Introduction Leg ulcers usually occur secondary to venous reflux or obstruction, but 20% of people with leg ulcers have arterial disease, with or without venous disorders. Between 1.5 and 3.0/1000 people have active leg ulcers. Prevalence increases with age to about 20/1000 in people aged over 80 years. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of standard treatments, adjuvant treatments, and organisational interventions for venous leg ulcers? What are the effects of interventions to prevent recurrence of venous leg ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2007 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 80 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: compression bandages and stockings, cultured allogenic (single or bilayer) skin replacement, debriding agents, dressings (cellulose, collagen, film, foam, hyaluronic acid-derived, semi-occlusive alginate), hydrocolloid (occlusive) dressings in the presence of compression, intermittent pneumatic compression, intravenous prostaglandin E1, larval therapy, laser treatment (low-level), leg ulcer clinics, multilayer elastic system, multilayer elastomeric (or non-elastomeric) high-compression regimens or bandages, oral treatments (aspirin, flavonoids, pentoxifylline, rutosides, stanozolol, sulodexide, thromboxane alpha2 antagonists, zinc), peri-ulcer injection of granulocyte-macrophage colony-stimulating factor, short-stretch bandages, single-layer non-elastic system, skin grafting, superficial vein surgery, systemic mesoglycan, therapeutic ultrasound, self-help (advice to elevate leg, advice to keep leg active, advice to modify diet, advice to stop smoking, advice to reduce weight), and topical treatments (antimicrobial agents, autologous platelet lysate, calcitonin gene-related peptide plus vasoactive intestinal polypeptide, freeze-dried keratinocyte lysate, mesoglycan, negative-pressure recombinant keratinocyte growth factor, platelet-derived growth factor). PMID:19445798
Leg ulcers are a common and costly problem that can be influenced by a number of medical conditions. It is imperative that the correct diagnosis is made and therefore a thorough medical history plus careful examination of the wound and the surrounding skin is required. At each visit the maximal longitudinal length should be recorded and the wound documented photographically.
Kate Short; Richard Bull
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
Summary Chronic ulceration of the lower leg is a frequent condition, with a prevalence of 3-5% in the population over 65 years of age. The incidence of ulceration is rising as a result of the ageing population and increased risk factors for atherosclerotic occlusion such as smoking, obesity and diabetes. Ulcers can be defined as wounds with afull thickness depthand
J. R. Mekkes; M. A. M. Loots; Wal van der A. C; J. D. Bos
This study investigated the prevalence, severity and characteristics of pain associated with venous leg ulceration. Sixty-five patients suffering with venous leg ulceration were randomised to one of three treatment groups over a 12-week treatment period. All patients received short-stretch compression bandaging. Data were collected by use of a visual analogue scale and the McGill Pain Questionnaire. Seventy per cent of patients reported pain on entry to the study and within 2 weeks of effective treatment initial pain was dramatically reduced. Patients typically described their pain as throbbing, sharp, itchy, sore and tender. The affective nature of pain was often described as tiring and patients evaluated their pain as being annoying and nagging. This study highlights the importance of pain associated with venous leg ulceration. PMID:12476504
We have given a brief summary of the scale of the problem caused by venous ulceration in the UK, and have then reviewed the various theories of causation, including a historical survey, and presented the evidence for and against the two main current theories of fibrin cuffs and white cell trapping. We also outline previous hypotheses of the aetiology of venous ulceration, including arteriovenous microanastomoses, stasis and oedema. The contribution of superficial venous incompetence in the pathogenesis of ulceration is also examined. PMID:1461849
Shami, S. K.; Shields, D. A.; Scurr, J. H.; Smith, P. D.
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
A 54-year-old man of Persian origin presented to our department with a 1-year history of ulcers on the right leg that had been unresponsive to numerous topical treatments, accompanied by lymphedema of the right leg. Medical history included hypergonadotropic hypogonadism, which had not been further investigated. He was treated for 20 years with testosterone IM once monthly, which he stopped a year before the current hospitalization for unclear reasons. The patient reported no congenital lymphedema. Physical examination revealed two deep skin ulcers (Figure 1) on the right leg measuring 10 cm in diameter with raised irregular inflammatory borders and a boggy, necrotic base discharging a purulent hemorrhagic exudate. Bilateral leg pitting edema and right lymphangitis with lymphadenitis were noted. He had low head hair implantment, sparse hair on the body and head, hyperpigmentation on both legs, onychodystrophia of the toenails (mainly the large toe and less prominent on the other toes), which was atrophic lichen-planus-like in appearance and needed no trimming (Figure 2), normal hand nails, oral thrush, and angular cheilitis. Other physical findings were gynecomastia, pectus excavatum, small and firm testicles, long extremities, asymmetrical goiter, systolic murmur 2/6 in left sternal border, and slow and inappropriate behavior. The patient's temperature on admission was 39 degrees C. Blood cultures were negative for bacterial growth. Results of laboratory investigations included hemoglobin (11.2 g/dL), hematocrit (26.8%), normal mean corpuscular volume and mean corpuscular hemoglobin volume, and red blood cell distribution width (16%). Blood smear showed spherocytes, slight hypochromia, anisocytosis, macrocytosis, and microcytosis. Blood chemistry values were taken for iron (4 micro g/dL [normal range 40-150 micro g/dL]), transferrin (193 mg/dL [normal range 220-400 mg/dL]), ferritin (1128 ng/mL [normal range 14-160 ng/mL]), transferrin saturation (1.5% [normal range 20%-55%]), serum folate (within normal limits), and vitamin B12 (within normal limits). Direct Coombs' test equaled positive 2 + IgG. All these values indicated anemia of chronic diseases combined with hemolytic anemia. Further blood work-up tested antinuclear antibody (positive <1:80 homogeneous pattern), rheumatoid factors (143 IU/mL [positive >8.5 IU/mL]), C-reactive protein (286 mg/L [normal range 0-5 mg/L]), anticardiolipin IgM antibody (9.0 monophosphoryl lipid U/mL [normal range 0-7.00 MPL U/mL]) and antithrombin III activity (135% [normal range 74%-114%]). Results of other blood tests were within normal limits or negative, including lupus anticoagulant, beta2 glycoprotein, anticardiolipin IgG Ab, anti-ss DNA Ab, C3, C4, anti-RO, anti-LA, anti-SC-70, anti-SM Ab, P-ANCA, C-ANCA, TSH, FT4, anti-T microsomal, antithyroglobulin, protein C activity, protein S free, cryoglobulins, serum immunoelectrophoresis, VDRL, hepatitis C antibodies, hepatitis B antigen, and human immunodeficiency virus. Endocrinological work-up examined luteinizing hormone (22.9 mIU/mL [normal range for adult men 0.8-6 mIU/mL]), follicle stimulating hormone (49.7 mIU/mL [normal range for adult men 1-11 mIU/mL]), testosterone (0.24 ng/mL [normal range for adult men 2.5-8.0 ng/mL]), bioavailable testosterone (0.02 ng/mL [normal range for adult men >0.6 ng/mL]), and percent bioavailable test (8.1% [normal value >20%]). These results indicate hypergonadotropic hypogonadism. Plasminogen activator inhibitor 1 was 6 U (normal value 5-20 U/mL). Karyotyping performed by G-banding technique revealed a 47 XXY karyotype, which is diagnostic of Klinefelter's syndrome. Doppler ultrasound of the leg ulcers disclosed partial thrombus in the distal right femoral vein. X-rays and bone scan displayed osteomyelitis along the right tibia. Histological examination of a 4-mm punch biopsy from the ulcer border revealed hyperkeratosis, acanthosis, hypergranulosis, and mixed inflammatory infiltrate containing eosinophils compatible with chronic ulcer. Multiple vessels were seen, compatible with a h
De Morentin, Helena Martinez; Dodiuk-Gad, Roni P; Brenner, Sarah
Background The prevalence of leg ulcer disease in Ireland has been poorly documented.\\u000a \\u000a \\u000a \\u000a Aims This study aimed to investigate the aetiology and prevalence of leg ulcers in one health district.\\u000a \\u000a \\u000a \\u000a Methods All patients receiving healthcare for an active leg ulcer in the Mid-Western Health Board (MWHB) region of Ireland (population:\\u000a 317,069) were identified in a defined two-month period. A cross-sectional survey of all
J. F. O’Brien; P. A. Grace; I. J. Perry; P. E. Burke
A comprehensive approach to the treatment of venous leg ulcer is described. Its main characteristics are: 1. Maximum debridement of wound area of the ulcer and suppressing of its microbial contamination 2. Wound conditioning and its preparation for autografting and especially 3. Simultaneous operation of varicose veins (stripping of vena saphena and ligature of venae perforates Cocketti) and application of dermoepidermal autograft to the ulcer. The procedure is presented as a case report. PMID:8948161
Brychta, P; Cerbák, P
INTRODUCTION Most leg ulcers are vascular based. Only if vascular therapy fails other causes are considered. We report the case of a female with incapacitating leg ulcers caused by a rare condition which was only diagnosed after failing treatment. PRESENTATION OF CASE The female had an extensive previous history including diabetes, renal insufficiency and cardiovascular disease and presented with three large and painful ulcers on her left lower leg. Standard treatment with antibiotics, wound excision and additional treatment with hyperbaric oxygen were ineffective. One month post hospital-admission calciphylaxis cutis caused by renal failure induced secondary hyperparathyroidism was diagnosed. Surgical treatment by a parathyroidectomy induced rapid regeneration of the ulcers. DISCUSSION Our patient's vast comorbidity and previous history had expanded differential considerations causing a delay in diagnosis. Our patient's previous history led us to believe her ulcers were vascular based, however her chronic renal failure appeared responsible for her condition. CONCLUSION Although less probable than venous insufficiency and concomittant leg ulcers or other differential considerations, calciphylaxis cutis should be part of the differential diagnosis in any end stage renal disease-patient with unexplained ulcers as an effective therapy is readily available. PMID:22288037
van Rijssen, L.B.; Brenninkmeijer, E.E.A.; Nieveen van Dijkum, E.J.M.
: 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
OBJECTIVE: To estimate the clinical and cost effectiveness of compression systems for treating venous leg ulcers. METHODS: Systematic review of research. Search of 19 electronic databases including Medline, CINAHL, and Embase. Relevant journals and conference proceedings were hand searched and experts were consulted. MAIN OUTCOME MEASURES: Rate of healing and proportion of ulcers healed within a time period. STUDY SELECTION: Randomised controlled trials, published or unpublished, with no restriction on date or language, that evaluated compression as a treatment for venous leg ulcers. RESULTS: 24 randomised controlled trials were included in the review. The research evidence was quite weak: many trials had inadequate sample size and generally poor methodology. Compression seems to increase healing rates. Various high compression regimens are more effective than low compression. Few trials have compared the effectiveness of different high compression systems. CONCLUSIONS: Compression systems improve the healing of venous leg ulcers and should be used routinely in uncomplicated venous ulcers. Insufficient reliable evidence exists to indicate which system is the most effective. More good quality randomised controlled trials in association with economic evaluations are needed, to ascertain the most cost effective system for treating venous leg ulcers. PMID:9302954
Fletcher, A.; Cullum, N.; Sheldon, T. A.
