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1

[Leg ulcers].  

PubMed

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

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

2013-11-01

2

Management of leg ulcers  

Microsoft Academic Search

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

P K Sarkar; S Ballantyne

2000-01-01

3

Management of leg ulcers  

PubMed Central

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

Sarkar, P; Ballantyne, S

2000-01-01

4

[Prevention of leg ulcer].  

PubMed

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

Marinovi? Kulisi?, Sandra

2013-10-01

5

Multidimensional leg ulcer assessment.  

PubMed

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

Anderson, Irene

6

[Martorell Hypertensive Ischaemic Leg Ulcer.  

PubMed

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

Nobbe, S; Hafner, J

2014-10-21

7

[Contemporary management of leg ulcer].  

PubMed

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

Huljev, Dubravko

2012-12-01

8

Chronic ulcer of the leg: clinical history  

Microsoft Academic Search

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

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

1987-01-01

9

Compression therapy in leg ulcer management.  

PubMed

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

Brown, V; Marshall, D

10

[Diagnostic and treatment of leg ulcers].  

PubMed

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

Velasco, M

2011-12-01

11

Leg ulcer management with topical medical honey.  

PubMed

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

Sare, Janice Leigh

2008-09-01

12

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

Microsoft Academic Search

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

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

2000-01-01

13

Compression in leg ulcer treatment: inelastic compression.  

PubMed

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

Mosti, Giovanni

2014-05-19

14

Venous Leg Ulcerations: A Treatment Update  

Microsoft Academic Search

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

Ronda S. Farah; Mark D. P. Davis

2010-01-01

15

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

PubMed

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

Spoljar, Sanja

2014-10-01

16

Oxpentifylline treatment of venous ulcers of the leg  

Microsoft Academic Search

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

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

1990-01-01

17

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

PubMed

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

Spoljar, Sanja

2013-10-01

18

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

PubMed

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

McKenzie, Morag

2013-06-01

19

Community clinics for leg ulcers and impact on healing  

Microsoft Academic Search

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

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

1992-01-01

20

Managing leg and foot ulcers: the role of Kerraboot.  

PubMed

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

Ashton, Jacqui

2004-09-01

21

Treatment of an atypical leg ulcer: pyoderma gangrenosum.  

PubMed

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

Knock, Karen; Butcher, Martyn

2003-06-01

22

Squamous cell carcinoma developed on chronic venous leg ulcer.  

PubMed

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

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

2015-01-01

23

Vascular leg ulcers: histopathologic study of 293 patients.  

PubMed

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

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

2014-12-01

24

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

Microsoft Academic Search

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

Royden Stanford; Danae Lowell; Shylaja Arya

25

A Team Approach to the Management of Intractable Leg Ulcers  

PubMed Central

Objectives: The management of intractable leg ulcers requires a team approach which includes vascular surgeons and plastic surgeons. We retrospectively reviewed the results of the management of intractable leg ulcers by plastic surgeons. Patients and Methods: A total of 73 patients with intractable leg ulcers, (79 limbs) were treated at the Department of Plastic Surgery at our institution. Skin perfusion pressure (SPP) around the ulcer on the limb was measured before and after arterial reconstructive procedures. Local ulcer management involved intra-wound continuous negative pressure and irrigation therapy or negative pressure wound therapy. We examined the rates of wound healing and associated prognostic factors. Results: There were 21 limbs without ischemia (non-peripheral arterial disease [Non-PAD] group) and 58 limbs with ischemia (PAD group). The healing rates were 66% in the PAD group and 81% in the Non-PAD group, but the difference between the groups was not significant. A total of 41 limbs in the PAD group underwent revascularization, which involved bypass surgery in 18 limbs and endovascular therapy in 23 limbs. The salvage rate of the revascularized limbs was 83% at 1 year. The primary patency rates at 1 year were 87% for bypass surgery and 58% for endovascular therapy. The healing rate of the revascularized limbs was 66%, and the presence of concomitant hemodialysis, infected ulcers, and limbs without improved SPP were shown to be poor prognostic factors. Limbs treated with bypass surgery had a better healing rate than limbs treated with endovascular therapy, but the difference was not significant. Conclusion: Good ulcer-healing rates were achieved by effective revascularization and aggressive local management. These results suggest that a team approach is useful for the management of intractable leg ulcers. (English translation of Jpn J Vasc Surg 2011; 20: 913-920) PMID:23641282

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

2013-01-01

26

Traffic light system for healed venous leg ulcer monitoring.  

PubMed

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

Hindley, Jenny

2012-09-01

27

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

PubMed

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

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

2013-06-01

28

A case of prolidase deficiency accompanying leg ulcers.  

PubMed

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

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

2015-03-01

29

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

PubMed

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

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

2004-01-01

30

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

Microsoft Academic Search

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

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

2003-01-01

31

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

Microsoft Academic Search

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

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

2003-01-01

32

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

PubMed

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

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

2014-06-01

33

Wound Teleconsultation in Patients with Chronic Leg Ulcers  

Microsoft Academic Search

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

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

2005-01-01

34

Topical Treatment of Nonhealing Venous Leg Ulcer with Propolis Ointment  

PubMed Central

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

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

2013-01-01

35

Leg ulcer plastic surgery descent by laser therapy  

NASA Astrophysics Data System (ADS)

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

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

1994-02-01

36

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

PubMed

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

Mapplebeck, Lynda

2008-03-01

37

Leg ulcers and the Urgocell Non-Adhesive wound dressing.  

PubMed

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

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

38

Cost effectiveness analysis of larval therapy for leg ulcers  

PubMed Central

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

2009-01-01

39

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

Microsoft Academic Search

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

Rolandas Dagilaitis; Vytautas Triponis; Ingrida Gudgalytë; Dalia Triponienë

40

Onychomycosis in patients with chronic leg ulcer and toenail abnormalities*  

PubMed Central

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

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

2015-01-01

41

Onychomycosis in patients with chronic leg ulcer and toenail abnormalities.  

PubMed

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

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

2015-01-01

42

Evaluating a superabsorbent hydropolymer dressing for exuding venous leg ulcers.  

PubMed

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

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

2001-01-01

43

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

Microsoft Academic Search

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

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

1999-01-01

44

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

Microsoft Academic Search

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

Oliver R Herber; Wilfried Schnepp; Monika A Rieger

2007-01-01

45

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

Microsoft Academic Search

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

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

2002-01-01

46

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

Microsoft Academic Search

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

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

2009-01-01

47

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

PubMed

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

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

2014-01-01

48

Living with venous leg ulceration: issues concerning adherence.  

PubMed

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

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

49

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

PubMed

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

Turczynski, R; Tarpila, E

1999-09-01

50

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

PubMed

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

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

2014-05-30

51

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

PubMed Central

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

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

2013-01-01

52

Low-frequency ultrasound to manage chronic venous leg ulcers.  

PubMed

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

Johnson, Sue

2003-10-01

53

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

Microsoft Academic Search

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

O Nelzén; D Bergqvist; A Lindhagen; T Hallböök

1991-01-01

54

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

Microsoft Academic Search

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

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

1999-01-01

55

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

Microsoft Academic Search

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

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

56

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

Microsoft Academic Search

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

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

2004-01-01

57

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

PubMed

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

Walshe, C

1995-12-01

58

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

PubMed

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

Flaherty, Elaine

59

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

Microsoft Academic Search

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

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

60

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

PubMed

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

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

61

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

PubMed Central

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

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

2011-01-01

62

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

PubMed

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

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

2014-12-01

63

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

PubMed

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

Skeik, N; Kia, F; Klosterman, D

2014-10-01

64

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

Microsoft Academic Search

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

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

2000-01-01

65

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

PubMed Central

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

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

2013-01-01

66

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

PubMed

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

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

2012-01-01

67

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

PubMed Central

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

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

2014-01-01

68

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

PubMed Central

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

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

2007-01-01

69

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

Microsoft Academic Search

Objective To assess the clinical effectiveness of weekly delivery of low dose, high frequency therapeutic ultrasound in conjunction with standard care for hard to heal venous leg ulcers.Design Multicentre, pragmatic, two arm randomised controlled trial.Setting Community and district nurse led services, community leg ulcer clinics, and hospital outpatient leg ulcer clinics in 12 urban and rural settings (11 in the

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

2011-01-01

70

An overview of technologies related to care for venous leg ulcers  

Microsoft Academic Search

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

Meghan Sarah Hegarty; Edward Grant; Lawrence Reid Jr.

2010-01-01

71

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

Microsoft Academic Search

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

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

1985-01-01

72

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

Microsoft Academic Search

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

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

1993-01-01

73

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

PubMed

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

Chia, Hui Y; Tang, Mark B Y

2014-12-01

74

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

PubMed Central

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

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

2014-01-01

75

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

Microsoft Academic Search

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

Kari Remes; Tapani Rönnemaa

1999-01-01

76

Walk On: Helping Former Drug Users Manage Leg Ulcers  

Microsoft Academic Search

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

Amy Oprean

2010-01-01

77

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

PubMed

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

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

2001-05-01

78

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

PubMed

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

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

2015-03-01

79

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

PubMed Central

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

2014-01-01

80

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

PubMed Central

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

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

2014-01-01

81

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

PubMed Central

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

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

2013-01-01

82

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

PubMed

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

Martin, Fiona

2014-06-01

83

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

PubMed

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

McNichol, Elaine

2014-09-01

84

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

Microsoft Academic Search

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

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

2000-01-01

85

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

PubMed

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

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

2000-04-01

86

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

PubMed

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

Pritchard, V

87

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

Microsoft Academic Search

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

Kirsti Skavberg Roaldsen; Gabriele Biguet; Britt Elfving

2011-01-01

88

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

PubMed

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

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

2006-01-01

89

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

PubMed Central

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

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

2006-01-01

90

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

PubMed Central

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

2009-01-01

91

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

Microsoft Academic Search

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

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

1998-01-01

92

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

PubMed Central

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

Nelson, E Andrea; Michaels, Jonathan A

2007-01-01

93

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

PubMed

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

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

2014-08-26

94

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

PubMed

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

Vanscheidt, W; Sadjadi, Z; Lillieborg, S

2001-01-01

95

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

PubMed Central

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

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

2011-01-01

96

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

NASA Astrophysics Data System (ADS)

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

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

1994-02-01

97

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

PubMed

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

Partsch, Hugo

2014-05-19

98

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

Microsoft Academic Search

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

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

2010-01-01

99

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

PubMed

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

Hindley, Jenny

2014-09-01

100

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

PubMed

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

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

2013-01-01

101

Ulcers  

MedlinePLUS

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

102

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

PubMed Central

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

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

2015-01-01

103

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

PubMed

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

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

2015-01-01

104

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

PubMed

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

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

2004-11-01

105

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

PubMed Central

Introduction The aim of the study was to assess the influence of a supervised programme of exercises on ankle joint mobility in patients with venous leg ulcerations. Material and methods The study was carried out between 2008 and 2009 at the Venous Ulcer Treatment Outpatient Clinic and Clinic of General and Vascular Surgery of the Dr Jan Biziel University Hospital no. 2 in Bydgoszcz. It was a randomized control study in which 32 patients with venous leg ulcerations were qualified. Patients with ulcerations were randomized to 2 groups – 16 patients were included in the group with a supervised programme of exercises and the other 16 patients were included in the control group performing physical exercises by themselves, without supervision. The ranges of ankle joint mobility were assessed before, during and after the end of the 9-week exercise programme. A 32 cm goniometer with a scale from 0° to 180° with accuracy to 1° was used for measurements. Results In both groups a substantial increase of ankle joint mobility (p < 0.05) was observed. The total ankle joint mobility after completion of the exercises was significantly higher in the group performing exercises under the supervision of a nurse. Having a significant effect on the mobility of the ankle were the ulceration area, the extent of lipodermatosclerosis, and the intensity of symptoms and signs of CVI (p < 0.05). Conclusions Supervised physical exercises broaden the range of ankle joint mobility. They should constitute an integral part of a holistic model of care for patients with venous leg ulcerations. PMID:22427773

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

2010-01-01

106

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

Microsoft Academic Search

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

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

2011-01-01

107

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

PubMed

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

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

2013-10-01

108

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

PubMed Central

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

2012-01-01

109

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

PubMed

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

Lorimer, Karen

2004-06-01

110

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

PubMed Central

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

Tuttle, Marie S.

2015-01-01

111

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

PubMed Central

Objective To assess the clinical effectiveness of weekly delivery of low dose, high frequency therapeutic ultrasound in conjunction with standard care for hard to heal venous leg ulcers. Design Multicentre, pragmatic, two arm randomised controlled trial. Setting Community and district nurse led services, community leg ulcer clinics, and hospital outpatient leg ulcer clinics in 12 urban and rural settings (11 in the United Kingdom and one in the Republic of Ireland). Participants 337 patients with at least one venous leg ulcer of >6 months’ duration or >5 cm2 area and an ankle brachial pressure index of ?0.8. Interventions Weekly administration of low dose, high frequency ultrasound therapy (0.5 W/cm2, 1 MHz, pulsed pattern of 1:4) for up to 12 weeks plus standard care compared with standard care alone. Main outcome measures Primary outcome was time to healing of the largest eligible leg ulcer. Secondary outcomes were proportion of patients healed by 12 months, percentage and absolute change in ulcer size, proportion of time participants were ulcer-free, health related quality of life, and adverse events. Results The two groups showed no significant difference in the time to healing of the reference leg ulcer (log rank test, P=0.61). After adjustment for baseline ulcer area, baseline ulcer duration, use of compression bandaging, and study centre, there was still no evidence of a difference in time to healing (hazard ratio 0.99 (95% confidence interval 0.70 to 1.40), P=0.97). The median time to healing of the reference leg ulcer was inestimable. There was no significant difference between groups in the proportion of participants with all ulcers healed by 12 months (72/168 in ultrasound group v 78/169 in standard care group, P=0.39 for Fisher’s exact test) nor in the change in ulcer size at four weeks by treatment group (model estimate 0.05 (95% CI –0.09 to 0.19)). There was no difference in time to complete healing of all ulcers (log rank test, P=0.61), with median time to healing of 328 days (95% CI 235 to inestimable) with standard care and 365 days (224 days to inestimable) with ultrasound. There was no evidence of a difference in rates of recurrence of healed ulcers (17/31 with ultrasound v 14/31 with standard care, P=0.68 for Fisher’s exact test). There was no difference between the two groups in health related quality of life, both for the physical component score (model estimate 0.69 (–1.79 to 3.08)) and the mental component score (model estimate –0.93 (–3.30 to 1.44)), but there were significantly more adverse events in the ultrasound group (model estimate 0.30 (0.01 to 0.60)). There was a significant relation between time to ulcer healing and baseline ulcer area (hazard ratio 0.64 (0.55 to 0.75)) and baseline ulcer duration (hazard ratio 0.59 (0.50 to 0.71)), with larger and older ulcers taking longer to heal. In addition, those centres with high recruitment rates had the highest healing rates. Conclusions Low dose, high frequency ultrasound administered weekly for 12 weeks during dressing changes in addition to standard care did not increase ulcer healing rates, affect quality of life, or reduce ulcer recurrence. Trial registration ISRCTN21175670 and National Research Register N0484162339 PMID:21385806

2011-01-01

112

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

PubMed

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

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

2014-12-01

113

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

PubMed

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

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

2014-12-01

114

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

Microsoft Academic Search

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

Aleksandar Jankovi?; Ivana Bini?

