All Topics All Peptic Ulcer - Multiple Languages To use the sharing features on ...

  7. 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 ...

  8. Urine-drainage leg bags: an overview.

    PubMed

    Wilson, Mary

    This article looks at leg bags from the perspective of the clinical guidance available, published research, review papers, the diverse nature of products available, and their use with catheters, sheaths or urinals. The part that leg bags play in catheter-associated urinary tract infection control is addressed. Other aspects of catheter safety are discussed, including the avoidance of catheter traction. Variations in leg-bag structure including bag size, inlet tubing, tap, connector and backing, along with the reasons for selecting a particular leg bag are considered, along with the choice of either leg-bag straps or sleeves. The article concludes that, as a result of the variation of leg bags available, patients may require assistance and support from health professionals in finding the right leg bag for them. PMID:26450819

  9. Raynaud, digital ulcers and calcinosis in scleroderma.

    PubMed

    Nitsche, Alejandro

    2012-01-01

    Raynaud, digital ulcers and calcinosis are frequent manifestations of patients with systemic sclerosis. Digital ulcers are seen in more than half of the patients with scleroderma. Hospitalizations, ischemic complications and impairment of hand function are frequently observed in patients with digital ulcers, especially if treatment is delayed. Rapid and intensive treatment escalation in patients with scleroderma and refractory Raynaud's phenomenon is one of the most effective preventive action available in order to avoid the development of digital ulcers and tissue loss. PMID:22835924

  10. Occupational mortality from gastric and duodenal ulcer.

    PubMed Central

    Sonnenberg, A; Sonnenberg, G S

    1986-01-01

    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

  11. 38 CFR 4.110 - Ulcers.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... DISABILITIES Disability Ratings The Digestive System § 4.110 Ulcers. Experience has shown that the term “peptic ulcer” is not sufficiently specific for rating purposes. Manifest differences in ulcers of the stomach... warrant two separate graduated descriptions. In evaluating the ulcer, care should be taken that...

  12. 38 CFR 4.110 - Ulcers.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... DISABILITIES Disability Ratings The Digestive System § 4.110 Ulcers. Experience has shown that the term “peptic ulcer” is not sufficiently specific for rating purposes. Manifest differences in ulcers of the stomach... warrant two separate graduated descriptions. In evaluating the ulcer, care should be taken that...

  13. 38 CFR 4.110 - Ulcers.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... DISABILITIES Disability Ratings The Digestive System § 4.110 Ulcers. Experience has shown that the term “peptic ulcer” is not sufficiently specific for rating purposes. Manifest differences in ulcers of the stomach... warrant two separate graduated descriptions. In evaluating the ulcer, care should be taken that...

  14. 38 CFR 4.110 - Ulcers.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... DISABILITIES Disability Ratings The Digestive System § 4.110 Ulcers. Experience has shown that the term “peptic ulcer” is not sufficiently specific for rating purposes. Manifest differences in ulcers of the stomach... warrant two separate graduated descriptions. In evaluating the ulcer, care should be taken that...

  15. Computed tomographic findings in penetrating peptic ulcer

    SciTech Connect

    Madrazo, B.L.; Halpert, R.D.; Sandler, M.A.; Pearlberg, J.L.

    1984-12-01

    Four cases of peptic ulcer penetrating the head of the pancreas were diagnosed by computed tomography (CT). Findings common to 3 cases included (a) an ulcer crater, (b) a sinus tract, and (c) enlargement of the head of the pancreas. Unlike other modalities, the inherent spatial resolution of CT allows a convenient diagnosis of this important complication of peptic ulcer disease.

  16. 38 CFR 4.110 - Ulcers.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... DISABILITIES Disability Ratings The Digestive System § 4.110 Ulcers. Experience has shown that the term “peptic ulcer” is not sufficiently specific for rating purposes. Manifest differences in ulcers of the stomach... warrant two separate graduated descriptions. In evaluating the ulcer, care should be taken that...

  17. 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...

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

    PubMed Central

    Ugail, Hassan; Wilson, Michael J

    2005-01-01

    Background Oedema, commonly known as tissue swelling, occurs mainly on the leg and the arm. The condition may be associated with a range of causes such as venous diseases, trauma, infection, joint disease and orthopaedic surgery. Oedema is caused by both lymphatic and chronic venous insufficiency, which leads to pooling of blood and fluid in the extremities. This results in swelling, mild redness and scaling of the skin, all of which can culminate in ulceration. Methods We present a method to model a wide variety of geometries of limbs affected by oedema and venous ulcers. The shape modelling is based on the PDE method where a set of boundary curves are extracted from 3D scan data and are utilised as boundary conditions to solve a PDE, which provides the geometry of an affected limb. For this work we utilise a mixture of fourth order and sixth order PDEs, the solutions of which enable us to obtain a good representative shape of the limb and associated ulcers in question. Results A series of examples are discussed demonstrating the capability of the method to produce good representative shapes of limbs by utilising a series of curves extracted from the scan data. In particular we show how the method could be used to model the shape of an arm and a leg with an associated ulcer. Conclusion We show how PDE based shape modelling techniques can be utilised to generate a variety of limb shapes and associated ulcers by means of a series of curves extracted from scan data. We also discuss how the method could be used to manipulate a generic shape of a limb and an associated wound so that the model could be fine-tuned for a particular patient. PMID:16078992

  19. Sweet's syndrome complicating ulcerative colitis: a rare association.

    PubMed

    Lopes Caola, Rute; Soares, Marta; Cardoso, Carla; Furtado, Antnio

    2016-01-01

    Sweet's syndrome (SS) is a neutrophilic dermatosis disorder of unknown aetiology, characterised by acute fever, neutrophilia, painful erythematous papules, nodules and plaques, and an infiltrate consisting predominantly of mature neutrophils in the upper dermis. Classical SS is a rare extra-intestinal manifestation of in?ammatory bowel disease (IBD). It is more common in Crohn's disease than in ulcerative colitis (UC). There is a predilection for women, and for patients with colonic disease and active IBD. We report the case of a 39-year-old woman with a flare of moderate severity UC treated with mesalazine who presented with a 5-day history of acute fever, painful papules and plaques on forearms and legs, episcleritis and cervical pain. Skin biopsies showed papillary dermis inflammatory cell infiltration composed mainly of neutrophils, without evidence of leukocytoclastic vasculitis or panniculitis, compatible with SS. The patient had an excellent response to systemic corticosteroids. Symptoms promptly improved and skin lesions resolved after 7?weeks. PMID:26791120

  20. [Combined therapy for a vascular ulcer. 2008 Biatain First Prize. A clinical case of a patient with an infected vascular ulcer].

    PubMed

    Romo Sanz, María Isabel; Juárez Vela, Raul

    2009-03-01

    The use of a combined therapy which includes hydropolymeric dressings with ionic silver and dressings which release of ibuprofen together with a constant reevaluation made it possible to heal an ulcer which had afflicted a patient for 10 years. In order to succeed in doing so, medical professionals started off with the evidence that, in the complicated process which the cicatrization of long-lasting wounds difficult to cure constitutes, a series of factors involved in tissue regeneration appear which, at the same time, are not expected and which delay and slow down this process (critical colonization and infection, nutritional and metabolic state, repetitive infections, vascular state or hormonal alterations). This case story won the 2008 Biatain First Prize in the category "Clinical Case Study of a patient with an infected leg ulcer". PMID:19462599

  1. [Ulcerative colitis and cytomegalovirus infection].

    PubMed

    Trraga Rodrguez, I; Ferreras Fernndez, P; Vicente Gutirrez, M; de Arriba, J J; Garca Mourio, M L

    2003-02-01

    Colitis ulcerous and citomegalovirus infection association have been reported in medical literature in sometimes, althougth this prevalence have lately increased. We report a case record of this association and do a review of this subject. It is not clear what factors are involved in this association, being necessary hore studies to know them. PMID:12703162

  2. Challenges in pressure ulcer prevention.

    PubMed

    Dealey, Carol; Brindle, C Tod; Black, Joyce; Alves, Paulo; Santamaria, Nick; Call, Evan; Clark, Michael

    2015-06-01

    Although this article is a stand-alone article, it sets the scene for later articles in this issue. Pressure ulcers are considered to be a largely preventable problem, and yet despite extensive training and the expenditure of a large amount of resources, they persist. This article reviews the current understanding of pressure ulcer aetiology: pressure, shear and microclimate. Individual risk factors for pressure ulceration also need to be understood in order to determine the level of risk of an individual. Such an assessment is essential to determine appropriate prevention strategies. The main prevention strategies in terms of reducing pressure and shear and managing microclimate are studied in this article. The problem of pressure ulceration related to medical devices is also considered as most of the standard prevention strategies are not effective in preventing this type of damage. Finally, the possibility of using dressings as an additional preventive strategy is raised along with the question: is there enough evidence to support their use? PMID:23786251

  3. A portable pulsed electromagnetic field (PEMF) device to enhance healing of recalcitrant venous ulcers: a double-blind, placebo-controlled clinical trial.

    PubMed

    Stiller, M J; Pak, G H; Shupack, J L; Thaler, S; Kenny, C; Jondreau, L

    1992-08-01

    A prospective, randomized, double-blind, placebo-controlled multicentre study assessed the clinical efficacy and safety of pulsed electromagnetic limb ulcer therapy (PELUT) in the healing of recalcitrant, predominantly venous leg ulcers. The portable device was used at home for 3 h daily during this 8-week clinical trial as an adjunct to a wound dressing. Wound surface area, ulcer depth and pain intensity were assessed at weeks 0, 4 and 8. At week 8 the active group had a 47.7% decrease in wound surface area vs. a 42.3% increase for placebo (P < 0.0002). Investigators' global evaluations indicated that 50% of the ulcers in the active group healed or markedly improved vs. 0% in the placebo group, and 0% of the active group worsened vs. 54% of the placebo group (P < 0.001). Significant decreases in wound depth (P < 0.04) and pain intensity (P < 0.04) favouring the active group were seen. Patients whose ulcers improved significantly after 8 weeks were permitted to continue double-blind therapy for an additional 4 weeks. Eleven active and one placebo patient continued therapy until week 12, with the active treatment group continuing to show improvement. There were no reports of adverse events attributable to this device. We conclude that the PELUT device is a safe and effective adjunct to non-surgical therapy for recalcitrant venous leg ulcers. PMID:1390143

  4. Recording pressure ulcer risk assessment and incidence.

    PubMed

    Plaskitt, Anne; Heywood, Nicola; Arrowsmith, Michaela

    2015-07-15

    This article reports on the introduction of an innovative computer-based system developed to record and report pressure ulcer risk and incidence at an acute NHS trust. The system was introduced to ensure that all patients have an early pressure ulcer risk assessment, which prompts staff to initiate appropriate management if a pressure ulcer is detected, thereby preventing further patient harm. Initial findings suggest that this electronic process has helped to improve the timeliness and accuracy of data on pressure ulcer risk and incidence. In addition, it has resulted in a reduced number of reported hospital-acquired pressure ulcers. PMID:26174286

  5. Endoscopic Management of Peptic Ulcer Bleeding

    PubMed Central

    Kim, Joon Sung; Park, Sung Min

    2015-01-01

    Acute upper gastrointestinal bleeding is a common medical emergency around the world and the major cause is peptic ulcer bleeding. Endoscopic treatment is fundamental for the management of peptic ulcer bleeding. Despite recent advances in endoscopic treatment, mortality from peptic ulcer bleeding has still remained high. This is because the disease often occurs in elderly patients with frequent comorbidities and are taking ulcerogenic medications. Therefore, the management of peptic ulcer bleeding is still a challenge for clinicians. This article reviews the various endoscopic methods available for management of peptic ulcer bleeding and the techniques in using these methods. PMID:25844337

  6. Chronic leg pain in athletes.

    PubMed

    Burrus, M Tyrrell; Werner, Brian C; Starman, Jim S; Gwathmey, F Winston; Carson, Eric W; Wilder, Robert P; Diduch, David R

    2015-06-01

    Chronic leg pain is commonly treated by orthopaedic surgeons who take care of athletes. The sources are varied and include the more commonly encountered medial tibial stress syndrome, chronic exertional compartment syndrome, stress fracture, popliteal artery entrapment syndrome, nerve entrapment, Achilles tightness, deep vein thrombosis, and complex regional pain syndrome. Owing to overlapping physical examination findings, an assortment of imaging and other diagnostic modalities are employed to distinguish among the diagnoses to guide the appropriate management. Although most of these chronic problems are treated nonsurgically, some patients require operative intervention. For each condition listed above, the pathophysiology, diagnosis, management option, and outcomes are discussed in turn. PMID:25157051

  7. Prevention and management of diabetic foot ulcers.

    PubMed

    Turns, Martin

    2015-03-01

    As part of an annual foot review, trained and competent personnel should examine patients' feet to detect risk factors for ulceration. Foot examination with shoes and stockings removed should include: palpation of foot pulses; testing foot sensations using 10g monofilament or vibration; inspection for significant callus or deformed nails; inspection for any structural deformity; asking about any previous ulceration; checking for signs of ulceration; asking about any pain; and inspecting footwear. Following assessment, a foot risk classification score should be given. The person with diabetes should then be informed of their risk score, with education offered regarding future foot-care management. Diabetic foot complications include ulceration, Charcot foot, painful neuropathy, gangrene and amputation. Risk factors for ulceration include non-palpable pulses, insensate foot, significant callus, deformed nails, history of previous ulcer or amputation, tissue damage or signs of ulceration, foot pain and unsuitable footwear. PMID:25757381

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

    PubMed

    Shen, Z H; Seipel, J E

    2012-12-01

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

  9. Cross-leg fillet flap for the reconstruction of severe bilateral leg burns.

    PubMed

    Fujimura, Taiju; Tomizuka, Yosuke; Fujita, Masato

    2009-10-01

    For a patient with fourth-degree burns involving both legs, we performed an amputation of the right leg at the thigh and covered the left knee joint with the posterior part of the right leg as a cross-leg fillet flap. It is reasonable to use tissue from one leg for reconstruction of the other leg in order to avoid bilateral leg amputation in the treatment of bilateral severe leg injury. We could transfer a sufficient amount of tissue by using this flap without donor site morbidity. Generally, hip or knee joint contracture is a major problem with the cross-leg flap. The long pedicle of this flap allowed the patient some leg movement and there was no contracture at his knee or hip joints. We cannot use this flap as a sensory flap because of pedicle cutting, but inappropriate sensation of the lower extremity is uncomfortable and reduces a patient's quality of life. The cross-leg fillet flap described here avoids donor site morbidity without the use of microsurgery. This flap will become a treatment option for severe bilateral leg injuries when one leg requires amputation. PMID:18617453

  10. Larval therapy applied to a large arterial ulcer: an effective outcome.

    PubMed

    Rafter, Linda

    This article is a review of larval therapy and includes a case study that uses larval therapy in the treatment of complex leg ulcer wounds. Complex wounds require careful management from the multidisciplinary team and present clinicians with intricate challenges to save the limb. Wound-bed preparation and debridement needs to be as effective and non-traumatic as possible for the patient. Larval therapy removes the devitalised tissue effectively with minimal tissue trauma. This case study reports on a patient with a non-progressing, full-thickness wound with exposed tendon following reconstructive surgery at a local vascular unit. The patient was left with very limited treatment options, as traditional dressings for the arterial ulcer nearly resulted in amputation due to the deterioration in the wound. As part of the patient's management, she was treated with larval therapy in an attempt to salvage her limb. This article follows the progress of complex leg ulcer wounds employing BioFoam dressing (BioMonde, Bridgend) for larvae debridement therapy over a 4-week period and incorporating five applications of three BioFoam dressing bags. This care pathway ensured the patient's safety by promoting effective wound healing with the larval therapy leading to excellent clinical patient outcomes. PMID:23587971

  11. Data driven models of legged locomotion

    NASA Astrophysics Data System (ADS)

    Revzen, Shai; Kvalheim, Matthew

    2015-05-01

    Legged locomotion is a challenging regime both for experimental analysis and for robot design. From biology, we know that legged animals can perform spectacular feats which our machines can only surpass on some specially controlled surfaces such as roads. We present a concise review of the theoretical underpinnings of Data Driven Floquet Analysis (DDFA), an approach for empirical modeling of rhythmic dynamical systems. We provide a review of recent and classical results which justify its use in the analysis of legged systems.

  12. Space Elevator Base Leg Architecture

    NASA Astrophysics Data System (ADS)

    Swan, C.; Swan, P. A.

    While the Space Elevator stretches for 104,000 kilometers, the region of most concern, from the survival perspective, is 2,500 kms and below. The threats inside this dangerous arena include debris, spacecraft, meteorites, lightening, winds, rogue waves, aircraft, and intentional human acts. Two major questions will be addressed that will influence the overall systems architecture of a Space Elevator. While the deployment phase of the development of the Space Elevator will only have a single ribbon from the surface of the Earth to well beyond the Geosynchronous altitude, a mature Space Elevator must never allow a complete sever of the system. Design approaches, materials selections, international policy development and assembly must ensure that the integrity of the Space Elevator be maintained. The trade space analysis will address the probability of an individual ribbon being severed, the length of time to repair, and the potential for a catastrophic Space Elevator cut. The architecture proposed for the base leg portion will address two questions: Shall there be multiple base legs to 2,500 kms altitude? And Should the anchor be based on land or at sea?

  13. Cancer complicating chronic ulcerative and scarifying mucocutaneous disorders

    SciTech Connect

    Kaplan, R.P. )

    1987-01-01

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

  14. Leg automaticity is stronger than arm automaticity during simultaneous arm and leg cycling.

    PubMed

    Sakamoto, Masanori; Tazoe, Toshiki; Nakajima, Tsuyoshi; Endoh, Takashi; Komiyama, Tomoyoshi

    2014-04-01

    Recent studies indicate that human locomotion is quadrupedal in nature. An automatic rhythm-generating system is thought to play a crucial role in controlling arm and leg movements. In the present study, we attempted to elucidate differences between intrinsic arm and leg automaticity by investigating cadence variability during simultaneous arm and leg (AL) cycling. Participants performed AL cycling with visual feedback of arm or leg cadence. Participants were asked to focus their attention to match the predetermined cadence; this affects the automaticity of the rhythm-generating system. Leg cadence variability was only mildly affected when the participants intended to precisely adjust either their arm or leg cycling cadence to a predetermined value. In contrast, arm cadence variability significantly increased when the participants adjusted their leg cycling cadence to a predetermined value. These findings suggest that different neural mechanisms underlie the automaticities of arm and leg cycling and that the latter is stronger than the former during AL cycling. PMID:24548625

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

    PubMed

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

    2012-03-01

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

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

    ERIC Educational Resources Information Center

    Gettman, Larry R.; Huckel, Jack R.

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

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

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

  18. Intestinal microbiota and ulcerative colitis.

    PubMed

    Ohkusa, Toshifumi; Koido, Shigeo

    2015-11-01

    There is a close relationship between the human host and the intestinal microbiota, which is an assortment of microorganisms, protecting the intestine against colonization by exogenous pathogens. Moreover, the intestinal microbiota play a critical role in providing nutrition and the modulation of host immune homeostasis. Recent reports indicate that some strains of intestinal bacteria are responsible for intestinal ulceration and chronic inflammation in inflammatory bowel diseases (IBD) such as ulcerative colitis (UC) and Crohn's disease (CD). Understanding the interaction of the intestinal microbiota with pathogens and the human host might provide new strategies treating patients with IBD. This review focuses on the important role that the intestinal microbiota plays in maintaining innate immunity in the pathogenesis and etiology of UC and discusses new antibiotic therapies targeting the intestinal microbiota. PMID:26346678

  19. Healing enhancement of chronic venous stasis ulcers utilizing H-WAVE device therapy: a case series

    PubMed Central

    2010-01-01

    Introduction Approximately 15% (more than 2 million individuals, based on these estimates) of all people with diabetes will develop a lower-extremity ulcer during the course of the disease. Ultimately, between 14% and 20% of patients with lower-extremity diabetic ulcers will require amputation of the affected limb. Analysis of the 1995 Medicare claims revealed that lower-extremity ulcer care accounted for $1.45 billion in Medicare costs. Therapies that promote rapid and complete healing and reduce the need for expensive surgical procedures would impact these costs substantially. One such example is the electrotherapeutic modality utilizing the H-Wave device therapy and program. It has been recently shown in acute animal experiments that the H-Wave device stimulation induces a nitric oxide-dependent increase in microcirculation of the rat Cremaster skeletal muscle. Moreover, chronic H-wave device stimulation of rat hind limbs not only increases blood flow but induces measured angiogenesis. Coupling these findings strongly suggests that H-Wave device stimulation promotes rapid and complete healing without need of expensive surgical procedures. Case presentation We decided to do a preliminary evaluation of the H-Wave device therapy and program in three seriously afflicted diabetic patients. Patient 1 had chronic venous stasis for 6 years. Patient 2 had chronic recurrent leg ulcerations. Patient 3 had a chronic venous stasis ulcer for 2 years. All were dispensed a home H-Wave unit. Patient 1 had no other treatment, patient 2 had H-Wave therapy along with traditional compressive therapy, and patient 3 had no other therapy. For patient 1, following treatment the ulcer completely healed with the H-Wave device and program after 3 months. For patient 2, by one month complete ulcer closure occurred. Patient 3 had a completely healed ulcer after 9 months. Conclusions While most diabetic ulcers can be treated successfully on an outpatient basis, a significant proportion will persist and become infected. Based on this preliminary case series investigation we found that three patients prescribed H-Wave home treatment demonstrate accelerated healing with excellent results. While these results are encouraging, additional large scale investigation is warranted before any interpretation is given to these interesting outcomes. PMID:20181141

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

    PubMed Central

    Serra, Raffaele; Gallelli, Luca; Conti, Angela; De Caridi, Giovanni; Massara, Mafalda; Spinelli, Francesco; Buffone, Gianluca; Cali, Francesco Giuseppe; Amato, Bruno; Ceglia, Simona; Spaziano, Giuseppe; Scaramuzzino, Luca; Ferrarese, Alessia Giovanna; Grande, Raffaele; de Franciscis, Stefano

    2014-01-01

    Background Mixed venous and arterial ulcers account for approximately 15%30% of all venous leg ulcerations. Several studies have shown that matrix metalloproteinases (MMPs) and neutrophil gelatinase-associated lipocalin (NGAL) play a central role in the pathophysiology of venous and arterial diseases. Some studies have shown the efficacy of glycosaminoglycans, such as sulodexide (SDX), in treating patients with leg ulcers. The aim of this study was to evaluate clinical effects of SDX and its correlation with MMPs and NGAL expression in patients with mixed arterial and venous leg ulcers. Methods Patients eligible for this study were of both sexes, older than 20 years, and with a clinical and instrumental diagnosis of mixed ulcer. Results Fifty-three patients of both sexes were enrolled and divided into two groups by means of randomization tables. Group A (treated group) comprised 18 females and ten males (median age: 68.7 years) treated with standard treatment (compression therapy and surgery) + SDX (600 lipoprotein lipase-releasing units/day intramuscularly) for 15 days followed by SDX 250 lipase-releasing units every 12 hours day orally for 6 months as adjunctive treatment. Group B (control group) comprised 17 females and eight males (median age: 64.2 years) treated with standard treatment only (compression therapy and surgery). The type of surgery was chosen according to anatomical level of vein incompetence: superficial venous open surgery and/or subfascial endoscopic perforating surgery. In all enrolled patients, blood samples were collected in order to evaluate the plasma levels of MMPs and NGAL through enzyme-linked immunosorbent assay. These results were compared to another control group (Group C) of healthy individuals. Moreover, biopsies of ulcers were taken to evaluate the tissue expression of MMPs and NGAL through Western blot analysis. Our results revealed that SDX treatment is able to reduce both plasma levels and tissue expression of MMPs improving the clinical conditions in patients with mixed ulcers. Conclusion Inhibition of MMPs could represent a possible therapeutic intervention to limit the progression of leg ulceration. In particular, our findings demonstrate the efficacy of SDX in patients with mixed arterial and venous chronic ulcers of the lower limbs. PMID:24872682

  1. Update on peripheral ulcerative keratitis

    PubMed Central

    Yagci, Ayse

    2012-01-01

    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

  2. AUTOANTIBODIES IN HUMAN ULCERATIVE COLITIS

    PubMed Central

    Broberger, Ove; Perlmann, Peter

    1959-01-01

    Sera from 30 children, suffering from ulcerative colitis, were examined for the presence of antibodies capable of reacting with antigens of normal human tissue. It was possible to demonstrate that most of the sera contained a precipitating and hemagglutinating factor, reacting with a constituent of human colonic tissue. This constituent was obtained, within 1 hour after death, from colonic tissue of newborn babies who had died without feeding. It could also be prepared from fetal tissue. The antigen can be extracted with phenol-water at 65°C. and seems to be a polysaccharide. The precipitating factor in the sera of the patients behaves electrophoretically as a γ-globulin. Phenol-water extracts from liver and from kidney also reacted positively with the sera from certain patients. There are indications which suggest that the antigen obtained from these tissues is identical with that from colon. Sera from 38 healthy children did not give any reactions with the extracts used. In additional controls, the sera of 32 children with various diseases, all of suspected autoimmune origin, were also tested. A few of these reacted positively with the phenol-water extracts from the organs mentioned above. Most likely, the antigen reacting in these cases is different from that reacting with the antibodies in the sera from patients with ulcerative colitis. The possible role of the antibodies in the pathogenesis of ulcerative colitis and the mechanism of their formation are discussed. PMID:13804543

  3. Spoilage association of chicken leg muscle.

    PubMed Central

    McMeekin, T A

    1977-01-01

    The ability of pure cultures of bacteria isolated from spoiling chicken leg muscle to produce strong off-odors was tested by using sterile leg muscle sections. Changes in the flora during storage and the incidence and identity of organisms capable of producing strong off-odors were noted. PMID:879780

  4. Non-contact optical imaging of healing and non-healing diabetic foot ulcers

    NASA Astrophysics Data System (ADS)

    Godavarty, A.; Khandavilli, Y.; Jung, Y.-J.; Rao, P. N. S.

    2015-03-01

    Diabetic foot ulcer is the most devastating complication of diabetes that is still un-recognized. The treatment costs of these ulcers are very high to eventually save the leg/foot from amputation. To date, clinicians employ visual inspection of the wound site during its standard 4-week of healing process via monitoring of surface granulation. There is a need to develop on-site, low-cost imaging tools that can monitor the wound healing process periodically during the standard 4-week treatment process. A novel ultra-portable near-infrared optical scanner (NIROS) has been developed at the Optical Imaging Laboratory that can perform non-contact 2D area imaging of the wound site. Non-contact optical imaging studies were carried on diabetic subjects with foot ulcers (at Somesh Diabetic Foot Clinic, India) that were of healing and non-healing nature. A 710 nm LED source and a compact NIR sensitive camera were employed during non-contact imaging of the diabetic foot in order to obtain the near-infrared absorption images. From these preliminary studies it was observed that the non-healing wounds had a greater absorption contrast with respect to the normal site, unlike in the healing wounds. Demonstrating the ability of NIROS to differentiate healing vs. non-healing wounds in diabetic subjects can potentially impact early intervention in the treatment of diabetic foot ulcers.

  5. Multiple cutaneous neutropenic ulcers associated with azathioprine

    PubMed Central

    Laha, Baisakhi; Guha, Rajib; Hazra, Avijit

    2012-01-01

    We report a case of neutropenic ulceration in a 42-year-old woman receiving azathioprine for pemphigus vulgaris. She developed multiple indolent ulcers involving the nose, neck, and back, after about 68 weeks following commencement of azathioprine 50 mg daily. The ulcers were large, disfiguring, dry, and with basal necrotic slough. They were painless and did not discharge pus. The absolute neutrophil count was severely depressed initially, but normalized following azathioprine withdrawal. Swab culture revealed colonization with Klebsiella pneumoniae and the ulcers healed with local debridement, treatment with imipenem, and topical application of mupirocin. However, nasal disfigurement persisted. Neutropenic ulceration is known to be associated with azathioprine therapy but we report this case because of the unusual presentationindolent cutaneous ulcers. Early recognition of the problem and drug withdrawal can prevent complications like disfigurement. PMID:23112431

  6. Engaging patients in pressure ulcer prevention.

    PubMed

    Hudgell, Lynne; Dalphinis, Julie; Blunt, Chris; Zonouzi, Maryam; Procter, Susan

    2015-05-01

    As patients increasingly care for themselves at home, they require accessible information to enable informed self-care. This article describes the development of an educational electronic application (app) designed for use by patients at risk of pressure ulcers, and their carers. The app can be downloaded to Windows, Android or Apple smartphones or tablets. The app is based on the current pressure ulcer prevention and management guidelines from the National Pressure Ulcer Advisory Panel and the National Institute for Health and Care Excellence, and is designed to educate patients and carers about how to prevent a pressure ulcer, how to recognise a pressure ulcer, and what to do if they suspect they are developing a pressure ulcer. We hope the app will be used to help with educational conversations among patients, carers and healthcare professionals. PMID:25942988

  7. Ulcerative necrobiosis lipoidica responsive to colchicine.

    PubMed

    Schofield, Clare; Sladden, Michael J

    2012-08-01

    Necrobiosis lipoidica is an uncommon granulomatous disease of unknown aetiology. Few treatments have emerged with consistent efficacy and the ulcerated form of necrobiosis lipoidica can be particularly difficult to treat. A 56-year-old non-diabetic woman with chronic ulcerative necrobiosis lipoidica unresponsive to other therapies was commenced on colchicine treatment. Complete resolution of the ulcers was observed after 2 months' therapy with colchicine 500?g twice daily. PMID:22881474

  8. Gastric emptying abnormal in duodenal ulcer

    SciTech Connect

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

    1986-07-01

    To investigate the possibility that an abnormality of gastric emptying exists in duodenal ulcer and to determine if such an abnormality persists after ulcer healing, scintigraphic gastric emptying measurements were undertaken in 16 duodenal ulcer patients before, during, and after therapy with cimetidine; in 12 patients with pernicious anemia, and in 12 control subjects. No difference was detected in the rate or pattern of gastric emptying in duodenal ulcer patients before and after ulcer healing with cimetidine compared with controls, but emptying of the solid component of the test meal was more rapid during treatment with the drug. Comparison of emptying patterns obtained in duodenal ulcer subjects during and after cimetidine treatment with those obtained in pernicious anemia patients and controls revealed a similar relationship that was characterized by a tendency for reduction in the normal differentiation between the emptying of solid and liquid from the stomach. The similarity in emptying patterns in these groups of subjects suggests that gastric emptying of solids may be influenced by changes in the volume of gastric secretion. The failure to detect an abnormality of gastric emptying in duodenal ulcer subjects before and after ulcer healing calls into question the widespread belief that abnormally rapid gastric emptying is a feature with pathogenetic significance in duodenal ulcer disease.