Compared to today, ulceration of the legs was much more common in the eighteenth and early nineteenth centuries and occurred in much younger people. The evidence for this, based mainly on the records of the hospitals, the dispensaries and medical records of the navy and army, is discussed. It is likely that the underlying pathology was much more varied in the past, with the possibility that ascorbic acid deficiency played a significant part in the high frequency of leg ulcers. Imagesp265-a PMID:7031237
Loudon, I. S. L.
Leg ulcers are a debilitating complication of patients with sickle cell disease, and their frequency in North America was reported to be 2.5% by the Cooperative Study of Sickle Cell Disease more than 20 years ago. We sought to determine if the frequency of leg ulcers in sickle cell patients in the United States had declined and to assess which treatments providers use most commonly. We sent an e-mail survey to health professionals belonging to the national Sickle Cell Adult Provider Network. Responses were obtained from 31 of them (26.0%). Most of them (96.0%) reported having some patients with leg ulcers. Providers reported a total of 185 patients with active leg ulcers and 224 in the previous 5 years, for a total of 409 patients. Hb SS (homozygous sickle cell anemia) was the most common genotype of affected individuals, followed by Hb SC (double heterozygote for Hb S [?6(A3)Glu?Val, GAG>GTG; HBB: c.20A>T] and Hb C [?6(A3)Glu?Lys, GAG>AAG; HBB: c.19G>A]). Males showed a 2:1 predominance. Two-thirds of patients were treated with either hydroxyurea (HU) or transfusion therapy and most used compression stockings and topical therapies as directed by wound care services. We conclude that leg ulcers continue to be a debilitating complication of young adults with sickle cell disease, despite improved supportive care and the widespread use of disease modifying agents such HU and transfusion. While some providers offer office-based ulcer care, the majority prefer specialty consultation including podiatry, plastic surgery and dermatology. Despite their frequency, there is no clear consensus among providers as to the best treatment. PMID:23600469
Delaney, Kara-Marie H.; Axelrod, Karen C.; Buscetta, Ashley; Hassell, Kathryn L.; Adams-Graves, Patricia E.; Seamon, Catherine; Kato, Gregory J.; Minniti, Caterina P.
BACKGROUND: The purpose of this manuscript was to determine whether the change in wound surface area over time could be described through nonlinear mathematics. METHODS: We studied 3,588 serial wound tracings of 338 venous leg ulcers (VLUs) that had been followed during a controlled, prospective, randomized trial of two topical wound treatments. RESULTS: A majority (72%) of VLUs exhibited surface
Matthew Cardinal; Tania Phillips; David E Eisenbud; Keith Harding; Jonathan Mansbridge; David G Armstrong
In this study the authors sought to gain insight into the lives of older women, to focus on the experience of living with leg ulcers and to explore women's views by talking to them about their experiences. Twelve English-speaking women aged over 70 years who had experienced leg ulceration for 3 years or more were interviewed. Analysis of the interview text revealed two overarching themes: (i) gaining and maintaining control over vulnerable limb(s); and (ii) lifestyle consequences of chronic leg ulceration and impaired mobility. These themes contained several subthemes including: (i) nagging pain; (ii) self-expertise and infection; (iii) leakage, smell and embarrassment; (iv) fighting for skin and limb integrity; (v) wearing non-preferred apparel; (vi) loneliness; and (vii) coping, determination and hope. The findings of this research show that elderly women who live with leg ulcers experience multiple consequences. While the everyday problems of living with an unhealed would are addressed by the community nurse, other more subtle consequences may be overlooked. Recognition of the complex and sometimes hidden concerns of these women could help to avert the sense of helplessness which currently exists. PMID:10839029
Hyde, C; Ward, B; Horsfall, J; Winder, G
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
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.; Kozka, M.; Urbanek, T.
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?cm(2)) 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?cm(2)) 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
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.
Clinical effectiveness and evidence-based practice are a central feature of the clinical governance framework. Few studies have examined factors that motivate nurses to change practice in line with evidence-based guidelines. The overall aim of this exploratory study was to examine community nurses' experience of taking part in a clinical effectiveness programme for the management of leg ulcers in the community and to identify factors most likely to ensure a change in practice. The implementation programme was conducted in the general practices within one district of a primary care audit group. Face-to-face interviews were conducted with all practice nurses and district nurses involved in the care of patients with leg ulcers from the participating practices. Nurses identified the presence of a credible facilitator, visible benefits for patients and a desire to carry out their work in an evidence-based way as factors likely to influence change. However, the degree of change achieved was not uniform across all participants and three typologies of nurses were identified according to their attitudes and level of involvement. PMID:11826316
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
We report here two cases of men, aged 46 and 23 years, with refractory chronic venous leg ulcers in association with sex chromosome aberrations: one with a 47,XXY/48,XXXY karyotype (Klinefelter syndrome) and the other with a 47,XYY karyotype (Jacob syndrome). In both patients, the occurrence of leg ulcers was the reason for seeking medical care; their medical history was other-wise unremarkable. Chromosomal analyses were performed due to the unusually young age for development of venous leg ulcers. The pathophysiology behind the occurrence of venous leg ulcers in patients with numerical aberrations of the sex chromosomes is incompletely understood. Involvement of elevated plasminogen activator inhibitor-1 levels in the pathogenesis of venous leg ulcers has been reported in patients with Klinefelter syndrome. Notably, our patient with 47,XXY/48,XXXY presented with androgen deficiency but normal plasminogen activator inhibitor-1 activity. PMID:21057745
Gattringer, Cornelia; Scheurecker, Christine; Höpfl, Reinhard; Müller, Hansgeorg
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
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; Pierard, Gerald E.; Hermanns-Le, Trinh; De Paepe, Anne; Dupuy, Alain
Non-healing leg ulcers are becoming a major public health problem. The high prevalence of leg ulcer directly affects patients' quality of life because it produces psychological (anxiety, depression), social and physical (amputation) handicap. Most leg ulcers become unsightly and they hardly if ever, yield to conventional treatment. Healing of an amputated part may pose a problem, hence amputation cannot be recommended without extensive pre-operative investigations. Prevalence is high among the poor, for whom expenses of surgery are not affordable. Few surgeons try skin graft but unfavourable local condition of the ulcer leads to rejection and all efforts prove futile. Keeping all these factors in mind, we have tested a Unani formulation for its ulcer healing properties; early results were surprising and in some cases unbelievable. PMID:23116214
Zulkifle, Mohd; Ansari, Abdul H; Shakir, Mohd; Kamal, Zahid; Alam, M Tanwir
This paper examines the context of managing a long-term condition within the community environment using appropriate evidence-based literature. It is a case study that focuses upon concordance with compression bandaging in treating venous leg ulceration and preventing ulcer recurrence through a well leg clinic. The challenges of this episode of care and the interventions put in place to improve concordance and promote self-care will be explained and analysed. PMID:23124371
Yarwood-Ross, Lee; Haigh, Carol
Background The purpose of this manuscript was to determine whether the change in wound surface area over time could be described through nonlinear mathematics. Methods We studied 3,588 serial wound tracings of 338 venous leg ulcers (VLUs) that had been followed during a controlled, prospective, randomized trial of two topical wound treatments. Results A majority (72%) of VLUs exhibited surface area reduction via an exponential decay model, particularly during the early stages of healing. These results were consistent with the mechanics of wound contraction and epithelial cell proliferation, supported by the higher frequency at which exponential surface area reduction associated with full wound closure (35% of wounds that fit the exponential model healed vs. 21% of wounds that did not fit the exponential model completely healed during the study period, p = 0.018). Goodness-of-fit statistics suggested that much of the individual variation in healing could be described as nonlinear variation from the exponential model. Conclusion We believe that parameter estimates from a mathematical model may provide a more accurate quantification of wound healing rates, and that similar models may someday reach routine use in comparing the efficacy of various treatments in routine practice and in product registration trials. PMID:19335882
Cardinal, Matthew; Phillips, Tania; Eisenbud, David E; Harding, Keith; Mansbridge, Jonathan; Armstrong, David G
Treatment of venous leg ulcers (VLU) represents a considerable challenge to the health care professional and to the patient alike. Much of the current literature regarding VLU focuses on either wound pathophysiology and treatment of chronic venous insufficiency or the patients' experience of the condition. We present two studies that examine more closely the clinicians' experience of treating VLU and reflect upon how that understanding may further enhance better outcomes for patients in the future. The first of these studies is a qualitative investigation of 49 clinicians treating VLU in the UK and USA. The second is a quantitative, online survey of 304 clinicians' beliefs, attitudes and practices in the UK, Germany and USA. Findings show that the clinicians' experience of treating VLU is often accompanied by frustration and dissatisfaction with treatment challenges and uncertain outcomes. Practices and treatment choices were found to vary widely and differ by countries. We conclude that a key aspect in improving VLU treatment is in listening to the frustrations of the clinician when considering new approaches to therapy. PMID:19912394
Cullen, George H; Phillips, Tania J
Antiphospholipid syndrome features not only deep vessel thrombosis but also may have cutaneous manifestations such as Raynaud phenomenon, acral necrosis, livedo reticularis, subcutaneous nodules, and leg ulcers. A 72-year-old man presented with a rapidly progressing leg ulcer. He was already on anticoagulation with warfarin due to atrial fibrillation and disclosed a history of stroke with temporary paresis of the left leg. Histopathology of a biopsy of the edge of the ulcer revealed occlusive arteriosclerosis of medium-sized arteries. Serology showed autoantibodies against cardiolipin, ?2- glycoprotein I, and phosphatidylserine which led to the diagnosis of antiphospholipid syndrome. Therapy with low molecular weight heparin, dexamethasone, and azathioprine in combination with stage-adjusted wound care led to complete healing of the ulcer within 5 months. PMID:23744031
Van Beek, N; Schumacher, N; Haase, O; Zillikens, D; Kahle, B; Schmidt, E
Activated protein C (APC) promotes angiogenesis and reepithelialisation and accelerates healing of diabetic ulcers. The aim of this study was to determine the relationship between the incidence of lower leg ulcers and plasma levels of APC's precursor, protein C (PC), in diabetic patients. Patients with diabetes who had a lower leg ulcer(s) for >6 months (n = 36) were compared with age-, type of diabetes-, and sex-matched subjects with diabetes but without an ulcer (n = 36, controls). Total PC was assessed using a routine PC colorimetric assay. There was a significantly (P < 0.001) lower level of plasma PC in patients with ulcers (103.3 ± 22.7, mean?±?SD) compared with control (127.1 ± 34.0) subjects, when corrected for age and matched for gender and type of diabetes. Ulcer type (neuropathic, ischaemic, or mixed) was not a significant covariate for plasma PC levels (P = 0.35). There was no correlation between PC levels and gender, type of diabetes, HbA1c, or C-reactive protein in either group. In summary, decreased circulating PC levels are associated with, and may predispose to, lower leg ulceration in patients with diabetes. PMID:23484147
Whitmont, K.; Fulcher, G.; Reid, I.; Xue, M.; McKelvey, K.; Xie, Y.; Aboud, M.; Ward, C.; Smith, M. M.; Cooper, A.; March, L.; Jackson, C. J.