2008-01-01

115

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

PubMed

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

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

2009-09-01

116

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

PubMed Central

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

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

2014-01-01

117

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

Microsoft Academic Search

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

Britt-Lousie Anderson

2003-01-01

118

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

SciTech Connect

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

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

1982-04-01

119

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

SciTech Connect

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

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

1982-04-01

120

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

PubMed

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

Rudolph, D

2001-03-01

121

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

PubMed

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

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

2014-10-01

122

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

Microsoft Academic Search

The last years of research have proposed that bacteria might be involved in and contribute to the lack of healing of chronic wounds. Especially it seems that Pseudomonas aeruginosa play a crucial role in the healing. At Copenhagen Wound Healing Centre it was for many years clinical suspected that once chronic venous leg ulcers were colonized (weeks or months preoperatively)

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

2011-01-01

123

Ulcers  

MedlinePLUS

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

124

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

PubMed Central

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

2014-01-01

125

Stasis Ulcer  

MedlinePLUS

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

126

The prevalence of thrombophilia in patients with chronic venous leg ulceration  

Microsoft Academic Search

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

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

2002-01-01

127

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

Microsoft Academic Search

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

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

2003-01-01

128

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

PubMed Central

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

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

2014-01-01

129

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

PubMed

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

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

2013-08-01

130

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

Microsoft Academic Search

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

Philip Coleridge Smith

2006-01-01

131

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

Microsoft Academic Search

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

Naoto Yamada; Eiju Uchinuma; Yoshimitsu Kuroyanagi

2008-01-01

132

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

PubMed Central

Background Objective: To determine the relative effectiveness of evidence-informed practice using two high compression systems: four-layer (4LB) and short-stretch bandaging (SSB) in community care of venous leg ulcers. Design and Setting: Pragmatic, multi-centre, parallel-group, open-label, randomized controlled trial conducted in 10 centres. Cognitively intact adults (?18 years) referred for community care (home or clinic) with a venous ulceration measuring ?0.7cm and present for ?1 week, with an ankle brachial pressure index (ABPI) ?0.8, without medication-controlled Diabetes Mellitus or a previous failure to improve with either system, were eligible to participate. Methods Consenting individuals were randomly allocated (computer-generated blocked randomization schedule) to receive either 4LB or SSB following an evidence-informed protocol. Primary endpoint: time-to- healing of the reference ulcer. Secondary outcomes: recurrence rates, health-related quality of life (HRQL), pain, and expenditures. Results 424 individuals were randomized (4LB n = 215; SSB n = 209) and followed until their reference ulcer was healed (or maximum 30 months). An intent-to-treat analysis was conducted on all participants. Median time to ulcer healing in the 4LB group was 62 days [95% confidence interval (CI) 51 to 73], compared with 77 days (95% CI 63 to 91) in the SSB group. The unadjusted Kaplan-Meier curves revealed the difference in the distribution of cumulative healing times was not significantly different between group (log rank ?2 = 0.001, P = 0.98) nor ulcers recurrence (4LB, 10.1%; SSB, 13.3%; p = 0.345). Multivariable Cox Proportional Hazard Modeling also showed no significant between-bandage differences in healing time after controlling for significant covariates (p = 0.77). At 3-months post-baseline there were no differences in pain (no pain: 4LB, 22.7%; SSB, 26.7%; p = 0.335), or HRQL (SF-12 Mental Component Score: 4LB, 55.1; SSB, 55.8; p = 0.615; SF-12 Physical Component Score: 4LB, 39.0; SSB, 39.6; p = 0.675). The most common adverse events experienced by both groups included infection, skin breakdown and ulcer deterioration. Conclusions The Canadian Bandaging Trial revealed that in the practice context of trained RNs using an evidence-informed protocol, the choice of bandage system (4LB and SSB) does not materially affect healing times, recurrence rates, HRQL, or pain. From a community practice perspective, this is positive news for patient-centred care allowing individual/family and practitioner choice in selecting compression technologies based on circumstances and context. Trial registration clinicaltrials.gov Identifier: NCT00202267 PMID:21995267

2011-01-01

133

Vascular pythiosis in a thalassemic patient presenting as bilateral leg ulcers  

PubMed Central

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

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

2012-01-01

134

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

PubMed

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

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

2012-12-01

135

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

Microsoft Academic Search

Wound pain is a serious problem for elderly patients suffering from chronic leg ulcers, and it may lead to reduced wound healing rates and reduced quality of life. Biatains-Ibu Non-adhesive (Coloplast A\\/S), a new pain-reducing moist wound healing dressing containing ibuprofen was tested for pain reduction, safety, and efficacy on 1012 patients in a single-blinded crossover study against Biatain Non-adhesive

Bo Jorgensen; Gitte Juel Friis; Finn Gottrup

2006-01-01

136

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

PubMed Central

The last years of research have proposed that bacteria might be involved in and contribute to the lack of healing of chronic wounds. Especially it seems that Pseudomonas aeruginosa play a crucial role in the healing. At Copenhagen Wound Healing Centre it was for many years clinical suspected that once chronic venous leg ulcers were colonized (weeks or months preoperatively) by P. aeruginosa, the success rate of skin grafting deteriorated despite aggressive treatment. To investigate this, a retrospective study was performed on the clinical outcome of 82 consecutive patients with chronic venous leg ulcers on 91 extremities, from the 1st of March 2005 until the 31st of August 2006. This was achieved by analysing the microbiology, demographic data, smoking and drinking habits, diabetes, renal impairment, co-morbidities, approximated size and age of the wounds, immunosuppressive treatment and complicating factors on the clinical outcome of each patient. The results were evaluated using a Student T-test for continuous parameters, chi-square test for categorical parameters and a logistic regression analysis to predict healing after 12 weeks. The analysis revealed that only 33,3% of ulcers with P. aeruginosa, isolated at least once from 12 weeks prior, to or during surgery, were healed (98% or more) by week 12 follow-up, while 73,1% of ulcers without P. aeruginosa were so by the same time (p?=?0,001). Smoking also significantly suppressed the outcome at the 12-week follow-up. Subsequently, a logistic regression analysis was carried out leaving P. aeruginosa as the only predictor left in the model (p?=?0,001). This study supports our hypothesis that P. aeruginosa in chronic venous leg ulcers, despite treatment, has considerable impact on partial take or rejection of split-thickness skin grafts. PMID:21655269

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

2011-01-01

137

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

PubMed

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

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

2013-08-01

138

Ischemic ulcers - self-care  

MedlinePLUS

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

139

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

PubMed

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

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

2012-01-01

140

Stasis dermatitis and ulcers  

MedlinePLUS

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

141

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

PubMed Central

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

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

2014-01-01

142

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

PubMed

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

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

2015-03-01

143

A Real World, Observational Registry of Chronic Wounds and Ulcers  

ClinicalTrials.gov

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

2014-10-29

144

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

PubMed

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

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

2014-05-01

145

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

PubMed

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

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

2011-01-01

146

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

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?

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

2014-01-01

147

A Review of Technological Approaches to Venous Ulceration  

Microsoft Academic Search

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

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

148

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

Microsoft Academic Search

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

Kent KC

149

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

PubMed

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

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

2015-01-01

150

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

PubMed Central

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

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

2008-01-01

151

Venous ulcers - self-care  

MedlinePLUS

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

152

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

PubMed

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

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

2012-08-01

153

Peptic ulcer  

MedlinePLUS

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

154

Mouth ulcers  

MedlinePLUS

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

155

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

Microsoft Academic Search

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

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

1997-01-01

156

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

PubMed Central

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

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

2008-01-01

157

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

Microsoft Academic Search

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

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

2007-01-01

158

Person Number leg1 leg2 leg3 leg4  

E-print Network

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

Bergstein, Paul

159

US skin disease assessment: ulcer and wound care.  

PubMed

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

Markova, Alina; Mostow, Eliot N

2012-01-01

160

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 ...

161

Ulcerative Colitis  

MedlinePLUS

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

162

Corneal Ulcer  

MedlinePLUS

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

163

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

PubMed

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

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

2013-01-01

164

Marjolin's Ulcer of the Scalp: a Reconstructive Challenge  

PubMed Central

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

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

2005-01-01

165

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

PubMed

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

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

2005-12-31

166

Causes of venous ulceration: a new hypothesis  

Microsoft Academic Search

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

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

1988-01-01

167

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

PubMed

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

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

2008-06-01

168

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 ...

169

Peptic Ulcer  

MedlinePLUS

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

170

Hyperhomocysteinaemia and chronic venous ulcers.  

PubMed

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

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

2015-02-01

171

Sarcoidosis mimicking a venous ulcer: a case report.  

PubMed

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

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

2009-11-01

172

Pterygotus legs  

NSDL National Science Digital Library

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

2001-03-01

173

Excessive bleeding from genital ulcers of Behçet's disease.  

PubMed

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

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

1997-09-01

174

Atypical ulcers.  

PubMed

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

Hoffman, Mark D

2013-01-01

175

Leg muscles  

NSDL National Science Digital Library

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

Uwe Gille (None; )

2007-07-29

176

Leg Strain  

MedlinePLUS

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

177

Ulcerative Sarcoidosis Successfully Treated with Apligraf  

Microsoft Academic Search

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

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

2001-01-01

178

Cutaneous ulcer as leading symptom of systemic cytomegalovirus infection.  

PubMed

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

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

2015-01-01

179

Cutaneous Ulcer as Leading Symptom of Systemic Cytomegalovirus Infection  

PubMed Central

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.

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

2015-01-01

180

Venous ulcers.  

PubMed

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

Reichenberg, Jason; Davis, Mark

2005-12-01

181

Pressure ulcer  

MedlinePLUS

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

182

Ugh! Ulcers  

MedlinePLUS

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

183

Peptic Ulcers  

MedlinePLUS

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

184

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

E-print Network

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

Henderson, Thomas C.

185

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

E-print Network

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

Payan, Yohan

186

Leg pain  

MedlinePLUS

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

187

Types of Ulcerative Colitis  

MedlinePLUS

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

188

Leg CT scan  

MedlinePLUS

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

189

Changes in the apparently normal limb in unilateral venous ulceration.  

PubMed

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

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

1987-10-01

190

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

PubMed

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

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

2013-10-01

191

[Marjolin ulcer].  

PubMed

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

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

2001-01-01

192

[Marjölin ulcer].  

PubMed

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

Paredes, F

1998-02-01

193

Malignancy in scars, chronic ulcers, and sinuses  

PubMed Central

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

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

1963-01-01

194

Leg lengthening - series (image)  

MedlinePLUS

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

195

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 ...

196

Ulcerative colitis - discharge  

MedlinePLUS

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

197

Ulcerative Colitis  

NSDL National Science Digital Library

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

Patient Education Institute

198

Foot, leg, and ankle swelling  

MedlinePLUS

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

199

Leg lengthening.  

PubMed

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

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

1993-04-01

200

Some Effects of Sustained Compression On Ulcerated Tissues  

Microsoft Academic Search

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

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

2002-01-01

201

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

PubMed

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

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

2013-10-01

202

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

Microsoft Academic Search

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

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

2008-01-01

203

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

PubMed

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

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

2014-10-01

204

Restless legs syndrome  

MedlinePLUS

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

205

Skin zinc concentrations in patients with varicose ulcers  

SciTech Connect

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

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

1990-06-01

206

Leg Injuries and Disorders  

MedlinePLUS

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

207

Preventing pressure ulcers  

MedlinePLUS

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

208

Marjolin's warty ulcer.  

PubMed

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

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

2011-02-01

209

Diagnosing oral ulcers.  

PubMed

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

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

2015-02-01

210

Peptic ulcer and dyspepsia  

Microsoft Academic Search

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

Andrew H. Soil

1999-01-01

211

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

Microsoft Academic Search

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

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

2002-01-01

212

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

PubMed Central

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

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

2007-01-01

213

Legged robots that balance  

SciTech Connect

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

Raibert, M.H.

1985-01-01

214

Antimicrobial therapy of peptic ulcers  

Microsoft Academic Search

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

Stephan Miehlke; David Y. Graham

1997-01-01

215

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

E-print Network

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

Bergstein, Paul

216

Marjolin’s Ulcer  

PubMed Central

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

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

2009-01-01

217

Science Nation: Ulcer Answers  

NSDL National Science Digital Library

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

218

Juxta CURES: compression for healing venous leg ulcers.  

PubMed

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

Nugent, Lisa

2013-09-01

219

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

PubMed

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

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

2002-06-01

220

Endocrinopathies and peptic ulcer  

Microsoft Academic Search

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

Seymour J. Gray

1964-01-01

221

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...

222

Diabetic foot ulcers  

Microsoft Academic Search

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

William J Jeffcoate; Keith G Harding

2003-01-01

223

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

PubMed

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

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

2014-01-01

224

Pressure Ulcer Prevention  

PubMed Central

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

2009-01-01

225

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....

226

Restless Legs Syndrome  

MedlinePLUS

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

227

Peripheral artery disease - legs  

MedlinePLUS

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

228

Legs of Mesolimulus  

NSDL National Science Digital Library

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

2001-03-01

229

Solitary ulcer of the rectum  

Microsoft Academic Search

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

M. R. Madigan; B. C. Morson

1969-01-01

230

Connective Tissue Ulcers  

PubMed Central

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

Dabiri, Ganary; Falanga, Vincent

2013-01-01

231

Actuator device for artificial leg  

NASA Technical Reports Server (NTRS)

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.

Burch, J. L. (inventor)

1976-01-01

232

UNUSUAL CAUSES OF CUTANEOUS ULCERATION  

PubMed Central

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

Panuncialman, Jaymie; Falanga, Vincent

2010-01-01

233

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

PubMed

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

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

2011-09-01

234

Peptic ulcer disease - discharge  

MedlinePLUS

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

235

Peripheral Ulcerative Keratitis  

MedlinePLUS

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

236

Capsaicin and Gastric Ulcers  

Microsoft Academic Search

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

M. N. Satyanarayana

2006-01-01

237

Cancer and Ulcerative Colitis  

PubMed Central

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

Aylett, Stanley

1971-01-01

238

Burns and Ulcerative Colitis  

PubMed Central

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

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

2006-01-01

239

Burns and ulcerative colitis.  

PubMed

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

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

2006-09-30

240

Treatment of venous ulcers  

Microsoft Academic Search

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

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

2005-01-01

241

Ulcers and gastritis.  

PubMed

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

Kashiwagi, H

2005-02-01

242

Athletes' leg pains.  

PubMed Central

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

Orava, S.; Puranen, J.

1979-01-01

243

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

PubMed

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

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

2008-01-01

244

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

245

Diabetic foot ulcerations: an overview.  