  9. [Solitary rectal ulcer: a case review].

    PubMed

    Salazar Ventura, Sonia; Ramos Barrientos, Milko

    2002-01-01

    A case of a 14-year-old male patient is reported, diagnosed with solitary rectal ulcer syndrome and showing rectal bleeding and pain, excessive straining and tenesmus as main symptoms. Rectal ulcerous lesion was detected through endoscopy and its definitive diagnosis was established by biopsy. Typical histology, clinical history and endoscopic appearance distinguish solitary rectal ulcer from other rectal ulcer-associated etiology. Because this is less frequent pathology and there are no national reports on the same, this case has been reported and a revision of literature made accordingly. PMID:12098747

  10. Pressure ulcer prevention in frail older people.

    PubMed

    Barry, Maree; Nugent, Linda

    2015-12-16

    Pressure ulcers are painful and cause discomfort, have a negative effect on quality of life, and are costly to treat. The incidence and severity of preventable pressure ulcers is an important indicator of quality of care; it is essential that healthcare providers monitor prevalence and incidence rates to ensure that care strategies implemented are effective. Frail older people are at increased risk of developing pressure ulcers. This article discusses the complexities of preventing pressure ulcers in frail older people and emphasises the importance of structured educational programmes that incorporate effective clinical leadership and multidisciplinary teamwork. PMID:26669407

  11. Corneal ulceration at an urban African hospital.

    PubMed Central

    Carmichael, T R; Wolpert, M; Koornhof, H J

    1985-01-01

    During a one-year survey 283 corneal ulcers from 274 patients were seen at St John's Eye Unit of Baragwanath Hospital. Central bacterial ulcers constituted the largest problem, and the commonest isolate in this group was Streptococcus pneumoniae. Mycotic and dendritic keratitis were relatively uncommon, while marginal catarrhal ulceration secondary to chronic staphylococcal lid disease was frequently seen. The microbiology of the various ulcers is described, and the placing of organisms into classes is stressed in determining significance of isolates. Many of the patients were male Africans who were either manual labourers or unemployed. Half the patients had used topical antibiotics before presentation. PMID:3936534

  12. Trigeminal neuropathy with nasal ulceration: report of two cases and one necropsy.

    PubMed Central

    Spillane, J D; Urich, H

    1976-01-01

    Two cases are reported of progressive trigeminal neutopathy with nasal ulceration. One patient developed signs of spinal cord involvement 15 years after the onset of trigeminal symptoms and died after a total course of 21 years. Necropsy revealed an unusual trigeminospinal system degeneration with deposition of amyloid-like substances in the affected structures. The other patient is alive eight years after the onset of symptoms, the only indication of a lesion outside the trigeminal nerve being a patch of numbness in one leg. Images PMID:177737

  13. Steerable Hopping Six-Legged Robot

    NASA Technical Reports Server (NTRS)

    Younse, Paulo; Aghazarian, Hrand

    2010-01-01

    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.

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

    PubMed

    Bergsten, Christer; Telezhenko, Evgenij; Ventorp, Michael

    2015-01-01

    Claw health, an important dairy cow welfare parameter, may be affected by early-life foot/leg stresses. To investigate this, groups of pregnant heifers were allocated to deep straw bedding (Soft) or cubicles (Hard), both with scraped concrete feeding alleys. After the grazing season, they were re-housed in cubicle systems, half on slatted concrete (Hard) and half on slatted rubber (Soft) alleys. Claw measurements, contact area and pressure distribution claw/flooring, claw disorders and leg lesions were recorded at the start and end of each housing season. Locomotion and leg lesions were also scored monthly after calving. Prevalence of sole haemorrhages was higher among pregnant heifers in cubicles than in deep straw. After calving, first-calvers on Hard floors had higher odds for lameness (OR = 3.6; P < 0.01), sole haemorrhages/ulcers (OR = 2.2; P < 0.05), white-line haemorrhages (OR = 2.8; P < 0.01) and leg lesions (OR = 2.6; P < 0.02) than those on Soft floors. Lowest prevalence and severity of sole and white-line haemorrhages (non-significant) in first-calvers was found in those on Soft floors and reared on Hard floors and the highest prevalence and severity on those on Hard floors reared on Soft floors. Soft flooring after calving is of most importance for healthy feet and legs. PMID:26479380

  15. Expansion Compression Contacts for Thermoelectric Legs

    NASA Technical Reports Server (NTRS)

    Sakamoto, Jeffrey

    2009-01-01

    In a proposed alternative to previous approaches to making hot-shoe contacts to the legs of thermoelectric devices, one relies on differential thermal expansion to increase contact pressures for the purpose of reducing the electrical resistances of contacts as temperatures increase. The proposed approach is particularly applicable to thermoelectric devices containing p-type (positive-charge-carrier) legs made of a Zintl compound (specifically, Yb14MnSb11) and n-type (negative charge-carrier) legs made of SiGe. This combination of thermoelectric materials has been selected for further development, primarily on the basis of projected thermoelectric performance. However, it is problematic to integrate, into a practical thermoelectric device, legs made of these materials along with a metal or semiconductor hot shoe that is required to be in thermal and electrical contact with the legs. This is partly because of the thermal-expansion mismatch of these materials: The coefficient of thermal expansion (CTE) of SiGe is 4.5 x 10(exp -6) C (exp -1), while the CTE of Yb14MnSb11 is 20 x 10(exp -6) C(exp -1). Simply joining a Yb14MnSb11 and a SiGe leg to a common hot shoe could be expected to result in significant thermal stresses in either or both legs during operation. Heretofore, such thermal stresses have been regarded as disadvantageous. In the proposed approach, stresses resulting from the CTE mismatch would be turned to advantage.

  16. Help-Seeking for Pre-Ulcer and Ulcer Conditions of Mycobacterium ulcerans Disease (Buruli Ulcer) in Ghana

    PubMed Central

    Ackumey, Mercy M.; Gyapong, Margaret; Pappoe, Matilda; Weiss, Mitchell G.

    2011-01-01

    This study examined sociocultural features of help-seeking for Buruli ulceraffected persons with pre-ulcers and ulcers in a disease-endemic area in Ghana. A sample of 181 respondents were purposively selected. Fisher's exact test was used to compare help-seeking variables for pre-ulcers and ulcers. Qualitative phenomenologic analysis of narratives clarified the meaning and content of selected quantitative help-seeking variables. For pre-ulcers, herbal dressings were used to expose necrotic tissues and subsequently applied as dressings for ulcers. Analgesics and left-over antibiotics were used to ease pain and reduce inflammation. Choices for outside-help were influenced by the perceived effectiveness of the treatment, the closeness of the provider to residences, and family and friends. Health education is required to emphasize the risk of self-medication with antibiotics and the importance of medical treatment for pre-ulcers, and to caution against the use of herbs to expose necrotic tissues, which could lead to co-infections. PMID:22144453

  17. Fast and Standardized Skin Grafting of Leg Wounds With a New Technique: Report of 2 Cases and Review of Previous Methods

    PubMed Central

    Hamnerius, Nils; Wallin, Ewa; Svensson, Åke; Stenström, Pernilla

    2016-01-01

    Background: Chronic leg ulcers remain a challenge to the treating physician. Such wounds often need skin grafts to heal. This necessitates a readily available, fast, simple, and standardized procedure for grafting. Objectives: The aim of this work was to test a novel method developed for outpatient transplant procedures. Methods: The procedure employs a handheld disposable dermatome and a roller mincer that cut the skin into standardized micrografts that can be spread out onto a suitable graft bed. Wounds were followed until healed and photographed. Results: The device was successfully used to treat and close a traumatic lower limb wound and a persistent chronic venous leg ulcer. The donor site itself healed by secondary intent with minimal cosmetic impairment. Conclusion: The method was successfully used to graft 2 lower extremity wounds. PMID:27004083

  18. Hot Leg Piping Materials Issues

    SciTech Connect

    V. Munne

    2006-07-19

    With Naval Reactors (NR) approval of the Naval Reactors Prime Contractor Team (NRPCT) recommendation to develop a gas cooled reactor directly coupled to a Brayton power conversion system as the space nuclear power plant (SNPP) for Project Prometheus (References a and b) the reactor outlet piping was recognized to require a design that utilizes internal insulation (Reference c). The initial pipe design suggested ceramic fiber blanket as the insulation material based on requirements associated with service temperature capability within the expected range, very low thermal conductivity, and low density. Nevertheless, it was not considered to be well suited for internal insulation use because its very high surface area and proclivity for holding adsorbed gases, especially water, would make outgassing a source of contaminant gases in the He-Xe working fluid. Additionally, ceramic fiber blanket insulating materials become very friable after relatively short service periods at working temperatures and small pieces of fiber could be dislodged and contaminate the system. Consequently, alternative insulation materials were sought that would have comparable thermal properties and density but superior structural integrity and greatly reduced outgassing. This letter provides technical information regarding insulation and materials issues for the Hot Leg Piping preconceptual design developed for the Project Prometheus space nuclear power plant (SNPP).

  19. Another alternative in leg revascularization.

    PubMed

    Shook, C D; Wiley, R F; Kautz, P D; Harris, R C

    1984-08-01

    Prosthetic grafts of various types have been the only alternative to revascularization of the leg when the saphenous vein is not used. Our complication rate with prosthetic grafts has led us to search for a different alternative. Long-segment endarterectomy of the iliac, femoral, and popliteal arteries has become a realistic procedure with the use of the Hall oscillating endarterectomy instrument. Although it may be difficult technically and more time-consuming than a usual bypass graft procedure, the results have been good. Fifty-eight procedures have been reported in 53 patients. Eighty-eight percent of the procedures were performed for limb salvage with a 5 percent operative mortality rate. There was an overall cumulative limb salvage rate of 88 percent. The cumulative patency rate with a follow-up of 5 to 24 months was 55 percent. Special emphasis has been placed on technical considerations and pitfalls of the procedure. The procedure is versatile and can be used in combination with a variety of both inflow and outflow procedures. PMID:6235753

  20. Current drag in two leg quantum ladders

    NASA Astrophysics Data System (ADS)

    Giamarchi, Thierry

    2016-03-01

    A two-leg ladder of either interacting bosons or tightly bound cooper pairs is investigated when a supercurrent is forced in one of the legs of the ladder. The two legs of the ladder are connected by a tunneling term. Using a bosonization representation of such an interacting ladder we show that up to a certain critical current the current in the first wire induces an identical supercurrent in the second wire. When this threshold is exceeded vortices are formed in the system and the current in the second wire reduces even if the driving current increases. Potential applications to condensed matter or cold atomic systems are discussed.

  1. Hemodynamic studies of the legs under weightlessness

    NASA Technical Reports Server (NTRS)

    Thornton, W. E.; Hoffler, G. W.

    1977-01-01

    Significant among the medical findings following prolonged space flight are reduced orthostatic tolerance and ergometric work capacity. Changes in hemodynamics of the legs with increased blood pooling and reduction in cardiac output must be considered one of the most probable causes of these effects. Concern for the above plus the observed marked tissue changes occurring in the legs during flight prompted the addition of several procedures to evaluate hemodynamic changes in the leg; resting arterial blood flow, venous compliance and muscle pumping were investigated. In so far as possible, the initial reaction to pressure in the smallest possible vein segment was examined.

  2. Biomechanical implications of mild leg length inequality.

    PubMed Central

    McCaw, S T; Bates, B T

    1991-01-01

    The effect of mild leg length inequality (lower extremity length difference less than 3 cm) on posture and gait has been the source of much controversy. Many opinions have been expressed both for and against the need for intervention to reduce the magnitude of the discrepancy. This paper emphasizes the need for accurate and reliable assessment of leg length differences using a clinically functional radiographic technique, and reviews the biomechanical implications of leg length inequality as related to the development of stress fractures, low back pain and osteoarthritis. PMID:1913023

  3. Colonoscopic evaluation in ulcerative colitis

    PubMed Central

    Paine, Elizabeth R.

    2014-01-01

    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

  4. Scleritis and Peripheral Ulcerative Keratitis

    PubMed Central

    Galor, Anat; Thorne, Jennifer E.

    2008-01-01

    Scleritis and peripheral ulcerative keratitis (PUK) can present as isolated conditions or as part of a systemic inflammatory or infectious disorder. Both are serious ocular conditions that can result in vision loss and therefore require early diagnosis and treatment. Nearly two-thirds of patients with non-infectious scleritis require systemic glucocorticoid therapy, and one fourth need a glucocorticoid-sparing agent, as well. Essentially all patients with non-infectious PUK require systemic glucocorticoids. Detailed clinical history, thorough physical examination, and thoughtful laboratory evaluations are all important in the exclusion of underlying disorders and extraocular involvement. PMID:18037120

  5. Skin ulceration due to cement.

    PubMed Central

    Robinson, S M; Tachakra, S S

    1992-01-01

    Despite legislation that requires manufacturers to inform the public about the dangers of contact with cement, severe ulceration from cement contact still occurs. We present a retrospective study of seven patients presenting to this department over a 2-year period. All were male and employed in the building trade, their injuries being sustained whilst at work. The injuries were to the lower limb, often multiple and required a median of seven visits before healing was complete. One required hospital admission and skin grafting. PMID:1449582

  6. Ulcerative colitis flare with splenic ven thrombosis

    PubMed Central

    Bozkurt, Huseyin Sancar; Kara, Banu; Citil, Serdal

    2015-01-01

    Patients with ulcerative colitis (UC) have an increased risk of thromboembolic events. Here, we present a 28-year-old man with active ulcerative pancolitis presenting via splenic vein thrombosis and left renal superior infarct that was not associated with a surgical procedure. PMID:26064409

  7. Vulvar Ulcers and Erosions: A Clinical Approach.

    PubMed

    Bohl, Tanja G

    2015-09-01

    Vulvar ulcers have a plethora of potential causes and variable clinical presentations that can prove to be a challenge to any clinician. The terminology of these causes can further add to the difficulty of diagnosis. A clinical approach to diagnosis and management is presented with classification tables and a discussion of the terminology of aphthosis, a common cause of vulvar ulceration. PMID:26176786

  8. [Relationship between disaster stress and peptic ulcers].

    PubMed

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

    2015-07-01

    There had been several reports about the increasing of peptic ulcers under a large-scale disaster or a war. But in human, it was still unclear that a severe psychological stress itself cause peptic ulcer independently of two major causes (Helicobacter pylori infection and nonsteroidal anti-inflammatory drugs). After Great East Japan earthquake in March 11th, 2011, one of the five most powerful earthquakes in the world since modern record keeping began in 1900, we also noticed remarkable increasing of patients with peptic ulcer in wide stricken area. Reports after this gigantic earthquake gave us two new important viewpoints. Disaster (psychological) stress possibly induce peptic ulcer independently of two major causes. And, people living in refugee shelter immediately after a disaster are strong risk group of peptic ulcer bleeding as well as an intake of anti-thrombotic agents. PMID:26165082

  9. Method of healing diabetic forefoot ulcers.

    PubMed Central

    Pollard, J P; Le Quesne, L P

    1983-01-01

    Six diabetic patients with neuropathic ulceration of the sole of the foot (seven feet, eight ulcers) were treated by the application of a below knee walking plaster with a rubber rocker. All the ulcers healed with this treatment, greatly reducing the usual period of hospital inpatient stay. After healing, study of the forces acting on the sole of the foot showed that these ulcers occur at the site of maximal horizontal shear force and confirmed that they occur at the site of maximal vertical force. This treatment is highly effective for neuropathic ulcers of the sole not affecting bone or complicated by deep sepsis. There may be a high rate of recurrence, however, reflecting inadequacy of methods of protecting damaged neuropathic feet. PMID:6401552

  10. Current and Emerging Biologics for Ulcerative Colitis

    PubMed Central

    Park, Sung Chul; Jeen, Yoon Tae

    2015-01-01

    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

  11. Comorbid Depression and Diabetic Foot Ulcers.

    PubMed

    Maydick, Diane R; Acee, Anna M

    2016-02-01

    In the United States, 9.3% of the population, or 29.1 million people have diabetes, and depression affects 20% to 40% of these individuals. Diabetic foot ulcers are a common and serious complication of diabetes and one of the most costly. It is estimated that 2% to 3% of persons with diabetes will develop diabetic foot ulcers each year. There is an association between depression and the development of diabetic foot ulcers. The estimated costs associated with managing diabetes, depression, and diabetic foot ulcers place a substantial burden on the U.S. healthcare system and society. Patients should be screened and evaluated by professionals qualified in the diagnosis and management of depression and diabetic foot ulcers. To be effective, an interprofessional approach that includes the patient and significant others should be used. PMID:26835804

  12. 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....

  13. Poison ivy on the leg (image)

    MedlinePLUS

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

  14. Passive zero-gravity leg restraint

    NASA Technical Reports Server (NTRS)

    Miller, Christopher R. (inventor)

    1989-01-01

    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.

  15. 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....

  16. Pitfalls in the diagnosis of leg pain.

    PubMed Central

    Provan, J L; Moreau, P; MacNab, I

    1979-01-01

    Problems may confront the practitioner in the diagnosis of leg pain related to exercise. The diagnostic features of the history and the physical examination that will help to elucidate the various causes of leg pain are outlined in this article, and the necessity for re-examination of the patient after a period of exercise is stressed. In most patients the diagnosis can most easily be made by means of clinical methods, without recourse to special investigations. PMID:229951

  17. Painful leg and moving toes syndrome

    PubMed Central

    Pandey, Sanjay

    2015-01-01

    Painful leg and moving toes (PLMT) syndrome is a distinct clinical entity and in majority of the patients there are some underlying causes related to spinal cord, cauda equina, or peripheral neuropathy. However, some cases are cryptogenic with no identifiable underlying cause. Response to treatment is disappointing in most of the cases. We report a 60-year-old lady who presented with very severe type of painful legs and moving toes (PLMT) with no underlying cause. PMID:26713024

  18. Microgravity, Mesh-Crawling Legged Robots

    NASA Technical Reports Server (NTRS)

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

    2008-01-01

    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.

  19. Rotational joint assembly for the prosthetic leg

    NASA Technical Reports Server (NTRS)

    Owens, L. J.; Jones, W. C. (Inventor)

    1977-01-01

    A rotational joint assembly for a prosthetic leg has been devised, which enables an artificial foot to rotate slightly when a person is walking, running or turning. The prosthetic leg includes upper and lower tubular members with the rotational joint assembly interposed between them. The assembly includes a restrainer mechanism which consists of a pivotably mounted paddle element. This device applies limiting force to control the rotation of the foot and also restores torque to return the foot back to its initial position.

  20. The Steroids for Corneal Ulcers Trial

    PubMed Central

    Srinivasan, Muthiah; Mascarenhas, Jeena; Rajaraman, Revathi; Ravindran, Meenakshi; Lalitha, Prajna; Glidden, David V.; Ray, Kathryn J.; Hong, Kevin C.; Oldenburg, Catherine E.; Lee, Salena M.; Zegans, Michael E.; McLeod, Stephen D.; Lietman, Thomas M.; Acharya, Nisha R.

    2013-01-01

    Objectives To provide comprehensive trial methods and baseline data for the Steroids for Corneal Ulcers Trial and to present epidemiological characteristics such as risk factors, causative organisms, and ulcer severity. Methods Baseline data from a 1:1 randomized, placebo-controlled, double-masked clinical trial comparing prednisolone phosphate, 1%, with placebo as adjunctive therapy for the treatment of bacterial corneal ulcers. Eligible patients had a culture-positive bacterial corneal ulcer and had been taking moxifloxacin for 48 hours. The primary outcome for the trial is best spectacle-corrected visual acuity at 3 months from enrollment. This report provides comprehensive baseline data, including best spectacle-corrected visual acuity, infiltrate size, microbio-logical results, and patient demographics, for patients enrolled in the trial. Results Of 500 patients enrolled, 97% were in India. Two hundred twenty patients (44%) were agricultural workers. Median baseline visual acuity was 0.84 logMAR (Snellen, 20/125) (interquartile range, 0.36-1.7; Snellen, 20/50 to counting fingers). Baseline visual acuity was not significantly different between the United States and India. Ulcers in India had larger infiltrate/scar sizes (P=.04) and deeper infiltrates (P=.04) and were more likely to be localized centrally (P=.002) than ulcers enrolled in the United States. Gram-positive bacteria were the most common organisms isolated from the ulcers (n=366, 72%). Conclusions The Steroids for Corneal Ulcers Trial will compare the use of a topical corticosteroid with placebo as adjunctive therapy for bacterial corneal ulcers. Patients enrolled in this trial had diverse ulcer severity and on average significantly reduced visual acuity at presentation. PMID:21987581

  1. Ulcers

    MedlinePLUS

    ... stomach is empty. Eating something or taking an antacid medication sometimes makes the pain go away for ... are taken every day for about 2 weeks. Antacids acid blockers or proton pump inhibitors are given ...

  2. Bilateral leg edema in an older woman.

    PubMed

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

    2015-01-01

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

  3. Passive legged, multi-segmented, robotic vehicle.

    SciTech Connect

    Hayward, David R.

    2003-11-01

    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.

  4. Rabbit gastric ulcer models: comparison and evaluation of acetic acid-induced ulcer and mucosectomy-induced ulcer

    PubMed Central

    Maeng, Jin Hee; Lee, Eunhye

    2013-01-01

    In this study, we examined rabbit gastric ulcer models that can serve as more clinically relevant models. Two types of ulcer model were studied: acetic acid-induced ulcers (AAU) and mucosal resection-induced ulcers (MRU). For AAU, rabbit gastric mucosa was exposed by median laparotomy and treated with bottled acetic acid. MRU was examined as a model for endoscopic mucosal resection (EMR). Normal saline was injected into the submucosal layer and the swollen mucosa was resected with scissors. Endoscopic mucosal resection (EMR) is frequently performed for treatment of early gastric cancers. This procedure inevitably leads to ulcers and bleeding. Bleeding control is the major concern in endoscopic mucosectomy, and some endoscopic hemostatic agents are currently under clinical and preclinical studies. MRU was developed as a model for these induced ulcers and the evaluation of the healing process. The clinical relevancy of those models was compared with that of rat models. Progressive healing was observed for 7 days based on histology. Rabbit models demonstrate round, deep ulcers with clear margins and well-defined healing stages that were difficult to define in rat models. PMID:23825482

  5. Anti-ulcer and ulcer healing potentials of Musa sapientum peel extract in the laboratory rodents

    PubMed Central

    Onasanwo, Samuel Adetunji; Emikpe, Benjamin Obukowho; Ajah, Austin Azubuike; Elufioye, Taiwo Olayemi

    2013-01-01

    Background: This study investigated the anti-ulcer and ulcer healing potentials of the methanol extract of Musa sapientum peel in the laboratory rats. Materials and Methods: Methanol extract of the peels on Musa sapientum (MEMS) was evaluated for its anti-ulcer using alcohol-induced, aspirin-induced, and pyloric ligation-induced models, and for its ulcer healing employing acetic acid-induced ulcer models in rats. Results: The findings from this experiment showed that MEMS (50, 100 and 200 mg/kg, b.w.) anti-ulcer and ulcer healing activity (P ? 0.05) is dose-dependent. Also, MEMS exhibited healing of the ulcer base in all the treated groups when compared with the control group. Conclusion: The outcomes of this experiment revealed that the anti-ulcer effect of MEMS may be due to its anti-secretory and cyto-protective activity. The healing of the ulcer base might not be unconnected with basic fibroblast growth factors responsible for epithelial regeneration. PMID:23900937

  6. Helicobacter pylori and associated duodenal ulcer.

    PubMed Central

    Yeung, C K; Fu, K H; Yuen, K Y; Ng, W F; Tsang, T M; Branicki, F J; Saing, H

    1990-01-01

    Twenty three children with coexistent duodenal ulcer and Helicobacter pylori infection were treated with either two weeks of amoxycillin (25 mg/kg/day) in addition to six weeks of cimetidine, or cimetidine alone. Endoscopy with antral and duodenal biopsies for urease test, microaerophilic culture, and histological studies were performed at entry, six weeks, 12 weeks, and at six months. Children with persistent H pylori infection at six weeks were given a further two weeks' course of amoxycillin. H pylori persisted in all children not receiving amoxycillin treatment but cleared in six of the 13 children (46%) treated with amoxycillin. With failure of H pylori clearance at six months, only two out of six (33%) ulcers had healed and 50% of patients had experienced ulcer recurrence. In contrast, when H pylori remained cleared all ulcers healed and no ulcer recurred. Persistent H pylori infection was associated with persistent gastritis and duodenitis despite endoscopic evidence of ulcer healing. Detection and eradication of H pylori deserves particular attention in the routine management of duodenal ulceration in children. PMID:2248531

  7. Exsanguination due to gastric ulceration in a foal.

    PubMed

    Traub-Dagartz, J; Bayly, W; Riggs, M; Thomas, N; Pankowski, R

    1985-02-01

    An Arabian foal with a congenital heart disease died due to hemorrhage secondary to a large gastric ulcer. Previously, death of foals with gastric ulcers has been due to diffuse peritonitis resulting from gastric ulcer perforation. The foal in this case report died due to hemorrhage secondary to a large gastric ulcer. PMID:3972690

  8. [Surgical treatment of ulcerous colitis].

    PubMed

    Labas, P; Jablonick, S; Michalko, L; Svec, R; Huorka, M

    1995-03-01

    Ulcerative colitis, being a typical medical disease, is encountered by the surgeon only in the stage of toxic megacolon or in case of sever complications during conservative treatment such as perforation, haemorrhage or obstruction. The authors operated six young women where they performed as the only choice total proctocolectomy with formation of an ileal reservoir which was sutured to the rectum stripped of the mucosa. Despite the serious condition at the time of operation, the patients survive the operation, although the percentage of postoperative complications is high, with the exception of one patient who died on the 126th day after operation. The remainder survive in a fair condition with complete and continence. PMID:7761948

  9. Positioning Therapy for Ulcerative Colitis.

    PubMed

    Grinspan, Ari; Kornbluth, Asher

    2015-08-01

    Ulcerative colitis (UC) is a chronic inflammatory condition of the colon, characterized by diffuse mucosal inflammation, bloody diarrhea, and urgency. The mainstay of treatment has been mesalamine agents, steroids, thiopurines, and anti-tumor necrosis factor alpha (TNF-?) antibodies. Over the past several years, new therapies have emerged which have provided clinicians new treatment options as well as new challenges in deciding which treatment is best for their patient at given points in their disease course. These agents include budesonide-Multi-Matrix System (MMX), adalimumab, golimumab, and vedolizumab. In addition, randomized controlled trials have investigated a combination therapy of infliximab and azathioprine and a controlled trial of infliximab versus cyclosporine for intravenous steroid refractory UC. This review will focus on where these agents may be optimally positioned in treatment algorithms for UC. PMID:26143627

  10. Biological therapy for ulcerative colitis.

    PubMed

    Arora, Zubin; Shen, Bo

    2015-05-01

    Ulcerative colitis (UC) is a major form of inflammatory bowel disease (IBD) worldwide. Better understanding of the pathogenesis of UC has led to the development of novel therapeutic agents that target specific mediators of the inflammatory cascade. A number of biological agents have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of UC and several more are currently in various phases of drug development. The commonly used agents include TNF? antagonists (e.g. infliximab, adalimumab, and golimumab) and anti-integrin agents (vedolizumab). These biological agents have profoundly influenced the management of UC patients, especially those with refractory disease. This paper reviews the currently available knowledge and evidence for the use of various biological agents in the treatment of UC. PMID:25344680

  11. Drug therapy for ulcerative colitis

    PubMed Central

    Xu, Chang-Tai; Meng, Shu-Yong; Pan, Bo-Rong

    2004-01-01

    Ulcerative colitis (UC) is an inflammatory destructive disease of the large intestine occurred usually in the rectum and lower part of the colon as well as the entire colon. Drug therapy is not the only choice for UC treatment and medical management should be as a comprehensive whole. Azulfidine, Asacol, Pentasa, Dipentum, and Rowasa all contain 5-aminosalicylic acid (5-ASA), which is the topical anti-inflammatory ingredient. Pentasa is more commonly used in treating Crohn’s ileitis because Pentasa capsules release more 5-ASA into the small intestine than Asacol tablets. Pentasa can also be used for treating mild to moderate UC. Rowasa enemas are safe and effective in treating ulcerative proctitis and proctosigmoiditis. The sulfa-free 5-ASA agents (Asacol, Pentasa, Dipentum and Rowasa) have fewer side effects than sulfa-containing Azulfidine. In UC patients with moderate to severe disease and in patients who failed to respond to 5-ASA compounds, systemic (oral) corticosteroids should be used. Systemic corticosteroids (prednisone, prednisolone, cortisone, etc.) are potent and fast-acting drugs for treating UC, Crohn’s ileitis and ileocolitis. Systemic corticosteroids are not effective in maintaining remission in patients with UC. Serious side effects can result from prolonged corticosteroid treatment. To minimize side effects, corticosteroids should be gradually reduced as soon as the disease remission is achieved. In patients with corticosteroid-dependent or unresponsive to corticosteroid treatment, surgery or immunomodulator is considered. Immunomodulators used for treating severe UC include azathioprine/6-MP, methotrexate, and cyclosporine. Integrated traditional Chinese and Western medicine is safe and effective in maintaining remission in patients with UC. PMID:15285010

  12. [Solitary ulcer syndrome: anatomo-clinical aspects].