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.
The bacterial microbiota plays an important role in the prolonged healing of chronic venous leg ulcers. The present study compared the bacterial diversity within ulcer material from 14 skin graft operations of chronic venous leg ulcers using culture-based methods and molecular biological methods, such as 16S rRNA gene sequencing, fingerprinting, quantitative polymerase chain reaction, and fluorescence in situ hybridization. Each wound contained an average of 5.4 species but the actual species varied between wounds. The diversity determined by culture-based methods and the molecular biological methods was different. All the wounds contained Staphylococcus aureus, whereas Pseudomonas aeruginosa was in six out of 14 wounds. Molecular methods detected anaerobic pathogens in four ulcers that were not detected with anaerobic culture methods. Quantitative polymerase chain reaction was used to compare the abundance of S. aureus and P. aeruginosa at different locations in the ulcers and their numbers varied greatly between samples taken at different locations in the same ulcer. This should be considered when ulcers are investigated in routine clinical care. The differences between the results obtained with culture-based and molecular-based approaches demonstrate that the use of one approach alone is not able to identify all of the bacteria present in the wounds. PMID:20082680
Thomsen, Trine R; Aasholm, Martin S; Rudkjøbing, Vibeke B; Saunders, Aaron M; Bjarnsholt, Thomas; Givskov, Michael; Kirketerp-Møller, Klaus; Nielsen, Per H
The prevalence and costs of chronic venous ulcer care in the US are increasing. The Johns Hopkins University Evidence-Based Practice Center recently completed a systematic review of the comparative effectiveness of advanced wound dressings, antibiotics, and surgical management of chronic venous ulcers. Of 10,066 citations identified in the literature search, only 66 (0.06%) met our liberal inclusion criteria for providing evidence on the effectiveness of interventions for chronic venous ulcers. Based on review of those studies, members of our team and a panel of informed stakeholders identified important research gaps and methodological deficiencies and prioritized specific future research needs. Based on that review, we provide the results of our assessment of future research needs for chronic venous ulcer care. Advanced wound dressings were considered to have the highest priority for future research, followed by venous surgery and antibiotics. An imperative from our assessment is that future research evaluating interventions for chronic venous ulcers meet quality standards. In a time of increasing cost pressure, the wound care community needs to develop high-quality evidence to justify the use of present and future therapeutic modalities. PMID:24134795
Lazarus, Gerald; Valle, M Fran; Malas, Mahmoud; Qazi, Umair; Maruthur, Nisa M; Doggett, David; Fawole, Oluwakemi A; Bass, Eric B; Zenilman, Jonathan
The aim of the study was to use negative pressure wound therapy (NPWT) in patients with chronic venous leg ulceration. The authors present their experience in treatment of 15 patients whose average ulceration surface area was 62.6 cm(2). In 10 patients, the ulcers healed within 6 weeks and in the remaining patients within 20 weeks. Based on the results obtained, the authors imply that NPWT is an effective method in the treatment of chronic venous leg. PMID:24696847
Kucharzewski, Marek; Mieszcza?ski, Pawe?; Wilemska-Kucharzewska, Katarzyna; Taradaj, Jakub; Kuropatnicki, Andrzej; Sliwi?ski, Zbigniew
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
Mieszczanski, Pawel; Wilemska-Kucharzewska, Katarzyna; Taradaj, Jakub; Kuropatnicki, Andrzej; Sliwinski, Zbigniew
The standard treatments for venous diseases of the lower limb include compression bandaging and stockings as well as surgical removal of varicose veins. There are a number of conditions in which these conventional treatments are ineffective, particularly in the management of leg ulceration. Drug treatments for healing venous leg ulcers have yet to be developed to the stage of good clinical efficacy, but these may assist in the management of patients. Flavonoid drugs have been widely used in the management of the symptoms of venous disease for many years and have recently been studied in some detail to assess their effects on the microcirculation. Work in animal models of ischemia-reperfusion show that MPFF (micronized purified flavonoid fraction) modulates leukocyte adhesion and prevents endothelial damage. Similar biochemical effects have been observed in patients with venous disease and may explain the efficacy of this drug in the management of edema and other symptoms of venous disease. There is clinical evidence that MPFF modifies venous leg ulcer healing. PMID:12934756
Coleridge Smith, Philip D
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
The purpose of this study was to describe the rate of closure observed in venous leg ulcers during treatment with ovine collagen extracellular matrix dressings and compression. Fourteen patients with 23 wounds were retrospectively evaluated with respect to healing rates, time to closure, and weekly facility charge fees. PMID:25198432
Bohn, Gregory A; Gass, Kimberly
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
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.
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
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
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; Munter, Christian; Meaume, Sylvie; Scalise, Alessandro; Mompo, Nacho Blanes; Jakobsen, Birte Petersen; Gottrup, Finn
The objective of this study was to assess the effect of oral treatment with Daflon 500 mg (micronized purified flavonoid fraction [MPFF]) on leg ulcer healing. This study was conducted as a meta-analysis of randomized prospective studies using Daflon 500 mg as an adjunct to conventional treatment. Medical literature databases and the manufacturer's records were searched for relevant clinical trials. Five prospective, randomized, controlled studies in which 723 patients with venous ulcers were treated between 1996 and 2001 were identified. Conventional treatment (compression and local care) in addition to Daflon 500 mg 2 tablets daily was compared with conventional treatment plus placebo in two studies (n = 309), or with conventional treatment alone in three studies (n = 414). The primary end point was complete ulcer healing at 6 months. The results are expressed as a reduction in the relative risk (RRR) of healing with 95% confidence intervals (CI). Since, in the present case, the desired treatment effect is increased ulcer healing, RRR should be positive to indicate a benefit of adjunctive Daflon 500 mg over conventional therapy alone. Type 1 error was set at 5%. At 6 months, the chance of ulcer healing was 32% better in patients treated with adjunctive Daflon 500 mg than in those managed by conventional therapy alone (RRR, 32%; 95% CI, 3% to 70%). This difference was present from month 2 (RRR, 44%; 95% CI, 7% to 94%), and was associated with a shorter time to healing (16 weeks vs 21 weeks; p = 0.0034). The benefit of Daflon 500 mg was found in the subgroup of ulcers between 5 and 10 cm2 in area (RRR, 40%; 95% CI, 6% to 87%), as well as in patients with ulcers of 6 to 12 months' duration (RRR, 44%; 95% CI, 6% to 97%). These results confirm that venous ulcer healing is accelerated by Daflon 500 mg treatment. Daflon 500 mg might be a useful adjunct to conventional therapy in large and longstanding ulcers that might be expected to heal slowly. PMID:16193225
Smith, Philip Coleridge
Acute wounds will generally heal independently of any interventions, whereas chronic wounds are chronic for a reason and are unlikely to successfully heal without intervention. In the treatment of venous leg ulcers, the gold standard will always be compression therapy. However, many wounds still do not heal despite best practice. Therefore, the use of adjunct therapies alongside standard care become the priority for healing. This article describes a small evaluation, involving 17 patients with chronic venous leg ulcers, that set out to determine the effect of a topical oxygen therapy on wound size. The therapy comprises a canister that sprays pure haemoglobin in a water solution into the wound. The haemoglobin spray needs to be used at least once every 3 days, and no training is required on its use. Results showed the device helped promote wound healing in 14 out of 17 wounds treated for more than 2 weeks. These patients had previously been shown to be non-healing during a 4-week run-in period where they received standard care, including compression therapy. PMID:25382133
Chronic venous insufficiency (CVI) occurs in a relatively large proportion of the population and is associated with significant morbidity, high cost of healthcare, loss of productivity and reduced quality of life. Lower extremity ulcers related to CVI have been estimated to affect 0.2-1% of the population in developed countries. The prevalence of venous ulcers in the US is estimated at 500,000-600,000, and increases with age. Estimates of the annual incidence of leg ulcer in the UK and Switzerland are 3.5 and 0.2 per 1000 individuals, respectively. Treatment of venous ulcers can be expensive, leading to a large economic burden on health services in many countries. The annual cost of CVI is estimated to be more than 1 billion US dollars in the US and between pound 400-600 million in the UK. Current treatments for CVI include surgery, sclerotherapy, compressive therapy (conventional therapy) and adjuvant pharmacotherapy. Various pharmacological agents have been used as adjuvant therapy but in many cases there is no definitive evidence of their efficacy. Effective treatment programs for venous leg ulcers could substantially reduce the economic impact of CVI on health services. In controlled studies, micronized purified flavonoid fraction (MPFF) adjuvant therapy has been shown to increase significantly the number of healed venous leg ulcers and to reduce significantly the healing time of ulcers compared with conventional therapy alone, potentially leading to an improvement in patients' quality of life. The treatment of venous leg ulcers with MPFF was also found to reduce overall treatment costs compared with conventional therapy alone. In a retrospective cost-effectiveness analysis based on direct medical costs only, MPFF therapy improved the cost-effectiveness ratio by 45% compared with conventional therapy. If intangible costs, such as loss of quality of life were included, the difference in cost-effectiveness ratios is likely to be even greater in favor of MPFF. Sensitivity analyzes showed that even with a 20% increase in drug price the cost-effectiveness ratio for MPFF therapy was substantially better than that for conventional therapy (1061.8 US dollars vs 1871.9 US dollars per ulcer healed). Hence, the addition of MPFF adjuvant therapy to the treatment of venous leg ulcers would be effective and potentially cost saving. PMID:12862500
Simka, Marian; Majewski, Eugeniusz
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
Patients with leg ulceration face changing self-care demands associated with the consequences of the disease and treatment. Often patients can manage their self-care for some time, but new therapeutic self-care demands may emerge that require more complex self-care actions. The purpose of this article is to describe the development of a nurse-led education program in North-Rhine Westphalia, Germany, that aims to help patients with leg ulcers to meet their therapeutic self-care demands. Orem's self-care deficit nursing theory is used as a framework to provide the conceptual context for this supportive-educative nursing system that is being tested in a multi-site clinical trial. PMID:18378825
Herber, Oliver R; Schnepp, Wilfried; Rieger, Monika A