PubMed

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

Daniels, T R

1998-09-01

246

JAMA Patient Page: Diabetic Foot Ulcers  

MedlinePLUS

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

247

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

Microsoft Academic Search

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

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

2008-01-01

248

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

PubMed Central

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

Chatterjee, Sasanka S.

2012-01-01

249

Metastable legged-robot locomotion  

E-print Network

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

Byl, Katie

2008-01-01

250

Leg or foot amputation  

MedlinePLUS

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

251

Athletes' leg pains  

Microsoft Academic Search

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

S. Orava; J. Puranen

1979-01-01

252

Ulcer disease of trout  

USGS Publications Warehouse

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

Fish, F.F.

1934-01-01

253

Gait Generation For Legged Robots  

Microsoft Academic Search

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

David Wettergreen; Chuck Thorpe

1992-01-01

254

Giant ulcerative dermatofibroma.  

PubMed

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

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

2013-01-01

255

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

SciTech Connect

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

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

1983-12-01

256

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

Microsoft Academic Search

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

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

2001-01-01

257

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

Microsoft Academic Search

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

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

258

ORTHOPEDIC LEG BRACE  

NASA Technical Reports Server (NTRS)

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

Myers, William Neil (Inventor)

2005-01-01

259

[Managing perilesional pressure ulcers].  

PubMed

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

Perceau, Géraldine

2013-01-01

260

Methotrexate and oral ulceration  

Microsoft Academic Search

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

G M J Deeming; J Collingwood; M N Pemberton

2005-01-01

261

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

PubMed

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

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

2015-01-01

262

[Dermatoses in leg amputees].  

PubMed

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

Wlotzke, U; Hohenleutner, U; Landthaler, M

1996-07-01

263

Pairs of Legs  

NSDL National Science Digital Library

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

264

Management of Chronic Pressure Ulcers  

PubMed Central

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

2009-01-01

265

Wooden Legs Videos  

NSDL National Science Digital Library

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

Suzanne Alejandre

2011-12-01

266

Ulcerative colitis and pregnancy  

Microsoft Academic Search

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

C P Willoughby; S C Truelove

1980-01-01

267

Diabetic Foot Ulcers  

Microsoft Academic Search

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

Andrew Boulton; Frank Bowling

268

Management of radiation ulcers  

SciTech Connect

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

Shack, R.B.

1982-12-01

269

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

PubMed

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

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

2014-09-01

270

Differentiating nocturnal leg cramps and restless legs syndrome.  

PubMed

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

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

2014-07-01

271

Maneuvers during legged locomotion.  

PubMed

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

Jindrich, Devin L; Qiao, Mu

2009-06-01

272

Maneuvers during legged locomotion  

NASA Astrophysics Data System (ADS)

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

Jindrich, Devin L.; Qiao, Mu

2009-06-01

273

Marjolin ulcer: an overlooked entity.  

PubMed

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

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

2011-08-01

274

JAMA Patient Page: Pressure Ulcers  

MedlinePLUS

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

275

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

PubMed

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

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

2008-05-01

276

Athermal laser treatment of the diabetic leg  

NASA Astrophysics Data System (ADS)

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

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

1995-03-01

277

Getting Your Sea Legs  

PubMed Central

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

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

2013-01-01

278

Design of robotic quadruped legs  

E-print Network

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

McKenzie, Jacob Elijah

2012-01-01

279

A metabolically efficient leg brace  

E-print Network

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

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

2006-01-01

280

Methotrexate and oral ulceration.  

PubMed

Methotrexate is well established in the drug treatment of various neoplastic diseases. More recently it has become increasingly used as a once-weekly, low-dose treatment of disorders such as psoriasis and rheumatoid arthritis. Clinical trials have shown its effectiveness in these conditions and it is likely that dentists will encounter patients taking this drug in general dental practice. Oral ulceration can occur as a side effect of methotrexate therapy. This may be due to lack of folic acid supplementation or overdosage due to confusion regarding its once-weekly regime. Illustrations of these problems, which have initially presented in a dental setting, are given. Important drug interactions of methotrexate relevant to dentistry are discussed. PMID:15702101

Deeming, G M J; Collingwood, J; Pemberton, M N

2005-01-22

281

Mucocutaneous ulcerations secondary to methotrexate.  

PubMed

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

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

2008-05-01

282

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

PubMed

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

Ødegård, C; Svendsen, M; Heringstad, B

2014-07-01

283

[The daily life of men who lives with chronic venous ulcer: phenomenological study].  

PubMed

The chronic venous leg ulcer is the major therapeutic problem of lower limb injuries, which can trigger changes in the daily life of the person affected by it. This study aimed to understand the daily life of men who lives with chronic venous ulcers. A phenomenological study was conducted with eight men, who were interviewed during June and July of 2001. The study asked questions related to: "Restrictions in social life" and "Recovering the skin integrity and restart the activities affected by the wound". The answers revealed that men with these ulcers have social implications in the areas of productivity and sexuality. This leads to restrictions in everyday life with loss in performance of socially established roles for men, leading to anxiety for his return at full performance of his social role. The findings suggest significant experiential aspects that may guide professionals in the planning and implementation of health actions aimed to treat these patients. PMID:24344590

da Silva, Marcelo Henrique; de Jesus, Maria Cristina Pinto; Merighi, Miriam Aparecida Barbosa; de Oliveira, Deise Moura; Biscotto, Priscilla Ribeiro; Silva, Greyce Pollyne Santos

2013-09-01

284

Colonic motility in ulcerative colitis  

PubMed Central

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

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

2014-01-01

285

Stance leg control: variation of leg parameters supports stable hopping.  

PubMed

The spring-loaded inverted pendulum describes the planar center-of-mass dynamics of legged locomotion. This model features linear springs with constant parameters as legs. In biological systems, however, spring-like properties of limbs can change over time. Therefore, in this study, it is asked how variation of spring parameters during ground contact would affect the dynamics of the spring-mass model. Neglecting damping initially, it is found that decreasing stiffness and increasing rest length of the leg during a stance phase are required for orbitally stable hopping. With damping, stable hopping is found for a larger region of rest-length rates and stiffness rates. Here, also increasing stiffness and decreasing rest length can result in stable hopping. Within the predicted range of leg parameter variations for stable hopping, there is no need for precise parameter tuning. Since hopping gaits form a subset of the running gaits (with vanishing horizontal velocity), these results may help to improve leg design in robots and prostheses. PMID:22183256

Riese, Sebastian; Seyfarth, Andre

2012-03-01

286

Pipe crawler with extendable legs  

DOEpatents

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

Zollinger, W.T.

1992-06-16

287

Pipe crawler with extendable legs  

DOEpatents

A pipe crawler for moving through a pipe in inchworm fashion having front and rear leg assemblies separated by air cylinders to increase and decrease the spacing between assemblies. Each leg of the four legs of an assembly is moved between a wall-engaging, extended position and a retracted position by a separate air cylinder. The air cylinders of the leg assemblies are preferably arranged in pairs of oppositely directed cylinders with no pair lying in the same axial plane as another pair. Therefore, the cylinders can be as long 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.

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

1992-01-01

288

Randomised controlled trial comparing European standard class 1 to class 2 compression stockings for ulcer recurrence and patient compliance.  

PubMed

The aim of this study was to determine the rate of venous ulcer recurrence and the level of compliance in patients wearing European class 1 or class 2 compression stockings. A total of 100 patients with healed venous leg ulcers were recruited, and were randomised to either class 1 (n = 50) or class 2 (n = 50) compression stockings. Follow-up was at 1 week, 3, 6, 9 and 12 months to monitor ulcer recurrence and compliance. Patients had a duplex scan to identify the source of venous incompetence. The rate of ulcer recurrence after 12 months was 16·1%, and the difference in recurrence rate between classes was not statistically significant (P = 0·287) although greater numbers in class 1 developed a recurrence. Participants (88·9%) were compliant; non-compliant patients were at a significantly greater risk of recurrence (P? 0·0001). Thirteen patients had both superficial and deep incompetence; those randomised to class 1 stockings (n = 4) developed ulcer recurrence. Patients with a history of multiple episodes of ulceration were more likely to develop a recurrence (P = 0·001). The lowest venous ulcer recurrence rates were seen in patients who were compliant with hosiery regardless of the compression level. Patients with both superficial and deep incompetence had a lower rate of recurrence with class 2 compression. PMID:23078587

Clarke-Moloney, Mary; Keane, Niamh; O'Connor, Veronica; Ryan, Mary Anna; Meagher, Helen; Grace, Pierce A; Kavanagh, Eamon; Walsh, Stewart R; Burke, Paul E

2014-08-01

289

Intramuscular pressures beneath elastic and inelastic leggings  

NASA Technical Reports Server (NTRS)

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).

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

1994-01-01

290

Treatment of Chronic Posttraumatic Leg Injury Using Autologous Fat Graft  

PubMed Central

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

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

2012-01-01

291

Prometheus Hot Leg Piping Concept  

NASA Astrophysics Data System (ADS)

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

Gribik, Anastasia M.; DiLorenzo, Peter A.

2007-01-01

292

OCEAN DRILLING PROGRAM LEG 120 SCIENTIFIC PROSPECTUS  

E-print Network

Co-Chief Scientist, Leg 120 Institute de Physique du Globe Lab. de Geophysique Marine 5 rue Rene Descartes 67084 Strasbourg Cedex, France Dr. Sherwood W. Wise, Jr. Co-Chief Scientist, Leg 120 Department

293

38 CFR 4.110 - Ulcers.  

Code of Federal Regulations, 2012 CFR

...Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE FOR RATING DISABILITIES Disability Ratings The Digestive System § 4.110 Ulcers. Experience has shown that the term “peptic ulcer” is not sufficiently specific for...

2012-07-01

294

38 CFR 4.110 - Ulcers.  

Code of Federal Regulations, 2011 CFR

...Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE FOR RATING DISABILITIES Disability Ratings The Digestive System § 4.110 Ulcers. Experience has shown that the term “peptic ulcer” is not sufficiently specific for...

2011-07-01

295

38 CFR 4.110 - Ulcers.  

Code of Federal Regulations, 2014 CFR

...Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE FOR RATING DISABILITIES Disability Ratings The Digestive System § 4.110 Ulcers. Experience has shown that the term “peptic ulcer” is not sufficiently specific for...

2014-07-01

296

38 CFR 4.110 - Ulcers.  

Code of Federal Regulations, 2010 CFR

...Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE FOR RATING DISABILITIES Disability Ratings The Digestive System § 4.110 Ulcers. Experience has shown that the term “peptic ulcer” is not sufficiently specific for...

2010-07-01

297

38 CFR 4.110 - Ulcers.  

Code of Federal Regulations, 2013 CFR

...Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE FOR RATING DISABILITIES Disability Ratings The Digestive System § 4.110 Ulcers. Experience has shown that the term “peptic ulcer” is not sufficiently specific for...

2013-07-01

298

Crohn's Disease and Ulcerative Colitis: Emotional Factors  

MedlinePLUS

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

299

Pressure ulcers - what to ask your doctor  

MedlinePLUS

Pressure ulcers are also called bedsores, or pressure sores. They can form when your skin and soft tissue press ... damaged or die. When this happens, a pressure ulcer may form. Below are some questions you may ...

300

Why Dont Whales Have Legs?  

NSDL National Science Digital Library

In this lesson, students are given a variety of materials and are asked to design a heat loss experiment that will result in a reasonable explanation of why whales do not have legs. Students will learn that natural selection favors a body design that is energy efficient.

S. Bedell

301

Animation of dynamic legged locomotion  

Microsoft Academic Search

This paper is about the use of control algorithms to animate dynamic legged locomotion. Control could free the animator from specifying the details of joint and limb motion while producing both physically realistic and natural looking results. We implemented computer animations of a biped robot, a quadruped robot, and a kangaroo. Each creature was modeled as a linked set of

Marc H. Raibert; Jessica K. Hodgins

1991-01-01

302

Rotational joint for prosthetic leg  

NASA Technical Reports Server (NTRS)

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.

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

1977-01-01

303

Nonhealing Ulcer: Acroangiodermatitis of Mali  

PubMed Central

An 18-year-old male presented with a nonhealing wound on left lower limb, pain and swelling over multiple joints, weight loss, and yellowish discoloration of eyes and urine for the past 4 years. On examination, the patient had pallor, icterus, and generalized lymphadenopathy with a nonhealing unhealthy ulcer over left medial malleolus. He had deformed joints with hepatomegaly and splenomegaly. His laboratory investigations were positive for antinuclear antibody (ANA) and anticardiolipin antibody (ACLA). Synovial fluid analysis showed inflammatory findings. Biopsy of margin of the ulcer showed findings consistent with Acroangiodermatitis of Mali. The patient was treated with disease-modifying antirheumatic drugs (DMARDs) and aspirin for juvenile idiopathic arthritis and secondary antiphospholipid antibody syndrome (APS), respectively. The ulcer was managed conservatively with systemic antibiotics and topical steroids along with limb elevation and compression elastic stockings. The patient's symptoms improved significantly, and he is in our followup. PMID:23259075

Varyani, Neeraj; Thukral, Anubhav; Kumar, Nilesh; Gupta, Kailash Kumar; Tandon, Ravi; Tripathi, Kamlakar

2011-01-01

304

Nonhealing ulcer: acroangiodermatitis of mali.  

PubMed

An 18-year-old male presented with a nonhealing wound on left lower limb, pain and swelling over multiple joints, weight loss, and yellowish discoloration of eyes and urine for the past 4 years. On examination, the patient had pallor, icterus, and generalized lymphadenopathy with a nonhealing unhealthy ulcer over left medial malleolus. He had deformed joints with hepatomegaly and splenomegaly. His laboratory investigations were positive for antinuclear antibody (ANA) and anticardiolipin antibody (ACLA). Synovial fluid analysis showed inflammatory findings. Biopsy of margin of the ulcer showed findings consistent with Acroangiodermatitis of Mali. The patient was treated with disease-modifying antirheumatic drugs (DMARDs) and aspirin for juvenile idiopathic arthritis and secondary antiphospholipid antibody syndrome (APS), respectively. The ulcer was managed conservatively with systemic antibiotics and topical steroids along with limb elevation and compression elastic stockings. The patient's symptoms improved significantly, and he is in our followup. PMID:23259075

Varyani, Neeraj; Thukral, Anubhav; Kumar, Nilesh; Gupta, Kailash Kumar; Tandon, Ravi; Tripathi, Kamlakar

2011-01-01

305

[Psychological factors in duodenal ulcers].  