    PubMed

    Villanacci, V; Zele, I; D'Errico, A; Azzaroli, P

    1985-07-31

    The clinical, radiological, endoscopic and histological aspects of a case of Isolated Ulcer Syndrome (IUS) of the rectum are examined. For over a decade and on the basis of its clinical, radiological, endoscopic and histological features, this condition was considered Ulcerous Rectocolitis and treated as such. The case presented serves to highlight the possibility of confusing this ulcer with other inflammatory colorectal conditions if only the clinical, radiological and endoscopic pictures are taken into consideration. The importance of histological examination of numerous bioptic samples is emphasised as essential for accurate diagnosis. PMID:4022434

  13. Sirolimus oral ulcer with Cedecea davisae superinfection.

    PubMed

    Mawardi, H; Pavlakis, M; Mandelbrot, D; Woo, S-B

    2010-10-01

    Cedecea davisae is a member of the Enterobacteriaceae family and is an uncommon pathogen. This organism has been isolated from the blood, sputum, and cutaneous ulcers of only a handful of patients, most of these being elderly or otherwise medically compromised. This is a report of a patient, status post renal transplantation, who developed an oral ulcer associated with sirolimus use and superinfected with C. davisae. According to the literature, this is the first case of C. davisae detected in the oral cavity. Antibiotic therapy led to prompt resolution of this very large ulcer. PMID:20525018

  14. [Treatment of ulcer disease by radical duodenoplasty].

    PubMed

    Chernov, V N; Dolgarev, S O

    2013-01-01

    Results of radical duodenoplasty for the treatment of ulcer disease in 645 patients were analyzed. Early postoperative complications were registered in 11-12% of patients, of them 2% were jatrogenic. The majority of complications were connected with anatomical difficulties of the operation. Long-term follow-up results revealed ulcer recurrence in 27% of patients, other complications (anastomotic stenosis, reflux gastritis, adhesive ileus, etc) were registered in 17.2%. Unsatisfactory results can be explained by the lack of differential approach to surgical treatment of patients with duodenal ulcers. PMID:23715394

  15. Small bowel ulcerative lesions are common in elderly NSAIDs users with peptic ulcer bleeding

    PubMed Central

    Tsibouris, Panagiotis; Kalantzis, Chissostomos; Apostolopoulos, Periklis; Zalonis, Antonios; Isaacs, Peter Edward Thomas; Hendrickse, Mark; Alexandrakis, Georgios

    2014-01-01

    AIM: To determine the frequency of small bowel ulcerative lesions in patients with peptic ulcer and define the significance of those lesions. METHODS: In our prospective study, 60 consecutive elderly patients with upper gastrointestinal bleeding from a peptic ulceration (cases) and 60 matched patients with a non-bleeding peptic ulcer (controls) underwent small bowel capsule endoscopy, after a negative colonoscopy (compulsory in our institution). Controls were evaluated for non-bleeding indications. Known or suspected chronic inflammatory conditions and medication that could harm the gut were excluded. During capsule endoscopy, small bowel ulcerative lesions were counted thoroughly and classified according to Graham classification. Other small bowel lesions were also recorded. Peptic ulcer bleeding was controlled endoscopically, when adequate, proton pump inhibitors were started in both cases and controls, and Helicobacter pylori eradicated whenever present. Both cases and controls were followed up for a year. In case of bleeding recurrence upper gastrointestinal endoscopy was repeated and whenever it remained unexplained it was followed by repeat colonoscopy and capsule endoscopy. RESULTS: Forty (67%) cases and 18 (30%) controls presented small bowel erosions (P = 0.0001), while 22 (37%) cases and 4 (8%) controls presented small bowel ulcers (P < 0.0001). Among non-steroidal anti-inflammatory drug (NSAID) consumers, 39 (95%) cases and 17 (33%) controls presented small bowel erosions (P < 0.0001), while 22 (55%) cases and 4 (10%) controls presented small bowel ulcers (P < 0.0001). Small bowel ulcerative lesions were infrequent among patients not consuming NSAIDs. Mean entry hemoglobin was 9.3 (SD = 1.4) g/dL in cases with small bowel ulcerative lesions and 10.5 (SD = 1.3) g/dL in those without (P = 0.002). Cases with small bowel ulcers necessitate more units of packed red blood cells. During their hospitalization, 6 (27%) cases with small bowel ulcers presented bleeding recurrence most possibly attributed to small bowel ulcers, nevertheless 30-d mortality was zero. Presence of chronic obstructive lung disease and diabetes was related with unexplained recurrence of hemorrhage in logistic regression analysis, while absence of small bowel ulcers was protective (relative risk 0.13, P = 0.05). CONCLUSION: Among NSAID consumers, more bleeders than non-bleeders with peptic ulcers present small bowel ulcers; lesions related to more severe bleeding and unexplained episodes of bleeding recurrence. PMID:25512771

  16. Squamous cell carcinoma in trophic ulcer cases.

    PubMed

    Arora, S K; Mukhija, R D

    1987-01-01

    Two cases having trophic ulcer over the heel, for long time, later developed squamous cell carcinoma are reported, because of its paucity in literature. Various factors blamed for carcinomatous change are enumerated. PMID:3611854

  17. Peripheral Ulcerative Keratitis with Pyoderma Gangrenosum

    PubMed Central

    Imbernn-Moya, Adrin; Vargas-Laguna, Elena; Aguilar, Antonio; Gallego, Miguel ngel; Vergara, Claudia; Nistal, Mara Fernanda

    2015-01-01

    Pyoderma gangrenosum is an unusual necrotizing noninfective and ulcerative skin disease whose cause is unknown. Ophthalmic involvement in pyoderma gangrenosum is an unusual event. Only a few cases have been reported, from which we can highlight scleral, corneal, and orbital cases. Peripheral ulcerative keratitis is a process which destroys the peripheral cornea. Its cause is still unknown although it is often associated with autoimmune conditions. Pyoderma gangrenosum should be included in the differential diagnosis of peripheral ulcerative keratitis. Early recognition of these manifestations can vary the prognosis by applying the appropriate treatment. We introduce a 70-year-old woman who suffered pyoderma gangrenosum associated with peripheral ulcerative keratitis in her left eye. The patient's skin lesions and peripheral keratitis responded successfully to systemic steroids and cyclosporine A. PMID:26527531

  18. [Nutritional management of healing pressure ulcers].

    PubMed

    di Valentin, Emmanuelle

    2013-01-01

    Wounds or pressure ulcers resulting from hospitalisation are a permanent feature of health care institutions. Treatment comprises several elements including nutritional care. This article offers an overview of a basic notion. PMID:23785863

  19. Tannins, Peptic Ulcers and Related Mechanisms

    PubMed Central

    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

    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

  20. [Peptic ulcer: facts and questions -- 2010].

    PubMed

    Hagymási, Krisztina; Tulassay, Zsolt

    2010-06-27

    Etiology and clinical manifestation of the peptic ulcer keep changes nowadays. Helicobacter pylori-infection, nonsteroidal anti-inflammatory drugs and small dosage acetic acid treatment are the main etiological factors. Helicobacter pylori positive peptic ulcer can be treated with eradication of the bacterium. Prevention of the NSAID-ulcer and the prescription of the acid suppressive therapy depend on the gastrointestinal and cardiovascular risk factors of patient. Despite of the effective therapies, there are still questions to answer. The number of Helicobacter pylori and NSAID negative ulcers is likely to increase, their therapy must be clarified. There's a fall in the eradication rate of Helicobacter pylori infection, the optimal treatment is missing. PMID:20558352

  1. Restoring Psychology's Role in Peptic Ulcer

    PubMed Central

    Overmier, J Bruce; Murison, Robert

    2013-01-01

    This paper reviews the history of the transition from the belief that gastrointestinal ulcers are caused primarily by psychological factors to the current state of belief that they are caused primarily by infection and argues that neither is fully accurate. We argue that psychological factors play a significant role as predisposing to vulnerability, modulating of precipitation, and sustaining of gastric ulceration. We review data that challenge the assumption of a simple infectious disease model and adduce recent preclinical data that confirm the predisposing, modulatory, and sustaining roles for psychological factors. We note that others, too, are now challenging the adequacy of the contemporary simple bacterial infection model. We hope to replace the competition between psychology and medicine with cooperation in understanding and treating patients suffering gastric ulceration and ulcer. PMID:23457084

  2. Sunitinib induced pyoderma gangrenosum-like ulcerations

    PubMed Central

    2011-01-01

    Pyoderma gangrenosum is a non-infectious neutrophilic skin disease commonly associated with underlying systemic diseases. Histopathological and laboratory diagnostics are unspecific in the majority of the cases and the diagnosis is made in accordance with the clinical picture. Here, we report the case of a 69-year old man with progredient pyoderma gangrenosum-like ulcerations under treatment with sunitinib due to hepatocellular carcinoma. A conventional ulcer therapy did not lead to a regression of the lesions. Solely cessation of sunitinib therapy resulted in an improvement of the ulcerations. Sunitinib is a multikinase inhibitor that targets the PDGF-? - and -?-, VEGF-1-3-, KIT-, FLT3-, CSF-1- and RET-receptor, thereby impairing tumour proliferation, pathological angiogenesis and metastasation. Here, we demonstrate that pyoderma gangrenosum-like ulcers may represent a serious side effect of sunitinib-based anti-cancer treatment. PMID:22027642

  3. The effect of leg length on jumping performance of short- and long-legged leafhopper insects.

    PubMed

    Burrows, M; Sutton, G P

    2008-04-01

    To assess the effect of leg length on jumping ability in small insects, the jumping movements and performance of a sub-family of leafhopper insects (Hemiptera, Auchenorrhyncha, Cicadellidae, Ulopinae) with short hind legs were analysed and compared with other long-legged cicadellids (Hemiptera, Auchenorrhyncha, Cicadellidae). Two species with the same jumping characteristics but distinctively different body shapes were analysed: Ulopa, which had an average body length of 3 mm and was squat, and Cephalelus, which had an average body length of 13 mm with an elongated body and head. In both, the hind legs were only 1.4 times longer than the front legs compared with 1.9-2.3 times in other cicadellid leafhoppers. When the length of the hind legs was normalised relative to the cube root of their body mass, their hind legs had a value of 1-1.1 compared with 1.6-2.3 in other cicadellids. The hind legs of Cephalelus were only 20% of the body length. The propulsion for a jump was delivered by rapid and synchronous rotation of the hind legs about their coxo-trochanteral joints in a three-phase movement, as revealed by high-speed sequences of images captured at rates of 5000 s(-1). The hind tarsi were initially placed outside the lateral margins of the body and not apposed to each other beneath the body as in long-legged leafhoppers. The hind legs were accelerated in 1.5 ms (Ulopa) and 2 ms (Cephalelus) and thus more quickly than in the long-legged cicadellids. In their best jumps these movements propelled Ulopa to a take-off velocity of 2.3 m s(-1) and Cephalelus to 2 m s(-1), which matches that of the long-legged cicadellids. Both short-legged species had the same mean take-off angle of 56 degrees but Cephalelus adopted a lower angle of the body relative to the ground (mean 15 degrees) than Ulopa (mean 56 degrees). Once airborne, Cephalelus pitched slowly and rolled quickly about its long axis and Ulopa rotated quickly about both axes. To achieve their best performances Ulopa expended 7 microJ of energy, generated a power output of 7 mW, and exerted a force of 6 mN; Cephalelus expended 23 microJ of energy, generated a power output of 12 mW and exerted a force of 11 mN. There was no correlation between leg length and take-off velocity in the long- and short-legged species, but longer legged leafhoppers had longer take-off times and generated lower ground reaction forces than short-legged leafhoppers, possibly allowing the longer legged leafhoppers to jump from less stiff substrates. PMID:18375856

  4. Probabilistic Mechanical Reliability Prediction of Thermoelectric Legs

    SciTech Connect

    Jadaan, Osama M.; Wereszczak, Andrew A

    2009-05-01

    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.

  5. Solitary Ulcerated Congenital Giant Juvenile Xanthogranuloma

    PubMed Central

    Ng, Su Yuen

    2015-01-01

    A 3-month-old female patient with a giant ulcerated nodule over the back since birth was diagnosed as congenital giant juvenile xanthogranuloma (JXG) based on clinical and histopathological examination. Congenital giant JXG with ulceration at birth is a rare presentation of JXG and commonly misdiagnosed. This case emphasizes the importance of being aware of the myriad presentations of JXG in order to make a correct diagnosis and avoid unnecessary investigations or treatment. PMID:26288431

  6. Solitary Ulcerated Congenital Giant Juvenile Xanthogranuloma.

    PubMed

    Ng, Su Yuen

    2015-01-01

    A 3-month-old female patient with a giant ulcerated nodule over the back since birth was diagnosed as congenital giant juvenile xanthogranuloma (JXG) based on clinical and histopathological examination. Congenital giant JXG with ulceration at birth is a rare presentation of JXG and commonly misdiagnosed. This case emphasizes the importance of being aware of the myriad presentations of JXG in order to make a correct diagnosis and avoid unnecessary investigations or treatment. PMID:26288431

  7. Foot and leg conformation traits have a small effect on genomic predictions of claw disorders in Norwegian Red cows.

    PubMed

    degrd, C; Svendsen, M; Heringstad, B

    2015-06-01

    The aim of this study was to evaluate whether the predictive correlation of genomic breeding values (GEBV) for claw disorders increased by including genetically correlated traits as additional information in the analyses. Predictive correlations of GEBV for claw disorders were calculated based on claw disorders only and by analyzing claw disorders together with genetically correlated foot and leg conformation traits. The claw disorders analyzed were corkscrew claw (CSC); infectious claw disorder, including dermatitis, heel horn erosion, and interdigital phlegmon; and laminitis-related claw disorder, including sole ulcer, white line disorder, and hemorrhage of sole and white line. The foot and leg conformation traits included were hoof quality, foot angle, rear leg rear view new, and rear leg rear view old. The data consisted of 183,728 daughters with claw health records and 421,319 daughters with foot and leg conformation scores. A 25K/54K single nucleotide polymorphism (SNP) data set containing 48,249 SNP was available for the analyses. The number of genotyped sires with daughter information in the analyses was 1,093 including claw disorders and 3,111 including claw disorders and foot and leg conformation traits. Predictive correlations of GEBV for CSC, infectious claw disorder, and laminitis-related claw disorder were calculated from a 10-fold cross-validation and from an additional validation set including the youngest sires. Only sires having daughters with claw health records were in the validation sets, thus increasing the reference population when adding foot and leg conformation traits. The results showed marginal improvement in the predictive correlation of GEBV for CSC when including hoof quality and foot angle, both in 10-fold cross-validation (from 0.35 to 0.37) and in the validation including the youngest sires (from 0.38 to 0.49). For infectious claw disorder and laminitis-related claw disorder, including foot and leg conformation traits had no effect on the predictive correlation of GEBV. Claw disorders are novel traits with a limited amount of historical data and, therefore, a small reference population. Increasing the reference population by including sires with daughter information on foot and leg conformation traits had small effect on the predictive correlation of GEBV. However, the small increase in predictive correlation of GEBV for CSC shows a possible gain when including moderate to high genetically correlated traits. PMID:25828662

  8. Sympathetic adaptations to one-legged training

    NASA Technical Reports Server (NTRS)

    Ray, C. A.

    1999-01-01

    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.

  9. [Prognostic criteria for ulcer closure (author's transl)].

    PubMed

    Schumpelick, V; Massarwa, O; Schreiber, H W

    1982-01-01

    A retrospective study was made based on 243 patients with simple closure of a perforated peptic ulcer in order to analyse factors influencing the results. Complications and mortality showed a good correlation with age, time between onset of symptoms and operation and size of the perforation, but no correlation with ulcer localization and history. Between 1 and 15 years after the operation, 39,4% of the patients were asymptomatic, 34,8% under conservative treatment, whilst 25,8% had to be reoperated on in the meantime. There was no correlation between recurrence and the age of the patients, the time between onset of symptoms and operation, the duration of stay in hospital, inability to work, alcohol and nicotine abuse. Ulcer history was the only factor influencing the late result significantly. Only 11% of patients with a short ulcer history (no longer than 6 months) had to be reoperated on whereas in those with a long ulcer history a recurrence rate of 70% can be expected. The importance of ulcer history for the choice of surgical treatment is emphasized. PMID:7109796

  10. The Molecular Genetics of Restless Legs Syndrome.

    PubMed

    Rye, David B

    2015-09-01

    Restless legs syndrome (RLS) is a common sensorimotor trait defined by symptoms that interfere with sleep onset and maintenance in a clinically meaningful way. Nonvolitional myoclonus while awake and asleep is a sign of the disorder and an informative endophenotype. The genetic contributions to RLS/periodic leg movements are substantial, are among the most robust defined to date for a common disease, and account for much of the variance in disease expressivity. The disorder is polygenic, as revealed by recent genome-wide association studies. Experimental studies are revealing mechanistic details of how these common variants might influence RLS expressivity. PMID:26329432

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

    PubMed Central

    Graham, David Y

    2014-01-01

    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

  12. Respiratory-Related Leg Movements and Their Relationship with Periodic Leg Movements During Sleep

    PubMed Central

    Manconi, Mauro; Zavalko, Irina; Bassetti, Claudio L.; Colamartino, Elisabetta; Pons, Marco; Ferri, Raffaele

    2014-01-01

    Study Objectives: To describe the time structure of leg movements (LM) in obstructive sleep apnea (OSA) syndrome, in order to advance understanding of their clinical significance. Location: Sleep Research Centre, Oasi Institute (IRCCS), Troina, Italy. Setting: Sleep laboratory. Patients: Eighty-four patients (16 females, 68 males, mean age 55.1 y, range 29-74 y). Methods: Respiratory-related leg movements (RRLM) and those unrelated to respiratory events (NRLM) were examined within diagnostic polysomnograms alone and together for their distributions within the sleep period and for their periodicity. Measurements and Results: Patients with OSA and RRLM exhibited more periodic leg movements in sleep (PLMS), particularly in NREM sleep. A gradual decrease in number of NRLM across the sleep period was observed in patients with RRLM. This pattern was less clear for RRLM. Frequency histograms of intermovement intervals of all LMs in patients with RRLM showed a prominent first peak at 4 sec, and a second peak at approximately 24 sec coincident with that of PLMS occurring in the absence of OSA. A third peak of lowest amplitude was the broadest with a maximum at approximately 42 sec. In patients lacking RRLM, NRLM were evident with a single peak at 2-4 sec. A stepwise linear regression analysis showed that, after controlling for a diagnosis of restless legs syndrome and apnea-hypopnea index, PLMS remained significantly associated with RRLM. Conclusion: The time structure of leg movements occurring in conjunction with respiratory events exhibit features of periodic leg movements in sleep occurring alone, only with a different and longer period. This brings into question the validity, both biologic and clinical, of scoring conventions with their a priori exclusion from consideration as periodic leg movements in sleep. Citation: Manconi M; Zavalko I; Bassetti CL; Colamartino E; Pons M; Ferri R. Respiratory-related leg movements and their relationship with periodic leg movements during sleep. SLEEP 2014;37(3):497-504. PMID:24587572

  13. [Influence of the movable support under one leg on human vertical posture during standing with asymmetric load on legs].

    PubMed

    Kazennikov, O V; Kireeva, T B; Shlykov, V Iu

    2014-01-01

    The posture in standing subjects was studied when the legs were placed on supports of different degrees of mobility, as well as, when a part of body weight was voluntary transferred to one leg. The aim of these experiments was to explore how the mobility of support under the feet affects the balance and how this influence could be changed by the load distribution between the legs during standing. When both legs were on rigid immovable supports, the posture maintaining was accomplished by control of center of pressure (CP) of both legs. When the subject transferred the weight on one foot the posture was maintained mainly due to the control of CP of loaded leg. When the legs were on the supports of different mobility, the balance was maintained by the control of CP of the leg on the immovable support. This result was observed both when the subject stood with symmetric load on the legs and when the load was transferred to one leg. Even when the leg was unloaded but was placed on immovable support its CP moved more in comparison with the CP of loaded leg on movable support. The results show that the support mobility under the legs is a factor that determines the mechanisms of the posture maintenance, and this factor is more significant than the load distribution between the legs. So, we can conclude that the upright posture is maintained accounting the physical properties of the supports under the feet. PMID:25702460

  14. A biological screw in a beetle's leg.

    PubMed

    van de Kamp, Thomas; Vagovi?, Patrik; Baumbach, Tilo; Riedel, Alexander

    2011-07-01

    The coxa-trochanteral joints on the legs of the weevil Trigonopterus oblongus (Pascoe) work as a biological screw-and-nut system. The apical portions of the coxae closely resemble nuts with well-defined inner threads covering 345. The corresponding trochanters have perfectly compatible external spiral threads of 410. PMID:21719669

  15. Options for Treating Restless Legs Syndrome

    MedlinePLUS

    ... pump to squeeze your legs during the night Near-infrared light therapy: treatments with a device that uses near-infrared ... Pneumatic compression devices work to lessen RLS symptoms. Near-infrared light therapy may help lessen RLS symptoms, but more research ...

  16. Integrated system for single leg walking

    NASA Astrophysics Data System (ADS)

    Simmons, Reid; Krotkov, Eric; Roston, Gerry

    1990-07-01

    The Carnegie Mellon University Planetary Rover project is developing a six-legged walking robot capable of autonomously navigating, exploring, and acquiring samples in rugged, unknown environments. This report describes an integrated software system capable of navigating a single leg of the robot over rugged terrain. The leg, based on an early design of the Ambler Planetary Rover, is suspended below a carriage that slides along rails. To walk, the system creates an elevation map of the terrain from laser scanner images, plans an appropriate foothold based on terrain and geometric constraints, weaves the leg through the terrain to position it above the foothold, contacts the terrain with the foot, and applies force enough to advance the carriage along the rails. Walking both forward and backward, the system has traversed hundreds of meters of rugged terrain including obstacles too tall to step over, trenches too deep to step in, closely spaced obstacles, and sand hills. The implemented system consists of a number of task-specific processes (two for planning, two for perception, one for real-time control) and a central control process that directs the flow of communication between processes.

  17. [Secondary leg edema--experimental study].

    PubMed

    Gregl, A

    1988-12-01

    Peripheral lymphedema can be induced experimentally by obliteration or destruction of the veins and/or lymphatics, extirpation of the lymph nodes and occlusion of lymphatics, circular incision of the soft tissues, experimentally induced thrombophlebitis and by simultaneous traumatization of the veins and lymphatics. Our own animal experiments were designed to provoke leg edema after ligation of the femoral vein and/or accompanying lymphatics below the inguinal ligament. In 23 animals, only one ligature of the femoral vein was applied, below the inguinal ligament and in 12 animals all accompanying lymphatics were ligated in addition. In all animals, the leg circumferences were measured in three precisely fixed positions before the experiments and daily for 22 days during the experiment. The greatest increase in circumference was found in the lower leg irrespective of the time of measurement. The peak increase of circumference was between the third and sixth day after the operation. Permanent lymph edema has not developed in any of the animals. At the latest after three weeks, the leg circumference has normalized. Additional ligation of the lymphatics merely led to a nonsignificant increase in circumference and to displacement of the maximum point by two to three days. Immediately after the operation, phlebographic and lymphographic control investigations were carried out in all animals. PMID:3245261

  18. Leg asymmetries and coordination dynamics in walking.

    PubMed

    Russell, Daniel M; Kalbach, Clint R; Massimini, Christopher M; Martinez-Garza, Cesar

    2010-01-01

    Models of interlimb coordination (H. Haken, J. A. S. Kelso, & H. Bunz, 1985; P. N. Kugler & M. T. Turvey, 1987) were tested in walking by examining the role of asymmetries between limbs. Participants walked on a treadmill with and without a metronome. Five asymmetry conditions were created via ankle loads of 0, 3, or 6 kg on either leg. With the metronome, participants matched the target period. Without the metronome, stride rate slowed as the mass was increased on either leg. The loads led to an increase in stride period that was predicted by Huygens' law and the hybrid pendulum-spring model. In agreement with extended Haken-Kelso-Bunz model predictions, leg asymmetries led to deviations from antiphase coordination. Also, perception-action coordination was influenced by the asymmetry between the legs and metronome. In contrast, no predicted stability effects were observed. These findings reveal that some properties of interlimb coordination, apparent in laboratory-based tasks, can also be observed in human walking. PMID:20363714

  19. [Bile and stress ulcer in the rat (author's transl)].

    PubMed

    Schumpelick, V

    1975-09-10

    The influence of bile on the ulcer formation under "restraint stress" condition was studied in rats with direct choledocho-gastrostomia resp. bile duct ligation. After 9 hrs. of immobilisation in plaster cuffs the animals with unrestricted bile flow via the choledochosstress gastrostomia showed as many ulcers as the sham-operated controls. There was no difference in the ulcer localisation, the region of the bile duct anastomosis was without any ulcer. After bile duct ligation the ulcer frequency was reduced to the half. These results are explained by a massive bile reflux under stress condition, of which the pathogenetic role in stress ulcer formation is discussed. PMID:1214546

  20. Athletic Footwear, Leg Stiffness, and Running Kinematics

    PubMed Central

    Bishop, Mark; Fiolkowski, Paul; Conrad, Bryan; Brunt, Denis; Horodyski, MaryBeth

    2006-01-01

    Context: The leg acts as a linear spring during running and hopping and adapts to the stiffness of the surface, maintaining constant total stiffness of the leg-surface system. Introducing a substance (eg, footwear) may affect the stiffness of the leg in response to changes in surface stiffness. Objective: To determine if the type of athletic footwear affects the regulation of leg stiffness in dynamic activities. Design: Repeated-measures design. Setting: Motion analysis laboratory. Patients or Other Participants: Nine healthy adults (age = 28 6.8 years, mass = 71.6 12.9 kg) free from lower extremity injuries. Intervention(s): Subjects hopped at 2.2 Hz on a forceplate under 3 footwear conditions (barefoot, low-cost footwear, high-cost footwear). Subjects ran on a treadmill at 2 speeds (2.23 m/s, 3.58 m/s) under the same footwear conditions. Main Outcome Measure(s): Limb stiffness was calculated from forceplate data. Kinematic data (knee and ankle angles at initial contact and peak joint excursion after contact) were collected during running. We calculated 1-way repeated-measures (stiffness) and 2-way (speed by footwear) repeated-measures analyses of variance (running kinematics) to test the dependent variables. Results: A significant increase in leg stiffness from the barefoot to the cushioned shoe condition was noted during hopping. When running shod, runners landed in more dorsiflexion but had less ankle motion than when running barefoot. No differences were seen between the types of shoes. The primary kinematic difference was identified as running speed increased: runners landed in more knee flexion. At the ankle, barefoot runners increased ankle motion to a significantly greater extent than did shod runners as speed increased. Conclusions: Footwear influences the maintenance of stiffness in the lower extremity during hopping and joint excursion at the ankle in running. Differences in cushioning properties of the shoes tested did not appear to be significant. PMID:17273463

  1. 11. NORTH VIEW OF INNER FACING OF SOUTHEASTERN LEG OF ...

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

    11. NORTH VIEW OF INNER FACING OF SOUTHEASTERN LEG OF SEA WALL. SOUTHERN END OF NORTHEASTERN LEG OF SEA WALL IN BACKGROUND. - Fort Delaware, Sea Wall, Pea Patch Island, Delaware City, New Castle County, DE

  2. A colored leg banding technique for Amazona parrots

    USGS Publications Warehouse

    Meyers, J.M.

    1995-01-01

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

  3. Acute leg volume changes in weightlessness and its simulation

    NASA Technical Reports Server (NTRS)

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

    1992-01-01

    Leg volume changes were studied in six subjects during 150 min of horizontal, 6 deg headdown tilt and supine immersion. Results were compared to previously obtained space flight data. It is found that, at equivalent study times, the magnitude of the leg volume changes during the simulations was less than one half that seen during space flight. Relative and absolute losses from the upper leg were greater during space flight, while relative losses were greater from the lower leg during simulations.

  4. Painless legs and moving toes: a syndrome related to painful legs and moving toes?

    PubMed

    Walters, A S; Hening, W A; Shah, S K; Chokroverty, S

    1993-07-01

    The syndrome of painful legs and moving toes consists of continuous or semicontinuous involuntary writhing movements of the toes associated with pain in the affected extremity. We report a 57-year-old man with a 33-year history of painless and semicontinuous involuntary movements of the toes of the left foot similar to those seen in painful legs and moving toes. There was no family history of movement disorder. The history and physical examination were negative for significant trauma, radiculopathy, or peripheral neuropathy. There were no other neurological findings or involuntary movements. It is unlikely that the involuntary movements were precipitated by neuroleptics or psychosis. CT scan of the head; EEG, CT, and MRI scans of the lumbosacral spine; and EMG and nerve conduction studies of the legs showed no significant abnormalities except for a predominant cocontraction of the left foot flexors and extensors at 0.6-1.2 Hz in a pattern sometimes seen in painful legs and moving toes. We conclude that there is a condition clinically and electrophysiologically similar to painful legs and moving toes that we call painless legs and moving toes, the etiology of which remains undetermined. PMID:8341307

  5. Differential diagnosis of ulcerative lesions in fish.

    PubMed Central

    Law, M

    2001-01-01

    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

  6. Vagotomy and double pyloroplasty for peptic ulcer.

    PubMed Central

    Hines, J R; Geurkink, R E; Kornmesser, T A; Wikholm, L; Davis, R P

    1975-01-01

    Seventy patients with peptic ulcers (55 duodenal and 15 gastric) were treated by truncal vagotomy and doulbe pyloroplasty during the past four years. Clinical and experimental data as presented lead us to believe that transecting the pylorus twice produces an incontinent pyloric sphincter and a larger gastric outlet than is found in other methods of pyloroplasty. This decreases gastric stasis and has led to a lower ulcer recurrence rate (1.5%). In addition the untoward postoperative sequelae are minimal. The 70 patients treated (for the most pare consecutive cases) exhibited the usual complications of peptic ulcer disease. Thirty-three had intractable pain, 23 bleeding (15 massive), 13 obstruction, and one acute perforation. There were no operative or postoperative deaths and the only serious postoperative complication was unrelated to the double pyloroplasty. During the followup period four patients have died of unrelated diseases. Of the remaining 66 patients one developed a probable recurrent peptic ulcer which has responded to medical management. Four patients have intermittent dumping, three have mild diarrhea and one has failed to gain weight, Constipation and weight gain are more common complaints. It would appear that vagotomy with double pyloroplasty is a safe and effective operation for peptic ulcers and that further clinical trials are warranted. PMID:1119866

  7. Reducing avoidable pressure ulcers in the community.

    PubMed

    Parnham, Alison; Pankhurst, Sarah; Dabell, Wendy

    2015-02-27

    The elimination of avoidable pressure ulcers remains a challenge in healthcare provision, represents an increasing financial burden on resources and continues to affect patients' quality of life. Many pressure ulcers are deemed to be avoidable and there are several factors that can influence this, including the development of a care delivery system and a service delivery strategy that incorporate a comprehensive structure, a meticulous process and measurable outcomes. Nottingham CityCare developed a strategy to reduce avoidable pressure ulcers. The implementation of the strategy in an inner city community setting is discussed. The importance of eliminating pressure ulcers is explored, and the barriers to care delivery are reviewed, demonstrating how a new culture in clinical practice can ensure the elimination of avoidable pressure ulcers. The challenges within the implementation process are reflected on and the implementation of the SSKIN (Surface, Skin inspection, Keep your patient moving, Incontinence and moisture, Nutrition and hydration) phenomenon is reviewed in relation to care delivery, record-keeping and evaluation. PMID:25711596

  8. Salivary enzymes in peptic ulcer disease

    PubMed Central

    Motamedi, Mojdeh; Mansour-Ghanaei, Fariborz; Sariri, Reyhaneh; Vesal, Mahmoud

    2013-01-01

    Aim Peptic ulcer, the common disease of the upper gastro-intestinal tract, occurs in about 5–10% of the world's population. Therefore, diagnosis of trace disease progression with a noninvasive method is of prime importance in the field of healthcare research. The aim of this study was to evaluate the validity of salivary enzymes as noninvasive biomarkers for peptic ulcer. Materials and methods In practice, 34 peptic ulcer patients and 30 healthy subjects donated their un-stimulated saliva samples after 8 h of fasting. The activity of some selected enzymes was measured using appropriate enzymatic assay methods. Results The results indicated an overall alternation in enzymatic activity of saliva in patients suffering from peptic ulcer. Biological activity of a-amylase, peroxidase and lactate dehydrogenase, showed significantly higher values in almost all patients as compared to control subjects. Conclusions Based on the results of salivary enzyme activity, it was concluded that besides the influence of their peptic ulcer on enzyme activity of saliva, the considerably higher activity of a-amylase could also be related to the major role of the enzyme on physiological oxidative stress. PMID:25737890

  9. Spider diffraction: a comparison of curved and straight legs

    SciTech Connect

    Richter, J.L.