Background: Current treatment modalities for chronic leg ulcers are time consuming, expensive, and only moderately successful. Recent data suggest that creating a subatmospheric pressure by vacuum-assisted closure (V.A.C., KCI Concepts, San Antonio, Texas) therapy supports the wound healing process. Methods: The efficacy of vacuum-assisted closure in the treatment of chronic leg ulcers was prospectively studied in a randomized controlled trial
Jeroen D. D. Vuerstaek; Tryfon Vainas; Jan Wuite; Patty Nelemans; Martino H. A. Neumann; Joep C. J. M. Veraart
Leg ulcer is a disabling complication in patients with sickle cell anemia (SCA) but the exact pathophysiological mechanisms are unknown. The aim of this study was to identify the hematological and hemorheological alterations associated with recurrent leg ulcers. Sixty-two SCA patients who never experienced leg ulcers (ULC-) and 13 SCA patients with a positive history of recurrent leg ulcers (ULC+) - but with no leg ulcers at the time of the study – were recruited. All patients were in steady state condition. Blood was sampled to perform hematological, biochemical (hemolytic markers) and hemorheological analyses (blood viscosity, red blood cell deformability and aggregation properties). The hematocrit-to-viscosity ratio (HVR), which reflects the red blood cell oxygen transport efficiency, was calculated for each subject. Patients from the ULC+ group were older than patients from the ULC- group. Anemia (red blood cell count, hematocrit and hemoglobin levels) was more pronounced in the ULC+ group. Lactate dehydrogenase level was higher in the ULC+ group than in the ULC- group. Neither blood viscosity, nor RBC aggregation properties differed between the two groups. HVR was lower and RBC deformability tended to be reduced in the ULC+ group. Our study confirmed increased hemolytic rate and anemia in SCA patients with leg ulcers recurrence. Furthermore, our data suggest that although systemic blood viscosity is not a major factor involved in the pathophysiology of this complication, decreased red blood cell oxygen transport efficiency (i.e., low hematocrit/viscosity ratio) may play a role. PMID:24223994
Connes, Philippe; Lamarre, Yann; Hardy-Dessources, Marie-Dominique; Lemonne, Nathalie; Waltz, Xavier; Mougenel, Danièle; Mukisi-Mukaza, Martin; Lalanne-Mistrih, Marie-Laure; Tarer, Vanessa; Tressières, Benoit; Etienne-Julan, Maryse; Romana, Marc
Leg ulcer is a disabling complication in patients with sickle cell anemia (SCA) but the exact pathophysiological mechanisms are unknown. The aim of this study was to identify the hematological and hemorheological alterations associated with recurrent leg ulcers. Sixty-two SCA patients who never experienced leg ulcers (ULC-) and 13 SCA patients with a positive history of recurrent leg ulcers (ULC+)--with no leg ulcers at the time of the study--were recruited. All patients were in steady state condition. Blood was sampled to perform hematological, biochemical (hemolytic markers) and hemorheological analyses (blood viscosity, red blood cell deformability and aggregation properties). The hematocrit-to-viscosity ratio (HVR), which reflects the red blood cell oxygen transport efficiency, was calculated for each subject. Patients from the ULC+ group were older than patients from the ULC- group. Anemia (red blood cell count, hematocrit and hemoglobin levels) was more pronounced in the ULC+ group. Lactate dehydrogenase level was higher in the ULC+ group than in the ULC- group. Neither blood viscosity, nor RBC aggregation properties differed between the two groups. HVR was lower and RBC deformability tended to be reduced in the ULC+ group. Our study confirmed increased hemolytic rate and anemia in SCA patients with leg ulcers recurrence. Furthermore, our data suggest that although systemic blood viscosity is not a major factor involved in the pathophysiology of this complication, decreased red blood cell oxygen transport efficiency (i.e., low hematocrit/viscosity ratio) may play a role. PMID:24223994
Connes, Philippe; Lamarre, Yann; Hardy-Dessources, Marie-Dominique; Lemonne, Nathalie; Waltz, Xavier; Mougenel, Danièle; Mukisi-Mukaza, Martin; Lalanne-Mistrih, Marie-Laure; Tarer, Vanessa; Tressières, Benoit; Etienne-Julan, Maryse; Romana, Marc
Venous leg ulcers are a frequent source of chronic ill-health and a considerable cost to health-care systems. This paper reports pilot study results from a randomized controlled trial to determine the effectiveness of a community-based 'Leg Club' environment on improving healing rates of venous leg ulcers. Leg Clubs offer a setting where people with similar problems can socialize in a supportive, information-sharing environment. A sample of 33 clients with a below-knee venous leg ulcer were randomized to treatment, either in their own homes or in a community Leg Club. Treatment was provided to all participants, whether in the control group or intervention group, by a team of trained wound-care nurses following evidence-based assessment and treatment guidelines. Data were collected on admission to the study and at 12 weeks from admission. Results showed a significant improvement in healing in the intervention group compared to the control group, as measured by ulcer area size and Pressure Ulcer Scale for Healing scores. These results suggest that a community Leg Club environment provides benefits additional to wound care expertise and evidence-based care. Knowledge gained from this study provides evidence to guide service delivery and improve client outcomes. PMID:15985095
Edwards, Helen; Courtney, Mary; Finlayson, Kathleen; Lewis, Caroline; Lindsay, Ellie; Dumble, Jean
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
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, Helio Amante; Abbade, Luciana Patricia Fernandes
Aim To estimate the cost-effectiveness of silver dressings using a health economic model based on time-to-wound-healing in hard-to-heal chronic venous leg ulcers (VLUs). Background Chronic venous ulceration affects 1–3% of the adult population and typically has a protracted course of healing, resulting in considerable costs to the healthcare system. The pathogenesis of VLUs includes excessive and prolonged inflammation which is often related to critical colonisation and early infection. The use of silver dressings to control this bioburden and improve wound healing rates remains controversial. Methods A decision tree was constructed to evaluate the cost-effectiveness of treatment with silver compared with non-silver dressings for four weeks in a primary care setting. The outcomes: ‘Healed ulcer’, ‘Healing ulcer’ or ‘No improvement’ were developed, reflecting the relative reduction in ulcer area from baseline to four weeks of treatment. A data set from a recent meta-analysis, based on four RCTs, was applied to the model. Results Treatment with silver dressings for an initial four weeks was found to give a total cost saving (£141.57) compared with treatment with non-silver dressings. In addition, patients treated with silver dressings had a faster wound closure compared with those who had been treated with non-silver dressings. Conclusion The use of silver dressings improves healing time and can lead to overall cost savings. These results can be used to guide healthcare decision makers in evaluating the economic aspects of treatment with silver dressings in hard-to-heal chronic VLUs. PMID:24945381
Jemec, Gregor B. E.; Kerihuel, Jean Charles; Ousey, Karen; Lauemøller, Sanne Lise; Leaper, David John
Debridement plays an essential role in the wound-bed preparation of necrotic and sloughy ulcers, being a mandatory step to achieve a well-debrided bed, proceeding towards healing. This study reports our experience with Versajet [Versajet Hydrosurgery System (Smith & Nephew, Hull, UK)], a new device for the debridement of exudating ulcers, based on Fluidjet technology, which excises and aspirates the unwanted tissue by using the Venturi effect. In a 10-month time period, a total of 68 patients, out of a setting of 167 patients, hospitalised as affected by chronic, hard-to-heal leg ulcers, stuck in the inflammatory phase, were treated with Versajet. Based on ulcer characteristics and clinical conditions, the remaining 99 patients underwent traditional debridement with moist dressings (controls). In the majority of Versajet-treated cases (46), an adequately debrided wound bed was achieved with one operative procedure; two and three procedures were required in 17 and 5 patients, respectively. Almost all the procedures were performed in the ward at the patient's bedside. This procedure is quick (mean time per treatment is about 5 minutes); when compared with a traditional treatment with moist dressings, Versajet considerably shortens the in-hospital stay and promotes a quicker healing process. When used by an experienced surgeon, Versajet allows a selective debridement, as it makes it possible to remove only the tissue centred in the working end and spare the healthy tissue. Debriding with Versajet is highly effective in reducing the bacterial load of the ulcer bed. The pain caused by Versajet is well tolerated, especially when set for gentle debridement. If multiple treatments are required, the combined use with moist dressings is synergistic, as the dressings soften the necrotic tissue, thus facilitating the following Versajet debridement. The results indicate that Versajet offers more precision than standard mechanical debridement and, at high settings, offers an alternative to surgical debridement. PMID:16618317
Mosti, Giovanni; Iabichella, Maria Letizia; Picerni, Pietro; Magliaro, Antonio; Mattaliano, Vincenzo
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.
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
BACKGROUND: Approximately 1 out of every 100 individuals has some form of venous insufficiency, which can lead to chronic venous disease and Venous Leg Ulcer (VLU). There are known underlying pathologies which contribute to the chronic nature of VLU including biofilm phenotype infections. RESULTS: Using pyrosequencing based approaches we evaluated VLU to characterize their microbial ecology. Results show that VLU
Randall D Wolcott; Viktoria Gontcharova; Yan Sun; Scot E Dowd
Background Venous leg ulcers can be very hard to heal and represent a significant medical need with no effective therapeutic treatment currently available. Principal Findings In wound edge biopsies from human venous leg ulcers we found a striking upregulation of dermal N-cadherin, Zonula Occludens-1 and the gap junction protein Connexin43 (Cx43) compared to intact skin, and in stark contrast to the down-regulation of Cx43 expression seen in acute, healing wounds. We targeted the expression of these proteins in 3T3 fibroblasts to evaluate their role in venous leg ulcers healing. Knockdown of Cx43 and N-cadherin, but not Zonula Occludens-1, accelerated cell migration in a scratch wound-healing assay. Reducing Cx43 increased Golgi reorientation, whilst decreasing cell adhesion and proliferation. Furthermore, Connexin43 and N-cadherin knockdown led to profound effects on fibroblast cytoskeletal dynamics after scratch-wounding. The cells exhibited longer lamelipodial protrusions lacking the F-actin belt seen at the leading edge in wounded control cells. This phenotype was accompanied by augmented activation of Rac-1 and RhoA GTPases, as revealed by Förster Resonance Energy Transfer and pull down experiments. Conclusions Cx43 and N-cadherin are potential therapeutic targets in the promotion of healing of venous leg ulcers, by acting at least in part through distinct contributions of cell adhesion, migration, proliferation and cytoskeletal dynamics. PMID:22615994
Mendoza-Naranjo, Ariadna; Cormie, Peter; Serrano, Antonio E.; Hu, Rebecca; O'Neill, Shay; Wang, Chiuhui Mary; Thrasivoulou, Christopher; Power, Kieran T.; White, Alexis; Serena, Thomas; Phillips, Anthony R. J.; Becker, David L.