PubMed

With the aid of a clinical questionnaire and the I-N-R-personality test of Eysenck (as modified by Böttcher), we examined 127 male patients with clinically and radiologically proven ulcer compared to 145 age-matched persons without gastric affections. The features extraversion, neuroticism (emotional lability) and rigidity were determined and the question of an association with symptoms, age at onset of disease as well as occupational and familial factors statistically analyzed. With high significance, duodenal ulcer patients are more often emotionally labile and psychically more rigid. In the event the disease manifests under the age of 30, in ulcer patients introversion too is pronounced with highly significant frequency. Those patients complaining of conflicts with collaborators, lack of sleep, occupational overexertion, noise, draught at work place, present, compared to others without these complaints, a frequently emotional lability with high significance. PMID:7341221

Bauer, B; Bergmann, M

1981-01-01

306

Kayexalate-induced colonic ulcer  

PubMed Central

A 61-year-old male presents to the emergency room with complaints of fatigue, dizziness and bright red blood per rectum (BRBPR) for 2 days. Past medical history was significant for gastroesophageal reflux disease, non-steroidal anti-inflammatory drug (NSAID) induced ulcer, and end-stage renal disease (GFR < 30) status post 2 failed renal grafts. Pertinent medications include pantoprazole and sodium polystyrene sulfonate in sorbitol (Kayexalate 30 g/d orally). On esophagogastroduodenoscopy (EGD) there was a single shallow, flat, non-bleeding gastric ulcer (3 mm) in the pre-pyloric region of the stomach with no stigmata of bleeding. A colonoscopy was performed showing evidence of colitis and localized ulcerations in the cecum which were biopsied. Histopathology revealed basophilic, nonpolarizable, rhomboid-like crystals without evidence of necrosis. PMID:24759345

Albeldawi, Mazen; Gaur, Varun; Weber, Luke

2014-01-01

307

Kayexalate-induced colonic ulcer.  

PubMed

A 61-year-old male presents to the emergency room with complaints of fatigue, dizziness and bright red blood per rectum (BRBPR) for 2 days. Past medical history was significant for gastroesophageal reflux disease, non-steroidal anti-inflammatory drug (NSAID) induced ulcer, and end-stage renal disease (GFR < 30) status post 2 failed renal grafts. Pertinent medications include pantoprazole and sodium polystyrene sulfonate in sorbitol (Kayexalate 30 g/d orally). On esophagogastroduodenoscopy (EGD) there was a single shallow, flat, non-bleeding gastric ulcer (3 mm) in the pre-pyloric region of the stomach with no stigmata of bleeding. A colonoscopy was performed showing evidence of colitis and localized ulcerations in the cecum which were biopsied. Histopathology revealed basophilic, nonpolarizable, rhomboid-like crystals without evidence of necrosis. PMID:24759345

Albeldawi, Mazen; Gaur, Varun; Weber, Luke

2014-08-01

308

Ulcerative Lichen Planus in Childhood  

PubMed Central

Lichen planus (LP) is a chronic inflammatory mucocutaneous condition which is relatively common in adults but rarely affects children. The present study is a report on an unusual case of ulcerative oral LP involving the dorsum of tongue in a 12-year-old boy. Patient complained of painful oral lesion on the tongue which was burning in nature and obstructing talking and eating spicy foods. On intraoral examination, a white ulcerative lesion on the dorsum of tongue was observed. Diagnosis was made based on clinical examination and histopathological features. We instituted local treatment and patient responded well to the treatment. Although rarely reported in childhood, lichen planus should be considered in a differential diagnosis of hyperkeratotic, reticular, and ulcerative lesions of the oral mucosa in children. PMID:24455324

Padmini, Chiyadu; Bai, K. Yellamma; Chaitanya, Vinil; Reddy, M. Shilpa

2013-01-01

309

[Peptic ulcer recurrence after selective proximal vagotomy].  

PubMed

A study of the structure of recurrences of ulcer disease was made on the basis of long-term follow-up results in 257 patients with selective proximal vagotomies. Real (with the presence of an ulcer) and false (without ulcer) recurrences are distinguished. The clinical aspects of the course and diagnosis of real and false recurrences are described. The principles of prophylaxis and treatment of ulcer disease recurrences are outlined. PMID:2756674

Polous, Iu M; Shidlovski?, V A; Gorbunova, V I; Va?sberg, G R

1989-04-01

310

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

PubMed Central

INTRODUCTION The current management of vulvar cancer depends on the extension of disease, and includes primary tumor resection with safety margin as well as inguinofemoral lymph node staging. We report the case of the first leg videoendoscopic inguinal lymphadenectomy performed in a woman with a squamous cell vulvar carcinoma. PRESENTATION OF CASE A 74 years old female referred to our institution complaining of vulvar mass associated with bleeding and swelling from external genitals, vaginal burning sensation and dysuria for 5 months. A vulvar–vaginal examination under narcosis reported a right major labium lesion of 5 cm with an irregular and ulcerated surface, easily bleeding on palpation, involving anteriorly the clitoral region and with a histological finding of a poorly differentiated squamous cell invasive carcinoma of the vulva ulcerating the surface epithelium. We performed, after adequate informed consent, a radical vulvectomy with a standard right inguinofemoral lymphadenectomy and a contralateral simultaneous video endoscopic inguinal lymphadenectomy-Leg procedure. DISCUSSION Our minimally invasive VEIL-Leg approach, performed for the first time in literature in a woman with vulvar cancer, could reduce the presence of high risk factors represented by surgical incision and by procedure-related complications, including wound infection and breakdown, hematoma, cellulitis and hernia formation. CONCLUSION A multicenter prospective randomized study will be helpful to clarify how this procedure could replace the standard laparotomic approach to inguinal lymphadenectomy in the vulvar cancer treatment and staging. PMID:24973526

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

2014-01-01

311

A non-adhesive foam dressing for exuding venous leg ulcers and pressure ulcers: six case studies.  

PubMed

Six patients had their wounds dressed with 3M Foam Dressing, a highly absorbent polyurethane foam covered with a breathable layer, for up to four weeks. The dressing was assessed for its effect on the wound and patient comfort, with promising results. PMID:14999990

Charles, H; Corser, R; Varrow, S; Hart, J

2004-02-01

312

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

E-print Network

MAGIC Leg0 CRUISE REPORT 2012-06-14 MAGIC Leg0 Cruise on the M/V Horizon Spirit under the command Laboratory) Mike Reynolds (Remote Measurements and Research Company) #12;2 MAGIC Leg0 Cruise Report, 2012-06-14 Abstract MAGIC cruise Leg0 occurred on the M/V Horizon Spirit, under the command of Captain Walt Rankin

313

[Prevention of pressure ulcer (bedsore)].  

PubMed

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

Sedmak, Dijana; Vrhovec, Marina; Huljev, Dubravko

2013-10-01

314

PSYCHIATRIC FACTORS IN ULCERATIVE COLITIS  

PubMed Central

SUMMARY Controlled study on 20 patients of ulcerative colitis was conducted at Gastroenterology Department of Civil Hospital, Ahmedabad. It has been observed that in three fourth of the cases, age of onset is before 40 years; & male, female ratio 4:1. No significant trend emerged in marital status, type of family, birth order, dietary habit and parental profile. The disease is common in lower socio-economic status. Ulcerative colitis patients are particularly exposed to stressful life situations and more prone to develop illness. PMID:21847291

Chakraborty, P.K.; Shah, Anil V.; Parikh, N.K.

1983-01-01

315

A Leg (or Three) to Stand On  

NSDL National Science Digital Library

The three "legs" on which science instruction rests are the content of science, process of science, and the nature of science. Each leg performs its own function and need not be competitive with the others. This article uses the metaphor of a three-legged stool to remind teachers that good science instruction must have a balance that is both stable and engaging.

Molly Weinburgh

2003-03-01

316

Acute Pancreatitis Due to a Duodenal Ulcer  

PubMed Central

Duodenal ulcers and acute pancreatitis are two of the most commonly encountered gastrointestinal diseases among the general population. However, duodenal ulcer-induced pancreatitis is very rarely reported worldwide. This report elaborates on a distinct medical treatment that contributes to partial or complete treatment of acute pancreatitis induced by a duodenal ulcer scar. PMID:25505728

Pyeon, Sung Ik; Kim, Yong Tae; Lee, Ban Seok; Lee, Sang Ho; Lee, Jae Nam; Cheong, Jae Hoon; Oh, Kong Jin

2014-01-01

317

Approach to microangiolopathic ulcerations: Diagnosis and therapy  

Microsoft Academic Search

Microangiolopatic ulcerations represent a peculiar kind of ulceration. Though not rare, there is still not enough known about them and treatment is inadequate, usually long term and deceiving. We have followed 66 patients with microangiolopathic ulcerations secondary to metabolic disorders (diabetes mellitus), vascular disorders (vascularitis, atherosclerosis, high blood pressure, arteritis, postthrombotic syndrome, atrophie blanche), postcombustive syndrome, scleroderma, lupus eritematosus, and

Patricia Cristodor; E. Sfetcu; Viorica Frantescu; F. C. Rada; M. Hancu; Monica Botez; Lavinia Serban

1994-01-01

318

Is gastric emptying abnormal in duodenal ulcer?  

Microsoft Academic Search

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

Stephen Holt; Robert C. Heading; Thomas V. Taylor; John A. Forrest; Peter Tothill

1986-01-01

319

Computed tomographic findings in penetrating peptic ulcer  

SciTech Connect

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

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

1984-12-01

320

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...

321

Healing refractory venous ulcers: new treatments offer hope.  

PubMed

Non-healing wounds are associated with an inflammatory and proteolytic wound environment, and recent therapeutic strategies have been focused on reversing these changes. Connexins, as members of gap junctions, are important in intercellular signaling and wound repair. Connexin 43 (Cx43) downregulation is associated with normal wound healing, and it has been found to be upregulated in non-healing venous leg ulcers (VLUs). Ghatnekar et al. (2014) report findings of a small phase II trial performed in Indian patients with chronic VLUs, reporting that ACT1, a mimetic peptide of Cx43, accelerates healing in the treatment group. Despite standard care with compression therapy and adjuvant therapy for refractory wounds, at present in clinical practice a significant number of patients remain unhealed. The potential for ACT1 exists to help heal refractory VLUs, but it faces additional regulatory hurdles. PMID:25501380

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

2015-01-01

322

Chapter 12. Atherosclerosis and peptic ulcer  

PubMed Central

Aortic and coronary atherosclerosis and the frequency of coronary stenosis and myocardial lesions were studied in subjects with peptic ulcer, in two subgroups with acute and chronic peptic ulcer, and in subjects who had undergone a stomach operation. In all these respects the groups were similar to each other. Men with peptic ulcer had the same amount of aortic atherosclerosis as the standardized average coronary atherosclerosis group but less coronary atherosclerosis, while women with peptic ulcer had less aortic and much less coronary atherosclerosis. The prevalence of coronary stenosis, fresh myocardial infarction, and myocardial scar was very low in those with peptic ulcer, especially in women. PMID:1087198

Sternby, N. H.

1976-01-01

323

Pressure ulcer prevention in the community setting.  

PubMed

Pressure ulcers are associated with reduced quality of life, affecting individuals physically, socially and emotionally. The financial cost to the NHS of preventing and treating such ulcers is substantial. Although largely preventable, pressure ulcers are still common. The Department of Health is committed to eliminating all avoidable pressure ulcers in NHS-provided care. This article explores methods of preventing pressure ulcers, with particular focus on risk assessment, skin inspection, pressure-relieving measures, nutrition and hydration, and patient and carer education. PMID:24044860

Jones, Donna

324

Endoscopic Management of Peptic Ulcer Bleeding  

PubMed Central

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.

Kim, Joon Sung; Park, Sung Min

2015-01-01

325

Hallux Ulceration in Diabetic Patients  

Microsoft Academic Search

We undertook a prospective cohort study to assess risk factors associated with hallux ulceration, and to determine the incidence of healing or amputation, in consecutive patients with diabetes mellitus who were treated over the observation period extending from September 2004 to March 2005, at the Jabir Abu Eliz Diabetic Centre, Khartoum City, Sudan. There were 122 diabetic patients in the

Mohamed ElMakki Ahmed; Abdulhakim O. Tamimi; Seif I. Mahadi; AbuBakr H. Widatalla; Mohamed A. Shawer

2010-01-01

326

Prevention and management of diabetic foot ulcers.  

PubMed

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

Turns, Martin

2015-03-01

327

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

PubMed

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

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

2012-03-01

328

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

PubMed Central

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

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

2014-01-01

329

Management of ulcers in lymphoedematous limbs  

PubMed Central

Lymphoedema is a progressive condition that can have a marked physical and psychological impact on affected patients and significantly reduce the quality of life. The ulcers on chronic lymphoedema patient, which often also makes it impossible for them to work. If left untreated, tends to progress or worsen. Ulcers in lymphoedema patients, therefore, represent not only a medical but also a psychological problem. The treatment is often regarded as being worse than it actually is. In our study of more than 25 years shows around 10% cases are due to chronic lymphodema. Ulcers of chronic lymphoedema are classified into four stages according to their presentation. Their management depends upon their stage of presentation. Patients with chronic lymphoedema and ulceration require a different approach to treatment. The specific issues associated with managing the patient with lymphoedematous ulceration include, limb shape distortion i.e., elephantiasis, care of the skin creases and folds, and swelling of the toes and fore foot. Stage I ulcers will heal with conservative treatment without any surgical intervention. Stage II ulcers needs debridement of the wound and split-thickness skin grafting. The most difficult to treat are the stage III and IV ulcers, due to associated skin changes and reduced vascularity. These cases need debulking along with excision of the ulcer. In order to prevent recurrence of the ulcer in all the four stages needs prolonged follow-up and limb care. PMID:23162225

Karnasula, Vishnu M.

2012-01-01

330

Hydrophilic polymer microemboli in a patient with a chronic cutaneous ulcer: a case report.  

PubMed

Hydrophilic polymer coatings were designed to reduce friction between the catheter and vessel wall and facilitate intravascular manipulations during catheterization and placement of drug-eluting stents. One newly reported complication of such hydrophilic coatings is the fragmentation and embolization of the polymer, which can lead to ischemia and infarct by blocking the small vasculature. In this report, we present a patient with a non-healing ulcer on the leg. Biopsy from the ulcer revealed the presence of hydrophilic polymer emboli within the dermal vessels. This is one of the few reports of such a complication involving the skin. Our objective is to emphasize the histopathologic features of this uncommon iatrogenic phenomenon. PMID:25370782

Hamidi, Sepehr; Stevens, Ryan; DeClerck, Brittney; Kim, Gene H

2014-12-01

331

Chronic ringworm infestation and Marjolin’s ulcer, an association unknown in the literature  

PubMed Central

We report here a case of Marjolin’s ulcer developing in a long-standing, inadequately treated, chronic ringworm infestation of the lower limb. A 35-year-old female patient with a ten-year history of a chronic ringworm infestation had developed a nonhealing ulcer in an area of infestation on the right leg. A biopsy revealed well-differentiated squamous cell carcinoma associated with the ringworm infection. A below-knee amputation by an inguinal block dissection was performed. We conclude that proper and timely treatment of fungal infections of the skin is needed to allow for healing of dermal infections and thus the prevention of the disastrous consequences that recurrent mechanical trauma from scratching of the affected area, leading to occult malignancy, which may occur in a small number of patients. PMID:21139833

Ashraf, Mohammad; Biswas, Jaydip

2010-01-01

332

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

PubMed

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

Shen, Z H; Seipel, J E

2012-12-01

333

Cancer morbidity in ulcerative colitis  

Microsoft Academic Search

Cancer morbidity at all sites has been studied in a series of 676 patients with ulcerative colitis under long-term review, of whom more than two-thirds had extensive disease, and the level and pattern of risk over time examined. Age-, sex-, and site-specific incidence rates were used to compute the number of cancers that might have been expected to occur. A

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

1982-01-01

334

Tool Blunts Cotter Pin Legs for Safety  

NASA Technical Reports Server (NTRS)

Jaws on new insertion tool contain upset point and anvil. Point forces cotter-pin legs into loop as it engages anvil. Cotter pin before insertion consists of loop and straight shaft composed of two legs welded together as tips. After insertion, welded legs have been shaped into loop. Tool used to prevent bent loose ends of cotter pins from scratching workers' fingers or cutting and entangling wires.