    1984-06-15

    It has been known for some time that, if curved legs rather than the usual straight ones are used in the spider that supports the secondary optics in certain telescopes, the visible diffraction effect is reduced. Fraunhofer theory is used to calculate the diffraction effects due to the curved leg spider. Calculated and photographic diffraction patterns are compared for straight and curved leg spiders.

  10. Thyroid Storm Precipitated by Duodenal Ulcer Perforation

    PubMed Central

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

    2015-01-01

    Thyroid storm is a rare and life-threatening complication of thyrotoxicosis that requires prompt treatment. Thyroid storm is also known to be associated with precipitating events. The simultaneous treatment of thyroid storm and its precipitant, when they are recognized, in a patient is recommended; otherwise such disorders, including thyroid storm, can exacerbate each other. Here we report the case of a thyroid storm patient (a 55-year-old Japanese male) complicated with a perforated duodenal ulcer. The patient was successfully treated with intensive treatment for thyroid storm and a prompt operation. Although it is believed that peptic ulcer rarely coexists with hyperthyroidism, among patients with thyroid storm, perforation of a peptic ulcer has been reported as one of the causes of fatal outcome. We determined that surgical intervention was required in this patient, reported despite ongoing severe thyrotoxicosis, and reported herein a successful outcome. PMID:25838951

  11. Current medical management of duodenal ulcer disease.

    PubMed Central

    Badley, B. W.

    1977-01-01

    Each of three agents used in the treatment of duodenal ulcer--magnesium--aluminum antacids in high doses, cimetidine and carbenoxolone sodium--appears to enhance the rate at which ulcers heal, although their ability to control symptoms has been less clearly demonstrated. Since a large proportion of ulcers heal either without treatment or when the patient is given a placebo, a rational management plan should emphasize the removal of known irritants and the provision of symptomatic relief while spontaneous healing is allowed to occur. Lack of response to such a regimen warrants more specific investigation and therapy. On the basis of current evidence, cimetidine appears to be the preferred therapeutic agent. PMID:603851

  12. Extracorporeal shockwave therapy in diabetic foot ulcers.

    PubMed

    Wang, Ching-Jen; Cheng, Jai-Hong; Kuo, Yur-Ren; Schaden, Wolfgang; Mittermayr, Rainer

    2015-12-01

    Diabetic foot ulcers (DFUs) are among the most common foot disorders with ulceration, infection, and gangrene that may ultimately lead to lower extremity amputation. The goals of treatment include the control of diabetes and proper shoe wear. An effective therapy and appropriate foot care are important in wound healing in DFUs. Recently, extracorporeal shockwave therapy (ESWT) was reported to significantly promote and accelerate the healing of complex soft tissue wounds as compared to the standard methods of treatment in DFUs. ESWT showed positive results in short-term and long-term outcomes in diabetic patients suffering from foot ulcers. In this article, we review the clinical results of ESWT in DFUs. PMID:26079500

  13. Advances in endoscopic imaging in ulcerative colitis.

    PubMed

    Tontini, Gian Eugenio; Pastorelli, Luca; Ishaq, Sauid; Neumann, Helmut

    2015-01-01

    Modern strategies for the treatment of ulcerative colitis require more accurate tools for gastrointestinal imaging to better assess mucosal disease activity and long-term prognostic clinical outcomes. Recent advances in gastrointestinal luminal endoscopy are radically changing the role of endoscopy in every-day clinical practice and research trials. Advanced endoscopic imaging techniques including high-definition endoscopes, optical magnification endoscopy, and various chromoendoscopy techniques have remarkably improved endoscopic assessment of ulcerative colitis. More recently, optical biopsy techniques with either endocytoscopy or confocal laser endomicroscopy have shown great potential in predicting several histological changes in real time during ongoing endoscopy. Here, we review current applications of advanced endoscopic imaging techniques in ulcerative colitis and present the most promising upcoming headways in this field. PMID:26365308

  14. What I Need to Know about Peptic Ulcer Disease

    MedlinePLUS

    ... induced peptic ulcer. However, many people with an H. pylori infection never develop a peptic ulcer. Doctors think H. ... Lab Tests To see if you have an H. pylori infection, your doctor will order these tests: ● ● Blood test. ...

  15. A new pressure ulcer conceptual framework

    PubMed Central

    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

    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 20102011) 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

  16. Treatment strategies for recurrent oral aphthous ulcers.

    PubMed

    Barrons, R W

    2001-01-01

    The clinical features, etiology, and treatment of recurrent aphthous ulcers (RAU) are discussed. Aphthous ulcers are among the most common oral lesions in the general population, with a frequency of up to 25% and three-month recurrence rates as high as 50%. The ulcers, which usually occur on the nonkeratinized oral mucosa, can cause considerable pain and may interfere with eating, speaking, and swallowing. RAU is classified as minor, major, and herpetiform on the basis of ulcer size and number. The cause of RAU is idiopathic in most patients. The most likely precipitating factors are local trauma and stress. Other associated factors include systemic diseases and nutritional deficiencies, food allergies, genetic predisposition, immune disorders, the use of certain medications, and HIV infection. The primary goals of therapy for RAU are relief of pain, reduction of ulcer duration, and restoration of normal oral function. Secondary goals include reduction in the frequency and severity of recurrences and maintenance of remission. Topical medications, such as antimicrobial mouthwashes and topical corticosteroids, can achieve the primary goals but have not been shown to alter recurrence or remission rates. Systemic medications can be tried if topical therapy is ineffective. Levamisole has shown variable efficacy in reducing ulcer frequency and duration in patients with minor RAU. Oral corticosteroids should be reserved for severe cases of major RAU that do not respond to topical agents. Thalidomide is effective but, because of its toxicity and cost, should be used only as an alternative to oral corticosteroids. RAU can be effectively managed with a variety of topical and systemic medications. PMID:11194135

  17. Walking on a 'peg leg': extensor muscle activities and sensory feedback after distal leg denervation in cockroaches.

    PubMed

    Noah, J A; Quimby, L; Frazier, S F; Zill, S N

    2004-03-01

    Previous studies in insects demonstrated that leg coordination changes following complete ablation of distal limb segments. However, normal coordination was restored when small 'peg leg' prostheses were attached to leg stumps to permit substrate contact. We have adapted this paradigm to preserve appropriate leg mass and inertia by severing all nerves and muscle tendons in the femur of the cockroach hind leg and converting the animal's own limb into a peg leg. Recordings of muscle activities and leg movements before and after denervation showed that: (1) the 'peg leg' is actively used in walking and regular bursts occur in motoneurons to leg extensor muscles; (2) driving of motoneuron activity is sufficient to produce 'fictive' bursting in a muscle whose tendon (apodeme) is cut in the ablation; and (3) similar motoneuron activities are found in walking on an oiled glass surface, when the effects of body weight and mechanical coupling are minimized. When distal segments were completely severed in these preparations, leg use and muscle bursting were disrupted but could be restored if the stumps were pressed against the substrate. These results support the hypothesis that feedback from receptors in proximal leg segments indicating forces allows for active leg use in walking. PMID:14727135

  18. Gastric ulcer healing after laser treatment in dogs.

    PubMed

    Marcuard, S P; Sinar, D R; Silverman, J F; Finley, J L

    1989-07-01

    Endoscopic laser photocoagulation of ulcers is increasingly used to produce hemostasis in patients who are actively bleeding or in patients with stigmata of recent hemorrhage. Little information is available describing ulcer healing rates after laser treatments. The aim of this study was to compare the healing rates of gastric ulcers treated with laser energy (Nd:YAG) with untreated ulcers in dogs. Two standard gastric ulcers (12-14 mm diameter) were created in each dog stomach using an ulcer maker (Quinton) under endoscopic guidance and one was randomly selected for laser treatment (L), while the other served as control (C). Ten laser spots were applied circumferentially around the ulcer crater with a mean energy of 595 J per ulcer. Ten dogs were studied; four of which were sacrificed after one week and six after two weeks. Healing of treated ulcers was compared with that of control ulcers and expressed as a percentage of the initial ulcer surface. Histologic injury and reepithelialization were scored by two pathologists unaware of the treatment. Laser-treated ulcers healed significantly slower than untreated ulcers at one week (53% L vs 94% C, P less than 0.05) and histologic injury was greater in ulcers treated with laser photocoagulation. At two weeks, only 82% of the laser-treated ulcer surface was healed in comparison with 94% (P less than 0.05) healing in untreated ulcers, although the mean histologic injury score was not different at two weeks. Reepithelialization was decreased both at one week (11% L vs 71% C, P less than 0.01) and at two weeks (75% L vs 100% C, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2743844

  19. Mucosal adenosine deaminase activity and gastric ulcer healing.

    PubMed

    Namiot, Z; Marcinkiewicz, M; Jaroszewicz, W; Stasiewicz, J; Gorski, J

    1993-10-26

    Adenosine deaminase activity was studied in gastric corpus mucosa close to an ulcer crater. It was found that 6 weeks of therapy with ranitidine was accompanied by a decrease in enzyme activity in the mucosa around healed ulcers and an increase around those which failed to heal. The different activities of adenosine deaminase in the vicinity of healed and unhealed ulcers may indicate its possible role in peptic ulcer healing. PMID:8276083

  20. Gastric ulcer penetrating to liver diagnosed by endoscopic biopsy

    PubMed Central

    Kayacetin, Ertugrul; Kayacetin, Serra

    2004-01-01

    Liver penetration is a rare but serious complication of peptic ulcer disease. Usually the diagnosis is made by operation or autopsy. Clinical and laboratory data were no specific. A 64-year-old man was admitted with upper gastrointestinal bleeding. Hepatic penetration was diagnosed as the cause of bleeding. Endoscopy showed a large gastric ulcer with a pseudotumoral mass protruding from the ulcer bed. Definitive diagnosis was established by endoscopic biopsies of the ulcer base. PMID:15188520

  1. The Mycotic Ulcer Treatment Trial

    PubMed Central

    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

    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

  2. Scattering of polarized photons at LEGS

    SciTech Connect

    Sandorfi, A.M.; Blanpied, G.; Blecher, M.; Giordano, G.; Kistner, O.C.; Matone, G.; Preedom, B.M.; Schaerf, C.; Sealock, R.M.; Thorn, C.E.

    1988-01-01

    The Laser-Electron-Gamma-Source (LEGS) facility at Brookhaven National Laboratory is now coming into operation. This facility delivers intense, monochromatic beams of medium-energy gamma rays that are almost completely polarized (linear or circular), and this degree of freedom has altered the status of a number of important experiments from being impossible to now being merely difficult. In this lecture we will describe the key features of the LEGS facility, and discuss two elastic scattering experiments on the nucleon, one in the region of the first resonance which is sensitive to the E2/M1 mixing ratio in the delta, and the other below pion threshold which is sensitive to the nucleon polarizabilities. These will illustrate the unique potential of the polarization degree of freedom. 36 refs., 9 figs., 4 tabs.

  3. Ulcerative cheilitis in a rhesus macaque.

    PubMed

    Bailey, C C; Miller, A D

    2012-03-01

    A 2-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 commissure. Histopathologic examination of the ulcer revealed infiltration by large numbers of degenerate and nondegenerate 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

  4. Effects of placental dressing indolent ulcers.

    PubMed

    Subramanian, T; Vijayarathinam, P; Sathyavan, V; Navaneethakrishnan, S; Anugraham, S; Anbalagan, K; Pandian, S K

    1990-11-01

    Fifteen cases of indolent ulcers of varying aetiology were treated by human placental dressing. An equal number of patients treated with antibiotics were taken as control. Human placental dressing for chronic ulcers was found to be effective in wound healing, inexpensive, freely available and devoid of side-effects. The immunological response which produces the clinical results by the use of human placenta has been studied. The raised level of immunoglobulins in the form of IgG and IgM was also seen. PMID:2086662

  5. Martorell's Ulcer: Diagnostic and Therapeutic Challenge

    PubMed Central

    Lima Pinto, Ana Paula Frade; Silva, Nelson Araújo; Osorio, Carolina Teixeira; Rivera, Lina Maria; Carneiro, Sueli; Ramos-e-Silva, Marcia; Gomes Bica, Blanca Elena Rios

    2015-01-01

    Martorell's ulcer is an uncommon ischemic and extremely painful lesion located in the distal portion of the lower limb, resulting from severe systemic and poorly controlled hypertension. It is common in women between 50 and 70 years of age. The diagnosis is clinical and mostly belated, following exclusion of other causes. The response to treatment takes time and is unsatisfactory. A combination of several drugs associated with surgery may be required for wound healing. The authors present a case of Martorell's hypertensive ulcer, with emphasis on the diagnostic and therapeutic difficulties. PMID:26351431

  6. Energy Efficient Legged Robotics at Sandia Labs

    SciTech Connect

    Buerger, Steve

    2014-12-16

    Sandia is developing energy efficient actuation and drive train technologies to dramatically improve the charge life of legged robots. The work is supported by DARPA, and Sandia will demonstrate an energy efficient bipedal robot at the technology exposition section of the DARPA Robotics Challenge Finals in June, 2015. This video, the first in a series, describes early development and initial integration of the Sandia Transmission Efficient Prototype Promoting Research (STEPPR) robot.

  7. Dynamic legged locomotion in robots and animals

    NASA Astrophysics Data System (ADS)

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

    1995-01-01

    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.

  8. In the Clinic. Restless Legs Syndrome.

    PubMed

    Bertisch, Suzanne

    2015-11-01

    This issue provides a clinical overview of restless legs syndrome, focusing on diagnosis, treatment, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers. PMID:26524584

  9. Exploratory clinical trial of combination wound therapy with a gelatin sheet and platelet-rich plasma in patients with chronic skin ulcers: study protocol

    PubMed Central

    Morimoto, Naoki; Kakudo, Natsuko; Matsui, Makoto; Ogura, Tsunetaka; Hara, Tomoya; Suzuki, Kenji; Yamamoto, Masaya; Tabata, Yasuhiko; Kusumoto, Kenji

    2015-01-01

    Introduction Chronic skin ulcers, such as diabetic ulcers, venous leg ulcers and pressure ulcers, are intractable and increasing in prevalence, representing a costly problem in healthcare. We developed a combination therapy with a gelatin sheet, capable of providing sustained release of platelet-rich plasma (PRP). The objective of this study is to investigate the safety and efficacy of autologous PRP covered with a hydrocolloid dressing and PRP covered with a gelatin sheet in the treatment of chronic skin ulcers. Methods and analysis Thirty patients with chronic skin ulcers who have not healed with conventional therapy for at least 1?month are being recruited. The patients will receive PRP after debridement, and the wounds will be covered with a hydrocolloid dressing or gelatin sheet. The efficacy will be evaluated according to the time from the beginning of PRP application to secondary healing or the day on which wound closure is achieved with a relatively simple surgical procedure, such as skin grafting or suturing. All patients will be followed up until 6?weeks after application to observe adverse events related to the application of PRP and the dressings. This study was designed to address and compare the safety and efficacy of PRP covered with a hydrocolloid dressing versus a gelatin sheet. If successful, this combination therapy may be an alternative to bioengineered skin substitutes containing living cells and lead to substantial progress in the management of chronic skin ulcers. Ethics and dissemination The study protocol was approved by the Institutional Review Board of Kansai Medical University (KMU Number 0649-1, 4 August 2014: V.1.0). The findings of this trial will be disseminated through peer-reviewed journals, and national and international scientific meetings as well as to the patients. Trial registration number UMIN000015689. PMID:25968005

  10. Haemophilus ducreyi Associated with Skin Ulcers among Children, Solomon Islands

    PubMed Central

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

    2014-01-01

    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

  11. Attitudes of Nurses Toward Pressure Ulcer Prevention: A Literature Review.

    PubMed

    Waugh, Shirley M

    2014-01-01

    Despite the existence of accepted guidelines to prevent pressure ulcers, interventions are not performed consistently. Many variables, including nurses' attitudes, contribute to the development of pressure ulcers. A review of the literature on nurses' attitudes toward pressure ulcer prevention is provided. PMID:26292449

  12. Leg contracture in mice: an assay of normal tissue response

    SciTech Connect

    Stone, H.B.

    1984-07-01

    Leg contracture, defined as the difference in extensibility of the control and irradiated hind legs of mice, was found to correlate with single doses of radiation from about 20 to 80 Gy. The time of development of the early phase of the response coincided with that reported for the appearance of the acute skin response, and in some cases, partially reversed as this reaction healed. The contracture then progressed again at a moderate rate through 90 days, and then more slowly through one year. Skin contraction, measured by decrease in intertattoo distance, was assayed in the same mice. It followed the same time course as leg contracture, but had a different dose-response relationship. To determine the contribution of skin contraction to the overall leg contracture response, mice were sacrificed and the leg contracture measured before and after the removal of the skin of the leg. After doses of up to 30 Gy, little contracture remained from skinning the leg, indicating that skin contraction was largely responsible for leg contracture in this dose range. After doses of about 45 Gy and above, some contracture remained in the skinned legs, although less than in intact legs. There was little or no enhancement of either skin contraction or leg contracture by the hypoxic cell sensitizers metronidazole or misonidazole.

  13. Complete healing of chronic wounds of a lower leg with haemoglobin spray and regeneration of an accompanying severe dermatoliposclerosis with intermittent normobaric oxygen inhalation (INBOI): a case report

    PubMed Central

    Barnikol, Wolfgang K. R.; Ptzschke, Harald

    2011-01-01

    A new healing procedure has been developed on the basis of the successful treatment of therapy-resistant hypoxic (and practically anoxic) leg ulcerations located within a heavy dermatoliposclerosis. The procedure involves an initial intra-ulceral application of haemoglobin followed by the intermittent administration of normobaric oxygen via inhalation. Haemoglobin is capable of externally supplying the granulating wound bed with oxygen at low partial pressure in a physiological manner, like a micro lung, so that oxidative stress can be avoided. A long-term daily administration of oxygen from within including the peri-ulceral skin is achieved by intermittent normobaric oxygen inhalation (INBOI) regularly throughout the day in the form of 1-hour sessions. Using this combined healing treatment during haemoglobin applications the ulcerations healed within about 1 month, and subsequently with INBOI therapy within further approx. 4 months the peri-ulceral skin regenerated as far as the oxygenation status was concerned: The peri-ulceral transcutaneous oxygen partial pressure (tcPO2) of zero (measured during breathing of normal air) rose to a satisfactory value of approx. 35 mmHg. After 28 months of treatment, the completely hypoxic and degenerated skin on the leg had practically returned to normal with a PO2 of 45 mmHg. Furthermore, the skin dermatoliposclerosis regressed. The skin regeneration was long-lasting, which was probably related to cellular tissue regeneration with an increase in the capillary density, whereby it had to be maintained by regular oxygen inhalation (INBOI maintaining treatment). By unintended intra-individual therapy variations it is evidenced that local hypoxia was the reason for skin degeneration: 3 x 1 h oxygen inhalation were sufficient for the healing treatment; 2 x 1 h sufficed for maintenance, whereas 2 x 0.5 h did not. The new procedure carries practically no risks, is simple, cheap and effective. Whereas the application of haemoglobin requires professional supervision, the oxygen inhalation can be carried out at home following initial guidance and monitoring by a physician. Using this novel method, the therapy-resistant ulceration could be closed within 5 months, during which daily outpatient care was only necessary for 1 month. The successful outcome of the treatment in terms of improvement of oxygen supply can monitored at any time using peri-ulceral tcPO2 measurements, whereby, due to the inhomogeneity of the values, measurements at a minimum of two locations at the wound edge are strongly recommended and more measurements at more skin locations would be preferable. Besides its use in the healing of ulcers, the new procedure is also suitable for the prevention of ulceration development (prophylactic INBOI treatment) in skin rendered susceptible due to the presence of hypoxia. Here, peri-ulceral transcutaneous oxygen partial pressures of below 10 mmHg should be considered as being critical and are an indication for a prophylactic oxygen inhalation treatment. The new procedure may also be suitable even before the peri-ulceral oxygen partial pressure falls below 10 mmHg. Four measures for rehabilitation, conservation, and prevention with regard to a healed chronic wound are proposed. PMID:21468328

  14. The VCU Pressure Ulcer Summit: Collaboration to Operationalize Hospital-Acquired Pressure Ulcer Prevention Best Practice Recommendations.

    PubMed

    Brindle, C Tod; Creehan, Sue; Black, Joyce; Zimmermann, Deb

    2015-01-01

    This executive summary reports outcomes of an interprofessional collaboration between experts in pressure ulcer prevention, bedside clinicians, regulatory agencies, quality improvement, informatics experts, and professional nursing organizations. The goal of the collaboration was to develop a framework to assist facilities to operationalize best practice recommendations to sustain organizational culture change in hospital-acquired pressure ulcer prevention, to develop a hospital-acquired pressure ulcer severity score, and to address topics related to the unavoidable pressure ulcer. PMID:26010220

  15. The influence of one-legged training on cardiorespiratory fitness.

    PubMed

    Bell, G; Neary, P; Wenger, H A

    1988-01-01

    Supported by University of Victoria Research Grant. The purpose of this investigation was to examine the influence of single leg training on one- and two-legged maximal oxygen consumption (VO2 max). Nine volunteers completed 7 weeks of one-legged interval training on a cycle ergometer adapted for single leg pedaling. The training regimen consisted of 15-20 intervals of 20 sec duration (1:3 work to rest ratio), 4 days a week at an intensity of 150% of the initial power output that elicited one-legged VO2 max. Pedaling cadence was maintained at 90 rpm. Heart rate (HR) was monitored throughout all training sessions. The results demonstrate that one-legged VO2 max was significantly increased (p < 0.05) from 3.36 l/min in the pretrained condition to 3.57 l/min and 3.69 l/min in the untrained (UT) and trained legs (T), respectively. No significant differences were observed between the UT and T legs for one-legged VO2 max after training. Two-legged VO2 max showed a 5% elevation following single leg training (p < 0.05). These data suggest that one-legged interval training of high intensity and short duration can improve both one- and two-legged maximal oxygen consumption. This finding implies that individuals can maintain aerobic power during rehabilitation following an injury to one limb, through the use of one-legged interval training on a cycle ergometer.J Orthop Sports Phys Ther 1988;10(1);8-11. PMID:18796979

  16. Pepsinogen C gene polymorphisms associated with gastric body ulcer.

    PubMed Central

    Azuma, T; Teramae, N; Hayakumo, T; Yasuda, K; Nakajima, M; Kodama, T; Inokuchi, H; Hayashi, K; Taggart, R T; Kawai, K

    1993-01-01

    This study was aimed to investigate the association of restriction fragment length polymorphisms (RFLPs) for pepsinogen genes with peptic ulcer disease. Eighty unrelated controls, 61 patients with gastric ulcer, and 57 patients with duodenal ulcer were studied. No genetic polymorphisms for pepsinogen A were detected by EcoRI digestion in Japanese subjects but a 100 base pairs insertion-deletion RFLP for the pepsinogen C gene was observed. The allele frequencies of the large (3.6 kilobase EcoRI fragment) and the small fragment (3.5 kilobase EcoRI fragment) were 80.6% and 19.4% respectively in controls, 55.4% and 44.6% in patients with gastric body ulcer, 79.4% and 20.6% in patients with gastric angular ulcer, 71.4% and 28.6% in patients with gastric antral ulcer, and 75.4% and 24.6% in patients with duodenal ulcer. The allele frequency of the small fragment was significantly higher in patients with gastric body ulcer than in controls and in patients with gastric angular or antral ulcer. The genotypes which possessed the small fragment were significantly more frequent in patients with gastric body ulcer (78.4%) than in controls (33.8%) and in patients with gastric angular or antral ulcer (37.5%). These results suggest that there is a significant association between the genetic polymorphism at the pepsinogen C gene locus and gastric body ulcer, and that the pepsinogen C RFLP is a useful marker of the genetic predisposition to this disorder. These results also indicate genetic heterogeneity of gastric ulcer disease, and suggest that the pepsinogen C RFLP may be a useful subclinical marker to explain the differences in genetic aetiologies of gastric body ulcer and gastric angular or antral ulcer. Images Figure 1 Figure 2 PMID:8098309

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

    PubMed

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

    2014-01-01

    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

  18. Squamous cell carcinoma arising from trophic ulcers.

    PubMed

    Boopalraj, J M; Muthusami, T C

    1979-01-01

    This study presents two cases of Squamous Cell Carcinomas arising from trophic ulcers of leprosy attending Leprosy Department, Government General Hospital, Madras. The aim of this presentation is to analyse these cases in the light of the earlier reports and to draw attention to certain significant features of them. PMID:449288

  19. Genital Ulcers: Their Diagnosis and Management

    PubMed Central

    Sacks, Stephen L.

    1987-01-01

    This article offers some background information on diagnosis and treatment of three major causes of genital ulcers: syphilis, herpes simplex virus (HSV), and chancroid. The author also discusses differential diagnoses and suggests an approach to treatment. ImagesFigure 1Figure 2Figure 3Figure 4Figure 6Figure 7 PMID:21263799

  20. Ulcerative Colitis - Multiple Languages: MedlinePlus

    MedlinePLUS

    ... List of All Topics All Ulcerative Colitis - Multiple Languages To use the sharing features on this page, please enable JavaScript. Chinese - Traditional (繁體中文) French (français) Hindi (हिन्दी) Japanese (日本語) Korean (한국어) ...