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
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
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 (< or = 10 cm and > 10 cm). The protocol called for a two-month treatment with Dios (one tablet = 450 mg micronized purified Diosmin) or a placebo, two tablets/day, in addition to compression therapy. Evaluations were performed every fifteen days, from D0 to D60. The primary endpoint, in accordance with Alexander House group requirements were: percentage of patients with complete ulcer healing, ie, comparison between Dios and Plac group at D60, and comparison of survival curves in each group between D0 and D60 (log rank test). Secondary endpoints included ulcer surface area assessed by computerized planimetric measurements, qualitative evaluation of ulcers, and symptoms. The patients were 105 men and women ranging in age from eighteen to eighty-five years, with standard compression stocking, who were undergoing standardized local care of ulcer and had no significant arterial disease (ankle/arm systolic pressure index > 0.8). Fifty-three patients received Dios, and 52 received Plac. The 2 groups were well matched for age (m +/- 1 SD = seventy-one +/- eleven years), gender, ulcer size, and associated disorders. Among patients with ulcer size < or = 10 cm (Dios = 44, Plac = 47) a significantly larger number of patients had a complete ulcer healing at two months in the Dios group (n = 14) in comparison with the Plac group (n = 6) (32% vs 13%, P = 0.028) with a significantly shorter time duration of healing (P = 0.037). No difference was shown for the secondary criteria, except for sensation of heavy legs (P = 0.039) and a less atonic aspect of ulcer (P = 0.030) in favor of Dios. Among the 14 patients with ulcer size > 10 cm (Dios = 9, Plac = 5), subjected to a descriptive analysis only, no ulcer healed. This study showed that a two-month course of Daflon 500 mg at a daily dose of two tablets, in addition to conventional treatment, is of benefit in patients with venous ulcer < or = 10 cm by accelerating complete healing. PMID:8995348
Guilhou, J J; Dereure, O; Marzin, L; Ouvry, P; Zuccarelli, F; Debure, C; Van Landuyt, H; Gillet-Terver, M N; Guillot, B; Levesque, H; Mignot, J; Pillion, G; Février, B; Dubeaux, D
PURPOSE To describe the strategies and costs associated with recruiting African American and white adults into a randomized controlled pilot trial. DESIGN “Cryotherapy for Venous Disorders: A Pilot Study” is a randomized controlled trial designed to determine the effects of a cool gel wrap and leg elevation intervention versus a leg elevation alone intervention on skin temperature, skin microcirculation, quality of life, and pain in adults with stages 4 and 5 chronic venous disorders. We sought to recruit 60 participants (21 African Americans, 37 whites, and 2 Hispanic or Latino) to complete the study. These enrollment targets reflect the demographic distribution of the community in which the study was conducted (33% African American, 66% white, and 2% Latino). Proactive and reactive recruitment strategies were implemented to recruit subjects. RESULTS Seventy-three individuals (9 African American men, 29 African American women, 11 white men, 22 white women, 1 Asian woman, and 1 Hispanic woman) were screened, and of those, 67 were randomized (9 African American men, 25 African American women, 9 white men, 22 white women, 1 Asian woman, and 1 Hispanic women). Fifty-eight completed the study, yielding an overall 11% attrition rate. An additional 8 subjects canceled or did not show up for a first appointment. Reactive recruitment strategies were most successful for recruiting men, women, African American, and white participants. The 3 most successful reactive strategies were referrals from providers/clinics (34%), flyers posted in the hospital elevators (22%), and targeted mailings from a business (16%). Of the healthcare provider referrals (19), wound care nurses referred 12 completed participants. The amount budgeted for advertisement was $5,000 (2% of the total grant award). The amount spent on recruitment including labor was $5,978, which averaged $103 per participant who completed the study (N = 58). Reactive strategies per participant completer proved more cost-efficient than proactive strategies ($83 vs $215). However, the time spent by the principal investigator (approximately 100 hours or 2.5 hours per week × 40 weeks) on recruitment, particularly maintaining frequent face-to-face contact with providers, increased success in the area of healthcare provider referrals. CONCLUSION A variety of recruitment strategies are needed to ensure a diverse participant response to clinical research studies. As nurses become more involved in research activities, and particularly in recruitment, it is important to understand the most effective types of strategies and costs associated with these activities. PMID:20075691
Kelechi, Teresa J.; Watts, Ashlee; Wiseman, Jan
In the present study we were interested, if apoptosis plays a role in the surrounding skin of venous ulcers, where microcirculatory disorders were already observed. For this purpose laser Doppler flow and partial oxygen pressure were measured in 17 patients at the ulcer edge, the transitional area of the lower leg and the thigh. Subsequently biopsies were taken from the respective sites and subjected to terminal deoxynucleotidyl transferase labelling (TUNEL) and immunohistochemistry using antibodies to determine the protein expression of Fas, Fas-L, Bax, Bcl-2, p53 and c-Myc. Laser Doppler flow was increased and transcutaneous oxygen partial pressure was decreased, with significant differences at the ulcer edge and the lower leg compared to the thigh. The skin biopsies did not show any differences when labelling for apoptotic cells. Keratinocytes of basal and spinous layer stained with antibodies against Fas, Fas-L and Bax in all probes of the three sites. c-Myc and p53 were negative in all keratinocytes of the skin probes. However, staining with Bcl-2 was significantly decreased at the ulcer edge in comparison to the lower leg and the thigh (p=0.017). Our study revealed that a disturbed microcirculation does not increase the number of apoptotic cells at the ulcer edge in patients with venous disease. The reduced staining pattern with Bcl-2 at the ulcer edge seems not to result in higher susceptibility to apoptosis, but it remains to be proven whether it is involved in epidermal acanthosis. PMID:18813857
Heising, Susanna; Giebel, Jürgen; Ostrowitzki, Anna-Lena; Riedel, Franziska; Haase, Hermann; Sippel, Kirstin; Jünger, Michael
Clinicians are interested in options for delivering community-based wound care. Studies have largely focused on nurse clinics as an alternative to people receiving wound care at home. A prospective, two-arm, cohort study of individuals who requested and received their preference for community-based leg ulcer care delivered in either their home or in a nurse-led clinic was conducted to explore the relationship between choice of care location and health outcomes. Provision of care was similar-ie, care was guided by an evidence-informed protocol and a trained nursing team. Individual and system level outcomes were compared between the groups, including 3-month healing rates, 1-year ulcer recurrence rate, time free of ulcers, health-related quality of life (HRQL), satisfaction with care, and resource use. Following the baseline assessment, data were collected every 3 months until healing occurred plus a 1-year follow-up to monitor recurrence. Of the 104 participants (average age 67.5 years), 56 chose home and 48 chose clinic-based care. More than half (55%) of the participants were men, 53.8% had an ulcer <5 cm(2) and <6 months' duration, 84% were English-speaking, and 51.9% had a previous episode of ulceration. No significant sociodemographic, HRQL, or clinical characteristic differences were found between groups at baseline. A trend toward improved healing for those choosing clinic care was observed (3-month healing rates at home were 48.1% versus clinic care 66.7%, P = 0.07) but neither healing outcome nor other variables, including resource utilization, were significantly different and post-hoc analysis revealed only 48% power to detect a difference in healing. The results confirm previous research indicating that the organization rather than the location of care is most important; however, observed differences in healing rates pose an important question for future inquiry regarding the potential impact of choice and whether the quality of care is standardized and delivered by the same team. The concept of providing individuals/families with the choice of care location warrants further research. PMID:21904018
Harrison, Margaret B; VanDenKerkhof, Elizabeth; Hopman, Wilma M; Graham, Ian D; Lorimer, Karen; Carley, Meg
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
Background. Epithelialization of cutaneous ulcers is a long-lasting process. To study the pathomechanism of impaired epithelialization, we evaluated the role of cell cycle- and apoptosis-related proteins in the regenerating epidermis. We characterized immunohistochemically the expression of cell cycle regulators p63, CD29, PCNA, p53, pro- and antiapoptotic proteins bcl2, bax, caspase 3 and DNA breaks, as well as keratin 10, 16
Hanna Galkowska; Waldemar L Olszewsk; Urszula Wojewodzka; Joanna Mijal; Ewa Filipiuk
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
The effectiveness of a four-layer compression bandage system in comparison with Class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers: a randomised controlled trial.