Stein, J. A.; Helble, D. R.

1982-01-01

335

The Legs Problem--For All Ages  

ERIC Educational Resources Information Center

This article presents an example of a versatile multi-solution problem that can be used right across the primary years. The basic problem is: "Noah saw 16 legs go past him into the Ark. How many creatures did he see?" Any even number can be used, although, 2 legs allows only one answer and with 16 legs there are already 14 different solutions, so…

Way, Jenni

2005-01-01

336

Multiple cutaneous neutropenic ulcers associated with azathioprine  

PubMed Central

We report a case of neutropenic ulceration in a 42-year-old woman receiving azathioprine for pemphigus vulgaris. She developed multiple indolent ulcers involving the nose, neck, and back, after about 6–8 weeks following commencement of azathioprine 50 mg daily. The ulcers were large, disfiguring, dry, and with basal necrotic slough. They were painless and did not discharge pus. The absolute neutrophil count was severely depressed initially, but normalized following azathioprine withdrawal. Swab culture revealed colonization with Klebsiella pneumoniae and the ulcers healed with local debridement, treatment with imipenem, and topical application of mupirocin. However, nasal disfigurement persisted. Neutropenic ulceration is known to be associated with azathioprine therapy but we report this case because of the unusual presentation—indolent cutaneous ulcers. Early recognition of the problem and drug withdrawal can prevent complications like disfigurement. PMID:23112431

Laha, Baisakhi; Guha, Rajib; Hazra, Avijit

2012-01-01

337

Approach to skin ulcers in older patients.  

PubMed Central

OBJECTIVE: To provide family physicians with an approach to managing skin ulcers in older patients. SOURCES OF INFORMATION: Clinical practice guidelines and best practice guidelines were summarized to describe an evidence-based approach. MAIN MESSAGE; Preventing ulcers is important in frail older patients. Using guidelines can help prevent ulcers in institutions. Clarifying the cause and contributing factors is the first step in management. Pressure and venous ulcers are common in elderly people. Poor nutrition, edema, arterial insufficiency, and anemia often impair wound healing. Adequate debridement is important to decrease risk of infection and to promote healing. There are guidelines for cleaning ulcers. Choice of dressings depends on the circumstances of each wound, but dressings should provide a moist environment. Options for dressings are summarized. CONCLUSION: Family physicians can manage skin ulcers effectively by applying basic principles and using readily available guidelines. PMID:15648380

Frank, Christopher

2004-01-01

338

Radiation of anginal pain to the legs.  

PubMed

Pain radiated from the chest to one or both legs (17 cases), or from the legs to the chest (two cases) in 19 patients with angina or acute myocardial infarction. The leg pain was assumed to be related to the angina pectoris when both were of a similar character and occurred together, when the leg pain occurred at rest, and when there were normal peripheral pulses in the leg. Pain was felt in the left leg by 10 patients, the right leg by two patients, and in both legs by seven. Three patients experienced pain in the thigh(s), six in the shin(s), and 10 had pain in both. In six patients the pain extended down to the inner two to four toes. The pain was always felt in front of the legs. This distribution accords with the suggestion that some sensory cardiac nerve fibres occur in the lumbar sympathetic ganglia and that pain is projected into the corresponding dermatomes. PMID:3942655

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

1986-02-01

339

Ulcerative necrobiosis lipoidica responsive to colchicine.  

PubMed

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

Schofield, Clare; Sladden, Michael J

2012-08-01

340

Scrotal ulceration in HIV-positive patients.  

PubMed Central

Four patients with scrotal ulceration were seen during a period of 9 months. All of them were HIV-positive homosexual men with coexisting skin conditions. Herpes simplex virus was not isolated from any of the ulcers, but a variety of bacteria was recovered. It is suggested that multiple factors peculiar to HIV-positive individuals may account for the development of such ulcers. Images PMID:2341146

Hillman, R J; Goldmeier, D; Taylor-Robinson, D

1990-01-01

341

Gastric emptying abnormal in duodenal ulcer  

SciTech Connect

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

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

1986-07-01

342

Treatment of restless legs syndrome.  

PubMed

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

Comella, Cynthia L

2014-01-01

343

Factor analysis of the International Restless Legs Syndrome Study Group's scale for restless legs severity  

Microsoft Academic Search

Objective: The International Restless Legs Syndrome Study Group has developed and validated a ten-item scale for assessing the severity of the restless legs syndrome. This International Restless Legs Severity Scale (IRLS) is reported to have a high degree of internal consistency and it has generally been used as a single scale. This study uses a factor analytic approach to evaluate

Richard P. Allen; Clete A. Kushida; Mark J. Atkinson

2003-01-01

344

Automated Pressure Ulcer Lesion Diagnosis for Telemedicine Systems  

E-print Network

Automated Pressure Ulcer Lesion Diagnosis for Telemedicine Systems Dimitrios I. Kosmopoulos dkosmo Force Hospital 11525 Athens, Greece Abstract The timely diagnosis and treatment of pressure ulcers for automated pressure ulcer stage classification can be integrated into an asynchronous telemedicine system

Kosmopoulos, Dimitrios I.

345

Chronic ulcerative stomatitis: Clinical, histopathologic, and immunopathologic findings  

E-print Network

Chronic ulcerative stomatitis: Clinical, histopathologic, and immunopathologic findings Lynn W, Ky STATE UNIVERSITY OF NEW YORK, UNIVERSITY OF KENTUCKY, AND IMMCO DIAGNOSTICS INC Chronic ulcerative involve the skin. Clinically, CUS patients exhibit erosive or ulcerative lesions of the oral mucosa

Dennett, Daniel

346

Running with a load increases leg stiffness.  

PubMed

Spring-mass models have been used to characterize running mechanics and leg stiffness in a variety of conditions, yet it remains unknown how running while carrying a load affects running mechanics and leg stiffness. The purpose of this study was to test the hypothesis that running with a load increases leg stiffness. Twenty-seven subjects ran at a constant speed on a force-measuring treadmill while carrying no load, and while wearing weight vests loaded with 10%, 20%, and 30% of body weight. We measured lower extremity motion and created a scaled musculoskeletal model of each subject, which we used to estimate lower extremity joint angles and leg length. We estimated dimensionless leg stiffness as the ratio of the peak vertical ground reaction force (normalized to body weight) and the change in stance phase leg length (normalized to leg length at initial foot contact). Leg length was calculated as the distance from the center of the pelvis to the center-of-pressure under the foot. We found that dimensionless leg stiffness increased when running with load (p=0.001); this resulted from an increase in the peak vertical ground reaction force (p<0.001) and a smaller change in stance phase leg length (p=0.025). When running with load, subjects had longer ground contact times (p<0.020), greater hip (p<0.001) and knee flexion (p=0.048) at the time of initial foot contact, and greater peak stance phase hip, knee, and ankle flexion (p<0.05). Our results reveal that subjects run in a more crouched posture and with higher leg stiffness to accommodate an added load. PMID:25728581

Silder, Amy; Besier, Thor; Delp, Scott L

2015-04-13

347

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

PubMed Central

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

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

2011-01-01

348

Pressure ulcer classification: defining early skin damage.  

PubMed

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

Russell, Linda

2002-09-01

349

OCEAN DRILLING PROGRAM LEG 112 PRELIMINARY REPORT  

E-print Network

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

350

OCEAN DRILLING PROGRAM LEG 138 SCIENTIFIC PROSPECTUS  

E-print Network

· OCEAN DRILLING PROGRAM LEG 138 SCIENTIFIC PROSPECTUS Eastern Equatorial Pacific Dr. Larry Mayer of the Ocean Drilling Program in consultation with the Planning Committee and the Pollution Prevention Corvallis, Oregon 97331-5503 Canada Dr. Tom Janecek Staff Scientist, Leg 138 Ocean Drilling Program Texas A

351

Reconfigurable Planar Three-Legged Parallel Manipulators  

E-print Network

planar platforms with three degrees of freedom (DOF) is presented for the first time. The architectureReconfigurable Planar Three-Legged Parallel Manipulators M. John D. Hayes Department of Mechanical to be missing in the body of literature is a planar three-legged parallel manipulator kinematic architecture

Hayes, John

352

OCEAN DRILLING PROGRAM LEG 175 PRELIMINARY REPORT  

E-print Network

OCEAN DRILLING PROGRAM LEG 175 PRELIMINARY REPORT BENGUELA CURRENT Dr. Wolfgang Berger Co, Texas 77845-9547 U.S.A. __________________ Paul J. Fox Director of Science Operations ODP The following scientists were aboard the JOIDES Resolution for Leg 175 of the Ocean Drilling Program: Wolfgang

353

Why do flamingos stand on one leg?  

PubMed

A series of observational studies of captive Caribbean flamingos Phoenicopterus ruber were conducted to determine why flamingos rest on one leg. While frequently asked by the general public, this basic question has remained unanswered by the scientific community. Here we suggest that the latency of flamingos to initiate forward locomotion following resting on one leg is significantly longer than following resting on two, discounting the possibility that unipedal resting reduces muscle fatigue or enhances predatory escape. Additionally, we demonstrate that flamingos do not display lateral preferences at the individual or group levels when resting on one leg, with each bird dividing its resting time across both legs. We show that while flamingos prefer resting on one leg to two regardless of location, the percentage of birds resting on one leg is significantly higher among birds standing in the water than among those on land. Finally, we demonstrate a negative relationship between temperature and the percentage of observed birds resting on one leg, such that resting on one leg decreases as temperature rises. Results strongly suggest that unipedal resting aids flamingos in thermoregulation. PMID:19637281

Anderson, Matthew J; Williams, Sarah A

2010-01-01

354

Prosthetic Leg Lesson Plan Biomedical Engineering  

E-print Network

they don't just tape PVC pipe and called in a "prosthetic leg". Materials · Drill #12;· Hot glue gun · Scissors · Bolts · Screws · Hot glue · PVC · 2x4 wood · Plungers · Foam · Painter sponge · T to suggest for the leg structure: PVC pipe, plunger, foam, wood 2x4, metal straps, etc. The list of possible

Provancher, William

355

Stump ulcers and continued prosthetic limb use  

Microsoft Academic Search

Stump ulcers are common problems in amputees. Temporary discontinuation of prosthetic limb use is frequently employed to facilitate healing. Inevitably, this limits activity and may, for instance, prevent an amputee from going to work. A survey of clinical practice was carried out based on the premise that controlled continued prosthetic limb use in patients with stump ulcers will not adversely

A. SALAWU; C. MIDDLETON; A. GILBERTSON; K. KODAVALI; V. NEUMANN

2006-01-01

356

Pressure ulcers: Back to the basics  

PubMed Central

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

Agrawal, Karoon; Chauhan, Neha

2012-01-01

357

Diagnosis and management of genital ulcers.  

PubMed

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

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

2012-02-01

358

Incidence and pathophysiology of peptic ulcer bleeding  

Microsoft Academic Search

Peptic ulcer accounts for about 50% of all cases of upper gastrointestinal bleeding. Acute mortality may be as high as 14%. Infection with Helicobacter plyori (Hp) and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) are the predominant risk factors. While the prevalence of Hp in ulcer bleeding is still debated, there is strong evidence that eradication of bacteria reduce the

Georg D. Arlt; Markus Leyh

2001-01-01

359

The burden of diabetic foot ulcers  

Microsoft Academic Search

Lower extremity ulcers represent a major concern for patients with diabetes and for those who treat them, from both a quality of life and an economic standpoint. Studies to evaluate quality of life have shown that patients with foot ulcers have decreased physical, emotional, and social function. Analyses of economic impact have shown (1) the majority of costs occur in

GayleE Reiber; BenjaminA Lipsky; GaryW Gibbons

1998-01-01

360

Protocol for treatment of diabetic foot ulcers  

Microsoft Academic Search

Each year, 82,000 limb amputations are performed in patients with diabetes mellitus. The majority of these amputations could be avoided by following strict protocols. The collective experience treating patients with neuropathic diabetic foot ulcers of 4 major diabetic foot programs in the United States and Europe were analyzed. The following protocol has been developed for patients with diabetic foot ulcers:

Harold Brem; Peter Sheehan; Andrew J. M Boulton

2004-01-01

361

Steerable Hopping Six-Legged Robot  

NASA Technical Reports Server (NTRS)

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

Younse, Paulo; Aghazarian, Hrand

2010-01-01

362

A descriptive study of pressure ulcer pain.  

PubMed

Despite increased emphasis on addressing patient pain, knowledge and information about pressure ulcer pain remains limited. To describe the quantitative and qualitative characteristics of pain related to pressure ulcers, a study was conducted among 47 hospitalized patients with pressure ulcers using the McGill Pain Questionnaire and Revised Faces Rating Scale. Volunteer participants, admitted for neurological disorders, ranged in age from 38 to 72 years (mean age 60.1 years +/- 8.23; 29 men, 18 women), six with Stage II, 32 with Stage III, and nine with Stage IV pressure ulcers. All but three (44, 94.6%) reported pressure ulcer pain; of those, 28 (59.5%) reported constant pressure ulcer pain and 41 (87.2%) did not specify when pain occurred. Dressing change, movement of the afflicted area, and pain at rest were reported by 32 (68.1%), nine (19.1%), and three (6.4%) patients, respectively. "Hot-burning" was the sensory descriptor most frequently used to describe the pain in 52%, 56%, and 67% of Stage II, Stage III, and Stage IV patients, respectively. Three out of six patients with Stage II ulcers rated their pain "discomforting," 32 of 32 with Stage III ulcers rated pain as "distressing," and nine out of nine with a Stage IV ulcer rated their pain as "horrible". Based on the Revised Faces Rating Scale, mean pain intensity was 6.04 +/- 2.78 (range 1 to 10), corresponding to moderate pain. For overall pain intensity, Patient Pain Index and Faces Rating Scale-Revised scores were highly correlated (r = 0.90, P <0.001). Pressure ulcers are painful, most patients report pain as "constant", and pain assessment should be included in all patient care plans. PMID:18382043

Günes, Ulkü Yapucu

2008-02-01

363

Does a crouched leg posture enhance running stability and robustness?  

PubMed

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

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

2011-07-21

364

Expansion Compression Contacts for Thermoelectric Legs  

NASA Technical Reports Server (NTRS)

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.