  1. Locomotion via paralyzed leg muscles: feasibility study for a leg-propelled vehicle.

    PubMed

    Glaser, R M; Gruner, J A; Feinberg, S D; Collins, S R

    1983-07-01

    Functional electrical stimulation has been used to restore some degree of controllable movement to paralyzed muscle. The purpose of this study was to demonstrate the feasibility of using electrically stimulated paralyzed leg muscles to propel a wheelchair-type vehicle. For this, a conventional manual wheelchair was modified by the addition of a drive system which permits forward propulsion by reciprocating movements of the legs. A battery-powered electrical stimulator using surface electrodes over the quadriceps muscles controls locomotive characteristics. This vehicle has been successfully operated by paraplegic and quadriplegic test subjects. Advantages of using paralyzed leg muscles for locomotion may include improvement in locomotive capability, circulation in the lower extremities, cardiovascular and respiratory fitness, strength and size of the exercised muscles and bones, and self-image. PMID:6101225

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

    PubMed Central

    Bergsten, Christer; Telezhenko, Evgenij; Ventorp, Michael

    2015-01-01

    Simple Summary In this study the effect of different flooring systems on locomotion, claw conformation, loading, claw- and leg disorders was assessed in heifers from one year before to one year after calving. After calving, heifers kept on alleys covered with rubber flooring were found to develop less lameness, fewer claw disorders of the sole horn and fewer leg lesions than those kept on concrete alleys. Recruitment heifers reared on soft deep straw bedding had fewer sole horn lesions and more overgrown claws before calving, but were more prone to severe sole horn lesions after calving, than those reared in cubicles with hard concrete floors. Abstract Claw health, an important dairy cow welfare parameter, may be affected by early-life foot/leg stresses. To investigate this, groups of pregnant heifers were allocated to deep straw bedding (Soft) or cubicles (Hard), both with scraped concrete feeding alleys. After the grazing season, they were re-housed in cubicle systems, half on slatted concrete (Hard) and half on slatted rubber (Soft) alleys. Claw measurements, contact area and pressure distribution claw/flooring, claw disorders and leg lesions were recorded at the start and end of each housing season. Locomotion and leg lesions were also scored monthly after calving. Prevalence of sole haemorrhages was higher among pregnant heifers in cubicles than in deep straw. After calving, first-calvers on Hard floors had higher odds for lameness (OR = 3.6; p < 0.01), sole haemorrhages/ulcers (OR = 2.2; p < 0.05), white-line haemorrhages (OR = 2.8; p < 0.01) and leg lesions (OR = 2.6; p < 0.02) than those on Soft floors. Lowest prevalence and severity of sole and white-line haemorrhages (non-significant) in first-calvers was found in those on Soft floors and reared on Hard floors and the highest prevalence and severity on those on Hard floors reared on Soft floors. Soft flooring after calving is of most importance for healthy feet and legs. PMID:26479380

  3. Genetic parameters for hoof lesions and their relationship with feet and leg traits in Canadian Holstein cows.

    PubMed

    Chapinal, N; Koeck, A; Sewalem, A; Kelton, D F; Mason, S; Cramer, G; Miglior, F

    2013-04-01

    The objectives were (1) to estimate the genetic parameters and breeding values of hoof lesions, (2) to estimate the phenotypic effect of each feet and legs conformation traits on hoof lesions, and (3) to estimate genetic correlations between hoof lesions with feet and legs conformation traits. The presence or absence of specific hoof lesions was recorded for each hoof. Lesions were classified into infectious (digital and interdigital dermatitis, foot rot, and heel erosion), horn (sole and toe ulcer, sole hemorrhage, and white line disease), and other lesions (interdigital hyperplasia, fissures, thin soles, and corkscrew claw). A total of 34,905 hoof health records from 27,179 cows and 365 herds, collected by 18 different hoof-trimmers in Ontario, Alberta, and British Columbia, were analyzed using linear animal models. In addition, 5 feet and leg conformation traits (foot angle, heel depth, bone quality, rear leg side view, and rear leg rear view) and locomotion from primiparous cows were considered (n=11,419 and 6,966 cows, for conformation traits and locomotion, respectively). At least one lesion was found in nearly 40% of the hoof trimming records. The heritability estimates for hoof lesions ranged from 0.01 for front horn lesions to 0.09 for rear infectious lesions. Despite the low heritability estimates, we observed large variability in sire estimated breeding value (EBV) for resistance to hoof lesions. Positive genetic correlations were found between the occurrence of front and rear infectious lesions (0.77) and between front and rear horn lesions (0.61), but not between infectious and horn lesions (0.08). For most of the conformation traits, low scores were phenotypically associated with higher incidence of horn lesions, whereas we found no evidence of a phenotypic effect of feet and leg traits on infectious lesions. The heritability of the conformation traits ranged from 0.04 for rear leg rear view to 0.22 for bone quality, whereas that for locomotion was 0.03. The genetic correlations between hoof lesions and conformation traits were low to moderate, yet most of the estimates were associated with high standard errors. In conclusion, although hoof lesions are lowly heritable traits, sufficient genetic variation exists (as evidenced by large variability in sire EBV) for genetic improvement through direct selection in the long term. Standardization of hoof health data collection is encouraged. PMID:23415531

  4. Nicorandil-induced tongue ulceration with or without fungal infection.

    PubMed

    Terai, Haruhiko; Yamanishi, Hirohisa; Shimahara, Masashi

    2012-01-01

    Oral ulceration is one of the common adverse effects of nicorandil in European countries. In Japan, however, only 9 cases of nicorandil-induced oral ulceration have been reported. Here, we report 3 cases of nicorandil-induced oral ulceration, one of which exhibited a unique clinical course associated with Candida infection. In this case, the initial discontinuation of nicorandil failed to ameliorate the lesion. However, the second discontinuation of the drug after the control of the Candida infection overlying the surface of the ulcer produced a favorable effect. This patient was diagnosed with nicorandil-induced tongue ulceration with Candida infection. PMID:21553069

  5. Validity of leg-to-leg bioelectrical impedance measurement in highly active women.

    PubMed

    Civar, Selma; Aktop, Abdurrahman; Tercan, Evren; Ozdol, Yeliz; Ozer, Kamil

    2006-05-01

    The aim of this study was to compare the validity of the leg-to-leg bioelectrical impedance analysis (BIA) method with that of anthropometry using hydrostatic weighing (HW) as the criterion test. A secondary objective was to cross-validate previously developed anthropometric regression equations as well as to develop a new regression equation formula based on the anthropometric data collected in this study. Three methods for assessing body composition (HW, BIA, and anthropometric) were applied to 60 women university athletes. The means and standard deviations of age, weight, height, and body mass index (BMI) of athletes were as follows: age, 20.70 +/- 1.43; weight, 56.19 +/- 7.83 kg; height, 163.33 +/- 6.11 cm; BMI, 21.01 +/- 2.63 kg x m(-2). Leg-to-leg BIA (11.82 +/- 2.39) has shown no statistical difference between percentage body fat determined by HW (11.63 +/- 2.42%) in highly active women (p > 0.05). This result suggests that the leg-to-leg BIA and HW methods were somewhat interchangeable in highly active women (R = 0.667; standard error of estimate [SEE] = 1.81). As a result of all cross-validation analyses, anthropometric and BIA plus anthropometric results have generally produced lower regression coefficients and higher SEEs for highly active women between the ages of 18 and 25 years. The regression coefficients (0.903, 0.926) and SEE (1.08, 0.96) for the new regression formulas developed from this study were better than the all the other formulas used in this study. PMID:16686564

  6. [Buruli ulcer in Togo: a hospital study].

    PubMed

    James, Komlavi; Attipou, Komla Klussé; James, Yaovi Edem; Blakime, Massalou; Tignokpa, Napo; Abete, Bawubadi

    2003-01-01

    Buruli ulcer is an emerging disease with a high prevalence in many West African countries neighbouring Togo. The aim of the present study is to assess the situation in Togolese hospitals. It was conducted for 2 years (between January 2000 and December 2001) based on the Buruli ulcer record files set up in Togolese hospitals, with a view to analyse the incidence of the disease, its characteristics in the patients and its topographic distribution in relation to their environment. During this period, 180 patients were recorded, 120 of whom were male and 18 female. The average age was 20.7 years and 20.6% of the cases were children. Lower limbs were more affected (153), followed by upper limbs (20), trunk (5), head and neck (2). Large ulcerative lesions were recorded in 11.11% of cases (n = 20), localised in 7.5% of the patients (n = 143), diffuse or metastatic in 9.4% of cases. No pre-ulcerative lesion was found. An increase in the incidence of the disease was observed from one year to the other while cases were notified in new care centres. Three risk areas were identified according to the origin of the patients : the laguna area of the coast, marshy inland areas where market crops and rice are cultivated and river valley areas. The study revealed that Buruli ulcer cases treated in Togolese hospitals were increasing year after year. A morbidity study is necessary to assess the importance of the disease on a national scale. PMID:12925323

  7. Malnutrition as a Precursor of Pressure Ulcers

    PubMed Central

    Litchford, Mary D.; Dorner, Becky; Posthauer, Mary Ellen

    2014-01-01

    Significance: Numerous studies have reported associations between declining nutrition status and risk for pressure ulcers. Oral eating problems, weight loss, low body weight, undernutrition, and malnutrition are associated with an increased risk for pressure ulcers. Moreover, inadequate nutrient intake and low body weight are associated with slow and nonhealing wounds. However, the biologic significance of deterioration in nutrition status and consistent methodologies to quantify malnutrition and diminished micronutrient stores as predictors of skin breakdown remains controversial. Recent Advances: The Academy of Nutrition and Dietetics (Academy) and the American Society for Parenteral and Enteral Nutrition (ASPEN) Consensus Statement: Characteristics Recommended for the Identification and Documentation of Adult Malnutrition provide a standardized and measureable set of criterion for all health professionals to use to identify malnutrition. The Agency for Healthcare Research and Quality identified malnutrition as one of the common geriatric syndromes associated with increased risk for institutionalization and mortality that may be impacted by primary and secondary preventions. Critical Issues: The purpose of this article is to examine the Academy/ASPEN consensus statement on characteristics of adult malnutrition in the context of the National Pressure Ulcer Advisory Panel (NPUAP)/European Pressure Ulcer Advisory Panel (EPUAP) Guidelines on the Prevention and Treatment of Pressure Ulcers. Future Directions: Moreover, clinicians, and in particular, registered dietitians have the opportunity to integrate the Characteristics of Malnutrition with the NPUAP/EPUAP 2009 Prevention and Treatment Clinical Practice Guidelines, into clinical assessment and documentation using the Nutrition Care Process. Consensus guidelines will provide consistent research criteria yielding more useful data than presently available. PMID:24761345

  8. On the Biomimetic Design of Agile-Robot Legs

    PubMed Central

    Garcia, Elena; Arevalo, Juan Carlos; Muoz, Gustavo; Gonzalez-de-Santos, Pablo

    2011-01-01

    The development of functional legged robots has encountered its limits in human-made actuation technology. This paper describes research on the biomimetic design of legs for agile quadrupeds. A biomimetic leg concept that extracts key principles from horse legs which are responsible for the agile and powerful locomotion of these animals is presented. The proposed biomimetic leg model defines the effective leg length, leg kinematics, limb mass distribution, actuator power, and elastic energy recovery as determinants of agile locomotion, and values for these five key elements are given. The transfer of the extracted principles to technological instantiations is analyzed in detail, considering the availability of current materials, structures and actuators. A real leg prototype has been developed following the biomimetic leg concept proposed. The actuation system is based on the hybrid use of series elasticity and magneto-rheological dampers which provides variable compliance for natural motion. From the experimental evaluation of this prototype, conclusions on the current technological barriers to achieve real functional legged robots to walk dynamically in agile locomotion are presented. PMID:22247667

  9. The role of nutrition for pressure ulcer management: national pressure ulcer advisory panel, European pressure ulcer advisory panel, and pan pacific pressure injury alliance white paper.

    PubMed

    Posthauer, Mary Ellen; Banks, Merrilyn; Dorner, Becky; Schols, Jos M G A

    2015-04-01

    Nutrition and hydration play an important role in preserving skin and tissue viability and in supporting tissue repair for pressure ulcer (PrU) healing. The majority of research investigating the relationship between nutrition and wounds focuses on PrUs. This white paper reviews the 2014 National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance Nutrition Guidelines and discusses nutrition strategies for PrU management. PMID:25775201

  10. Become the PPUPET Master: Mastering Pressure Ulcer Risk Assessment With the Pediatric Pressure Ulcer Prediction and Evaluation Tool (PPUPET).

    PubMed

    Sterken, David J; Mooney, JoAnn; Ropele, Diana; Kett, Alysha; Vander Laan, Karen J

    2015-01-01

    Hospital acquired pressure ulcers (HAPU) are serious, debilitating, and preventable complications in all inpatient populations. Despite evidence of the development of pressure ulcers in the pediatric population, minimal research has been done. Based on observations gathered during quarterly HAPU audits, bedside nursing staff recognized trends in pressure ulcer locations that were not captured using current pressure ulcer risk assessment tools. Together, bedside nurses and nursing leadership created and conducted multiple research studies to investigate the validity and reliability of the Pediatric Pressure Ulcer Prediction and Evaluation Tool (PPUPET). PMID:25450444

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

    PubMed

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

    2015-01-01

    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

  12. Human CD34+ stem cells promote healing of diabetic foot ulcers in rats

    PubMed Central

    Elsharawy, Mohamed A.; Naim, Magda; Greish, Sahar

    2012-01-01

    OBJECTIVE Diabetic patients with foot ulcers usually manifest with high amputation and mortality rates. Preliminary evidence supports the effectiveness of stem cell (St) therapy on diabetic foot ulcers. The objective of this study was to evaluate the efficacy of stem cells in the healing of wounds among streptozotocin-induced diabetic albino rats. METHODS Thirty male albino rats were divided into three groups each of 10 rats: control group, diabetic control (DC) group and St group. Diabetes was induced by intra-peritoneal injection of streptozotocin. A full thickness circular wound of ?10mm in diameter was performed on the front of right legs of all rats. In the diabetic St group, the wounds were treated by injection of umbilical cord blood-derived CD34+ stem cells into the wound bed. Half of each group rats were sacrificed after 1 week and the rest after 2 weeks. The wound areas were used for histopathology, immunohistochemistry and transmission electron microscope studies. Assessment of wound surface area, epidermal thickness, blood vessel proliferation and collagen deposition were performed. RESULTS There was a significant decrease in mean wound surface area, increase in mean epidermal thickness, blood vessel proliferation and collagen deposition in the St group compared with the DC group. CONCLUSION Treatment with CD34+-enriched cells decreased wound size, accelerated epidermal healing and dramatically accelerated revascularization of the wounds compared with the DC group. PMID:22159252

  13. Healing of venous ulcers using compression therapy: Predictions of a mathematical model.

    PubMed

    Flegg, Jennifer A; Kasza, Jessica; Darby, Ian; Weller, Carolina D

    2015-08-21

    Venous Leg Ulceration (VLU) is a chronic condition for which healthcare systems worldwide face rising treatment costs. VLU can be due to sustained venous hypertension which causes the veins to become cuffed with fibrin, inhibiting the supply of nutrients to the wound site. For patients that cannot tolerate compression therapy with an inelastic short stretch (SS) bandage, the mainstay treatment, an elastic three layered (3L) bandage is an alternative. In this paper, a mathematical model is developed to investigate whether the healing of venous ulcers under SS and 3L bandages occurs at different rates and to postulate the reason for any difference. The two treatments were applied to a simplified wound geometry, under the assumption that the rate limiting step of healing is the supply of oxygen to the wounded tissue. Clinical data of wound size over time under the two treatments from Weller et al. (2012) was used to fit key, unknown, model parameters using a least squares approach. Numerical results are presented for the oxygen distribution within the wound space, using the fitted parameter values. The 3L bandage allows more oxygen flow into the wound than the SS bandage and, hence, the 3L bandage results in faster healing, however the difference is more significant for wounds of larger initial size. The model can be used as a predictive tool in a clinical setting to estimate the time to heal for a wound of a given initial size, treated with either a SS or 3L bandage. PMID:25957521

  14. Restless Leg Syndrome: A Neglected Diagnosis

    PubMed Central

    Einollahi, Behzad; Izadianmehr, Neda

    2014-01-01

    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 patients 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 patients 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 physicians attention and clinical experience with this condition and using IRLSSG. PMID:25695039

  15. [Bow legged adjectives in ancient literature].

    PubMed

    Simon, Frantisek; Steger, Florian

    2011-01-01

    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

  16. Coordinated intelligent adaptive control of legged robots

    NASA Astrophysics Data System (ADS)

    McLauchlan, Lifford; Mehrbeo?lu, Mehrbe

    2006-05-01

    In planetary or hazardous environment exploration, there will be unforseen environmental circumstances which can not be planned. To overcome telerobotic control issues due to communication delays, autonomous robot control becomes necessary. Autonomously controlled landers and instrumentation can be used in exploration, such as lunar and martian missions. However, wheeled robots have difficulty in exploring uneven terrain; thus, legged robots can be used in such situations. This research develops intelligent and adaptive control of mobile robots to perform functions such as environmental exploration in coordination and obstacle avoidance. The coordinated control is demonstrated in simulations.

  17. Transcutaneous laser treatment of leg veins.

    PubMed

    Meesters, Arne A; Pitassi, Luiza H U; Campos, Valeria; Wolkerstorfer, Albert; Dierickx, Christine C

    2014-03-01

    Leg telangiectasias and reticular veins are a common complaint affecting more than 80% of the population to some extent. To date, the gold standard remains sclerotherapy for most patients. However, there may be some specific situations, where sclerotherapy is contraindicated such as needle phobia, allergy to certain sclerosing agents, and the presence of vessels smaller than the diameter of a 30-gauge needle (including telangiectatic matting). In these cases, transcutaneous laser therapy is a valuable alternative. Currently, different laser modalities have been proposed for the management of leg veins. The aim of this article is to present an overview of the basic principles of transcutaneous laser therapy of leg veins and to review the existing literature on this subject, including the most recent developments. The 532-nm potassium titanyl phosphate (KTP) laser, the 585-600-nm pulsed dye laser, the 755-nm alexandrite laser, various 800-983-nm diode lasers, and the 1,064-nm neodymium yttrium-aluminum-garnet (Nd:YAG) laser and various intense pulsed light sources have been investigated for this indication. The KTP and pulsed dye laser are an effective treatment option for small vessels (<1 mm). The side effect profile is usually favorable to that of longer wavelength modalities. For larger veins, the use of a longer wavelength is required. According to the scarce evidence available, the Nd:YAG laser produces better clinical results than the alexandrite and diode laser. Penetration depth is high, whereas absorption by melanin is low, making the Nd:YAG laser suitable for the treatment of larger and deeply located veins and for the treatment of patients with dark skin types. Clinical outcome of Nd:YAG laser therapy approximates that of sclerotherapy, although the latter is associated with less pain. New developments include (1) the use of a nonuniform pulse sequence or a dual-wavelength modality, inducing methemoglobin formation and enhancing the optical absorption properties of the target structure, (2) pulse stacking and multiple pass laser treatment, (3) combination of laser therapy with sclerotherapy or radiofrequency, and (4) indocyanin green enhanced laser therapy. Future studies will have to confirm the role of these developments in the treatment of leg veins. The literature still lacks double-blind controlled clinical trials comparing the different laser modalities with each other and with sclerotherapy. Such trials should be the focus of future research. PMID:24220848

  18. Is leg compression beneficial for alpine skiers?

    PubMed Central

    2013-01-01

    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

  19. Gabapentin encarbil (Horizant) for restless leg syndrome.

    PubMed

    2011-09-01

    Gabapentin enacarbil (Horizant-GlaxoSmithKline), a new extended-release (ER) tablet formulation of gabapentin, has been approved by the FDA for treatment of moderate-to-severe restless legs syndrome (RLS). The immediate-release (IR) formulation of gabapentin (Neurontin,and others), which is approved for treatment of epilepsy and postherpetic neuralgia, has been used for many years to treat RLS. Another ER tablet formulation of gabapentin (Gralise) has been approved by the FDA for treatment of postherpetic neuralgia. PMID:21897349

  20. Protective Efficacy of a DNA Vaccine Encoding Antigen 85A from Mycobacterium bovis BCG against Buruli Ulcer

    PubMed Central

    Tanghe, Audrey; Content, Jean; Van Vooren, Jean-Paul; Portaels, Franoise; Huygen, Kris

    2001-01-01

    Buruli ulcer, caused by Mycobacterium ulcerans, is characterized by deep and necrotizing skin lesions, mostly on the arms and legs. Together with tuberculosis and leprosy, this mycobacterial disease has become a major health problem in tropical and subtropical regions, particularly in central and western Africa. No specific vaccine is available for Buruli ulcer. There is, however, evidence in the literature that suggests a cross-reactive protective role of the tuberculosis vaccine M. bovis BCG. To identify potential mechanisms for this cross-protection, we identified and characterized the M. ulcerans homologue of the important protective mycobacterial antigen 85 (Ag85A) from BCG. The homologue is well conserved in M. ulcerans, showing 84.1% amino acid sequence identity and 91% conserved residues compared to the sequence from BCG. This antigen was sufficiently conserved to allow cross-reactive protection, as demonstrated by the ability of M. ulcerans- infected mice to exhibit strong cellular immune responses to both BCG and its purified Ag85 complex. To further address the mechanism of cross-reactive protection, we demonstrate here that prior vaccination with either BCG or plasmid DNA encoding BCG Ag85A is capable of significantly reducing the bacterial load in the footpads of M. ulcerans- infected mice, as determined by Ziehl-Neelsen staining and by actual counting of CFU on 7H11 Middlebrook agar. Together, the results reported here support the potential of a cross-protective Ag85-based future vaccine against tuberculosis, Buruli ulcer, and leprosy. PMID:11500410

  1. Determining the volumetric steam content in a BWR gravity leg

    SciTech Connect

    Fedulin, V.N.; Bartolomei, G.G.; Solodkii, V.A.; Shmelev, V.E.

    1987-09-01

    The structure of two-phase flow in a large-diameter limited-height gravity leg was investigated in the VK-50 reactor. Phase distribution properties and a physical model of the steam-water mixture flow in the gravity leg were described. On the basis of experimentally derived date a method was proposed for the calculation of volumetric steam content in the leg.

  2. Leg length discrepancy following irradiation for childhood tumors

    SciTech Connect

    Robertson, W.W. Jr.; Butler, M.S.; D'Angio, G.J.; Rate, W.R. )

    1991-05-01

    Leg length inequality developed in 12 of 67 children who were treated with radiation therapy to the kidney, abdomen, pelvis, or lower extremities. All these children survived childhood cancer to the age of skeletal maturity. Of the 12 with anisomelia, seven were symptomatic. There were significant relationships between the development of leg length inequality and the total dose of radiation to the pelvic area, asymmetric irradiation to the pelvis, and high-dose irradiation to the leg.

  3. Olanzapine-induced restless legs syndrome.

    PubMed

    Zhao, Mangsuo; Geng, Tongchao; Qiao, Liyan; Zhang, Mingjie; Shi, Jie; Huang, Fangjie; Lin, Xianzhong; Wang, Jing; Zuo, Huancong

    2014-09-01

    Only nine patients with olanzapine-induced restless legs syndrome (RLS) have been reported in the literature to our knowledge. We describe two patients with olanzapine-induced RLS treated at our hospital and review the nine reported patients. There were five women and six men aged between 28 and 62 years in the overall group. RLS symptoms emerged at olanzapine doses between 2.5 and 20mg. The symptoms improved in all patients when the dose was reduced and immediately disappeared when the medication was stopped. International Restless Legs Scale (IRLS) scores ranged from 10 to 35. Three patients had a family history of idiopathic RLS. Supplemental drugs were administered to control RLS symptoms in five patients. Ropinirole was effective in one patient, while two patients did not respond to the drug. Propoxyphene effectively relieved symptoms in one patient who did not respond to ropinirole or clonazepam. RLS symptoms did not recur following substitution of other antipsychotic drugs for olanzapine. In conclusion, olanzapine can induce RLS, particularly in patients with a family history of idiopathic RLS. More than half of the patients experienced severe to very severe symptoms. A dose-dependent relationship was observed between olanzapine and RLS symptoms. A gradual increase in dose may prevent olanzapine-induced RLS. The optimal treatment for olanzapine-induced RLS is discontinuation of olanzapine. PMID:24874697

  4. Three particle superstring amplitudes with massive legs

    NASA Astrophysics Data System (ADS)

    Boels, Rutger H.

    2012-06-01

    On-shell superspaces and associated spinor helicity techniques give an efficient formulation of the Ward identities of on-shell supersymmetry for scattering amplitudes and supply tools to construct their solutions. Based on these techniques in this paper the general solutions of the Ward identities are presented for three particle scattering amplitudes with one, two or three massive legs for simple supersymmetry in ten and eight dimensions. It is shown in examples how these solutions may be used to obtain concrete amplitudes for the closed (IIB) and open superstring in a flat background. Explicit results include all three point amplitudes with one massive leg whose functional form is shown to be dictated completely by super-Poincare symmetry. The resulting surprisingly simple series only involves massive superfields labelled by completely symmetric little group representations. The extension to more general explicit three and higher point amplitudes in string theory is initiated. In appendices the field content of the fundamental massive superfields of the open and closed superstring are listed in terms of the Dynkin labels of a variety of groups which may be of independent interest.

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

    PubMed Central

    2012-01-01

    Background Ghana is a Buruli ulcer (BU) endemic country yet there is paucity of socio-cultural research on BU. Examining distinctive experiences and meanings for pre-ulcers and ulcers of BU may clarify the disease burden, illness experience and local perceptions of causes and spread, and environmental features of BU, which are useful to guide public health programmes and future research. This study aimed to explain local meanings and experiences of BU for persons with pre-ulcers and ulcers in the Ga-West and Ga-South municipalities in Accra. Methods Semi-structured interviews based on the Explanatory Model Interview Catalogue framework were administered to 181 respondents comprising 15 respondents with pre-ulcers and 166 respondents with ulcers. The Wilcoxon rank-sum test was used to compare categories of illness experiences (PD) and perceived causes (PC) among respondents with pre-ulcer and ulcer conditions. The Fishers 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

  6. Plantar Pressure in Diabetic Peripheral Neuropathy Patients with Active Foot Ulceration, Previous Ulceration and No History of Ulceration: A Meta-Analysis of Observational Studies

    PubMed Central

    Fernando, Malindu Eranga; Crowther, Robert George; Pappas, Elise; Lazzarini, Peter Anthony; Cunningham, Margaret; Sangla, Kunwarjit Singh; Buttner, Petra; Golledge, Jonathan

    2014-01-01

    Aims Elevated dynamic plantar pressures are a consistent finding in diabetes patients with peripheral neuropathy with implications for plantar foot ulceration. This meta-analysis aimed to compare the plantar pressures of diabetes patients that had peripheral neuropathy and those with neuropathy with active or previous foot ulcers. Methods Published articles were identified from Medline via OVID, CINAHL, SCOPUS, INFORMIT, Cochrane Central EMBASE via OVID and Web of Science via ISI Web of Knowledge bibliographic databases. Observational studies reporting barefoot dynamic plantar pressure in adults with diabetic peripheral neuropathy, where at least one group had a history of plantar foot ulcers were included. Interventional studies, shod plantar pressure studies and studies not published in English were excluded. Overall mean peak plantar pressure (MPP) and pressure time integral (PTI) were primary outcomes. The six secondary outcomes were MPP and PTI at the rear foot, mid foot and fore foot. The protocol of the meta-analysis was published with PROPSERO, (registration number CRD42013004310). Results Eight observational studies were included. Overall MPP and PTI were greater in diabetic peripheral neuropathy patients with foot ulceration compared to those without ulceration (standardised mean difference 0.551, 95% CI 0.2900.811, p<0.001; and 0.762, 95% CI 0.3031.221, p?=?0.001, respectively). Sub-group analyses demonstrated no significant difference in MPP for those with neuropathy with active ulceration compared to those without ulcers. A significant difference in MPP was found for those with neuropathy with a past history of ulceration compared to those without ulcers; (0.467, 95% CI 0.181 0.753, p?=?0.001). Statistical heterogeneity between studies was moderate. Conclusions Plantar pressures appear to be significantly higher in patients with diabetic peripheral neuropathy with a history of foot ulceration compared to those with diabetic neuropathy without a history of ulceration. More homogenous data is needed to confirm these findings. PMID:24915443

  7. [Effectiveness of immunostimulants in nonspecific ulcerative colitis].

    PubMed

    Perederi?, V G; Tkach, S M; Bychkova, N G; Blazhenko, I L

    1990-01-01

    Clinical and immunologic efficacies of some immunostimulants (levamisole, sodium nucleinate, thymic preparations) included in therapeutic schemes in nonspecific ulcerous colitis both separately and in various combinations were under study. The efficacy of these stimulants was found to depend on the disease severity and proved to be the highest in the light course. Thymalin and sodium nucleinate showed the highest clinical and immunologic efficacies, particularly if used together. Levamisole administration was associated with frequent side effects and had no essential advantages over basic therapy. This permits a conclusion that immunostimulants are pathogenetically validated in therapy of ulcerous colitis, for they result in reduction or elimination of immunity insufficiency and their administration leads to a positive clinical effect in the majority of cases. PMID:2374965

  8. Crater-Like Ulceration of Aortic Arch.

    PubMed

    Simon, Caterina; Calabrese, Alice; Canu, Gianluca; Merlo, Maurizio; Galletti, Lorenzo

    2014-12-01

    We report the case of a 78-year-old female who presented to our hospital with signs of hemorrhagic shock and breathlessness. A transthoracic echocardiography demonstrated pericardial effusion. Computed tomography of the chest showed a penetrating atherosclerotic ulcer of the aortic arch with an intramural hematoma of the ascending and descending aorta. Endovascular repair with stent-grafting was urgently performed and a pericardial window placement was done to reduce mediastinal bleeding. PMID:26798748

  9. Guidelines for evaluating decubitus ulcer research.

    PubMed

    Abruzzese, R S

    1989-02-01

    The classic critique of research is applied to a systematic evaluation of the components of research reports and company literature related to pressure ulcer products and devices. Emphasis is on the need to control variables that influence the findings; some of these are: relief of pressure, nutrition and hydration, comparability of subjects, the Hawthorne Effect and the Pygmalion Effect. Replication of research before adopting products/devices for protocol use is advocated. PMID:2751832

  10. The biomechanical management of diabetic foot ulcers.

    PubMed

    McGuire, J B; Nawoczenski, D

    The primary goal in the treatment of diabetic foot ulcers is to obtain wound closure as expeditiously as possible and prevent the recurrence of foot wounds due to neuropathy, foot deformity, and poor circulation. Interventions that bring about the quick resolution of afoot wound and reduce the rate of recurrence have been shown to lower the risk of developing a secondary infection and decrease the incidence of lower extremity amputation in the diabetic patient. PMID:15973815

  11. Concordance in diabetic foot ulcer infection

    PubMed Central

    Nelson, E Andrea; Backhouse, Michael Ross; Bhogal, Moninder S; Wright-Hughes, Alexandra; Lipsky, Benjamin A; Nixon, Jane; Brown, Sarah; Gray, Janine

    2013-01-01

    Introduction Accurate identification of pathogens, rather than colonising bacteria, is a prerequisite for targeted antibiotic therapy to ensure optimal patient outcome in wounds, such as diabetic foot ulcers. Wound swabs are the easiest and most commonly used sampling technique but most published guidelines recommend instead removal of a tissue sample from the wound bed, which is a more complex process. The aim of this study was to assess the concordance between culture results from wound swabs and tissue samples in patients with suspected diabetic foot infection. Methods and analysis Patients with a diabetic foot ulcer that is thought to be infected are being recruited from 25 sites across England in a cross-sectional study. The coprimary endpoints for the study are agreement between the two sampling techniques for three microbiological parameters: reported presence of likely isolates identified by the UK Health Protection Agency; resistance of isolates to usual antibiotic agents; and, the number of isolates reported per specimen. Secondary endpoints include appropriateness of the empiric antibiotic therapy prescribed and adverse events. Enrolling 400 patients will provide 80% power to detect a difference of 3% in the reported presence of an organism, assuming organism prevalence of 10%, discordance of 5% and a two-sided test at the 5% level of significance. Assumed overall prevalence is based on relatively uncommon organisms such as Pseudomonas. We will define acceptable agreement as κ>0.6. Ethics and dissemination Concordance in diabetic foot ulcer infection (CODIFI) will produce robust data to evaluate the two most commonly used sampling techniques employed for patients with a diabetic foot infection. This will help determine whether or not it is important that clinicians take tissue samples rather than swabs in infected ulcers. This study has been approved by the Sheffield NRES Committee (Ref: 11/YH/0078) and all sites have obtained local approvals prior starting recruitment. Study registration NRES Ref: 11/YH/0078, UKCRN ID: 10440, ISRCTN: 52608451 PMID:23293263

  12. Endoscopic hemoclip treatment for bleeding peptic ulcer

    PubMed Central

    Lai, Yung Chih; Yang, Sien Sing; Wu, Chi Hwa; Chen, Tzen Kwan

    2000-01-01

    AIM: To evaluate the efficacy of endoscopic hemoclip in the t reatment of bleeding peptic ulcer. METHODS: Totally, 40 patients with F1a and F1b hemorrhagic activity of peptic ulcers were enrolled in this uncontrolled prospective study for e ndoscopic hemoclip treatment. We used a newly developed rotatable clip-device for the application of hemoclip (MD850) to stop bleeding. Endoscopy was repeated if there was any sign or suspicion of rebleeding, and re-clipping was performed if necessary and feasible. RESULTS: Initial hemostatic rate by clipping was 95%, and rebl eeding rate was only 8%. Ultimate hemostatic rates were 87%, 96%, and 93% in the F1a and F1b subgroups, and total cases, respectively. In patients with shock on admission, hemoclipping achieved ultimate hemostasis of 71% and 83% in F1a and F1b subgroups, respectively. Hemostasis reached 100% in patients without shock regardless of hemorrhagic activity being F1a or F1b. The average number of clips used per case was 3.0 (range 2-5). Spurting bleeders required more clips on av erage than did oozing bleeders (3.4 versus 2.8). We observed no obvious co mplications, no tissue injury, or impairment of ulcer healing related to hemocli pping. CONCLUSION: Endoscopic hemoclip placement is an effective and safe method. With the improvement of the clip and application device, the procedu re has become easier and much more efficient. Endoscopic hemoclipping deserves further study in the treatment of bleeding peptic ulcers. PMID:11819522

  13. Crater-Like Ulceration of Aortic Arch

    PubMed Central

    Simon, Caterina; Calabrese, Alice; Canu, Gianluca; Merlo, Maurizio; Galletti, Lorenzo

    2014-01-01

    We report the case of a 78-year-old female who presented to our hospital with signs of hemorrhagic shock and breathlessness. A transthoracic echocardiography demonstrated pericardial effusion. Computed tomography of the chest showed a penetrating atherosclerotic ulcer of the aortic arch with an intramural hematoma of the ascending and descending aorta. Endovascular repair with stent-grafting was urgently performed and a pericardial window placement was done to reduce mediastinal bleeding.