An increasing number of compression systems available for treatment of venous leg ulcers and limited evidence on the relative effectiveness of these systems are available. The purpose of this study was to conduct a randomised controlled trial to compare the effectiveness of a four-layer compression bandage system and Class 3 compression hosiery on healing and quality of life (QL) in patients with venous leg ulcers. Data were collected from 103 participants on demographics, health, ulcer status, treatments, pain, depression and QL for 24 weeks. After 24 weeks, 86% of the four-layer bandage group and 77% of the hosiery group were healed (P = 0·24). Median time to healing for the bandage group was 10 weeks, in comparison with 14 weeks for the hosiery group (P = 0·018). The Cox proportional hazards regression found participants in the four-layer system were 2·1 times (95% CI 1·2-3·5) more likely to heal than those in hosiery, while longer ulcer duration, larger ulcer area and higher depression scores significantly delayed healing. No differences between groups were found in QL or pain measures. Findings indicate that these systems were equally effective in healing patients by 24 weeks; however, a four-layer system may produce a more rapid response. PMID:22716129
Finlayson, Kathleen J; Courtney, Mary D; Gibb, Michelle A; O'Brien, Jane A; Parker, Christina N; Edwards, Helen E
Wound pain is a serious problem for elderly patients suffering from chronic leg ulcers, and it may lead to reduced wound healing rates and reduced quality of life. Biatain-Ibu Non-adhesive (Coloplast A/S), a new pain-reducing moist wound healing dressing containing ibuprofen was tested for pain reduction, safety, and efficacy on 10+2 patients in a single-blinded crossover study against Biatain Non-adhesive (Coloplast A/S). Pain was measured with a Numeric Box Scale before, during, and after dressing change. Quality of life was measured using the World Health Organization-5 Well-Being Index. Dressing moist wound healing properties such as absorption capacity and leakage were tested together with assessment of wound exudate and blood plasma content of ibuprofen. Use of the Biatain-Ibu foam dressing correlated with a decrease in pain intensity scores from 7 in the run-in period to approximately 2.5 in the Biatain-Ibu treatment phase. Quality of life measures were improved which together with the reduced pain could contribute to faster wound healing. The moist wound healing properties of Biatain-Ibu were similar to that of the Biatain Non-adhesive and ulcer size was reduced by 24% during the treatment period. Neither side effects nor systemic plasma concentrations of ibuprofen were observed. These data indicate that Biatain-Ibu could reduce persistent and temporary wound pain, increase Quality of life, was found safe to use, and had excellent moist wound healing properties. PMID:16808800
Jørgensen, Bo; Friis, Gitte Juel; Gottrup, Finn
Low-frequency ultrasound may facilitate debridement and healing of chronic wounds, including lower leg wounds in patients with chronic venous insufficiency (CVI). To evaluate the use of a low-frequency ultrasound (LFU) device with a curette, two patients with CVI and chronic wounds were treated for a period of 2 to 3 weeks. A 63-year-old woman with rheumatoid arthritis and two wounds, one on the right lower leg (250 cm³) and one wound on the left medial leg (0.80 cm³), present for 12 months; and a 77-year-old man with cardiopulmonary issues with seven wounds, three on the left medial calf (1.2 cm³, 11.40 cm³, and 0.72 cm³), one on the left anterior calf (0.30 cm³), two on the right posterior calf (0.90 cm³, 0.30 cm³), and one on the right anterior calf (0.14 cm³), present for 3 months consented to participate in the study. Both patients received low-intensity (50-70 ?m), low-frequency (35 kHz) ultrasound at an intensity of 50% through a saline mist in addition to antimicrobial dressing with silver, a multilayer compression bandage system applied at every visit, and pain medication as needed. Both patients received treatments every 1 to 3 weeks that were not timed. Treatment continued until no additional slough or other necrotic tissue could be removed from the wound bed; the female patient received two treatment sessions and the male received three. Average wound volume did not change significantly from the first to last treatment session (t(8)-1.2, P = 0.26). Five wounds (56%) with initial measurements of 0.8 cm³, 0.72 cm³, 0.3 cm³, 0.3 cm³, and 0.14 cm³ reduced in volume by 100%. Mean wound characteristic scores changed significantly (P <0.05) for amount of fibrin, periwound skin, drainage amount, and color. In addition, the number of wounds filled with slough decreased from 89% at the first session to 22% at the final treatment session. The results of this study suggest LFU may have been beneficial for these patients with CVI. Additional studies using larger sample sizes are needed to evaluate the effect of this treatment on a variety of chronic wounds and to compare its effectiveness to other debridement methods. PMID:24515985
Maher, Sara F; Halverson, Jessica; Misiewicz, Rob; Reckling, Trisha; Smart, Ojas; Benton, Carol; Schoenherr, Dawn
The bacterial microfloras of 8 healing and 10 nonhealing chronic venous leg ulcers were compared by using a combination of cultural analysis and denaturing gradient gel electrophoresis (DGGE) of PCR-amplified 16S rRNA gene products. Cultural analysis of the microflora revealed that the majority of both wound types carried the aerobes Staphylococcus and Pseudomonas spp. (89 and 80%, respectively). Sequencing of 16S ribosomal DNAs selected on the basis of DGGE profiling allowed the identification of strains not detected by cultural means. Of considerable interest was the finding that more than 40% of the sequences represented organisms not cultured from the wound from which they were amplified. DGGE profiles also revealed that all of the wounds possessed one apparently common band, identified by sequencing as Pseudomonas sp. The intensity of this PCR signal suggested that the bacterial load of nonhealing wounds was much higher for pseudomonads compared to healing wounds and that it may have been significantly underestimated by cultural analysis. Hence, the present study shows that DGGE could give valuable additional information about chronic wound microflora that is not apparent from cultural analysis alone. PMID:15297496
Davies, Charlotte E.; Hill, Katja E.; Wilson, Melanie J.; Stephens, Phil; Hill, C. Michael; Harding, Keith G.; Thomas, David W.
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
Compression therapy--including inelastic, elastic, and intermittent pneumatic compression--is the standard of care for venous ulcers (VLUs) and chronic venous insufficiency, but there is no consensus in the literature regarding the most effective type of compression therapy. A prospective, randomized, clinical pilot study was conducted among 70 patients with unilateral VLUs treated in a hospital dermatology department in Poland to compare three types of compression therapy (intermittent pneumatic compression, stockings, and short-stretch bandages) in persons with superficial deep venous reflux alone or combined with the segmental variety. Study endpoints were change in ulcer dimensions and proportions healed. Patients with superficial or combined superficial and deep vein insufficiency were randomly allocated to receive one of the three therapies (one of each vein type for each treatment option, six groups total). All patients received saline-soaked gauze dressings along with micronized purified flavonoid fraction, diosmin, hesperidin, and Daflon 500 once daily. Compression treatments were changed or pneumatic compression provided daily for 15 days. Wound size reduction and percentage of wounds healed were significantly higher in groups receiving intermittent pneumatic compression or stockings than in groups using short-stretch bandages (for percentage change of ulcer surface area, P = 0.02; for healing rates P = 0.01). These results warrant additional randomized controlled clinical studies with a larger sample size and longer patient follow-up. PMID:23934375
Dolibog, Pawel; Franek, Andrzej; Taradaj, Jakub; Polak, Anna; Dolibog, Patrycja; Blaszczak, Edward; Wcislo, Ligia; Hrycek, Antoni; Urbanek, Tomasz; Ziaja, Jacek; Kolanko, Magdalena
Ulcers commonly occur in the oral cavity, their main symptom being pain. There are different ways to classify oral ulcers. The most widely accepted form divides them into acute ulcers--sudden onset and short lasting--and chronic ulcers--insidious onset and long lasting. Commonest acute oral ulcers include traumatic ulcer, recurrent aphthous stomatitis, viral and bacterial infections and necrotizing sialometaplasia. On the other hand, oral lichen planus, oral cancer, benign mucous membrane pemphigoid, pemphigus and drug-induced ulcers belong to the group of chronic oral ulcers. It is very important to make a proper differential diagnosis in order to establish the appropriate treatment for each pathology. PMID:16277953
Bascones-Martínez, Antonio; Figuero-Ruiz, Elena; Esparza-Gómez, Germán Carlos
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).
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
Buruli ulcer is an indolent necrotizing disease of the skin, subcutaneous tissue, and bone that is caused by Mycobacterium ulcerans. Buruli ulcer is presently the third most common mycobacterial disease of humans, after tuberculosis and leprosy, and the least understood of the three. The disease remained largely ignored by many national public health programs, but more recently, it has been
Françoise Portaels; Manuel T. Silva; Wayne M. Meyers
Chronic venous insufficiency (CVI) results from venous hypertension secondary to superficial or deep venous valvular reflux, as well as venous obstruction. The most severe clinical manifestation of CVI is venous leg ulceration that can result in significant morbidity, including venous gangrene and amputation, albeit rare. Treatment modalities are aimed at reducing venous hypertension. Diuretic therapy, although widely used, only provides short-term improvement of the edema but provides no long-term benefit. Compression therapy is the cornerstone in the management of CVI. Compression can be achieved using compression bandaging, compression pumps, or graduated compression stockings. Topical steroid creams may reduce inflammation, venous eczema, and pain in the short term, but they can be detrimental in the long run. Apligraf (a living, bilayered, cell-based product) in conjunction with compression therapy was noted to be more effective in healing venous leg ulcerations, when compared with treatment with compression therapy and zinc paste. Endovascular and surgical techniques that minimize valvular reflux and relieve venous obstruction improve venous hemodynamics, promoting wound healing. PMID:24840970
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.
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We have fabricated several kinds of uni-leg thermoelectric (TE) modules using Sb-doped n-type Mg2Si. In order to evaluate the influence of the structure of the modules on their durability with respect to heat-cycling, modules of two different types were evaluated. One was a conventional-structured module, in which the upper and lower surfaces of the legs were each fixed to a ceramic substrate. The other was a `half skeleton' module, in which the `cold-side' substrate was removed and a thermal-conductive sheet was used instead of a ceramic plate for the cold-side insulator. From the result of this evaluation, it was confirmed that, although some variation in the output power was observed for the `half-skeleton' module, the power variation was markedly less than for the conventional-structured module. Additionally, to improve the output power of the module, we replaced the Al2O3 substrate with Si3N4, which has a higher thermal conductivity than the Al2O3 substrate. The observed output power of a module (25 mm × 24 mm × 8.3 mm) fabricated using the Si3N4 substrate was 1,293 mW at ?T = 500 K. The output value of the module using the Si3N4 plate was improved by 29 % compared with the output value of the module using the Al2O3 substrate. Moreover, based on the structures of these modules, a 36 mm × 41 mm × 8.3 mm module was fabricated. The expected value of the output power of the module was 1.9 W at ?T = 500 K.