Sakamoto, Jeffrey

2009-01-01

365

Ulcers  

MedlinePLUS

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

366

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

PubMed Central

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

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

2013-01-01

367

Iron for restless legs syndrome  

PubMed Central

Background Restless legs syndrome (RLS) is a common neurologic syndrome and is associated with iron deficiency in many patients. It is unclear whether iron therapy is effective treatment for RLS. Objectives The objective of this review was to assess the effects of iron supplementation (oral or intravenous) for patients with RLS. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Jan 1995 to April 2011); EMBASE (Jan 1995 to April 2011); PsycINFO (Jan 1995 to April 2011); and CINAHL (Jan 1995 to April 2011). Corresponding authors of included trials and additional members of the International Restless Legs Syndrome Study Group were contacted to locate additional published or unpublished trials. Selection criteria Controlled trials comparing any formulation of iron with placebo, other medications, or no treatment in adults diagnosed with RLS according to expert clinical interview or explicit diagnostic criteria. Data collection and analysis Two review authors extracted data and at least two authors assessed trial quality. We contacted trial authors for missing data. Main results Six studies (192 total subjects) were identified and included in this analysis. The quality of trials was variable. Our primary outcome was restlessness or uncomfortable leg sensations, which was quantified using the IRLS severity scale in four trials and another RLS symptom scale in a fifth trial. Combining data from the four trials using the IRLS severity scale, there was no clear benefit from iron therapy (mean difference in IRLS severity scores of -3.79, 95% CI: -7.68 to 0.10, p = 0.06). However, the fifth trial did find iron therapy to be beneficial (median decrease of 3 points in the iron group and no change in the placebo group on a 10 point scale of RLS symptoms, p = 0.01). Quality of life was improved in the iron group relative to placebo in some studies but not others. Changes in periodic limb movements were not different between groups (measured in two studies). Objective sleep quality, subjective sleep quality and daytime functioning were not different between treatment groups in the studies that assessed them. The single study of subjects with end stage renal disease did show a benefit of therapy. Most trials did not require subjects to have co-morbid iron deficiency and several excluded patients with severe anemia. The single study that was limited to iron deficient subjects did not show clear benefit of iron supplementation on RLS symptoms. There was no clear superiority of oral or intravenous delivery of iron. Iron therapy did not result in significantly more side effects than placebo (RR 1.39, 95% CI 0.85 to 2.27). Authors' conclusions There is insufficient evidence to determine whether iron therapy is beneficial for the treatment of RLS. Further research to determine whether some or all types of RLS patients may benefit from iron therapy, as well as the best route of iron administration, is needed. PMID:22592724

Trotti, Lynn M; Bhadriraju, Srinivas; Becker, Lorne A

2014-01-01

368

Guts & Glory H. pylori: Cause of Peptic Ulcer  

Microsoft Academic Search

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

Ashley Johnson; Bryan Kratz; Lorraine Scanlon; Alina Spivak

369

Diabetic Heel Ulcer in the Sudan: Determinants of Outcome  

Microsoft Academic Search

Heel ulceration, on average, costs 1.5 times more than metatarsal ulceration. The aim of this study was to analyze the determinant factors of healing in diabetic patients with heel ulcers and the late outcomes at Jabir Abu Eliz Diabetic Centre Khartoum, Khartoum, Sudan. Data were collected prospectively for 96 of 100 diabetic patients presenting with heel ulcers at the Jabir Abu

Haseeb E. Bakheit; Mohamed F. Mohamed; Seif ElDin I. Mahadi; Abu Bakr H. Widatalla; Mohamed A. Shawer; Amar H. Khamis; Mohamed E. Ahmed

370

Diabetic foot ulcers. Pathophysiology, assessment, and therapy.  

PubMed Central

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

Bowering, C. K.

2001-01-01

371

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

PubMed

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

Affatato, S; Toni, A

2000-07-01

372

Passive Leg Raising during Pregnancy.  

PubMed

Objective?To determine if passive leg raising (PLR) significantly increases cardiac output in a cohort of healthy pregnant women during the third trimester. Study Design?Using a noninvasive monitor, baseline hemodynamic measurements for arterial blood pressure, systolic and diastolic blood pressure, heart rate, cardiac output, cardiac index, stroke volume, and systemic vascular resistances were obtained with patients in the semirecumbent position. Measurements were repeated after a 3-minute PLR maneuver in supine, right lateral decubitus, and left lateral decubitus positions. Results?After 10 minutes of bed rest, the cohort's mean baseline heart rate was 80?±?12 beats/minute. Baseline stroke volume was 98?±?14 mL, mean cardiac output was 7.8?±?1.2 L/min, and mean cardiac index was 4.32?±?0.63 L/min. The baseline systemic vascular resistance value was 893?±?160 dynes/sec/cm(5). Baseline mean arterial blood pressure was 84?±?11?mm Hg. Following a PLR maneuver in the supine position, heart rate decreased significantly. No difference was noted in other measurements. Findings were similar with PLR in the left lateral decubitus. PLR in the right lateral decubitus resulted in significantly decreased heart rate, cardiac output, and cardiac index. Conclusions?PLR did not result in cardiac output recruitment in a cohort of healthy pregnant women during the third trimester. PMID:25241109

Marques, Nicole Ribeiro; Martinello, Caroline; Kramer, George C; Costantine, Maged M; Vadhera, Rakesh B; Saade, George R; Hankins, Gary D; Pacheco, Luis D

2015-03-01

373

Hot Leg Piping Materials Issues  

SciTech Connect

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

V. Munne

2006-07-19

374

Aetiopathogenesis of restless legs syndrome.  

PubMed

The pathogenesis of restless legs syndrome (RLS) is not yet completely understood. However, recent research addressed the hypothesis that dopaminergic pathways are involved in the mechanisms responsible for the syndrome both for sensory and motor symptoms. Different aspects of RLS physiopathogenesis are discussed: the genetic components indicating different chromosomes are responsible for the heterogeneity in the phenotypic expression of the familial forms of RLS; the neurophysiologic data showing the hyperexcitability of the cortico-motor efferents at supraspinal level, with spinal cord involvement leading to a definition of RLS as a syndrome of somatosensory misperception, disturbed gain regulation and/or a shifted threshold; the paucity of neuroimaging data, which do not definitively clarify the eventual dopaminergic dysfunction in RLS patients, at least at the basal ganglia level; an illustration of the iposideremic hypothesis starting from the therapeutic effect of iron, although not for all patients, and based on some neurophysiologic and neuropathologic results both in humans and animal models; and finally the role of the opioid system, suggesting an imbalance of dopamine-opiate system inputs to brain regions involved in motor responses and pain perception, and representing an aberrant behavioural response to sensory inputs. All these theories may have a final common pathway in the dopaminergic system, reinforcing the empirical results of benefit with dopamine or dopamine-agonist treatments in RLS. PMID:17235431

Zucconi, M; Manconi, M; Ferini Strambi, L

2007-01-01

375

Radiographical evaluation of ulcerative colitis  

PubMed Central

Radiographical modalities have become important diagnostic tools in cases of ulcerative colitis (UC). Imaging can be used non-invasively to determine the extent of involvement, severity of disease and to detect disease-related complications and extra-intestinal inflammatory bowel disease (IBD) manifestations. While abdominal X-rays and barium enemas still retain their relevance in specific clinical settings, the use of computed tomography enterography (CTE) or magnetic resonance enterography (MRE) are now used as first-line investigations to exclude active small bowel disease in IBD patients and can be utilized to detect active colonic inflammation. Additionally, CT colonography and MR colonography are emerging techniques with potential applications in UC. Ultrasonography, leukocyte scintigraphy and positron emission tomography are novel abdominal imaging modalities currently being explored for IBD interrogations. This plethora of radiological imaging options has become a vital component of UC assessments. PMID:24843072

Deepak, Parakkal; Bruining, David H.

2014-01-01

376

Biological therapy for ulcerative colitis.  

PubMed

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

Arora, Zubin; Shen, Bo

2014-10-24

377

[Gastroduodenal ulcer refractory to conservative treatment].  

PubMed

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

Velenciuc, Natalia; Melinte, C; Velenciuc, I

2006-01-01

378

Automatic system for corneal ulcer diagnostic  

NASA Astrophysics Data System (ADS)

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

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

1997-05-01

379

Recurring pressure ulcers: identifying the definitions. A National Pressure Ulcer Advisory Panel white paper.  

PubMed

Currently, there is a lack of consensus regarding the accepted terminology pertaining to the pressure ulcer healing progression and recidivism. This lack of uniformity can negatively impact initiation of treatment pathways, completion of appropriate interventions, clinical documentation, medical coding, patient education, discharge planning and healthcare revenue through out the healthcare system. The purpose of this paper is to introduce a standard nomenclature as it pertains to pressure ulcer healing progression and any recidivism that may occur. The National Pressure Ulcer Advisory Panel has formulated a framework of terms regarding pressure ulcer progression. We also developed a clearer nomenclature for lack of progress and recidivism of pressure ulcers. This document should serve as a starting point for the discussion of the pressure ulcer care, research, and terminology. PMID:24844329

Tew, Cindy; Hettrick, Heather; Holden-Mount, Sarah; Grigsby, Rebekah; Rhodovi, Julie; Moore, Lyn; Ghaznavi, Amir M; Siddiqui, Aamir

2014-01-01

380

[Systemic infusion therapy versus retrograde intravenous perfusion: comparative results in patients with diabetic neuropathic plantar ulcer].  

PubMed

Concerning the resistance of diabetic neuropathic plantar ulcers (DNPU) against systemically applied drugs, the "Retrograde Venous Perfusion" (RVP) was introduced as a therapeutic alternative by C. P. Ferreira in 1988. An isotonic saline solution containing gentamycin, buflomedil, dexamethasone, heparin and lignocain is injected into a dorsal foot vein under arterial occlusion of the lower leg. In the present study RVP treatment was done in 20 patients with DNPU and the results were compared to a group treated with systemic intravenous infusions (SVI; n = 20). After 10 days of treatment, 8 out of 20 ulcers were closed (SVI: 4). In 9 ulcers (SVI: 4) size had diminuted by > 30%. Non responders were not observed under RVP in contrast to SVI (7/20 cases). In 4 of 5 patients with osteolytic bone lesions (SVI: 0/7), partial restoration was observed. Rate of toe amputation dropped to 0% (SVI: 20%). Considering the striking differences between either regimen, RVP can be recommended for treatment of DNPU especially when complicated by osteomyelitis. PMID:8379178

Seidel, C; Bühler-Singer, S; Richter, U G; Hornstein, O P

1993-01-01

381

Marjolin ulcers arising on extremities.  

PubMed

Marjolin ulcer, epidermoid carcinoma arising on nonhealing scar tissue, is well known for its aggressiveness compared with other forms of squamous cell carcinoma. It is thought to be even more aggressive when it arises on an extremity. Therefore, Marjolin ulcer located on an extremity is unique in its aggressiveness and calls for immediate attention and extensive surgery. We have treated 81 patients with extremity lesions between 1982 and 2003, 62 of which have been followed up for at least 5 years. The cases that were lost to follow-up and our more recent cases have not been included in this study. Medical records of these 62 patients were reviewed retrospectively. All the lesions were carcinomas arising on old burn scars. The mean age was 48.0 years. The average interval between burn and carcinoma was 35.9 years. Male to female ratio was approximately 1:2. About 72.6% of the patients were treated with wide local excision only and 21.0% of the patients had wide excision together with regional lymph node dissection. Only 6.4% of the cases have been treated with amputation combined with regional lymph node dissection. Postoperative regional lymph metastasis was seen in 40.3% of the patients and 41.9% of the patients have developed lung metastasis during the follow-up. Presence of metastasis, high histologic grade, and tumor size were found to have a direct effect on survival rates. The mean survival was 4.55 for the whole study group. The 5-year survival rate was 42.9% in upper extremity and 58.3% in lower extremity groups. Estimated mean time of survival for the disease has been calculated to be 7.76 years using statistical analysis. We suggest that tumor size is an important prognostic factor in addition to histologic grade. Treatment algorithm is reviewed, and the importance of adequate surgery is emphasized. PMID:20179482

Tiftikcioglu, Yigit Ozer; Ozek, Cuneyt; Bilkay, Ufuk; Uckan, Ali; Akin, Yalcin

2010-03-01

382

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....

383

Passive zero-gravity leg restraint  

NASA Technical Reports Server (NTRS)

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

Miller, Christopher R. (inventor)

1989-01-01

384

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....

385

OCEAN DRILLING PROGRAM LEG 154 PRELIMINARY REPORT  

E-print Network

02543 Free School Lane U.S.A. Cambridge CB2 3RS United Kingdom Dr. Carl Richter Staff Scientist, Leg 154 School Lane, Cambridge CB2 3RS, United Kingdom) Carl Richter, Staff Scientist (Ocean Drilling Program

386

OCEAN DRILLING PROGRAM LEG 181 PRELIMINARY REPORT  

E-print Network

Cambridge CB2 3EQ Australia United Kingdom Dr. Carl Richter Staff Scientist, Leg 181 Ocean Drilling ProgramCave Department of Earth Sciences University of Cambridge Downing Street Cambridge CB2 3EQ United Kingdom Work

387

Endoscopic application of EGF-chitosan hydrogel for precipitated healing of GI peptic ulcers and mucosectomy-induced ulcers.  

PubMed

The gastrointestinal (GI) endoscopy has become a standard diagnostic tool for GI ulcers and cancer. In this study we studied endoscopic application of epidermal growth factor-containing chitosan hydrogel (EGF-CS gel) for treatment of GI ulcer. We hypothesized that directional ulcer-coating using EGF-CS gel via endoscope would precipitate ulcer-healing. EGF-CS gel was directly introduced to the ulcer-region after ulceration in acetic acid-induced gastric ulcer (AAU) and mucosal resection-induced gastric ulcer (MRU) rabbit and pig models. The ulcer dimensions and mucosal thicknesses were estimated and compared with those in the control group. Healing efficacy was more closely evaluated by microscopic observation of the ulcer after histological assays. In the AAU model, the normalized ulcer size of the gel-treated group was 2.3 times smaller than that in the non-treated control group on day 3 after ulceration (P < 0.01). In the MRU model, the normalized ulcer size of the gel-treated group was 5.4 times smaller compared to that in the non-treated control group on day 1 after ulceration (P < 0.05). Histological analysis supported the ability of EGF-CS gel to heal ulcers. The present study suggests that EGF-CS gel is a promising candidate for treating gastric bleeding and ulcers. PMID:24338378

Maeng, Jin Hee; Bang, Byoung Wook; Lee, Eunhye; Kim, Jungju; Kim, Hyung Gil; Lee, Don Haeng; Yang, Su-Geun

2014-02-01

388

Rotational joint assembly for the prosthetic leg  

NASA Technical Reports Server (NTRS)

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.

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

1977-01-01

389

Bilateral leg edema in an older woman.  

PubMed

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

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

2015-01-01

390

Passive legged, multi-segmented, robotic vehicle.  

SciTech Connect

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

Hayward, David R.