  14. The Sphingosine-1-Phosphate Lyase (LegS2) Contributes to the Restriction of Legionella pneumophila in Murine Macrophages

    PubMed Central

    Abu Khweek, Arwa; Kanneganti, Apurva; C. Guttridge D, Denis; Amer, Amal O.

    2016-01-01

    L. pneumophila is the causative agent of Legionnaires’ disease, a human illness characterized by severe pneumonia. In contrast to those derived from humans, macrophages derived from most mouse strains restrict L. pneumophila replication. The restriction of L. pneumophila replication has been shown to require bacterial flagellin, a component of the type IV secretion system as well as the cytosolic NOD-like receptor (NLR) Nlrc4/ Ipaf. These events lead to caspase-1 activation which, in turn, activates caspase-7. Following caspase-7 activation, the phagosome-containing L. pneumophila fuses with the lysosome, resulting in the restriction of L. pneumophila growth. The LegS2 effector is injected by the type IV secretion system and functions as a sphingosine 1-phosphate lyase. It is homologous to the eukaryotic sphingosine lyase (SPL), an enzyme required in the terminal steps of sphingolipid metabolism. Herein, we show that mice Bone Marrow-Derived Macrophages (BMDMs) and human Monocyte-Derived Macrophages (hMDMs) are more permissive to L. pneumophila legS2 mutants than wild-type (WT) strains. This permissiveness to L. pneumophila legS2 is neither attributed to abolished caspase-1, caspase-7 or caspase-3 activation, nor due to the impairment of phagosome-lysosome fusion. Instead, an infection with the legS2 mutant resulted in the reduction of some inflammatory cytokines and their corresponding mRNA; this effect is mediated by the inhibition of the nuclear transcription factor kappa-B (NF-κB). Moreover, BMDMs infected with L. pneumophila legS2 mutant showed elongated mitochondria that resembles mitochondrial fusion. Therefore, the absence of LegS2 effector is associated with reduced NF-κB activation and atypical morphology of mitochondria. PMID:26741365

  15. The Sphingosine-1-Phosphate Lyase (LegS2) Contributes to the Restriction of Legionella pneumophila in Murine Macrophages.

    PubMed

    Abu Khweek, Arwa; Kanneganti, Apurva; C Guttridge D, Denis; Amer, Amal O

    2016-01-01

    L. pneumophila is the causative agent of Legionnaires' disease, a human illness characterized by severe pneumonia. In contrast to those derived from humans, macrophages derived from most mouse strains restrict L. pneumophila replication. The restriction of L. pneumophila replication has been shown to require bacterial flagellin, a component of the type IV secretion system as well as the cytosolic NOD-like receptor (NLR) Nlrc4/ Ipaf. These events lead to caspase-1 activation which, in turn, activates caspase-7. Following caspase-7 activation, the phagosome-containing L. pneumophila fuses with the lysosome, resulting in the restriction of L. pneumophila growth. The LegS2 effector is injected by the type IV secretion system and functions as a sphingosine 1-phosphate lyase. It is homologous to the eukaryotic sphingosine lyase (SPL), an enzyme required in the terminal steps of sphingolipid metabolism. Herein, we show that mice Bone Marrow-Derived Macrophages (BMDMs) and human Monocyte-Derived Macrophages (hMDMs) are more permissive to L. pneumophila legS2 mutants than wild-type (WT) strains. This permissiveness to L. pneumophila legS2 is neither attributed to abolished caspase-1, caspase-7 or caspase-3 activation, nor due to the impairment of phagosome-lysosome fusion. Instead, an infection with the legS2 mutant resulted in the reduction of some inflammatory cytokines and their corresponding mRNA; this effect is mediated by the inhibition of the nuclear transcription factor kappa-B (NF-?B). Moreover, BMDMs infected with L. pneumophila legS2 mutant showed elongated mitochondria that resembles mitochondrial fusion. Therefore, the absence of LegS2 effector is associated with reduced NF-?B activation and atypical morphology of mitochondria. PMID:26741365

  16. Ulcerative Colitis: A Challenge to Surgeons

    PubMed Central

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

    2012-01-01

    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

  17. Stable operation of an elastic three-segment leg.

    PubMed

    Seyfarth, A; Gnther, M; Blickhan, R

    2001-05-01

    Quasi-elastic operation of joints in multi-segmented systems as they occur in the legs of humans, animals, and robots requires a careful tuning of leg properties and geometry if catastrophic counteracting operation of the joints is to be avoided. A simple three-segment model has been used to investigate the segmental organization of the leg during repulsive tasks like human running and jumping. The effective operation of the muscles crossing the knee and ankle joints is described in terms of rotational springs. The following issues were addressed in this study: (1) how can the joint torques be controlled to result in a spring-like leg operation? (2) how can rotational stiffnesses be adjusted to leg-segment geometry? and (3) to what extend can unequal segment lengths and orientations be advantageous? It was found that: (1) the three-segment leg tends to become unstable at a certain amount of bending expressed by a counterrotation of the joints; (2) homogeneous bending requires adaptation of the rotational stiffnesses to the outer segment lengths; (3) nonlinear joint torque-displacement behaviour extends the range of stable leg bending and may result in an almost constant leg stiffness; (4) biarticular structures (like human gastrocnemius muscle) and geometrical constraints (like heel strike) support homogeneous bending in both joints; (5) unequal segment lengths enable homogeneous bending if asymmetric nominal angles meet the asymmetry in leg geometry; and (6) a short foot supports the elastic control of almost stretched knee positions. Furthermore, general leg design strategies for animals and robots are discussed with respect to the range of safe leg operation. PMID:11357549

  18. A modular network for legged locomotion

    NASA Astrophysics Data System (ADS)

    Golubitsky, Martin; Stewart, Ian; Buono, Pietro-Luciano; Collins, J. J.

    1998-04-01

    In this paper we use symmetry methods to study networks of coupled cells, which are models for central pattern generators (CPGs). In these models the cells obey identical systems of differential equations and the network specifies how cells are coupled. Previously, Collins and Stewart showed that the phase relations of many of the standard gaits of quadrupeds and hexapods can be obtained naturally via Hopf bifurcation in small networks. For example, the networks they used to study quadrupeds all had four cells, with the understanding that each cell determined the phase of the motion of one leg. However, in their work it seemed necessary to employ several different four-oscillator networks to obtain all of the standard quadrupedal gaits. We show that this difficulty with four-oscillator networks is unavoidable, but that the problems can be overcome by using a larger network. Specifically, we show that the standard gaits of a quadruped, including walk, trot and pace, cannot all be realized by a single four-cell network without introducing unwanted conjugacies between trot and pace - conjugacies that imply a dynamic equivalence between these gaits that seems inconsistent with observations. In this sense a single network with four cells cannot model the CPG of a quadruped. We also introduce a single eight-cell network that can model all of the primary gaits of quadrupeds without these unwanted conjugacies. Moreover, this network is modular in that it naturally generalizes to provide models of gaits in hexapods, centipedes, and millipedes. The analysis of models for many-legged animals shows that wave-like motions, similar to those obtained by Kopell and Ermentrout, can be expected. However, our network leads to a prediction that the wavelength of the wave motion will divide twice the length of the animal. Indeed, we reproduce illustrations of wave-like motions in centipedes where the animal is approximately one-and-a-half wavelength long - motions that are consistent with this prediction. We discuss the implications of these results for the development of modular control networks for adaptive legged robots.

  19. Mucosal adenosine deaminase activity and stump ulcer healing.

    PubMed

    Namiot, Z; Namiot, A; Stasiewicz, J; Marcinkiewicz, M; Jaroszewicz, W; Górski, J

    1995-06-01

    Adenosine deaminase activity was studied in endoscopically taken slices from gastric mucosa in patient after partial gastric resection performed due to complicated duodenal ulcer, and currently with peptic ulcer in the stump. The samples of gastric mucosa were taken before and after 6 weeks of treatment with ranitidine, 150 mg twice daily, at a distance within 2 cm and greater than 2 cm from the ulcer crater. Adenosine deaminase activity was measured in mucosa homogenates by determination of ammonia liberated from substrate. It was found that therapy with ranitidine was accompanied by an increase in enzyme activity in the mucosa surrounding unhealed stump ulcers, while no changes were noted in mucosa around healed stump ulcers. A possible role of mucosal adenosine deaminase activity in stump ulcer healing is postulated. PMID:7670131

  20. [Japanese guideline for the management of gastric ulcer].

    PubMed

    Sugano, Kentaro

    2004-07-01

    Japanese guideline for the management of gastric ulcer prepared by a research group supported by government funding was published in 2003 as a concise book for use in general practice. Overall management strategy classified based on etiology of ulcer was shown as a flow chart. Recommendation of treatment strategy for NSAID ulcer with PPI, and for H. pylori-positive gastric ulcer with eradication therapy are in line with internationally acknowledged consensus. A number of so-called mucoprotective drugs most of which are available in Japanese market alone, however, were given low priority when choosing single regimen, and their use in combination with acid suppressant, the most popular ulcer regimens in Japan, was not recommended due to lack of reliable evidence. Though it will take some time for general physicians to widely adopt this guideline, it undoubtedly will serve for reasonable gastric ulcer management in Japan. PMID:15283160

  1. Experimental anti-ulcer activity of Veronica officinalis L. extracts.

    PubMed

    Scarlat, M; Sandor, V; T?ma?, M; Cuparencu, B

    1985-05-01

    In indomethacin-induced ulcers in albino rats, the anti-ulcerogenic effects of some extracts prepared from Veronica officinalis L. were investigated. The extracts had a significant anti-ulcerogenic activity. In ulcer healing experiments performed in rats by administering reserpine, the extracts were found to enhance the regeneration of the gastric mucosa. These results seem to confirm the popular observations according to which the decoction from Veronica officinalis L. possessed useful properties in the treatment of gastric ulcers. PMID:4021513

  2. Series Elastic Actuators for legged robots

    NASA Astrophysics Data System (ADS)

    Pratt, Jerry E.; Krupp, Benjamin T.

    2004-09-01

    Series Elastic Actuators provide many benefits in force control of robots in unconstrained environments. These benefits include high force fidelity, extremely low impedance, low friction, and good force control bandwidth. Series Elastic Actuators employ a novel mechanical design architecture which goes against the common machine design principal of "stiffer is better." A compliant element is placed between the gear train and driven load to intentionally reduce the stiffness of the actuator. A position sensor measures the deflection, and the force output is accurately calculated using Hooke"s Law (F=Kx). A control loop then servos the actuator to the desired output force. The resulting actuator has inherent shock tolerance, high force fidelity and extremely low impedance. These characteristics are desirable in many applications including legged robots, exoskeletons for human performance amplification, robotic arms, haptic interfaces, and adaptive suspensions. We describe several variations of Series Elastic Actuators that have been developed using both electric and hydraulic components.

  3. Concrete hulls for tension-leg platforms

    SciTech Connect

    De Oliveira, J.G. ); Fjeld, S. )

    1990-06-01

    This paper describes the main features of a concrete-hull tension-leg-platform (TLP) concept developed for the Heidrun field in the Haltenbanken area of the Norwegian sector of the North Sea. The hydrodynamic response and the methods adopted to optimize the hull dimensions, as well as the mooring system and hull mechanical outfitting, are discussed first. Then construction methods are briefly described. Inspection, maintenance, and repair are also addressed. Finally, the advantages of the concrete-hull TLP concept are summarized, including the concrete hull's adaptability to a large range of design requirements, low cost, and short construction time. This paper shows that the concrete-hull TLP is a very cost-efficient solution for the development of deepwater fields.

  4. Gabapentin Enacarbil: Pharmacotherapy of Restless Legs Syndrome

    PubMed Central

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

    2010-01-01

    Restless Legs Syndrome (RLS) is a prevalent sleep-associated movement disorder greatly affecting patients’ quality of life (QoL). Several drugs can be used to control this condition although the first-line dopamine agents often cause adverse effects. Non-dopaminergic drugs such as oral gabapentin (GBP) have been more recently advocated. Despite ameliorating RLS symptoms, GBP’s pharmacokinetic limitations restrict its overall effectiveness. A novel specifically designed prodrug, gabapentin enacarbil (GE), has demonstrated successful RLS alleviation with a superior pharmacokinetic profile. This review aims to examine the efficacy and tolerability of both GBP and GE as pharmacotherapy for RLS. Despite some heterogeneity and limitations across research methodologies, GE appears to be a potential RLS therapy superior to GBP and other dopaminergic agents. PMID:23861631

  5. When restless legs syndrome turns malignant.

    PubMed

    Schulte, Eva C; Gross, Nadine; Slawik, Helen; Winkelmann, Juliane

    2013-06-01

    Usually symptoms of restless legs syndrome (RLS) respond well to treatment with dopaminergic drugs, opiates, or anticonvulsant medications. Yet sometimes symptoms can be severe and become refractory, even to high-dose combination therapy. Here we present two cases of familial RLS with rigorous and unusual motor and sensory symptoms in the form of episodes of myoclonic hyperkinesias and painful sensations in addition to more characteristic features of RLS. Stepwise reduction of all RLS-and antidepressant medication down to opiate monotherapy-and subsequent opiate rotation led to an improvement of symptoms. Yet in both cases, reintroduction of low-dose dopaminergic drugs was necessary to achieve satisfactory treatment effect. We have termed this form of RLS refractory to multiple combinations of all classes of commonly used drugs malignant RLS. Therapeutically simplification and reduction of the drug scheme and opiate rotation should be considered in malignant RLS. PMID:23643657

  6. Adult Sacrococcygeal Teratoma: The third leg

    PubMed Central

    Yekula, M.S. Kiran Kumar; Yekula, Anudeep

    2015-01-01

    Introduction Sacrococcygeal Teratoma (SCT) is a rare benign neoplasm comprised of mixed elements derived from two or more germ cell layers. They are extremely rare in adults. They attract attention because of their gross appearance and bizarre histology. Presentation of case A 25 year old male presented to Surgical OPD, Government General Hospital, Guntur Medical College, Guntur with a large mass comprising a partially developed 3rd leg and rudimentary external genitalia in the lower back. He complained of cosmetic blemish, difficulty in sitting, sleeping and walking. Discussion He was diagnosed mature Sacrococcygeal Teratoma Altman Type II based on history, clinical examination, ultrasound, MRI. Histopathology confirmed the diagnosis. He had complete surgical excision with primary wound closure and a good postoperative recovery. A 3-year follow-up using clinical, biochemical and radiological assessment revealed no evidence of recurrence. Conclusion Mature SCT, though very rare in adults, are usually benign. Complete surgical excision remains the mainstay of treatment. PMID:26275739

  7. How critical is chronic critical leg ischaemia?

    PubMed

    Kroese, A J; Stranden, E

    1998-01-01

    "Critical" according to the Oxford dictionary means: a "turning point" where an acute change for better or worse may be anticipated. Thus, the meaning of the word "critical" complies with its use in relation to ischaemia. We don't really know, prospectively, what will happen to the critically ischaemic limb, whether it will improve or worsen. The answer to the question "How critical is critical leg ischaemia (CLI)?" must be: "We don't know!" The addition of ankle systolic pressure as an objective haemodynamic measurement has not made the definition of the Second European Consensus Group significantly better than the original Fontaine classification, grade III and IV. For clinical practice the Fontaine classification will be sufficient. For scientific purposes macro- and microcirculatory assessments and information about the patient's risk profile should be added. PMID:9676324

  8. Restless legs syndrome: pathophysiology and modern management.

    PubMed

    Nagandla, Kavitha; De, Somsubhra

    2013-07-01

    Restless legs syndrome (RLS) is a common sensory motor neurological disorder that is characterised by an irresistible urge to move the legs that significantly affects the quality of life of the patient. Prevalence in the general population is 5-25% and it is twice as prevalent in women as in men. RLS is the most common movement disorder in pregnancy with a fourfold increased risk of developing this disorder later in life. The pathophysiology of RLS is centred on dopaminergic dysfunction, reduced central nervous system iron, genetic linkages, or alteration in neurotransmitters such as hypocretins, endorphins levels and immune dysfunction and inflammatory mechanisms. With the emergence of new evidence, there are changes to the previous treatment recommendations for RLS. There is sufficient evidence to conclude that dopamine agonists such as rotigotine transdermal patch, pramipexole, ropinirole, gabapentin enacarbil, pregabalin and gabapentin are effective in the short-term treatment of RLS and rotigotine, followed by gabapentin enacarbil, ropinirole, pramipexole and gabapentin for long-term treatment. Based on expert consensus, the recommendation for daily RLS is dopamine agonists or gabapentin or low-potency opioids. Levodopa is less preferred for treating daily RLS due to its high risk of augmentation. For intermittent RLS, it is levodopa or dopamine agonists or low-potency opioids or benzodiazepines. For refractory RLS, the choice is to change to gabapentin or a different dopamine agonist, addition of a second agent like gabapentin or benzodiazepine to the existing drug or changing to a high-potency opioid or tramadol. Medications with safety record in pregnancy include opioids and antiepileptics such as carbamazepine and gabapentin. There are concerns that patients with RLS are at risk for metabolic deregulation, autonomic dysfunction and cardiovascular morbidity. However, a recent study concluded that RLS is not associated with increased risk of cardiovascular complications. PMID:23524988

  9. ODYSSEUS autonomous walking robot: The leg/arm design

    NASA Technical Reports Server (NTRS)

    Bourbakis, N. G.; Maas, M.; Tascillo, A.; Vandewinckel, C.

    1994-01-01

    ODYSSEUS is an autonomous walking robot, which makes use of three wheels and three legs for its movement in the free navigation space. More specifically, it makes use of its autonomous wheels to move around in an environment where the surface is smooth and not uneven. However, in the case that there are small height obstacles, stairs, or small height unevenness in the navigation environment, the robot makes use of both wheels and legs to travel efficiently. In this paper we present the detailed hardware design and the simulated behavior of the extended leg/arm part of the robot, since it plays a very significant role in the robot actions (movements, selection of objects, etc.). In particular, the leg/arm consists of three major parts: The first part is a pipe attached to the robot base with a flexible 3-D joint. This pipe has a rotated bar as an extended part, which terminates in a 3-D flexible joint. The second part of the leg/arm is also a pipe similar to the first. The extended bar of the second part ends at a 2-D joint. The last part of the leg/arm is a clip-hand. It is used for selecting several small weight and size objects, and when it is in a 'closed' mode, it is used as a supporting part of the robot leg. The entire leg/arm part is controlled and synchronized by a microcontroller (68CH11) attached to the robot base.

  10. Optimal management of digital ulcers in systemic sclerosis

    PubMed Central

    Abraham, Shawn; Steen, Virginia

    2015-01-01

    Raynaud’s phenomenon and digital ulcerations are two common clinical features seen in patients with systemic sclerosis. They are painful and lead to significant morbidity and altered hand function within this patient population. While currently there are no US Food and Drug Administration (FDA)-approved medications for the treatment of digital ulcerations in the United States, clinical trials have supported the use of pharmacologic and nonpharmacologic modalities in facilitating healing of existing digital ulcers and preventing formation of new ulcers. This article reviews the published data on these therapeutic options. PMID:26109864

  11. Incidence and clinical features of endoscopic ulcers developing after gastrectomy

    PubMed Central

    Chung, Woo Chul; Jeon, Eun Jung; Lee, Kang-Moon; Paik, Chang Nyol; Jung, Sung Hoon; Oh, Jung Hwan; Kim, Ji Hyun; Jun, Kyong-Hwa; Chin, Hyung Min

    2012-01-01

    AIM: To determine the precise incidence and clinical features of endoscopic ulcers following gastrectomy. METHODS: A consecutive series of patients who underwent endoscopic examination following gastrectomy between 2005 and 2010 was retrospectively analyzed. A total of 78 patients with endoscopic ulcers and 759 without ulcers following gastrectomy were enrolled. We analyzed differences in patient age, sex, size of the lesions, method of operation, indications for gastric resection, and infection rates of Helicobacter pylori (H. pylori) between the nonulcer and ulcer groups. RESULTS: The incidence of endoscopic ulcers after gastrectomy was 9.3% and that of marginal ulcers was 8.6%. Ulcers were more common in patients with Billroth II anastomosis and pre-existing conditions for peptic ulcer disease (PUD). Infection rates of H. pyloridid not differ significantly between the two groups. The patients who underwent operations to treat PUD had lower initial levels of hemoglobin and higher rates of hospital admission. CONCLUSION: H. pylori was not an important factor in ulcerogenesis following gastrectomy. For patients who underwent surgery for PUD, clinical course of marginal ulcers was more severe. PMID:22783050

  12. Familial association between coeliac disease and ulcerative colitis: preliminary communication.

    PubMed Central

    Mayberry, J F; Smart, H L; Toghill, P J

    1986-01-01

    One hundred and twenty patients who were members of the Nottinghamshire Coeliac Group completed a questionnaire about the occurrence of coeliac disease, ulcerative colitis and Crohn's disease amongst first-degree relatives. Siblings were at a 20-fold risk of developing coeliac disease and a 15-fold risk of developing ulcerative colitis, and significantly increased risks for these two conditions were also seen in other family members. The relatives of patients with coeliac disease are at increased risk not only of developing coeliac disease but also ulcerative colitis. This provides further support for a possible role of a dietary allergen in the development of ulcerative colitis. PMID:3701765

  13. Device-related atypical pressure ulcer after cardiac surgery.

    PubMed

    Glasgow, D; Millen, I S; Nzewi, O C; Varadarajaran, B

    2014-08-01

    Medical devices must be closely monitored to prevent harm to patients. Pressure ulcers secondary to medical devices present a significant health burden in terms of length of stay in hospital and cost. Intensivists, anaesthetists and other professionals involved in managing critically ill patients following cardiac surgery need to be aware that pressure ulcers may develop in atypical sites and present at a later stage of the hospital stay. This case report highlights the important issue of device-related pressure ulcers in the cardiac surgical intensive care setting, particularly when the clinical status of the patient may preclude routine assessment and prophylaxis. An algorithm for preventing such pressure ulcers is suggested. PMID:25139595

  14. A three-leg model producing tetrapod and tripod coordination patterns of ipsilateral legs in the stick insect.

    PubMed

    Tóth, T I; Daun-Gruhn, S

    2016-02-01

    Insect locomotion requires the precise coordination of the movement of all six legs. Detailed investigations have revealed that the movement of the legs is controlled by local dedicated neuronal networks, which interact to produce walking of the animal. The stick insect is well suited to experimental investigations aimed at understanding the mechanisms of insect locomotion. Beside the experimental approach, models have also been constructed to elucidate those mechanisms. Here, we describe a model that replicates both the tetrapod and tripod coordination pattern of three ipsilateral legs. The model is based on an earlier insect leg model, which includes the three main leg joints, three antagonistic muscle pairs, and their local neuronal control networks. These networks are coupled via angular signals to establish intraleg coordination of the three neuromuscular systems during locomotion. In the present three-leg model, we coupled three such leg models, representing front, middle, and hind leg, in this way. The coupling was between the levator-depressor local control networks of the three legs. The model could successfully simulate tetrapod and tripod coordination patterns, as well as the transition between them. The simulations showed that for the interleg coordination during tripod, the position signals of the levator-depressor neuromuscular systems sent between the legs were sufficient, while in tetrapod, additional information on the angular velocities in the same system was necessary, and together with the position information also sufficient. We therefore suggest that, during stepping, the connections between the levator-depressor neuromuscular systems of the different legs are of primary importance. PMID:26581871

  15. Laboratory on legs: an architecture for adjustable morphology with legged robots

    NASA Astrophysics Data System (ADS)

    Haynes, G. Clark; Pusey, Jason; Knopf, Ryan; Johnson, Aaron M.; Koditschek, Daniel E.

    2012-06-01

    For mobile robots, the essential units of actuation, computation, and sensing must be designed to fit within the body of the robot. Additional capabilities will largely depend upon a given activity, and should be easily reconfigurable to maximize the diversity of applications and experiments. To address this issue, we introduce a modular architecture originally developed and tested in the design and implementation of the X-RHex hexapod that allows the robot to operate as a mobile laboratory on legs. In the present paper we will introduce the specification, design and very earliest operational data of Canid, an actively driven compliant-spined quadruped whose completely different morphology and intended dynamical operating point are nevertheless built around exactly the same "Lab on Legs" actuation, computation, and sensing infrastructure. We will review as well, more briefly a second RHex variation, the XRL platform, built using the same components.

  16. Gender Differences in Leg Stiffness and Stiffness Recruitment Strategy During Two-Legged Hopping

    PubMed Central

    Padua, Darin A.; Arnold, Brent L.; Carcia, Christopher R.; Granata, Kevin P.

    2006-01-01

    The authors compared leg stiffness (KVERT), muscle activation, and joint movement patterns between 11 men and 10 women during hopping. Physically active and healthy men and women performed continuous 2-legged hopping at their preferred rate and at 3.0 Hz. Compared with men, women demonstrated decreased KVERT; however, after the authors normalized for body mass, gender differences in KVERT were eliminated. In comparison with men, women also demonstrated increased quadriceps and soleus activity, as well as greater quadriceps-to-hamstrings coactivation ratios. There were no significant gender differences for joint movement patterns (p > .05). The relationship between the observed gender differences in muscle recruitment and the increased risk of anterior cruciate ligament injury in women requires further study. PMID:15730945

  17. A terradynamics of legged locomotion on granular media.

    PubMed

    Li, Chen; Zhang, Tingnan; Goldman, Daniel I

    2013-03-22

    The theories of aero- and hydrodynamics predict animal movement and device design in air and water through the computation of lift, drag, and thrust forces. Although models of terrestrial legged locomotion have focused on interactions with solid ground, many animals move on substrates that flow in response to intrusion. However, locomotor-ground interaction models on such flowable ground are often unavailable. We developed a force model for arbitrarily-shaped legs and bodies moving freely in granular media, and used this "terradynamics" to predict a small legged robot's locomotion on granular media using various leg shapes and stride frequencies. Our study reveals a complex but generic dependence of stresses in granular media on intruder depth, orientation, and movement direction and gives insight into the effects of leg morphology and kinematics on movement. PMID:23520106

  18. Adaptive leg coordination with a biologically inspired neurocontroller

    NASA Astrophysics Data System (ADS)

    Braught, Grant; Thomopoulos, Stelios C.

    1996-10-01

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

  19. Rembrandt's 'Beggar with a wooden leg' and other comparable prints.

    PubMed

    ten Kate, J J; Jennekens, F G I; Vos-Niël, J M E

    2009-02-01

    Rembrandt's etching of a beggar with a wooden leg is notable because the two lower limbs of the presumed beggar are present and not deformed. Using the facilities of four specialised Dutch art institutes, we carried out a systematic investigation to find other etchings and engravings of subjects with artificial legs supporting non-amputated limbs, from the period 1500 to 1700 AD. We discovered 28 prints produced by at least 18 artists. Several offered clues to a disorder of a knee, the lower leg or the foot. All individuals were adult males, suggesting the probability of traumatic lesions. We conclude that in this period artificial legs were not only used in the case of absence of part of a lower limb, but also for other reasons, notably disorders of the knee, lower leg or foot. They may also have been used to attract compassion. PMID:19190068

  20. Protection against high intravascular pressure in giraffe legs.

    PubMed

    Petersen, Karin K; Hørlyck, Arne; Ostergaard, Kristine H; Andresen, Joergen; Broegger, Torbjoern; Skovgaard, Nini; Telinius, Niklas; Laher, Ismael; Bertelsen, Mads F; Grøndahl, Carsten; Smerup, Morten; Secher, Niels H; Brøndum, Emil; Hasenkam, John M; Wang, Tobias; Baandrup, Ulrik; Aalkjaer, Christian

    2013-11-01

    The high blood pressure in giraffe leg arteries renders giraffes vulnerable to edema. We investigated in 11 giraffes whether large and small arteries in the legs and the tight fascia protect leg capillaries. Ultrasound imaging of foreleg arteries in anesthetized giraffes and ex vivo examination revealed abrupt thickening of the arterial wall and a reduction of its internal diameter just below the elbow. At and distal to this narrowing, the artery constricted spontaneously and in response to norepinephrine and intravascular pressure recordings revealed a dynamic, viscous pressure drop along the artery. Histology of the isolated median artery confirmed dense sympathetic innervation at the narrowing. Structure and contractility of small arteries from muscular beds in the leg and neck were compared. The arteries from the legs demonstrated an increased media thickness-to-lumen diameter ratio, increased media volume, and increased numbers of smooth muscle cells per segment length and furthermore, they contracted more strongly than arteries from the neck (500 ± 49 vs. 318 ± 43 mmHg; n = 6 legs and neck, respectively). Finally, the transient increase in interstitial fluid pressure following injection of saline was 5.5 ± 1.7 times larger (n = 8) in the leg than in the neck. We conclude that 1) tissue compliance in the legs is low; 2) large arteries of the legs function as resistance arteries; and 3) structural adaptation of small muscle arteries allows them to develop an extraordinary tension. All three findings can contribute to protection of the capillaries in giraffe legs from a high arterial pressure. PMID:24005251

  1. Rectal ulcer with an elusive diagnosis: all that ulcers is not Crohn disease

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A single rectal ulcer is an uncommon finding in children with gastrointestinal disease. Although inflammatory bowel disease (IBD) is foremost among the differential diagnoses, a primary immunological defect should not be forgotten. Because of the paucity of literature on the association of rectal ul...