Nemoto, Takashi; Iida, Tsutomu; Sato, Junichi; Suda, Hiroshi; Takanashi, Yoshifumi
Summary and conclusions In so far as can be judged, the features of ulcerative disease of the colon in the aforementioned three patients have many\\u000a points in common. However, the intensity and severity of the disease as it afflicted the three patients are different. If\\u000a the patient in Case 2 had been permitted to continue without treatment for several more weeks,
Charles J. Donald; Philip W. Brown
Introduction Unrelieved pressure or friction of the skin, particularly over bony prominences, can lead to pressure ulcers in up to one third of people in hospitals or community care, and one fifth of nursing home residents. Pressure ulcers are more likely in people with reduced mobility and poor skin condition, such as older people or those with vascular disease. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of preventive interventions in people at risk of developing pressure ulcers? What are the effects of treatments in people with pressure ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 64 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: air-filled vinyl boots, air-fluidised supports, alternating-pressure surfaces (including mattresses), alternative foam mattresses, constant low-pressure supports, debridement, electric profiling beds, electrotherapy, hydrocellular heel supports, low-air-loss beds (including hydrotherapy beds), low-level laser therapy, low-tech constant-low-pressure supports, medical sheepskin overlays, nutritional supplements, orthopaedic wool padding, pressure-relieving overlays on operating tables, pressure-relieving surfaces, repositioning (regular "turning"), seat cushions, standard beds, standard care, standard foam mattresses, standard tables, surgery, therapeutic ultrasound, topical lotions and dressings, topical negative pressure, and topical phenytoin. PMID:21524319
Introduction Unrelieved pressure or friction of the skin, particularly over bony prominences, can lead to pressure ulcers in up to a third of people in hospitals or community care, and a fifth of nursing home residents. Pressure ulcers are more likely in people with reduced mobility and poor skin condition, such as older people or those with vascular disease. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of preventive interventions in people at risk of developing pressure ulcers? What are the effects of treatments in people with pressure ulcers? We searched: Medline, Embase, The Cochrane Library and other important databases up to February 2007 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 60 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: air-filled vinyl boots, air-fluidised supports, alternating pressure surfaces (including mattresses), alternative foam mattresses, constant low-pressure supports, debridement, electric profiling beds, electrotherapy, hydrocellular heel supports, low-air-loss beds (including hydrotherapy beds), low-level laser therapy, low-tech constant low-pressure supports, medical sheepskin overlays, nutritional supplements, orthopaedic wool padding, pressure-relieving overlays on operating tables, pressure-relieving surfaces, repositioning (regular "turning"), seat cushions, standard beds, standard care, standard foam mattresses, standard tables, surgery, therapeutic ultrasound, topical lotions and dressings, topical negative pressure, and topical phenytoin. PMID:19450317
A simplified method of total contact casting for diabetic plantar ulcerations is described in which a standard, well-molded short-leg walking cast is applied. Weekly cast changes are performed initially, followed by longer cast change intervals. Either fiberglass or plaster casting tape appears equally efficacious. Healing of all ulcers was demonstrated in 12 patients treated with this technique. PMID:10148327
Huband, M S; Carr, J B
Summary Pressure ulcer is a common syndrome of diffi cult treatment among bedridden individuals, with clinical and socioeconomic repercussions. A recently developed natural biomembrane (NBM) as a therapeutic option for leg ulcers with debriding and neo-angiogenic properties encouraged us to apply it as a treatment for pressure ulcers. The authors report the results obtained with the NBM dressing on alternate
Marco Andrey Cipriani Fradea; Adriana Martinelli Salathiela; Eduardo Lopez Mazzucatoa; Joaquim Coutinho Nettob; Norma Tiraboschi Fossa
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))
Ulcered lesions on the legs and feet caused by venous insufficiency and other conditions require long-term clinical treatment and follow-up. To facilitate the analysis of the tissue composition of a lesion, we propose color imaging and image processing methods. Methods considering the bottom tissues are proposed for the segmentation of a given image into regions corresponding to red granulation, yellow
E. A. G. Dorileo; Marco A. C. Frade; Rangaraj M. Rangayyan; Paulo M. Azevedo-Marques
We present the first case of retrograde ablation of the small saphenous vein to treat active venous ulceration. A 73-year-old gentleman with complicated varicose veins of the left leg and a non-healing venous ulcer despite previous successful endovenous treatment to his left great saphenous vein underwent mechanochemical ablation of his small saphenous vein with the ClariVein® system, under local anaesthetic, using a retrograde cannulation technique. Post-operatively the patient had improved symptomatically and the ulcer size had reduced. This report highlights that patients with small saphenous vein incompetence and active ulceration can be treated successfully with retrograde mechanochemical ablation. PMID:24347131
Moore, Hayley M; Lane, Tristan Ra; Franklin, Ian J; Davies, Alun H
Venous hypertension due to venous insufficiency causes venous ulcers. Duplexsonography is a widely accepted non invasive method to assess venous insufficiency with venous reflux measurements. Retrograde venous flow is defined as venous reflux. The testing of venous reflux is reliable if transvalvular pressure is sufficiently high and transvalvular flow velocity exceeds 30 cm/s. Reflux testing in the proximal leg veins (V. femoralis communis, V. femoralis, V. saphena magna) is done using a standardised Valsalva Manoeuvre (exspiration into a tube up to a pressure of 30 mmHg, pressure established within 0.5 seconds, pressure hold for 3 seconds). Distal leg vein testing (V. poplitea, V. tibialis posterior, V. saphena parva) is recommended with a two handed - compression distally to the tested veins. The most important parameter is venous reflux time, a cut off of > 2 seconds is recommended. PMID:21360458
A robot with a body, at least one leg on each side of the body, and a hip connecting the leg to the body. The hip is configured to abduct and adduct the leg. A linkage is configured to rotate the leg along a predetermined path.
A. Saunders, M. Buehler
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.
A series of 31 infants and children with acute duodenal ulcer verified by endoscopy was studied over an eight year period. Eighteen (58%) of them were under 2 years of age. The most common symptom was upper gastrointestinal bleeding (n = 27, 87%). Twenty nine patients (94%) had a preceding illness characterised by diarrhoea, upper respiratory tract infection, or fever, which was not necessarily treated with antipyretic drugs. Initial endoscopy showed that ulcer lesions were solitary in 14 patients and present on the anterior wall (n = 11), posterior wall (n = 2), or both (n = 1). Multiple ulcers were found in 17 patients, and present in the bulb with (n = 6) or without (n = 11) extension into the second part of duodenum. The most conspicuous finding was the irregularly shaped ulcers seen in eight young children with similar clinical and endoscopic features. Sixteen patients were re-endoscoped one to two weeks after the initial examination; the ulcers had entirely disappeared in 13, and there were only small residual ulcers in three. Thirty patients were treated medically and only one (with uncontrollable haemorrhage) required operation. Most patients were symptom free two to six years after the initial diagnosis. Our results suggest that young children may develop acute duodenal ulcers after viral illnesses whether or not they are treated with drugs, mainly antipyretics. This kind of acute duodenal ulcer usually heals quickly irrespective of the morphology, site, and number of ulcers. Images Figure PMID:2774612
Hsu, H Y; Chang, M H; Wang, T H; Hsu, J Y; Wang, C Y; Lin, M I; Wu, M H
Venous leg ulcers are common, chronic, debilitating, and expensive. Evidence supports use of compression bandaging, with superficial venous surgery in selected cases, but these interventions frequently fail to achieve healing. We describe a series of 152 consecutive referrals from a nurse-led specialist dermatology clinic to a vascular surgical service; a group posing particularly challenging problems. This observational study, with median follow-up of 18 months, describes outcomes in a number of important clinically identifiable subgroups. Its findings may assist service planning and discussion of the surgical role within multidisciplinary ulcer management. PMID:19398420
Neequaye, S K; Douglas, A D; Hofman, D; Wolz, M; Sharma, R; Cummings, R; Hands, L
Buruli ulcer is a recognized public health problem in West Africa. In Benin, from 1989 to 2001, the Centre Sanitaire et Nutritionnel Gbemoten (CSNG) treated >2,500 Buruli ulcer patients. From March 2000 to February 2001, field trips were conducted in the Zou and Atlantique regions. The choice of the 2 regions was based on the dis- tance from CSNG and
Martine Debacker; Julia Aguiar; Christian Steunou; Claude Zinsou; Wayne M. Meyers; Françoise Portaels
Marginal ulcer is a well-known complication of gastroenterostomy. It occurs in 3% of patients post-Billroth II subtotal gastrectomy; it occurs in less than 1% if truncal vagotomy is included but in up to 30% of patients with gastroenterostomy without vagotomy [10, 11, 14, 16]. These ulcers occur at the anastomosis, but always on the jejunal side, and are known to
G. F. Gowen; R. E. Campbell; M. M. McFarland; B. A. Alman
A 72-year-old female with venous insufficiency presented to a hospital-based multidisciplinary wound clinic after 20 years of recurrent episodes of venous leg ulcers. Examination showed bilateral leg ulcers with no evidence of arterial insufficiency, but complicated by considerable devitalised tissue, abnormally high bacterial load and the presence of multi-resistant organisms. The ulcers were initially treated with larvae to aid debridement and reduce the bacterial load, prior to skin grafting. Although ulcer free for a period of 4 months, further debridement was required when the skin condition deteriorated. Surgical intervention was chosen as the preferred method by the surgeons for a second acute care admission using hydrosugery, along with supplementary skin grafts and compression. Ongoing management, consisting of regular debridement, skin care and compression therapy, continues. PMID:24142139
McInnes, W; Ruzehaji, N; Wright, N; Cowin, A J; Fitridge, R
Executive Summary In April 2008, the Medical Advisory Secretariat began an evidence-based review of the literature concerning pressure ulcers. Please visit the Medical Advisory Secretariat Web site, http://www.health.gov.on.ca/english/providers/program/mas/tech/tech_mn.html to review these titles that are currently available within the Pressure Ulcers series. Pressure ulcer prevention: an evidence based analysis The cost-effectiveness of prevention strategies for pressure ulcers in long-term care homes in Ontario: projections of the Ontario Pressure Ulcer Model (field evaluation) Management of chronic pressure ulcers: an evidence-based analysis (anticipated pubicstion date - mid-2009) Purpose A pressure ulcer, also known as a pressure sore, decubitus ulcer, or bedsore, is defined as a localized injury to the skin/and or underlying tissue occurring most often over a bony prominence and caused by pressure, shear, or friction, alone or in combination. (1) Those at risk for developing pressure ulcers include the elderly and critically ill as well as persons with neurological impairments and those who suffer conditions associated with immobility. Pressure ulcers are graded or staged with a 4-point classification system denoting severity. Stage I represents the beginnings of a pressure ulcer and stage IV, the severest grade, consists of full thickness tissue loss with exposed bone, tendon, and or muscle. (1) In a 2004 survey of Canadian health care settings, Woodbury and Houghton (2) estimated that the prevalence of pressure ulcers at a stage 1 or greater in Ontario ranged between 13.1% and 53% with nonacute health care settings having the highest prevalence rate (Table 1). Executive Summary Table 1: Prevalence of Pressure Ulcers* Setting Canadian Prevalence,% (95% CI) Ontario Prevalence,Range % (n) Acute care 25 (23.8–26.3) 23.9–29.7 (3418) Nonacute care† 30 (29.3–31.4) 30.0–53.3 (1165) Community care 15 (13.4–16.8) 13.2 (91) Mixed health care‡ 22 (20.9–23.4) 13.1–25.7 (3100) All health care settings 26 (25.2–26.8) 13.1–53.3 (7774) * CI indicates confidence interval. † Nonacute care included sub-acute care, chronic care, complex continuing care, long-term care, and nursing home care. ‡ Mixed health care includes a mixture of acute, nonacute, and/or community care health care delivery settings. Pressure ulcers have a considerable economic impact on health care systems. In Australia, the cost of treating a single stage IV ulcer has been estimated to be greater than $61,000 (AUD) (approximately $54,000 CDN), (3) while in the United Kingdom the total cost of pressure ulcers has been estimated at £1.4–£2.1 billion annually or 4% of the National Health Service expenditure. (4) Because of the high physical and economic burden of pressure ulcers, this review was undertaken to determine which interventions are effective at preventing the development of pressure ulcers in an at-risk population. Review Strategy The main objective of this systematic review is to determine the effectiveness of pressure ulcer preventive interventions including Risk Assessment, Distribution Devices, Nutritional Supplementation, Repositioning, and Incontinence Management. A comprehensive literature search was completed for each of the above 5 preventive interventions. The electronic databases searched included MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, EMBASE, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature. As well, the bibliographic references of selected studies were searched. All studies meeting explicit inclusion and exclusion criteria for each systematic review section were retained and the quality of the body of evidence was determined using the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) system. (5) Where appropriate, a meta-analysis was undertaken to determine the overall estimate of effect of the preventive intervention under review. Summary of Findings Ris