2003-11-01

391

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

PubMed Central

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

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

2014-01-01

392

Propranolol for recalcitrant ulcerated hemangioma of infancy.  

PubMed

Hemangioma of infancy (HOI) is a common, self-resolving, benign tumor that frequently requires no intervention. Ulceration is one of the main complications of HOI, and active treatment is usually required to manage pain, potential scarring, and occasionally bleeding and infection. Since the discovery that oral propranolol is an effective treatment for complicated HOI, it has been replacing systemic corticosteroids as first-line therapy, and early recommendations for treatment protocols have been devised. We report the successful treatment of six children with recalcitrant ulcerated HOI using propranolol. In all cases, complete, rapid healing occurred. Two children experienced recurrence of ulceration after ceasing propranolol, but this was rapidly controlled by restarting treatment. No adverse effects were encountered. We propose that ulceration in HOI is an indication for propranolol treatment if more conservative therapies have failed. PMID:21854419

Hong, Esther; Fischer, Gayle

2012-01-01

393

Tannins, Peptic Ulcers and Related Mechanisms  

PubMed Central

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

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

2012-01-01

394

Automatic system for corneal ulcer diagnostic: II  

NASA Astrophysics Data System (ADS)

Corneal Ulcer is a deepithelization of the cornea and it is a very common disease in agricultural countries. The clinician most used parameter in order to identify a favorable ulcer evolution is the regress of the affected area. However, this kind of evaluation is subjective, once just the horizontal and vertical axes are measured based on a graduated scale and the affected area is estimated. Also, the registration of the disease is made by photographs. In order to overcome the subjectiveness and to register the images in a more accessible way (hard disks, floppy disks, etc.), we have developed an automatic system in order to evaluate the affected area (the ulcer). An optical system is implemented in a Slit Lamp (SL) and connected to a CCD detector. The image is displayed in PC monitor by a commercial frame grabber and a dedicated software for determining the area of the ulcer (precision of 20 mm) has been developed.

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

1998-06-01

395

Automatic analysis of the corneal ulcer  

NASA Astrophysics Data System (ADS)

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

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

1999-06-01

396

Restoring Psychology's Role in Peptic Ulcer  

PubMed Central

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

Overmier, J Bruce; Murison, Robert

2013-01-01

397

Helicobacter pylori and Ulcers: A Paradigm Revised  

NSDL National Science Digital Library

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

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

2010-07-12

398

[Mycobacterium chelonae and solitary rectal ulcer].  

PubMed

Solitary rectal ulcer is of varied etiology and the appearance of this syndrome due to Mycobacterium chelonae is exceptional. We present a case of a solitary rectal ulcer associated with Mycobacterium chelonae subspecies chelonae in an immunocompetent individual. This microorganism is involved in cutaneous, ocular, pulmonary and soft tissue infections. Treatment of infections has traditionally been surgical, although various antibiotic treatments have been used depending on the sensitivity of the microorganism, the severity of the infection and the surgical possibilities. PMID:11149222

Rodríguez, J C; Reyes, D M; Royo, G; Andrada, E; Sillero, C

2000-12-01

399

Marjolin's ulcer presenting in the neck.  

PubMed

'Marjolin's ulcer' is a term that has come to be used for epidermal squamous cell carcinomas that have developed in areas of chronic inflammation. To our knowledge this is the first ever report of a Marjolin's ulcer developing following long-term irritation of the skin of the neck. The history of the eponym is traced and reveals that Marjolin probably never actually described this pathological process. PMID:11177375

Simmons, M A; Edwards, J M; Nigam, A

2000-12-01

400

Not at risk — Nevertheless a pressure ulcer  

Microsoft Academic Search

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

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

2006-01-01

401

The peptic ulcer syndrome in the Negro  

Microsoft Academic Search

Summary  1. Negroes constituted 12.7 per cent of all the peptic ulcer patients admitted to the Cook County Hospital during the period\\u000a of one year, while slightly higher or lower percentages are found in other hospitals admitting both White and Negro patients.\\u000a \\u000a 2. Environmentally conditioned psychic factors play an equally important role in the genesis of peptic ulcer in White and

Frederick Steigmann

1936-01-01

402

Gastritis and peptic ulcer disease in childhood  

Microsoft Academic Search

Inflammation of the gastric and duodenal mucosa is the end result of an imbalance between mucosal defensive and aggressive\\u000a factors. The degree of inflammation and imbalance between defensive and aggressive factors can then result in varying degrees\\u000a of gastritis and\\/or frank mucosal ulceration. Gastritis and ulcers of the duodenum or stomach can be classified either as\\u000a primary or secondary. The

U. Blecker; B. D. Gold

1999-01-01

403

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

PubMed Central

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

Graham, David Y

2014-01-01

404

Abstract--Applying electromyographic (EMG) signal pattern recognition to artificial leg control is challenging because leg  

E-print Network

Abstract--Applying electromyographic (EMG) signal pattern recognition to artificial leg control is challenging because leg EMGs are non-stationary. Time-frequency features are suitable for representing non of this study was to quantify the computation speed of Graphic Processor Unit (GPU) on EMG time

Sun, Yan Lindsay

405

Changes in leg volume during microgravity simulation  

NASA Technical Reports Server (NTRS)

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

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

1992-01-01

406

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

PubMed Central

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

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

2012-01-01

407

Body Mass Index and Pressure Ulcers: Improved Predictability of Pressure Ulcers in Intensive Care Patients  

PubMed Central

Background Obesity contributes to immobility and subsequent pressure on skin surfaces. Knowledge of the relationship between obesity and development of pressure ulcers in intensive care patients will provide better understanding of which patients are at high risk for pressure ulcers and allow more efficient prevention. Objectives To examine the incidence of pressure ulcers in patients who differ in body mass index and to determine whether inclusion of body mass index enhanced use of the Braden scale in the prediction of pressure ulcers. Methods In this retrospective cohort study, data were collected from the medical records of 4 groups of patients with different body mass index values: underweight, normal weight, obese, and extremely obese. Data included patients’ demographics, body weight, score on the Braden scale, and occurrence of pressure ulcers. Results The incidence of pressure ulcers in the underweight, normal weight, obese, and extremely obese groups was 8.6%, 5.5%, 2.8%, and 9.9%, respectively. When both the score on the Braden scale and the body mass index were predictive of pressure ulcers, extremely obese patients were about 2 times more likely to experience an ulcer than were normal weight patients. In the final model, the area under the curve was 0.71. The baseline area under the curve for the Braden scale was 0.68. Conclusions Body mass index and incidence of pressure ulcers were related in intensive care patients. Addition of body mass index did not appreciably improve the accuracy of the Braden scale for predicting pressure ulcers. PMID:25362673

Hyun, Sookyung; Li, Xiaobai; Vermillion, Brenda; Newton, Cheryl; Fall, Monica; Kaewprag, Pacharmon; Moffatt-Bruce, Susan; Lenz, Elizabeth R.

2015-01-01

408

Conjoined legs: Sirenomelia or caudal regression syndrome?  

PubMed Central

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

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

2013-01-01

409

Probabilistic Mechanical Reliability Prediction of Thermoelectric Legs  

SciTech Connect

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

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

2009-05-01

410

Sympathetic adaptations to one-legged training  

NASA Technical Reports Server (NTRS)

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

Ray, C. A.

1999-01-01

411

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

PubMed

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

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

2014-01-01

412

Growth arrest and leg-length discrepancy.  

PubMed

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

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

2013-03-01

413

Lower Leg Compartment Syndrome after Appendicectomy  

PubMed Central

A 10-year-old boy presented with severe left lower leg pain, uncontrolled with increasing analgesia after appendicectomy. A diagnosis of acute compartment syndrome was made after a delayed referral to the orthopaedic service. The patient subsequently underwent an emergency fasciotomy and made a good functional recovery. To the best of our knowledge this is the first reported case of paediatric lower leg compartment syndrome after appendicectomy in the literature. The case report serves to highlight the importance of maintaining a high index of suspicion for compartment syndrome. PMID:25755900

O'Neill, Shane C.; Lui, Darren F.; Murphy, Colm; Kiely, Patrick J.

2015-01-01

414

Hydroxyurea and colonic ulcers: a case report  

PubMed Central

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

2014-01-01

415

Salivary enzymes in peptic ulcer disease  

PubMed Central

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

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

2013-01-01

416

Reducing avoidable pressure ulcers in the community.  

PubMed

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

Parnham, Alison; Pankhurst, Sarah; Dabell, Wendy

2015-02-25

417

An index to measure the healing potential of ischaemic ulcers using Thallium 201  

Microsoft Academic Search

Prediction of healing of ulcers in ischaemic limbs can preclude unnecessary treatment for ulcers that cannot heal. Non-invasive methods are of marked value as the ischaemic limb is susceptible to further ulceration from local skin penetration. Relative hyperemia of the ulcer was measured by scintillation count over the ulcer and at points 2.5 cm from the edge of the ulcer.

M. E. SIEGEL; C. A. STEWART; F. W. WAGNER; I. SAKIMURA

418

Mindfulness May Be Helpful for People with Ulcerative Colitis  

MedlinePLUS

... Menu Mindfulness May Be Helpful for People With Ulcerative Colitis Mindfulness-based stress reduction (MBSR), a type of ... QOL) and decrease perceived stress in people with ulcerative colitis. These findings come from a small pilot study ...

419

Marjolin ulcers: secondary carcinomas in chronic wounds.  

PubMed

Marjolin ulcers are malignant tumors arising in chronic wounds. Strictly defined, they include carcinomas that transform from the chronic open wounds of pressure sores or burn scars. They behave aggressively and have a propensity for local recurrence and lymph node metastases. A retrospective study was done at a single institution identifying six individuals who had chronic wound ulcers that underwent malignant transformation into a carcinoma. Sinus tract degeneration in osteomyelitis was not included. The average latency time between ulcer formation and documentation of a malignancy was 30 years. All wounds were about the pelvis or flank. Major oncologic surgical procedures were done in an attempt to eradicate the cancer. High-grade tumors had positive lymph node metastases, portending a grave prognosis. All four individuals with nodal metastases eventually died of systemic disease. Early recognition and proper staging offers the best chance for cure. PMID:12132863

Esther, R J; Lamps, L; Schwartz, H S

1999-01-01

420

Reducing hospital-acquired pressure ulcers.  

PubMed

The cost of treating a hospital-acquired pressure ulcer (HAPU) places a significant burden on healthcare facilities. Associated expenses potentially include increased supplies, equipment, specialty beds, staffing, nutritional support, laboratory testing, and hospital length of stay. The quarterly HAPU data revealed an increased prevalence in our 25-bed intermediate care unit at Central DuPage Hospital at Winfield, Illinois. There were 6 occurrences of HAPU during fiscal year 2005 to fiscal year 2006, and 5 occurred during fiscal year 2006 to 2007. Based on these data, our unit quality council investigated contributory factors and reviewed current tools and standards of practice related to pressure ulcer prevention. Strategic plans were developed to reduce the incidence of HAPU. Follow-up monitoring revealed no HAPU occurrence from October 2006 through September 2007. Pressure ulcer prevention strategies proved effective in reducing incidence during a 1-year period and have been approved as standards of practice for the unit. PMID:19155823

Chicano, Susan G; Drolshagen, Colleen

2009-01-01

421

[Surgical policy in nonspecific ulcerative colitis].  

PubMed

Results of surgical treatment of 101 patients with nonspecific ulcerative colitis are analyzed. In 73 (72.3%) patients variants of abdomino-anal coloproctectomy were performed, 22 of them underwent total coloproctectomy with terminal ileo- or colostoma creation. In 21 (20.8%) patients who had no inflammatory-ulcerative process in the rectum resection of the affected part of the colon with ileo--or colorectal anastomosis was performed, in 8 cases suturing device AKA-2 was used. In 7 (6.9%) patients who had undergone total coloproctectomy S-type intestinal reservoir and reservoir-anal anastomosis were created. Rate of postoperative complications was 16.8%, lethality--3.0%. 6 months after creation of reservoir-anal anastomosis nearly complete recovery of anal sphincter function was seen that permits to regard this surgery as a method of choice in the treatment of patients with total ulcerative colitis. PMID:12744131

Navruzov, S N; Iusupbekov, A A; Khudaiarov, A A; Rustamov, A E; Sapaev, D A; Turaev, G Kh; Rakfmonov, S T

2003-01-01

422

Thyroid Storm Precipitated by Duodenal Ulcer Perforation  

PubMed Central

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.

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

2015-01-01

423

Pathogenesis and therapy of gastric and duodenal ulcer disease  

Microsoft Academic Search

Despite the decreasing frequency of Helicobacter pylori-induced peptic ulcers, peptic ulcer disease remains a major clinical problem partly because nonsteroidal anti-inflammatory drug ulcers have increased in frequency. The reduction in nonsteroidal anti-inflammatory drug ulcers by use of selective cyclooxygenase-2 inhibitors will not eliminate the problem because of in- creased use of aspirin for cardiovascular prophylaxis. This article reviews current concepts

Akiko Shiotani; David Y. Graham

2002-01-01

424

A new pressure ulcer conceptual framework  

PubMed Central

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

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

2014-01-01

425

Nighttime Leg Cramps Peak in Summer, Study Says  

MedlinePLUS

... online searches about leg cramps by people in Australia and the United States. Prescriptions for quinine in ... in July. Online searches about leg cramps in Australia were highest in January, which is mid-summer ...

426

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

427

A colored leg banding technique for Amazona parrots  

USGS Publications Warehouse

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

Meyers, J.M.

1995-01-01

428

Leg Injuries and Disorders - Multiple Languages: MedlinePlus  

MedlinePLUS

... Leg Injuries and Disorders - Multiple Languages Arabic (???????) French (français) Russian (???????) Somali (af Soomaali) Spanish (español) ... Sitting (Arabic) ??????? Bilingual PDF Health Information Translations French (français) Active Leg Range of Motion Exercises: Lying ...