  2. Feeding Tubes and the Prevention or Healing of Pressure Ulcers

    PubMed Central

    Teno, Joan M.; Gozalo, Pedro; Mitchell, Susan L.; Kuo, Sylvia; Fulton, Ana T.; Mor, Vincent

    2013-01-01

    Background The evidence regarding the use of feeding tubes in persons with advanced dementia to prevent or heal pressure ulcers is conflicting. Using national data, we set out to determine whether percutaneous endoscopic gastrostomy (PEG) tubes prevent or help heal pressure ulcers in nursing home (NH) residents with advanced cognitive impairment (ACI). Methods A propensity-matched cohort study of NH residents with ACI and recent need for assistance in eating was conducted by matching each NH resident who had a feeding tube inserted during a hospitalization to 3 without a PEG tube inserted. Using the Minimum Data Set (MDS), we examined 2 outcomes: first, whether residents without a pressure ulcer developed a stage 2 or higher pressure ulcer (n=1124 with PEG insertion); and second, whether NH residents with a pressure ulcer (n=461) experienced improvement of the pressure ulcer by their first posthospitalization MDS assessment (mean [SD] time between evaluations, 24.6 [32.7] days). Results Matched residents with and without a PEG insertion showed comparable sociodemographic characteristic, rates of feeding tube risk factors, and mortality. Adjusted for risk factors, hospitalized NH residents receiving a PEG tube were 2.27 times more likely to develop a new pressure ulcer (95% CI, 1.952.65). Conversely, those with a pressure ulcer were less likely to have the ulcer heal when they had a PEG tube inserted(OR 0.70 [95% CI, 0.550.89]). Conclusions Feeding tubes are not associated with prevention or improved healing of a pressure ulcer. Rather, our findings suggest that the use of PEG tube is associated with increased risk of pressure ulcers among NH residents with ACI. PMID:22782196

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

    PubMed Central

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

    2004-01-01

    AIM: Helicobacter pylori causes chronic gastritis, peptic ulcer, gastric cancer and MALT-lymphoma. Different genotypes of Helicobacter pylori are confirmed from diverse geographic areas. Its association with bleeding peptic ulcer remains controversial. The aim of this study was to investigate the Helicobacter pylori vacA alleles, cagA and iceA in patients with bleeding peptic ulcer. METHODS: We enrolled patients with bleeding, non-bleeding peptic ulcers and chronic gastritis. Biopsy specimens were obtained from the antrum of the stomach for rapid urease test, bacterial culture and PCR assay. DNA extraction and polymerase chain reaction were used to detect the presence or absence of cagA and to assess the polymorphism of vacA and iceA. RESULTS: A total of 168 patients (60.4%) (25 patients with chronic gastritis, 26 patients with bleeding gastric ulcer, 51 patients with non-bleeding gastric ulcer, 26 patients with bleeding duodenal ulcer, and 40 patients with non-bleeding duodenal ulcer) were found to have positive PCR results between January 2001 and December 2002. Concerning genotypes, we found cagA (139/278, 50%), vacA s1a (127/278, 45.7%), and ice A1 (125/278, 45%) predominated in all studied patients. In patients with bleeding peptic ulcers, vacA s1a and m1T were fewer than those in patients with non-bleeding peptic ulcers (37/106 vs 69/135, P = 0.017, and 4/106 vs 21/135, P = 0.002). CONCLUSION: In patients with peptic ulcers, H pylori vacA s1a and m1T prevent bleeding complication. PMID:14966926

  4. Impact of Facial Conformation on Canine Health: Corneal Ulceration

    PubMed Central

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

    2015-01-01

    Concern has arisen in recent years that selection for extreme facial morphology in the domestic dog may be leading to an increased frequency of eye disorders. Corneal ulcers are a common and painful eye problem in domestic dogs that can lead to scarring and/or perforation of the cornea, potentially causing blindness. Exaggerated juvenile-like craniofacial conformations and wide eyes have been suspected as risk factors for corneal ulceration. This study aimed to quantify the relationship between corneal ulceration risk and conformational factors including relative eyelid aperture width, brachycephalic (short-muzzled) skull shape, the presence of a nasal fold (wrinkle), and exposed eye-white. A 14 month cross-sectional study of dogs entering a large UK based small animal referral hospital for both corneal ulcers and unrelated disorders was carried out. Dogs were classed as affected if they were diagnosed with a corneal ulcer using fluorescein dye while at the hospital (whether referred for this disorder or not), or if a previous diagnosis of corneal ulcer(s) was documented in the dogs’ histories. Of 700 dogs recruited, measured and clinically examined, 31 were affected by corneal ulcers. Most cases were male (71%), small breed dogs (mean± SE weight: 11.4±1.1 kg), with the most commonly diagnosed breed being the Pug. Dogs with nasal folds were nearly five times more likely to be affected by corneal ulcers than those without, and brachycephalic dogs (craniofacial ratio <0.5) were twenty times more likely to be affected than non-brachycephalic dogs. A 10% increase in relative eyelid aperture width more than tripled the ulcer risk. Exposed eye-white was associated with a nearly three times increased risk. The results demonstrate that artificially selecting for these facial characteristics greatly heightens the risk of corneal ulcers, and such selection should thus be discouraged to improve canine welfare. PMID:25969983

  5. Failure of colonoscopic surveillance in ulcerative colitis.

    PubMed Central

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

    1993-01-01

    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 examinations reached the right colon. There was no procedure related death. One Dukes's A cancer was detected. Forty one patients (25%) defaulted. Of these 25 remain well; 13 are unaccounted for, and one died from colonic cancer. One patient had colectomy for medical reasons, and another died of carcinoma of the pancreas. Retrospectively an additional 16 eligible patients were identified who had not been recruited. Of these, 14 remain well, two are unaccounted for. None developed colonic cancer. Four patients refused colonoscopy. All remain well. Over the same period seven other cases of colonic cancer were found in association with ulcerative colitis, two in patients who had erroneously been diagnosed as having only proctitis and were therefore not entered into the programme, but were found at operation to have total colitis, one in a patient with colitis of seven years duration, and four patients who had previously attended the clinic but had been lost to follow up before 1978 and then had represented with new symptoms during the surveillance period. Thus, of the nine colitis related cancers diagnosed in this centre during the study period only one was detected by the surveillance programme. The results of this large study, a a review of published works, cast doubts on the effectiveness of colonoscopic surveillance programmes in detecting colorectal cancer in patients with ulcerative colitis. PMID:8174957

  6. Don't break a leg: running birds from quail to ostrich prioritise leg safety and economy on uneven terrain

    PubMed Central

    Birn-Jeffery, Aleksandra V.; Hubicki, Christian M.; Blum, Yvonne; Renjewski, Daniel; Hurst, Jonathan W.; Daley, Monica A.

    2014-01-01

    Cursorial ground birds are paragons of bipedal running that span a 500-fold mass range from quail to ostrich. Here we investigate the task-level control priorities of cursorial birds by analysing how they negotiate single-step obstacles that create a conflict between body stability (attenuating deviations in body motion) and consistent leg force–length dynamics (for economy and leg safety). We also test the hypothesis that control priorities shift between body stability and leg safety with increasing body size, reflecting use of active control to overcome size-related challenges. Weight-support demands lead to a shift towards straighter legs and stiffer steady gait with increasing body size, but it remains unknown whether non-steady locomotor priorities diverge with size. We found that all measured species used a consistent obstacle negotiation strategy, involving unsteady body dynamics to minimise fluctuations in leg posture and loading across multiple steps, not directly prioritising body stability. Peak leg forces remained remarkably consistent across obstacle terrain, within 0.35 body weights of level running for obstacle heights from 0.1 to 0.5 times leg length. All species used similar stance leg actuation patterns, involving asymmetric force–length trajectories and posture-dependent actuation to add or remove energy depending on landing conditions. We present a simple stance leg model that explains key features of avian bipedal locomotion, and suggests economy as a key priority on both level and uneven terrain. We suggest that running ground birds target the closely coupled priorities of economy and leg safety as the direct imperatives of control, with adequate stability achieved through appropriately tuned intrinsic dynamics. PMID:25355848

  7. Don't break a leg: running birds from quail to ostrich prioritise leg safety and economy on uneven terrain.

    PubMed

    Birn-Jeffery, Aleksandra V; Hubicki, Christian M; Blum, Yvonne; Renjewski, Daniel; Hurst, Jonathan W; Daley, Monica A

    2014-11-01

    Cursorial ground birds are paragons of bipedal running that span a 500-fold mass range from quail to ostrich. Here we investigate the task-level control priorities of cursorial birds by analysing how they negotiate single-step obstacles that create a conflict between body stability (attenuating deviations in body motion) and consistent leg force-length dynamics (for economy and leg safety). We also test the hypothesis that control priorities shift between body stability and leg safety with increasing body size, reflecting use of active control to overcome size-related challenges. Weight-support demands lead to a shift towards straighter legs and stiffer steady gait with increasing body size, but it remains unknown whether non-steady locomotor priorities diverge with size. We found that all measured species used a consistent obstacle negotiation strategy, involving unsteady body dynamics to minimise fluctuations in leg posture and loading across multiple steps, not directly prioritising body stability. Peak leg forces remained remarkably consistent across obstacle terrain, within 0.35 body weights of level running for obstacle heights from 0.1 to 0.5 times leg length. All species used similar stance leg actuation patterns, involving asymmetric force-length trajectories and posture-dependent actuation to add or remove energy depending on landing conditions. We present a simple stance leg model that explains key features of avian bipedal locomotion, and suggests economy as a key priority on both level and uneven terrain. We suggest that running ground birds target the closely coupled priorities of economy and leg safety as the direct imperatives of control, with adequate stability achieved through appropriately tuned intrinsic dynamics. PMID:25355848

  8. Recurrent oral ulcers--an overview.

    PubMed

    Gaffar, A

    2001-01-01

    Recurrent oral ulcers (ROUs) are the most common oral mucosal disease. The etiology of ROUs is complex. The factors include mechanical trauma, genetics, stress, smoking, and viral and bacterial infections. Treatment modalities depend on the differential diagnosis of ROUs and could consist of antimicrobial agents, anti-inflammatory agents, immunomodulators, or over-the-counter medications. New therapy available in the form of a coating polymer, Colgate ORABASE Soothe.N.Seal, is clinically proven to provide rapid relief and healing of ROUs. PMID:11915640

  9. Epithelial Cell Apoptosis in Recurrent Aphthous Ulcers.

    PubMed

    Al-Samadi, A; Drozd, A; Salem, A; Hietanen, J; Hyrinen-Immonen, R; Konttinen, Y T

    2015-07-01

    A recurrent aphthous ulcer (RAU) is a common inflammatory ulcerative lesion affecting oral mucosa. We studied the eventual apoptosis of epithelial cells from the point of view of ulcer and inflammation. RAU lesions and healthy mucosa samples were immunostained for caspase-3 and high-mobility group box 1 (HMGB1). DNA nicks were identified using TUNEL staining. We studied the effects of tumor necrosis factor ? (TNF?) and interferon ? (IFN?) on the toll-like receptor 2 and 4 (TLR2 and TLR4) expression of human oral SCC-25 keratinocytes. We also studied the effects of self-DNA, all-thiol-HMGB1, and disulfide-HMGB1 on epithelial cells, with or without IFN?. At the edge of RAU lesions, all epithelial cell layers were caspase-3(+), TUNEL(+), and HMGB-1(+) and had widened intercellular spaces. In contrast, healthy epithelial cells were negative for caspase-3 and TUNEL staining. HMGB1 was seen in only the basal cell layers, and the cells retained close cell-to-cell contacts. Self-DNA increased TNF-? mRNA (P = 0.02) in SCC-25 cells. Both TNF? and IFN? (P = 0.01) increased TLR2. Upon TNF? stimulation, SCC-25 cells lost their nuclear HMGB1 staining. HMGB1 did not increase IL-8, IL-6, or TNF-? mRNA in SCC-25 cells, which was unaffected by the presence of IFN?. We conclude that in healthy epithelium, the most superficial cells at the end of their life cycle are simply desquamated. In contrast, RAU is characterized by top-to-bottom apoptosis such that dead cells may slough off, leading to an ulcer. Because of a lack of scavenging anti-inflammatory macrophages, apoptotic cells probably undergo secondary necrosis releasing proinflammatory danger signals, which may contribute to the peripheral inflammatory halo. This is supported by self-DNA-induced TNF? synthesis. In contrast to TLR4- and TLR2-binding lipopolysaccharide used as a positive control, disulfide-HMGB1 did not stimulate proinflammatory cytokines. PMID:25861801

  10. Spinal cord injury pressure ulcer treatment: an experience-based approach.

    PubMed

    Sunn, Gabriel

    2014-08-01

    Pressure ulcers continue to impact the lives of spinal cord injury patients severely. Pressure ulcers must be accurately staged according to National Pressure Ulcer Advisory recommendations before treatment design. The first priority in treatment of pressure ulcers is offloading. Intact skin ulcers may be treated with noncontact nonthermal low-frequency ultrasound. Superficial pressure ulcers may be treated with a combination of collagenase and foam dressings. Deeper pressure ulcers warrant negative-pressure wound therapy dressings along with biologic adjuncts to fill in wound depth. Discovery and treatment of osteomyelitis is a high priority when initially evaluating pressure ulcers. Surgical intervention must always be considered. PMID:25064794

  11. Study of a Monoclonal Antibody KHK4083 in Moderate Ulcerative Colitis

    ClinicalTrials.gov

    2016-01-28

    Ulcerative Colitis; Digestive System Diseases; Colitis, Ulcerative; Colitis; Gastrointestinal Diseases; Inflammatory Bowel Diseases; Intestinal Diseases; Colonic Diseases; Autoimmune Disease; Abdominal Pain

  12. Compliant leg behaviour explains basic dynamics of walking and running.

    PubMed

    Geyer, Hartmut; Seyfarth, Andre; Blickhan, Reinhard

    2006-11-22

    The basic mechanics of human locomotion are associated with vaulting over stiff legs in walking and rebounding on compliant legs in running. However, while rebounding legs well explain the stance dynamics of running, stiff legs cannot reproduce that of walking. With a simple bipedal spring-mass model, we show that not stiff but compliant legs are essential to obtain the basic walking mechanics; incorporating the double support as an essential part of the walking motion, the model reproduces the characteristic stance dynamics that result in the observed small vertical oscillation of the body and the observed out-of-phase changes in forward kinetic and gravitational potential energies. Exploring the parameter space of this model, we further show that it not only combines the basic dynamics of walking and running in one mechanical system, but also reveals these gaits to be just two out of the many solutions to legged locomotion offered by compliant leg behaviour and accessed by energy or speed. PMID:17015312

  13. Respiratory and leg muscles perceived exertion during exercise at altitude.

    PubMed

    Aliverti, A; Kayser, B; Lo Mauro, A; Quaranta, M; Pompilio, P; Dellac, R L; Ora, J; Biasco, L; Cavalleri, L; Pomidori, L; Cogo, A; Pellegrino, R; Miserocchi, G

    2011-07-31

    We compared the rate of perceived exertion for respiratory (RPE,resp) and leg (RPE,legs) muscles, using a 10-point Borg scale, to their specific power outputs in 10 healthy male subjects during incremental cycle exercise at sea level (SL) and high altitude (HA, 4559 m). Respiratory power output was calculated from breath-by-breath esophageal pressure and chest wall volume changes. At HA ventilation was increased at any leg power output by ? 54%. However, for any given ventilation, breathing pattern was unchanged in terms of tidal volume, respiratory rate and operational volumes of the different chest wall compartments. RPE,resp scaled uniquely with total respiratory power output, irrespectively of SL or HA, while RPE,legs for any leg power output was exacerbated at HA. With increasing respective power outputs, the rate of change of RPE,resp exponentially decreased, while that of RPE,legs increased. We conclude that RPE,resp uniquely relates to respiratory power output, while RPE,legs varies depending on muscle metabolic conditions. PMID:21435397

  14. Dynamics of the support leg in soccer instep kicking.

    PubMed

    Inoue, Koichiro; Nunome, Hiroyuki; Sterzing, Thorsten; Shinkai, Hironari; Ikegami, Yasuo

    2014-01-01

    We aimed to illustrate support leg dynamics during instep kicking to evaluate the role of the support leg action in performance. Twelve male soccer players performed maximal instep kicks. Their motions and ground reaction forces were recorded by a motion capture system and a force platform. Moments and angular velocities of the support leg and pelvis were computed using inverse dynamics. In most joints of the support leg, the moments were not associated with or counteracting the joint motions except for the knee joint. It can be interpreted that the initial knee flexion motion counteracting the extension joint moment has a role to attenuate the shock of landing and the following knee extension motion associated with the extension joint moment indirectly contributes to accelerate the swing of kicking leg. Also, appreciable horizontal rotation of the pelvis coincided with increase of the interaction moment due to the hip joint reaction force on the support leg side. It can be assumed that the interaction moment was the main factor causing the pelvis counter-clockwise rotation within the horizontal plane from the overhead view that precedes a proximal-to-distal sequence of segmental action of the swing leg. PMID:24575753

  15. Human leg design: optimal axial alignment under constraints.

    PubMed

    Gnther, Michael; Keppler, Valentin; Seyfarth, Andr; Blickhan, Reinhard

    2004-06-01

    Alignment of joints with respect to the leg axis reduces the moment arm of external forces and therefore joint torques. Moreover, it affects the gearing of muscle forces and displacements. Thus, it influences tissue stress, cost of support and locomotion, and stability. Assuming that alignment is of general advantage we propose a mathematical criterion quantifying the axial alignment using the static torque equilibrium of a three-segment leg. Using this criterion derived from joint torque minimisation we asked for optimal leg designs (segment lengths and joint angles) at varied leg lengths. The trivial "straight is best" solution is excluded and the configuration space is restricted by geometrical constraints such as the ground contact. For different total leg lengths we could identify different optimal segment length combinations and appropriately adjusted joint angles. The extended human leg configuration characterised by a short foot and a combination of unequal ankle and knee angles emerges as a global optimum from our analysis. For crouched configurations allowing for larger leg extensions an angle symmetrical 1:1:1 segment length combination is best. The plantigrade optimum is enforced by the requirement of the distal segment (foot) being shorter than the opposite outer segment (thigh), as well as by the ground contact constraint. Different (e.g. digitigrade) geometries might be of advantage in different biological contexts with different constraints. The fact that small mammals use a crouched equal segment design implies that other locomotor requirements such as stability, strain rates, and acceleration distance per step might dominate. PMID:15164226

  16. Cimetidine for peptic ulcer in patients with arthritis.

    PubMed Central

    Croker, J R; Cotton, P B; Boyle, A C; Kinsella, P

    1980-01-01

    Patients taking anti-inflammatory drugs for arthritis are prone to dyspepsia, and management of peptic ulcer is difficult because surgery is poorly tolerated. In this open study cimetidine treatment was associated with ulcer healing in 17 out of 21 patients with arthritis even when anti-inflammatory treatment was continued. Remission was maintained for 1 year by continued cimetidine therapy. PMID:7416819

  17. Ulcerative Colitis and Crohn's Disease: Implications for College Health Programs

    ERIC Educational Resources Information Center

    Gelphi, A. P.

    1977-01-01

    The author reviews clinical patterns of inflammatory bowel disorders, establishes a perspective for recognizing ulcerative colitis, ulcerative proctitis, and Crohn's disease in relation to other bowel inflammations, and suggests some epidemiologic strategies for studying etiology, pathogenesis, and natural history of the diseases. (MJB)

  18. [Managing pressure ulcers in palliative care in geriatric units].

    PubMed

    Forasassi, Christine; Meaume, Sylvie

    2015-01-01

    Many elderly people at the end of life, in geriatric units, suffer from pressure ulcers despite preventive care. Measures are put in place in order to prevent the occurrence of new pressure ulcers and to define a local and general treatment strategy for those already occured . The priority remains to relieve the pain and improve the patient's comfort and quality of life. PMID:26027187

  19. Zinc compounds, a new treatment in peptic ulcer.

    PubMed

    Escolar, G; Bulbena, O

    1989-01-01

    Effects of zinc in gastric ulcer have been reviewed through investigations carried out on zinc acexamate (ZAC). ZAC is an organic compound that has been shown to possess an experimental antiulcer effect and a wide therapeutic index, making it a useful drug in the treatment of peptic ulcer disease. ZAC protects from ulceration in several experimental models such as pylorus occlusion, reserpine-induced ulcer, necrotizing agents, PAF-induced ulcer and cold-restraint stress. ZAC first reduces the gastric acid output by inhibiting the mast cell degranulation, an action likely to be mediated through a membrane stabilizing action. Secondly, it enhances the mucosal protection factors by increasing mucus secretion, inhibiting the H+ retrodiffusion and improving microcirculation. ZAC is also effective in acetic acid-induced chronic ulcer, restoring the continuity of the damaged mucosa. Several clinical trials have shown the usefulness of ZAC in acute and maintenance treatment of both gastric and duodenal ulcers. Endoscopic studies showed that ZAC reduced the inflammatory processes (gastritis and duodenitis) associated with ulcer healing. This reduction was statistically significant and not observed with other comparative treatments (H2-antagonists). The observed side-effects were minimal and affected less than 2% of treated patients. The pharmacological profile, clinical effectiveness and good tolerance of ZAC suggest this compound as an interesting option in the treatment of peptic disease. PMID:2661183

  20. Genital ulcers associated with acute Epstein-Barr virus infection.

    PubMed

    Taylor, S; Drake, S M; Dedicoat, M; Wood, M J

    1998-08-01

    To date there have been only five reported cases of females with genital ulceration associated with primary Epstein-Barr virus infection. We describe two further patients and review the clinical features of all seven cases, noting the typical features, particularly purple ulcer margins and systemic symptoms, which should alert the physician to consider this diagnosis. PMID:9924475

  1. Genital ulcers associated with acute Epstein-Barr virus infection

    PubMed Central

    Taylor, S.; Drake, S. M.; Dedicoat, M.; Wood, M. J.

    1998-01-01

    To date there have been only five reported cases of females with genital ulceration associated with primary Epstein-Barr virus infection. We describe two further patients and review the clinical features of all seven cases, noting the typical features, particularly purple ulcer margins and systemic symptoms, which should alert the physician to consider this diagnosis. ??? PMID:9924475

  2. Dressings for Preventing Pressure Ulcers: A Meta-analysis.

    PubMed

    Huang, Lei; Woo, Kevin Y; Liu, Li-Bao; Wen, Rui-Juan; Hu, Ai-Ling; Shi, Cheng-Gang

    2015-06-01

    The purpose of this analysis is to determine the effectiveness of dressing material in the prevention of pressure ulcers. Results showed that hydrocolloid, foam, and film were more effective than a standard care protocol in patients at risk for pressure ulcers. PMID:25988736

  3. Acute necrotising ulcerative gingivitis in an immunocompromised young adult.

    PubMed

    Hu, Jessie; Kent, Paul; Lennon, Joshua M; Logan, Latania K

    2015-01-01

    Acute necrotising ulcerative gingivitis is an acute onset disease characterised by ulceration, necrosis, pain and bleeding in gingival surfaces. It is predominantly seen in severely malnourished children and young adults with advanced HIV infection. We present a unique presentation in a young adult with high-grade osteogenic sarcoma. PMID:26376700

  4. Heel pressure ulcers: purple heel and deep tissue injury.

    PubMed

    Salcido, Richard; Lee, Augustine; Ahn, Chulhyun

    2011-08-01

    The heel is a frequent site of pressure ulcer formation, in particular, the development of suspected deep tissue injury. This article reviews the epidemiology, pathophysiology and prevention of heel pressure ulcers. Also, the related concept of purple heel, a not-well-recognized entity, is introduced. PMID:21768788

  5. Interaction Between Leg Muscle Performance and Sprint Acceleration Kinematics.

    PubMed

    Lockie, Robert G; Jalilvand, Farzad; Callaghan, Samuel J; Jeffriess, Matthew D; Murphy, Aron J

    2015-12-22

    This study investigated relationships between 10 m sprint acceleration, step kinematics (step length and frequency, contact and flight time), and leg muscle performance (power, stiffness, strength). Twenty-eight field sport athletes completed 10 m sprints that were timed and filmed. Velocity and step kinematics were measured for the 0-5, 5-10, and 0-10 m intervals to assess acceleration. Leg power was measured via countermovement jumps (CMJ), a five-bound test (5BT), and the reactive strength index (RSI) defined by 40 cm drop jumps. Leg stiffness was measured by bilateral and unilateral hopping. A three-repetition maximum squat determined strength. Pearson's correlations and stepwise regression (p ? 0.05) determined velocity, step kinematics, and leg muscle performance relationships. CMJ height correlated with and predicted velocity in all intervals (r = 0.40-0.54). The 5BT (5-10 and 0-10 m intervals) and RSI (5-10 m interval) also related to velocity (r = 0.37-0.47). Leg stiffness did not correlate with acceleration kinematics. Greater leg strength related to and predicted lower 0-5 m flight times (r = -0.46 to -0.51), and a longer 0-10 m step length (r = 0.38). Although results supported research emphasizing the value of leg power and strength for acceleration, the correlations and predictive relationships (r(2) = 0.14-0.29) tended to be low, which highlights the complex interaction between sprint technique and leg muscle performance. Nonetheless, given the established relationships between speed, leg power and strength, strength and conditioning coaches should ensure these qualities are expressed during acceleration in field sport athletes. PMID:26839607

  6. Interaction Between Leg Muscle Performance and Sprint Acceleration Kinematics

    PubMed Central

    Lockie, Robert G.; Jalilvand, Farzad; Callaghan, Samuel J.; Jeffriess, Matthew D.; Murphy, Aron J.

    2015-01-01

    This study investigated relationships between 10 m sprint acceleration, step kinematics (step length and frequency, contact and flight time), and leg muscle performance (power, stiffness, strength). Twenty-eight field sport athletes completed 10 m sprints that were timed and filmed. Velocity and step kinematics were measured for the 0–5, 5–10, and 0–10 m intervals to assess acceleration. Leg power was measured via countermovement jumps (CMJ), a five-bound test (5BT), and the reactive strength index (RSI) defined by 40 cm drop jumps. Leg stiffness was measured by bilateral and unilateral hopping. A three-repetition maximum squat determined strength. Pearson’s correlations and stepwise regression (p ≤ 0.05) determined velocity, step kinematics, and leg muscle performance relationships. CMJ height correlated with and predicted velocity in all intervals (r = 0.40–0.54). The 5BT (5–10 and 0–10 m intervals) and RSI (5–10 m interval) also related to velocity (r = 0.37–0.47). Leg stiffness did not correlate with acceleration kinematics. Greater leg strength related to and predicted lower 0–5 m flight times (r = −0.46 to −0.51), and a longer 0–10 m step length (r = 0.38). Although results supported research emphasizing the value of leg power and strength for acceleration, the correlations and predictive relationships (r2 = 0.14–0.29) tended to be low, which highlights the complex interaction between sprint technique and leg muscle performance. Nonetheless, given the established relationships between speed, leg power and strength, strength and conditioning coaches should ensure these qualities are expressed during acceleration in field sport athletes. PMID:26839607

  7. Analytical Study of Active Prosthetic Legs

    NASA Astrophysics Data System (ADS)

    Ono, Kyosuke; Katsumata, Mie

    Walking with prosthesis has not been well analyzed mathematically and it seems that the design of powered prosthesis has been done empirically so far. This paper presents a dynamic simulation of a normal human walking and walking with an active prosthesis. We also studied the two controlling methods of a powered thigh prosthesis based on multi-body simulation of human walking. First we measured the normal human walking gait, then, we showed that a 3-DOF human walking model can walk on level ground by applying tracking control to the measured walking gait within a certain range of tuned walking period. Next, we applied the tracking control and self-excited control to the powered thigh prosthesis and compared the robustness and efficiency of the two control methods by numerical simulation. As a result, we found that the self-excited control can significantly decrease the hip joint torque and specific cost to 1/3 compared with the tracking control. Moreover, the self-excited control is superior to the tracking control because tuning for the walking period is not needed for the active prosthetic leg.

  8. Progress on the Legs Polarized HD Target

    NASA Astrophysics Data System (ADS)

    Lowry, M. M.; Lincoln, F.; Miceli, L.; Saitoh, T.; Sandorfi, A. M.; Wei, X.; Whisnant, C. S.

    2002-04-01

    A deuterium-hydride ice target with frozen spin polarization is under development for use at LEGS, TJNAF, and elsewhere. This target features favorable dilution factors and an open geometry. HD gas is isotopically purified by distillation, doped with a small amount of ortho-H2 and frozen into a mesh of aluminum wires which conducts away the heat from the ortho to para conversion of the H2. The wires constitute only about 20% of the target by mass and their contribution is readily determined by empty target measurements. The 2.5 cm diameter by 5 cm long cylinder of ice is created inside a dilution refrigerator-superconducting magnet system, where it is subsequently cooled to 15 mK in a 17 T magnetic field. The H reaches its equilibrium polarization of 80% in a few days. Transfers of spin from the H to the D, and subsequent re-polarizations of the H, allow a D polarization of 50% to be reached. After 6 to 8 weeks of aging, the ortho-H2 decays sufficiently to allow removal of the target and storage in a separate dewar. The target is transferred into an inbeam dewar for bombardment. After an NMR calibration, the target is vaporized, ready to begin a new cycle. The current status and future program are discussed.

  9. Restless legs syndrome and pregnancy: A review

    PubMed Central

    Srivanitchapoom, Prachaya; Pandey, Sanjay; Hallett, Mark

    2014-01-01

    Restless legs syndrome (RLS) is a common sensorimotor neurological disorder that is diagnosed according to the revised criteria of the International RLS Study Group (IRLSSG). The pathophysiology of RLS is still unknown and its prevalence is influenced by ethnicity, age, and gender. RLS is divided into two types by etiology: primary or idiopathic and secondary. Primary RLS is strongly influenced by a genetic component while secondary RLS is caused by other associated conditions such as end-stage renal disease or peripheral neuropathy. Another common condition associated with RLS is pregnancy. The prevalence of RLS during pregnancy is two to three times higher than in the normal population and is influenced by the trimester and the number of parity. The main mechanisms that may contribute to the pathophysiology of RLS during pregnancy are hormonal changes and iron and folate status. Standard medications for treating RLS during pregnancy are not established. Most medications have been used according to the evidence from non-pregnant patients. Therefore, consideration of the medical treatment for treating RLS during pregnancy should be balanced between the benefit of relieving the symptoms and maternal and fetal risk. In general, the prognosis of RLS during pregnancy is good and symptoms are usually relieved after delivery. PMID:24768121

  10. Why Do Alcoholic Beverages Have "Legs"?

    NASA Astrophysics Data System (ADS)

    Silverstein, Todd P.

    1998-06-01

    After a sip of wine, "legs" of liquid typically run up and down the inside of the glass for many minutes. This phenomenon stems from the dipole-dipole intermolecular forces that are so important in understanding the physical behavior of aqueous solutions. The combination of cohesive forces within the liquid and adhesive forces between the liquid and a solid surface can explain physical phenomena such as viscosity, surface tension, capillary action, and the shape of the meniscus. Aqueous ethanol solutions tend to have cohesive forces that are weaker than those of pure water, while their adhesive forces toward polar glass surfaces are roughly equivalent to those of water. Because adhesive forces are stronger than cohesive forces, wine may cling to the glass surface, hovering high above the remainder of the wine in the bottom of the glass. As ethanol evaporates, however, cohesive forces increase until the wine falls in a thin stream. Upon touching the surface of the wine in the bottom of the glass, ethanol concentration is restored, cohesive forces weaken, and the thin stream of wine rises back to the top of the glass.

  11. Accuracy of clinical diagnosis of genital ulcer disease.

    PubMed

    Dangor, Y; Ballard, R C; da L Exposto, F; Fehler, G; Miller, S D; Koornhof, H J

    1990-01-01

    In Africa, establishment of an accurate clinical diagnosis in cases of genital ulcer disease is difficult owing to atypical presentation of ulcerations and mixed infections. This is compounded by the frequent lack of suitable laboratory facilities. In 240 cases of genital ulcer disease among mineworkers in Carletonville, South Africa, this study endeavored to correlate the clinical diagnosis with laboratory findings. Clinical accuracy and positive and negative predictive values were determined for each type of genital ulcer disease encountered. Overall, the accuracy of clinical diagnosis was 68% for single infections, 80% for chancroid, 55% for primary syphilis, 27% for lymphogranuloma venereum (LGV), and 22% for genital herpes. Adequate laboratory facilities are indispensible for the establishment of an accurate etiologic diagnosis of genital ulcer disease and thus the institution of appropriate antimicrobial therapy. PMID:2175951

  12. [Indications for surgical treatment of hard scarring gastric ulcers].

    PubMed

    Durleshter, V M; Korochanskaia, N V; Serikova, S N

    2014-01-01

    It was done the comparative analysis of the morphofunctional state of the upper gastrointestinal tract between 350 patients with effective conservative treatment and 104 patients with hard scarring gastric ulcers. The analysis identified the predictors of ineffective medical treatment and led to deliver the indications for timely surgical treatment. It was identified the next indications for planned organ-preserving surgical treatment of patients with hard scarring gastric ulcers: penetrating and non-healing ulcers with large or gigantic size in case of the adequate medical therapy, high-grade dysplasia and colonic metaplasia of the gastric epithelium in the borders or fundus of the ulcer,ulcers combination with fixed cardio-fundal or fundo-corporal hiatal hernias; hypotonic-hypokinetic type of the gastric and duodenal activity with the development of gastrostasis and pronounced duodenogastric reflux. PMID:24781063

  13. Antiviral treatment in patients with cytomegalovirus positive ulcerative colitis.

    PubMed

    Ozturk, Kadir

    2014-11-15

    Cytomegalovirus (CMV) is a common virus in patients with ulcerative colitis receiving immunosuppressive drugs. Many studies suggested that CMV infection is an exacerbating factor in patients with ulcerative colitis. The role of CMV in exacerbations of ulcerative colitis has been discussed. One of studies starting this discussion is an article entitled "CMV positive ulcerative colitis: A single center experience and literature review" by Kopylov et al. However, we think that there are some points that should be emphasized about the study. Especially, the small number of patients in the study has led to meaningless results. Large controlled prospective trials are needed to clarify the benefit of antiviral therapy for active ulcerative colitis patients. PMID:25401002

  14. Antiviral treatment in patients with cytomegalovirus positive ulcerative colitis

    PubMed Central

    Ozturk, Kadir

    2014-01-01

    Cytomegalovirus (CMV) is a common virus in patients with ulcerative colitis receiving immunosuppressive drugs. Many studies suggested that CMV infection is an exacerbating factor in patients with ulcerative colitis. The role of CMV in exacerbations of ulcerative colitis has been discussed. One of studies starting this discussion is an article entitled CMV positive ulcerative colitis: A single center experience and literature review by Kopylov et al. However, we think that there are some points that should be emphasized about the study. Especially, the small number of patients in the study has led to meaningless results. Large controlled prospective trials are needed to clarify the benefit of antiviral therapy for active ulcerative colitis patients. PMID:25401002

  15. Do pressure ulcer risk assessment scales improve clinical practice?

    PubMed Central

    Kottner, Jan; Balzer, Katrin

    2010-01-01

    Standardized assessment instruments are deemed important for estimating pressure ulcer risk. Today, more than 40 so-called pressure ulcer risk assessment scales are available but still there is an ongoing debate about their usefulness. From a measurement point of view pressure ulcer (PU) risk assessment scales have serious limitations. Empirical evidence supporting the validity of PU risk assessment scale scores is weak and obtained scores contain varying amounts of measurement error. The concept of pressure ulcer risk is strongly related to the general health status and severity of illness. A clinical impact due do the application of these scales could also not be demonstrated. It is questionable whether completion of standardized pressure ulcer risk scales in clinical practice is really needed. PMID:21197359

  16. [A case of acquired immunodeficiency syndrome with ileocecal ulcer].

    PubMed

    Iwasaki, Tetsuyoshi; Saruta, Masayuki; Sawada, Ryoichi; Ide, Daisuke; Arihiro, Seiji; Matsuoka, Mika; Katoh, Tomohiro; Tajiri, Hisao

    2015-10-01

    We report a case of a patient with acquired immunodeficiency syndrome (AIDS) and ileocecal ulcer. A 31-year-old man was admitted with chief complaints of decreased body weight and abdominal pain. Colonoscopy revealed a round punched-out ulcer on the ileocecal valve. Initially, we suspected entero-Behet's disease and simple ulcer as the cause of the ileocecal ulcer. However, after histologic examination of tissue biopsies obtained during colonoscopy, we diagnosed the patient as having cytomegalovirus (CMV) enteritis. Based on the patient's white blood cell depletion and CMV enteritis, we performed a human immunodeficiency virus (HIV) antibody test. The test was positive, and the diagnosis of AIDS was established. The number of patients with AIDS has been increasing in Japan; thus, we should consider the possibility of CMV enteritis and AIDS in young adult patients affected by ileocecal ulcer with no notable history. PMID:26440687

  17. Tracheobronchitis with dyspnea in a patient with ulcerative colitis.

    PubMed

    Hiyoshi, Masaya; Kawai, Kazushige; Shibuya, Mihoko; Ozawa, Tsuyoshi; Kishikawa, Junko; Nirei, Takako; Tanaka, Toshiaki; Tanaka, Junichiro; Kiyomatsu, Tomomichi; Tada, Tomohiro; Kanazawa, Takamitsu; Kazama, Shinsuke; Shoda, Hirofumi; Sumitomo, Shuji; Kubo, Kanae; Yamaguchi, Hironori; Ishihara, Soichiro; Sunami, Eiji; Kitayama, Joji; Yamamoto, Kazuhiko; Watanabe, Toshiaki

    2015-01-01

    We herein report the case of a 42-year-old man with a one-year history of ulcerative colitis who presented with exacerbated bloody diarrhea, a productive cough and increasing breathing difficulties. Colonoscopy revealed typical deep ulcers in the rectosigmoid colon and atypical multiple sucker-like ulcers in the transverse colon, and computed tomography of the chest demonstrated wall thickening of the trachea and bronchi. In addition, bronchoscopy showed ulcers in the trachea, and histopathology disclosed findings of necrosis and inflammation of the subepithelial tissue of the trachea. Based on these findings, the patient's respiratory symptoms were strongly suspected to be due to ulcerative colitis-related tracheobronchitis. Treatment with systemic corticosteroids subsequently resulted in a rapid clinical improvement. PMID:25832936

  18. Eosinophilic ulcer of the tongue--Case report.

    PubMed

    Didona, Dario; Paolino, Giovanni; Donati, Michele; Didona, Biagio; Calvieri, Stefano

    2015-01-01

    Eosinophilic ulcer of the oral mucosa is a rare, self-limiting, chronic and benign lesion of unknown pathogenesis that affects the oral mucosa. We present the case of a 65 year-old Caucasian female with a five month history of a painful ulcer on the lateral side of her tongue. The ulcer was not adhered to the underlying structures and there was no evidence of regional lymph node involvement. Laboratory examinations and X-rays revealed no abnormalities. Topical treatments had been performed without any improvement. Histopathological examination showed an ulcerated surface and mixed inflammatory infiltrate with several eosinophils extending into the mucosa and submucosa. No cellular atypia was observed. Based on the patient-s history and mucosal biopsy, a final diagnosis of eosinophilic ulcer of the oral mucosa was made. PMID:26312683

  19. Pressure Ulcers: Factors Contributing to Their Development in the OR.

    PubMed

    Engels, Dawn; Austin, Melody; McNichol, Laurie; Fencl, Jennifer; Gupta, Sat; Kazi, Haseeb

    2016-03-01

    The prevention of health care-associated pressure ulcers (HAPUs) is an important quality measure because HAPUs are considered a never event. The literature suggests that the prevalence rate of pressure ulcers is 8.5% or higher among patients who undergo surgical procedures that last longer than three hours. We performed a retrospective chart review to determine what factors contribute to the development of pressure ulcers in patients who undergo surgical procedures. The sample population included patients who acquired a pressure ulcer that was not present at admission and developed during their postoperative hospital stay. The project revealed consistent risk factors that may contribute to the development of pressure ulcers in patients who have undergone surgical procedures. These findings can drive the implementation of preventive measures to reduce the occurrence of HAPUs associated with surgical procedures. PMID:26924365

  20. [Detection of lymph vessel changes in venous diseases of the leg using imaging procedures].

    PubMed

    Tiedjen, K U

    1989-12-01

    Chronic venous insufficiency reveals both functional correlations with the lymphatic system of the limbs as well as pathological-anatomical. The functional correlation initially consists in an enhancement of function as a manifestation of a compensation mechanism of lymphatic drainage in relation to the insufficient venous system. Finally, if the lymphatics are themselves damaged in their further course, a safety valve insufficiency occurs with resulting lymphostasis. Apart from this participation, regional damages to the lymphatic fascicles play a role in chronic venous insufficiency in trophic disorders, as for example leg ulcer and atrophy. However, these are far less significant for the overall function of lymphatic drainage. As a role, they show a pronounced collateralization, and thus good possibilities of functional compensation. In particular indirect lymphography with water-soluble contrast medium is suitable as imaging technique in diagnostics with regard to the morphology. Isotope lymphography is suitable with regard to investigating the function of lymphatic drainage and for circumscribed local disorders. As native techniques, xeroradiography and computed tomography are very suitable to analyse tissue damage of the cutis and subcutis resulting from chronic venous insufficiency and from lymphostasis and to make indirect inferences from this with regard to the chronicity of this disease process. PMID:2699137

  1. The pathway to foot ulceration in diabetes.

    PubMed

    Boulton, Andrew J M

    2013-09-01

    It should now be possible to achieve a reduction in the incidence of foot ulceration and amputations as knowledge about pathways that result in both these events increases. However, despite the universal use of patient education and the hope of reducing the incidence of ulcers in high-risk patients, there are no appropriately designed large, randomized controlled trials actually confirming that education works. It has been recognized for some years that education as part of a multidisciplinary approach to care of the diabetic foot can help to reduce the incidence of amputations in certain settings. Ultimately, however, a reduction in neuropathic foot problems will only be achieved if we remember that the patients with neuropathic feet have lost their prime warning signal—pain—that ordinarily brings patients to their doctor. Very little training is offered to health care professionals as to how to deal with such patients. Much can be learned about the management of such patients from the treatment of individuals with leprosy: if we are to succeed, we must realize that with loss of pain there is also diminished motivation in the healing of and prevention of injury. PMID:23992891

  2. Pressure ulcer grading and appropriate equipment selection.

    PubMed

    Charlton, Sarah

    2014-08-12

    This article explores the process and rationale for designing a poster to support community nurses in selecting appropriate pressure-relieving equipment based on accurate risk assessment and correct pressure ulcer grading. The project was prompted by the requirement to update community nurses' knowledge and ensure pressure-relieving equipment selection was evidence-based and not reliant on personal preference. The 2012 NHS Midlands and East 'Stop the pressure' campaign provided community nurses with a framework for pressure ulcer prevention and management. The attention to support surfaces highlighted the need for appropriate equipment. However the tissue viability team found that the introduction of this pathway alone did not help with the practical issues of appropriate equipment selection. The poster was designed with consideration as to how adults learn, and by looking to the Plan, Do, Study, Act (PDSA) cycle. This provided the framework for enabling new ideas and changes to practice to be tested on a small scale before full implementation. PMID:25117600

  3. Ulcerating Ileocolitis in Severe Amatoxin Poisoning

    PubMed Central

    Hilty, Matthias Peter; Halama, Marcel; Zimmermann, Anne-Katrin; Maggiorini, Marco; Geier, Andreas

    2015-01-01

    Amatoxin poisoning is still associated with a great potential for complications and a high mortality. While the occurrence of acute gastroenteritis within the first 24 hours after amatoxin ingestion is well described, only very few descriptions of late gastrointestinal complications of amatoxin poisoning exist worldwide. We present the case of a 57-year-old female patient with severe amatoxin poisoning causing fulminant but reversible hepatic failure that on day 8 after mushroom ingestion developed severe abdominal pain and watery diarrhea. Ulcerating ileocolitis was identified by computed tomography identifying a thickening of the bowel wall of the entire ileum and biopsies taken from the ileum and large bowel revealing distinct ileitis and proximally accentuated colitis. The absence of discernible alternative etiologies such as infectious agents makes a causal relationship between the ulcerating ileocolitis and the amatoxin poisoning likely. Diarrhea and varying abdominal pain persisted over several weeks and clinical follow-up after six months showed a completely symptom-free patient. The case presented highlights the importance to consider the possibility of rare complications of Amanita intoxication in order to be able to respond to them early and adequately. PMID:26357578

  4. Cohort study of atypical pressure ulcers development.

    PubMed

    Jaul, Efraim

    2014-12-01

    Atypical pressure ulcers (APU) are distinguished from common pressure ulcers (PU) with both unusual location and different aetiology. The occurrence and attempts to characterise APU remain unrecognised. The purpose of this cohort study was to analyse the occurrence of atypical location and the circumstances of the causation, and draw attention to the prevention and treatment by a multidisciplinary team. The cohort study spanned three and a half years totalling 174 patients. The unit incorporates two weekly combined staff meetings. One concentrates on wound assessment with treatment decisions made by the physician and nurse, and the other, a multidisciplinary team reviewing all patients and coordinating treatment. The main finding of this study identified APU occurrence rate of 21% within acquired PU over a three and a half year period. Severe spasticity constituted the largest group in this study and the most difficult to cure wounds, located in medial aspects of knees, elbows and palms. Medical devices caused the second largest occurrence of atypical wounds, located in the nape of the neck, penis and nostrils. Bony deformities were the third recognisable atypical wound group located in shoulder blades and upper spine. These three categories are definable and time observable. APU are important to be recognisable, and can be healed as well as being prevented. The prominent role of the multidisciplinary team is primary in identification, prevention and treatment. PMID:23374746

  5. [Scrotal ulcers revealing pulmonary and genitourinary tuberculosis].

    PubMed

    Ferreira, Olga Cristina Soares; Osrio, Filipa; Lisboa, Carmen; Silva, Maria Jos; Eloy, Catarina; Paiva, Maria Emlia; Azevedo, Filomena

    2011-01-01

    A 76-year-old male patient with an angioimmunoblastic T-cell lymphoma under treatment with fludarabine was referred because of scrotal ulcers, evolving for several months. Respiratory, gastrointestinal, and urinary symptoms were denied. Histopathological examination showed the presence of a chronic inflammatory process with epithelioid granulomas. Ziehl-Neelsen stain was positive for acid-fast bacilli. PCR analysis allowed the identification of a mycobacteria strain belonging to the Mycobaterium tuberculosis complex. Skin biopsy was repeated and culture revealed M. tuberculosis sensitive to traditional tuberculostatic drugs. This bacteria was also isolated in bronchial and urinary specimens. Although no abnormal findings were detected on chest radiography or abdominal ultrasonography, scrotal ultrasound showed areas of nodular thickening in the lower part of the epididymis. The diagnosis of cutaneous, lung, and genitourinary tuberculosis was made and the patient was treated with multidrug therapy (rifampicin 600 mg/day, isoniazid 250 mg/day, pyrazinamide 1500 mg/day, and ethambutol 1200 mg/day for the first 2 months, followed by rifampicin and isoniazid with the same dosages for the subsequent 7 months). Complete resolution of skin lesions was observed after two months of treatment. Diagnosis and treatment modalities are discussed. This case emphasizes the importance of considering tuberculosis in the differential diagnosis of genital ulcer. PMID:21906490

  6. Surveillance in ulcerative colitis: burdens and benefit.

    PubMed Central

    Jones, H W; Grogono, J; Hoare, A M

    1988-01-01

    A review of all patients with ulcerative colitis in one health district between 1975-84 revealed an incidence and prevalence of 7.1 and 84/100,000 population respectively. One hundred and ninety five new patients were diagnosed and 313 patients seen and followed up in the clinic for 1168 patient years. None of these patients died from colitis or a complication. On routine colonoscopy three cases had high grade dysplasia and two asymptomatic carcinomas (Duke's stage A and B). Eighty four patients were known to have ulcerative colitis, but were lost to follow up from the hospital clinic; the total time they were not under hospital surveillance was 315 patient years. At the end of the study these patients were contacted or clinical details obtained from their general practitioners. Five of these patients subsequently presented with symptomatic carcinomas (two Duke's B, one Duke's C and two with metastases); three of these five patients have died from their tumours. Of 48 patients thought to have only mild colitis on initial investigation 21 (43%) had substantial colitis (and two carcinomas) on colonoscopy after eight years of disease. Therefore, patients with apparently distal colitis should be followed in the clinic as well as those with known extensive colitis. For a surveillance programme in a district general hospital, eight patients per 100,000 population need to be seen weekly, 12 colonoscopies/100,000 population need to be carried out annually and the cost for each carcinoma detected is approximately 6015 pounds. PMID:3128464

  7. Pressure ulcer related pain in community populations: a prevalence survey

    PubMed Central

    2014-01-01

    Background Pressure ulcers are costly to the healthcare provider and can have a major impact on patients quality of life. One of the most distressing symptoms reported is pain. There is very little published data on the prevalence and details of pain experienced by patients with pressure ulcers, particularly in community populations. The study was conducted in two community NHS sites in the North of England. Methods The aim was to estimate the prevalence of pressure area related pain within a community population. We also explored the type and severity of the pain and its association with pressure ulcer classification. A cross-sectional survey was performed of community nurses caseloads to identify adult patients with pressure ulcers and associated pain. Consenting patients then had a full pain assessment and verification of pressure ulcer grade. Results A total of 287 patients were identified with pressure ulcers (0.51 per 1000 adult population). Of the 176 patients who were asked, 133 (75.6%) reported pain. 37 patients consented to a detailed pain assessment. Painful pressure ulcers of all grades and on nearly all body sites were identified. Pain intensity was not related to number or severity of pressure ulcer. Both inflammatory and neuropathic pain were reported at all body sites however the proportion of neuropathic pain was greater in pressure ulcers on lower limbs. Conclusions This study has identified the extent and type of pain suffered by community patients with pressure ulcers and indicates the need for systematic and regular pain assessment and treatment. PMID:25024642

  8. Repair of severe composite tissue defects in the lower leg using two different cross-leg free composite tissue flaps.

    PubMed

    Yu, Li; Tan, JinHai; Cai, Lin; Yu, GuoRong; Tao, ShengXiang; Wei, RenXiong; Chen, ZhenGuang

    2012-01-01

    This article reports 2 cross-leg free composite tissue flaps for repairing the severe composite tissue defects in lower leg without suitable adjacent recipient vasculature for microvascular anastomosis. The osseous myocutaneous flap of ilium and tensor fascia lata pedicled with ascending branch of lateral femoral circumflex vessels and the osseous muscle flap of scapula and latissimus dorsi pedicled with subscapular vessels were performed, respectively, to reconstruct the bone and soft-tissue defects in the lower leg of 2 patients. Both donor vessels were the posterior tibial artery and great saphenous vein from the contralateral lower leg. The legs and the bone flaps were immobilized by an external fixator. The periods of pedicle division were 43 and 67 days, respectively, after transplantation. Both flaps survived after pedicle division and the patients regained the ability to walk. There were no such complications as joint stiffness or donor site morbidity except for a linear scar. The 2 cross-leg free composite tissue flaps were optional methods for salvaging limbs that were otherwise nonreconstructable. But the indication for cross-leg free-tissue flap should be limited strictly. PMID:21301302

  9. The VCU Pressure Ulcer Summit-Developing Centers of Pressure Ulcer Prevention Excellence: A Framework for Sustainability.

    PubMed

    Creehan, Sue; Cuddigan, Janet; Gonzales, Dana; Nix, Denise; Padula, William; Pittman, Joyce; Pontieri-Lewis, Vicky; Walden, Christine; Wells, Belinda; Wheeler, Robinetta

    2016-01-01

    Hospital-acquired pressure ulcer occurrences have declined over the past decade as reimbursement policies have changed, evidence-based practice guidelines have been implemented, and quality improvement initiatives have been launched. However, the 2006-2008 Institute for Healthcare Improvement goal of zero pressure ulcers remains difficult to achieve and even more challenging to sustain. Magnet hospitals tend to have lower hospital-acquired pressure ulcer rates than non-Magnet hospitals, yet many non-Magnet hospitals also have robust pressure ulcer prevention programs. Successful programs share commonalities in structure, processes, and outcomes. A national summit of 55 pressure ulcer experts was convened at the Virginia Commonwealth University Medical Center in March 2014. The group was divided into 3 focus groups; each was assigned a task to develop a framework describing components of a proposed Magnet-designated Center of Pressure Ulcer Prevention Excellence. Systematic literature reviews, analysis of exemplars, and nominal group process techniques were used to create the framework. This article presents a framework describing the proposed Magnet-designated Centers of Pressure Ulcer Prevention Excellence. Critical attributes of Centers of Excellence are identified and organized according to the 4 domains of the ANCC model for the Magnet Recognition Program: transformational leadership; structural empowerment; exemplary professional practice; and new knowledge innovation and improvements. The structures, processes, and outcome measures necessary to become a proposed Center of Pressure Ulcer Prevention Excellence are discussed. PMID:26808304

  10. Restless Leg Syndrome Across the Globe: Epidemiology of the Restless Legs Syndrome/Willis-Ekbom Disease.

    PubMed

    Koo, Brian B

    2015-09-01

    There are more than 50 epidemiologic studies measuring the prevalence of restless legs syndrome/Willis-Ekbom disease (RLS/WED) across 5 of the 6 inhabited continents (not Australia), most conducted in North America and Europe. Sufficient studies have been conducted in Asia, North America, and Europe to make inferences on RLS/WED prevalence by region. RLS/WED prevalence is thought to be highest in North America and Europe and lower in Asia. These differences across regions may be explained by cultural, environmental, and genetic factors. Future investigation is needed to determine to what extent these factors affect expression of RLS/WED according to world region. PMID:26329429

  11. [Influence of Achilles tendon vibration on the human vertical posture during standing with asymmetrical leg loading].

    PubMed

    Kazennikov, O V; Kireeva, T B; Shlykov, V Iu

    2014-01-01

    The shift of center of pressure (CP) of body and CP of each leg was studied during Achilles tendon vibration of one or both legs while subject was standing with symmetrical load on the legs or with the load transferred on one leg. The CP shift of standing subject during unilateral Achilles tendon vibration depended both on the side of the tendon vibration and on the leg load. When standing with a load transferred on one leg the shift of common CP was larger than when the vibration was applied to the loaded leg. The CP shift of one leg was greater if the vibration, and the load was applied to it. Vibration of unloaded leg caused a CP shift in the contralateral loaded leg. In this case, the vibration of left unloaded leg caused no noticeable CP shift of left leg, while the vibration of the unloaded right leg caused CP shift of right foot. In the same conditions of load and vibration the CP displacement of right leg was larger than the CP shift of left foot. It can be assumed that the change in the load on the leg and unilateral vibration of leg muscles change of the internal representation of the vertical body axis, which affects the CP position of one leg during the muscles vibration. PMID:25272772

  12. Detail of tower support construction shows two legs, cross beams ...

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

    Detail of tower support construction shows two legs, cross beams end concrete point load footing on west side. Camera is pointed NW. - Badger Mountain Lookout, .125 mile northwest of Badger Mountain summit, East Wenatchee, Douglas County, WA

  13. Professor Karl-Axel Ekbom and restless legs syndrome.

    PubMed

    Teive, Hlio A G; Munhoz, Renato P; Barbosa, Egberto Reis

    2009-05-01

    The authors provide an historical review of restless legs syndrome, emphasizing the contribution of Professor Karl-Axel Ekbom, the Swedish neurologist who made the first detailed clinical description of this disease. PMID:18829374

  14. Deployable Landing Leg Concept for Crew Exploration Vehicle

    NASA Technical Reports Server (NTRS)

    Lawrence, Charles; Solano, Paul; Bartos, Karen

    2007-01-01

    The NASA Exploration program is investigating the merits of land landing concepts for the Crew Exploration Vehicle (CEV). Four options are under investigation: retro-rockets which fire and slow the vehicle before contact with the landing surface, deployable crushable material which deploys just before landing and crushes during land contact, airbags which deploy just before landing and deflate during land contact, and deployable legs which deploy before landing and contain material that absorbs energy during land contact. The purpose of the present work is to determine the effectiveness of the deployable leg concept. To accomplish this goal, structural models of the deployable leg concept are integrated with the Crew Model (CM) and computational simulations are performed to determine vehicle and component loadings and acceleration levels. Details of the modeling approach, deployable leg design, and resulting accelerations are provided.

  15. Dynamic Leg Exercise Improves Tolerance to Lower Body Negative Pressure

    NASA Technical Reports Server (NTRS)

    Watenpaugh, D. E.; Ballard, R. E.; Stout, M. S.; Murthy, G.; Whalen, R. T.; Hargens, A. R.

    1994-01-01

    These results clearly demonstrate that dynamic leg exercise against the footward force produced by LBNP substantially improves tolerance to LBNP, and that even cyclic ankle flexion without load bearing also increases tolerance. This exercise-induced increase of tolerance was actually an underestimate, because subjects who completed the tolerance test while exercising could have continued for longer periods. Exercise probably increases LBNP tolerance by multiple mechanisms. Tolerance was increased in part by skeletal muscle pumping venous blood from the legs. Rosenhamer and Linnarsson and Rosenhamer also deduced this for subjects cycling during centrifugation, although no measurements of leg volume were made in those studies: they found that male subjects cycling at 98 W could endure 3 Gz centrifugation longer than when they remained relaxed during centrifugation. Skeletal muscle pumping helps maintain cardiac filling pressure by opposing gravity-, centrifugation-, or LBNP-induced accumulation of blood and extravascular fluid in the legs.

  16. Lateral stability of piles in ungrouted jacket legs

    SciTech Connect

    Flick, L.D.; Green, D.J.

    1983-05-01

    The lateral stability of a pile within an ungrouted jacket leg of a template type offshore platform is investigated analytically and experimentally. The results suggest that significant increases in stability related allowable stresses may often be permissible.

  17. Swimming with stiff legs at low Reynolds number.

    PubMed

    Takagi, Daisuke

    2015-08-01

    Locomotion at low Reynolds number is not possible with cycles of reciprocal motion, an example being the oscillation of a single pair of rigid paddles or legs. Here, I demonstrate the possibility of swimming with two or more pairs of legs. They are assumed to oscillate collectively in a metachronal wave pattern in a minimal model based on slender-body theory for Stokes flow. The model predicts locomotion in the direction of the traveling wave, as commonly observed along the body of free-swimming crustaceans. The displacement of the body and the swimming efficiency depend on the number of legs, the amplitude, and the phase of oscillations. This study shows that paddling legs with distinct orientations and phases offers a simple mechanism for driving flow. PMID:26382516

  18. Periodic Limb Movement Disorder and Restless Legs Syndrome

    MedlinePLUS

    ... described as burning, creeping, or tugging or like insects crawling inside the legs. Walking or moving or ... are done overnight. In polysomnography, brain activity, heart rate, breathing, muscle activity, and eye movements are monitored ...

  19. 32. FIRST LEVEL, VIEW OF LEG NUMBER 1, SHOWING TENSIONING ...

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

    32. FIRST LEVEL, VIEW OF LEG NUMBER 1, SHOWING TENSIONING DEVICE AND FLOOR ACCESS PANEL; LOOKING WEST - Northwestern Consolidated Elevator "A", 119 Fifth Avenue South, Minneapolis, Hennepin County, MN

  20. Using Malaria Medication for Leg Cramps Is Risky

    MedlinePLUS

    ... Products Vaccines, Blood & Biologics Articulos en Espanol Using Malaria Medication for Leg Cramps is Risky Printer-friendly ... approved only to treat a certain type of malaria (uncomplicated malaria) caused by the parasite Plasmodium falciparum. ...