429

Constraint programming for Platonic Beast legged robots  

Microsoft Academic Search

We describe the architecture of a system for programming the high degree-of-freedom Platonic Beast legged robot with constraints. This includes software for distributed control of the robot using the least constraint approach, and hardware for supporting this programming model with distributed computing and communication. We have implemented this system, and we describe results to date

D. K. Pai; R. A. Barman

1996-01-01

430

Force and motion management in legged locomotion  

Microsoft Academic Search

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

Kenneth J. Waldron

1986-01-01

431

OCEAN DRILLING PROGRAM LEG 132 ENGINEERING PROSPECTUS  

E-print Network

(Engineering Leg II) is the second of a series of cruises designed to support the development and operational the demand for dedicated ship time. Although ODP/TAMU continues to emphasize thorough shore-based testing to drive an active secondary heave compensation system. The system was designed to maintain extremely

432

OCEAN DRILLING PROGRAM LEG 137 SCIENTIFIC PROSPECTUS  

E-print Network

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

433

OCEAN DRILLING PROGRAM LEG 129 SCIENTIFIC PROSPECTUS  

E-print Network

France Dr. Roger Larson Co-Chief Scientist, Leg 129 Graduate School of Oceanography University of Rhode in this publication may be copied without restraint for library, abstract service, educational or personal research in the Jurassic. Finally, data from these sites will elucidate the physical state of some of the oldest sediments

434

OCEAN DRILLING PROGRAM LEG 154 SCIENTIFIC PROSPECTUS  

E-print Network

02543 Free School Lane U.S.A. Cambridge CB2 3RS United Kingdom Dr. Carl Richter Staff Scientist, Leg 154 restraint for library, abstract service, educational, or personal research purposes; however, republication in the oceans. Mixing between these water masses creates the initial chemical and physical properties for deep

435

OCEAN DRILLING PROGRAM LEG 181 SCIENTIFIC PROSPECTUS  

E-print Network

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

436

OCEAN DRILLING PROGRAM LEG 101 PRELIMINARY REPORT  

E-print Network

Wolfgang Schlager Co-Chief Scientist, Leg 101 Rosenstiel School of Marine and Atmospheric Sciences 4600, Jr. (University of Texas Institute for Geophysics, Austin, Texas) Co-Chief Scientist Wolfgang Schlager (Rosenstiel School of Marine and Atmospheric Sciences, Miami, Florida) Co-Chief Scientist Paul

437

OCEAN DRILLING PROGRAM LEG 160 PRELIMINARY REPORT  

E-print Network

Federal Republic of Germany Edinburgh EH9 3JW United Kingdom Dr. Carl Richter Staff Scientist, Leg 160 Foundation (United States) Natural Environment Research Council (United Kingdom) European Science Foundation, University of Edinburgh, West Mains Road, Edinburgh EH9 3JW, United Kingdom; E-mail: a

438

OCEAN DRILLING PROGRAM LEG 176 PRELIMINARY REPORT  

E-print Network

OCEAN DRILLING PROGRAM LEG 176 PRELIMINARY REPORT RETURN TO HOLE 735B Dr. Henry B.Dick Co Drilling Program: Henry B. Dick, Co-Chief Scientist (Department of Geology and Geophysics, Woods Hole, Plouzané cedex 29280, France, Internet: dbideau@ifremer.fr) Jeffrey S. Gee, Paleomagnetist (Scripps

439

Leg mechanisms for hydraulically actuated robots  

Microsoft Academic Search

The performance of highly dynamic robotic machines is directly associated with both the actuation means and the specific mechanical properties\\/configuration of the system. Hydraulic actuation demonstrates significant competitive advantages when minimum weight and volume, large forces and wide range of speeds are required and this makes it very suitable for systems such as legged robots. The geometry and design of

Yousheng Yang; Claudio Semini; Nikolaos G. Tsagarakis; Emanuele Guglielmino; Darwin G. Caldwell

2009-01-01

440

Marjolin ulcer in hidradenitis suppurativa: case reports.  

PubMed

Hidradenitis suppurativa is a chronic, recurrent, inflammatory disease of apocrine gland-bearing skin areas. Long-standing low-grade infection and chronic abscess formation result in ulcers, fistulas, and progressive scars. A rare complication is the development of squamous cell carcinoma, known as Marjolin ulcer. We report 3 cases in which squamous cell carcinoma developed despite medical treatments and local excisions. Because of the poor prognosis associated with squamous cell carcinoma, we advocate wide excision of hidradenitis suppurativa lesions when other treatments have failed. PMID:20179481

Grewal, Navanjun S; Wan, Derrick C; Roostaeian, Jason; Rubayi, Salah R

2010-03-01

441

Recurrent myopericarditis with extensive ulcerative colitis  

PubMed Central

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

Freeman, Hugh James; Salh, Baljinder

2010-01-01

442

[The use of papain in plantar ulcers].  

PubMed

This work has as a goal to contribute to decrease the inability in leprosy and continuous recurrence of plantar ulcers, through the use of a treatment method using papaine and actions of health education. This work has been done in a health centre with patients that presented plantar ulcers and agreed to participate in the proposed treatment. Analysing and comparing the obtained data before and after treatment, a greater adhesion of patients to this treatment, a quicker healing in relation to other methods used before and a greater interaction with the patient has been observed. PMID:9220838

Otuka, E S; Pedrazzani, E S; Pioto, M P

1996-01-01

443

Endoscopic management of acute peptic ulcer bleeding.  

PubMed

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

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

2014-12-01

444

Perforated Duodenal Ulcer in a Cow  

PubMed Central

A case report of perforated duodenal ulcer in a ten year old Holstein cow is presented. On three occasions, sudden anorexia and rapidly progressing abdominal fluid distension were associated with metabolic alkalosis, hypochloremia and hypokalemia. Rumen fluid at the time of the second episode was acidic and contained an excessive amount of chloride ion. An abdominal mass dorsal to the abomasum involving the pylorus and several loops of small bowel was identified but not corrected at surgery. Necropsy confirmed a 1.5 cm diameter duodenal ulcer 6 cm distal to the pylorus. PMID:17422146

Fatimah, I.; Butler, D. G.; Physick-Sheard, P. W.

1982-01-01

445

Biological therapy for ulcerative colitis: An update  

PubMed Central

Of the diverse biological agents used for patients with ulcerative colitis, the anti-tumor necrosis factor-? agents infliximab and adalimumab have been used in large-scale clinical trials and are currently widely used in the treatment of inflammatory bowel disease patients. Recent studies have indicated that golimumab, oral tofacitinib and vedolizumab reportedly achieved good clinical response and remission rates in ulcerative colitis patients. Thus, we believe that the detailed investigation of various studies on clinical trials may provide important information for the selection of appropriate biological agents, and therefore, we have extensively reviewed such trials in the present study. PMID:25309060

Seo, Geom Seog; Chae, Soo-Cheon

2014-01-01

446

!SOPHAGOGASTRIC ULCERS IN THE PIG ; PROPHYLAXIS After having expressed the hypothesis that esophagogastric ulcers are the consequence of  

E-print Network

SUMMARY !SOPHAGOGASTRIC ULCERS IN THE PIG ; PROPHYLAXIS After having expressed the hypothesis that esophagogastric ulcers are the consequence of troubles in the gastric secretion and that the ulcerogenic factors

Paris-Sud XI, Université de

447

Differences in peptic ulcer between East and West  

Microsoft Academic Search

In general, peptic ulcer occurs at equal rates in the East and the West but with marked regional differences in both, even within the same country. In the West, the incidence of peptic ulcer, particularly duodenal ulcer, rose sharply at the turn of the century and has shown a rapid decline in the past three decades. In the East, the

Shiu Kum Lam

2000-01-01

448

Severe and Refractory Peptic Ulcer Disease: The Diagnostic Dilemma  

Microsoft Academic Search

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

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

2005-01-01

449

DiÄerences in peptic ulcer between East and West  

Microsoft Academic Search

In general, peptic ulcer occurs at equal rates in the East and the West but with marked regional diÄerences in both, even within the same country. In the West, the incidence of peptic ulcer, particularly duodenal ulcer, rose sharply at the turn of the century and has shown a rapid decline in the past three decades. In the East, the

Shiu Kum; Lam OBE

2000-01-01

450

How reliable is determination of ulcer size by endoscopy?  

Microsoft Academic Search

The suface areas of 23 artificial ulcers in a rubber manikin and of 35 ulcers in 35 consecutive patients admitted for endoscopy of the upper gastrointestinal tract were estimated by six endoscopists. Of the 138 estimations made in the manikin 80% underestimated the true size of the ulcer: the mean (+\\/- SD) was -29 +\\/- 40%. The largest and the

A Sonnenberg; M Giger; L Kern; C Noll; K Study; K B Weber; A L Blum

1979-01-01

451

Dysregulated circulating dendritic cell function in ulcerative colitis is partially  

E-print Network

Dysregulated circulating dendritic cell function in ulcerative colitis is partially restored://dx.doi.org/ . / / Research Article Dysregulated Circulating Dendritic Cell Function in Ulcerative Colitis Is Partially. Dendritic cells regulate immune responses to microbial products and play a key role in ulcerative colitis

Wirosoetisno, Djoko

452

Dynamic biomechanical modeling for foot ulcer prevention *, A. Perrier,,  

E-print Network

Dynamic biomechanical modeling for foot ulcer prevention V. Luboz *, A. Perrier,, , M. Bucki , F AGIM, France; # IDS; $ IUF, France Keywords: foot ulcer prevention; biomechanical model; dynamic analysis 1. Introduction Most foot ulcers are the consequence of a trauma (repetitive high stress, ill

Boyer, Edmond

453

Clinical study Deep tissue injury rat model for pressure ulcer  

E-print Network

Clinical study Deep tissue injury rat model for pressure ulcer research on spinal cord injury Fang model; Implant; Histology Abstract Many rat/mouse pressure ulcer (PU) models have been developed to test for pressure ulcer research on spinal cord injury, Journal of Tissue Viability (2009), doi:10.1016/j.jtv.2009

Makhsous, Mohsen

454

Ulcerated hemangiomas: Clinical characteristics and response to therapy  

Microsoft Academic Search

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

Ho Jin Kim; Mary Colombo; Ilona J. Frieden

2001-01-01

455

The Mycotic Ulcer Treatment Trial  

PubMed Central

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

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

2013-01-01

456

Bilateral photoplethysmography studies of the leg arterial stenosis  

Microsoft Academic Search

A newly developed portable multi-channel photoplethysmography (PPG) device has been used for comparative studies of 20 healthy control subjects and 45 patients with diagnosed arterial stenosis in a leg. The peripheral blood pulsations were detected simultaneously at four body sites---the same fingers and toes of both arms and legs. The PPG pulses recorded at the periphery of the stenotic leg,

Renars Erts; Janis Spigulis; Indulis Kukulis; Maris Ozols

2005-01-01

457

Treatment of Ulcerative Colitis in the Elderly  

Microsoft Academic Search

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

Ashwin N. Ananthakrishnan; David G. Binion

2009-01-01

458

Outcome of benign strictures in ulcerative colitis  

Microsoft Academic Search

IntroductionLong standing ulcerative colitis (UC) is associated with an increased risk of colorectal cancer (CRC), with a cumulative incidence of about 15% at 30 years. The finding of a colonic stricture in a patient with colitis raises the possibility of neoplasia. Unlike in Crohn's disease, benign strictures in UC are rare and historically have been managed surgically with colectomy, partly

A Ignjatovic; P Tozer; K Grant; J Wilson; A L Hart; J T Jenkins; S Thomas-Gibson; S K Clark; B P Saunders

2011-01-01

459

Modern Endoscopic Therapy of Peptic Ulcer Bleeding  

Microsoft Academic Search

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

Shajan Peter; C. Mel Wilcox

2008-01-01

460

Bleeding abomasal ulcers in dairy cows  

Microsoft Academic Search

The clinical signs and changes in blood and rumen fluid, and the results of therapy are described in 35 cows suffering from bleeding abomasal ulcer. The most important pathological findings were moderate to severe anaemia with pale mucous membranes and tachycardia, dark coloured to black faeces, a disturbed general condition and anorexia. Two of the cows were slaughtered immediately. The

U Braun; R Bretscher; D Gerber

1991-01-01

461

Plantar trophic ulcers in patients with leprosy  

Microsoft Academic Search

Summary Thirty patients with leprosy were studied to correlate the presence and the site of ulcers with the neurological status of the plantar surface of the foot, the range of motion of the ankle and the pattern of ground pressure beneath the foot as obtained by a Footprint apparatus. A highly significant association was found between the presence of an

S. Sabato; Z. Yosipovitch; A. Simkin; J. Sheskin

1982-01-01

462

Peptic Ulcer Disease and H. pylori  

MedlinePLUS

... the endoscope to • take photos of the peptic ulcer. • obtain a biopsy of the lining of the stomach or small intestine. A biopsy is a procedure that involves taking a small piece of tissue for examination with a microscope by a pathologist— ...

463

Proctocolectomy without ileostomy for ulcerative colitis  

Microsoft Academic Search

An operation has been developed that permits total removal of all disease-prone mucosa in ulcerative colitis but avoids the need for a permanent ileostomy. The colon and upper half of the rectum are excised and the remaining inflamed mucosa is stripped from the rectal stump down to the dentate line of the anal canal. A pouch is fashioned from a

A G Parks; R J Nicholls

1978-01-01

464

Predicting outcome in severe ulcerative colitis  

Microsoft Academic Search

BACKGROUND: Simple criteria are needed to predict which patients with severe ulcerative colitis will respond poorly to intensive medical treatment and require colectomy. AIMS: To find out if the early pattern of change in inflammatory markers or other variables could predict the need for surgery and to evaluate the outcome of medical treatment during one year follow up. PATIENTS: 51

S P Travis; J M Farrant; C Ricketts; D J Nolan; N M Mortensen; M G Kettlewell; D P Jewell

1996-01-01

465

Failure of colonoscopic surveillance in ulcerative colitis  

Microsoft Academic Search

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

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

1993-01-01

466

Ulcer healing activity of Mumijo aqueous extract against acetic acid induced gastric ulcer in rats  

PubMed Central

Objective: Gastric ulcer is an important clinical problem, chiefly due to extensive use of some drugs. The aim was to assess the activity of Mumijo extract (which is used in traditional medicine) against acetic acid induced gastric ulcer in rats. Materials and Methods: The aqueous extract of Mumijo was prepared. Animals were randomly (n = 10) divided into four groups: Control, sham-operated group (received 0.2 ml of acetic acid to induce gastric ulcer), Mumijo (100 mg/kg/daily) were given for 4 days postacetic acid administration, and ranitidine group (20 mg/kg). The assessed parameters were pH and pepsin levels (by Anson method) of gastric contents and gastric histopathology. Ranitidine was used as reference anti-ulcer drug. Results: The extract (100 mg/kg/daily, p.o.) inhibited acid acetic-induced gastric ulceration by elevating its pH versus sham group (P < 0.01) and decreasing the pepsin levels compared to standard drug, ranitidine (P < 0.05). The histopathology data showed that the treatment with Mumijo extract had a significant protection against all mucosal damages. Conclusion: Mumijo extract has potent antiulcer activity. Its anti-ulcer property probably acts via a reduction in gastric acid secretion and pepsin levels. The obtained results support the use of this herbal material in folk medicine. PMID:25709338

Shahrokhi, Nader; Keshavarzi, Zakieh; Khaksari, Mohammad

2015-01-01

467

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

PubMed

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

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

2015-01-01

468

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

PubMed

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

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

2013-10-01

469

Description and Drawings of the Human Leg  

E-print Network

Desoription and drawings of the human l e g . Description and Drawings of The Human Leg. John Bigger 1909. The Human Leg. The purpose of t h i s work i s to enable one to o b t a i n a more v i v i d and l a s t i n g idea of the r e l a t i o n... of the hones, muscles, "blood v e s s e l s , and nerves of the human l e g . To accomplish t h i s we took the r i g h t l e g of a-negro man and made twenty t h r u cross s e c t i o n s c o u n t i n g those of the f o o t . The l e g had "been p i c k l...

Bigger, John Dinsmore

1909-01-01