20. 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
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
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
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
Group A ?-hemolytic streptococcal infections have been reported to cause neuropsychiatric symptoms, such as chorea, tics, and obsessive-compulsive disorder, presumably through autoimmune damage to basal ganglia. Mycoplasma pneumoniae infections have also been reported to cause damage to the basal ganglia. Restless legs syndrome is a movement disorder with focal restlessness, an irresistible desire to move, and exacerbation by long periods
Muneaki Matsuo; Katsunori Tsuchiya; Yuhei Hamasaki; Harvey S. Singer
Recent intervention of nonspecific genital ulcers has added refreshing dimensions to genital ulcer disease. It was considered pertinent to dwell on diverse clinical presentation and diagnostic strategies. It seems to possess spectrum. It includes infective causes, Epstein Bar Virus, tuberculosis, Leishmaniasis, HIV/AIDS related ulcers and amoebiasis. Noninfective causes are immunobullous disorders, aphthosis, Behcet's disease (BD), inflammatory bowel disease, lichen planus and lichen sclerosis et atrophicus, drug reactions, premalignant and malignant conditions, pyoderma gangrenosum, and hidradenitis suppurativa. The diagnostic features and treatment option of each disorder are succinctly outlined for ready reference. PMID:24559562
Sehgal, Virendra N; Pandhi, Deepika; Khurana, Ananta
Objectives To investigate changes in ulcer healing time and antibiotic treatment in Sweden following the introduction of the Registry of Ulcer Treatment (RUT), a national quality registry, in 2009. Design A statistical analysis of RUT data concerning the healing time and antibiotic treatment for patients with hard-to-heal ulcers in Sweden between 2009 and 2012. Setting RUT is a national web-based quality registry used to capture areas of improvement in ulcer care and to structure wound management by registering patients with hard-to-heal leg, foot and pressure ulcers. Registration includes variables such as gender, age, diagnosis, healing time, antibiotic treatment, and ulcer duration and size. Population Every patient with a hard-to-heal ulcer registered with RUT between 2009 and 2012 (n=1417) was included. Main outcome measures Statistical analyses were performed using Stata V.12.1. Healing time was assessed with the Kaplan-Meier analysis and adjustment was made for ulcer size. A log-rank test was used for equality of survivor functions. Results According to the adjusted registry in December 2012, patients’ median age was 80?years (mean 77.5?years, range 11–103?years). The median healing time for all ulcers, adjusted for ulcer size, was 146?days (21?weeks) in 2009 and 63?days (9?weeks) in 2012 (p=0.001). Considering all years between 2009 and 2012, antibiotic treatment for patients with hard-to-heal ulcers was reduced from 71% before registration to 29% after registration of ulcer healing (p=0.001). Conclusions Healing time and antibiotic treatment decreased significantly during 3?years after launch of RUT. PMID:23959752
Oien, Rut F; Forssell, Henrik W
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
In this study of people with diabetes mellitus and peripheral neuropathy, it was found that the feet of patients with a history of hallux ulceration were more pronated and less able to complete a single-leg heel rise compared with the feet of patients with a history of ulceration elsewhere on the foot. The range of active first metatarsophalangeal joint dorsiflexion was found to be significantly lower in the affected foot. Ankle dorsiflexion, subtalar joint range of motion, and angle of gait differed from normal values but were similar to those found in other studies involving diabetic subjects and were not important factors in the occurrence of hallux ulceration. These data indicate that a more pronated foot type is associated with hallux ulceration in diabetic feet. Further studies are required to evaluate the efficacy of footwear and orthoses in altering foot posture to manage hallux ulceration. PMID:16707629
Nubé, Vanessa L; Molyneaux, Lynda; Yue, Dennis K
\\u000a Design of two and multi-legged robots like four legged, six legged, and eight legged robots shows a practical usefulness of\\u000a Bionics for the domain of robotics. Depending on the number of legs, such robotic platforms can be inspired from body constitution,\\u000a walking mechanics, and behavior of humans, animals (four legged), insects (six legged), or spiders (eight legged). There is\\u000a also
BACKGROUND—Mooren's ulcer is a progressive intractable destructive peripheral ulceration of the cornea, probably of autoimmune aetiology. The disease is rare in the northern hemisphere but is more common in southern and central Africa and the Indian subcontinent. Although rare, its predominance in certain racial groups and their second generation migrants worldwide indicates a genetic as well as a geographic predisposition. The highly polymorphic human leucocyte antigens (HLA) confer genetic susceptibility to several autoimmune disorders. Therefore, a possible link between Mooren's ulcer and HLA type was investigated.?METHODS—Patients (n=22) with non-infective destructive peripheral corneal inflammatory disease were recruited worldwide. Differential diagnosis confirmed Mooren's ulceration in 12 cases. HLA typing (HLA-A, B, C, DRB, DQB) was performed by serology and PCR using sequence specific primers. The patients came from varied ethnic backgrounds and their HLA typing results were compared with published data from ethnically matched control populations.?RESULTS—Of the 12 patients with Mooren's ulcer, 10 (83%) were HLA-DR17(3) positive (including all nine patients of Asian, Indonesian, and black African origin), and 10 (83%) were HLA-DQ2 positive. The frequency of HLA-DR17(3) and DQ2 was higher in the Mooren's ulcer group compared to published data from ethnically matched control populations, where the expected antigen frequencies range between 5% and 40%.?CONCLUSION—These results suggest a possible association between HLA-DR17(3) and/or DQ2 and susceptibility to Mooren's ulcer.?? PMID:10611103
Taylor, C.; Smith, S.; Morgan, C.; Stephenson, S.; Key, T.; Srinivasan, M; Cunningham, E.; Watson, P.
... 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- ...
The relationship between the leg compliance and factors related to the size of leg muscle and to physical fitness was investigated in ten healthy subjects. Vascular compliance of the leg, as determined by a mercury strain gauge, was found to be not significantly correlated with any variables associated with physical fitness per se (e.g., peak O2 uptake, calf strength, age, body weight, or body composition. On the other hand, leg compliance correlated with the calf cross-sectional area (CSA) and the calculated calf volume, with the CSA of calf muscle being the most dominant contributing factor (while fat and bone were poor predicators). It is suggested that leg compliance can be lowered by increasing calf muscle mass, thus providing structural support to limit the expansion of leg veins.
Convertino, Victor A.; Doerr, Donald F.; Flores, Jose F.; Hoffler, G. Wyckliffe; Buchanan, Paul
This investigation evaluated the microstructural and mechanical properties of human skin at and adjacent to pressure ulcers (PUs). Healthy breast and leg tissue served as control tissue . The tissue was characterized through uniaxial tensile testing and histomorphometric analysis . The PU tissue had significantly fewer straight and wavy fibers, but the fibers present were significantly wider and longer than
Laura E. Edsberg; Renee Cutway; Shirley Anain; Joseph R. Natiella
Leg edema is a common problem in the elderly and requires further evaluation and management. Method: From October 1990 to July 1992, 245 patients presented to the Cleveland Clinic Florida with leg edema. All patients were counseled about the benefits of twenty-minute, three-times-a-day raised-leg exercises. Fifty seven (57) of the 245 patients were not compliant with this regimen (nonexercise group).
Jerry O. Ciocon; Daisy Galindo-Ciocon; Diana J. Galindo
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.
Non ulcer dyspepsia is one of the most common problems encountered in primary care practice. The underlying pathophysiology of non ulcer dyspepsia is not fully understood, but it is known that this condition is associated with H. pylori infection and motility disorder. The presenting abdominal symptoms are non specific: they include bloating, belching, flatulence, excessive fullness after eating and nausea. Psychological condition such as anxiety, depression and stress do play a role in the recurrence of symptoms. Upper GI endoscopy is necessary in patients who presents with alarm symptoms suggestive of possible underlying organic condition before one makes the diagnosis of non ulcer dyspepsia. Pharmacological therapy using H2 receptor antagonist and proton pump inhibitors are effective for symptom relief. Patient's education and supportive care should be part of the management strategy in recurrent chronic dyspepsia. PMID:18942314
Loh, K Y; Siang, T K
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.
AIMS(1) To validate a leg to leg bioimpedance analysis (BIA) device in the measurement of body composition in children by assessment of its agreement with dual energyx ray absorptiometry (DXA) and its repeatability. (2) To establish a reference range of percentage body fat in Hong Kong Chinese children.METHODSSequential BIA and DXA methods were used to determine body composition in 49
R Y T Sung; P Lau; C W Yu; P K W Lam; E A S Nelson
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
This patent describes an offshore platform assembly. It comprises a floatable hull having wells extending vertically therethrough; a plurality of inclined supporting legs secured to the hull and movable between a first, retracted position and a second, hull supporting position; flexible guide means for absorbing bending moments and forces acting on a leg chord of a corresponding leg which moves through a flexible guide means during elevation of the hull, each of the guide means being positioned in a corresponding well of the hull; means for elevating the hull with respect to the supporting legs; and wherein each of the flexible guide means is movable to a limited degree along a horizontal plane to absorb bending moments and forces acting on a corresponding leg while the hull is being elevated to an operating level.
Goldman, J.; Bennett, R.M.
prosthetic leg design include: leg structure, cushioning system, attachments, stabilizing system, and connections throughout the prosthetic device. Leg Structure: The lower leg structure should be an average child will need a smaller design. Students can also make their leg adjustable just like the lower
Many frequently cited studies of the interaction of chronic idiopathic ulcerative colitis (CIUC) and pregnancy were performed in the 1950s before pharmacotherapy for this disease was common. We retrospectively reviewed obstetrical records at a large maternity facility to determine the effects of CIUC on pregnancy and on fetal outcome. We observed that the prevalence of CIUC in pregnant women was
Robert R. Schade; David H. Van Thiel; Judith S. Gavaler
Abdominal compartment syndrome (ACS) is defined as an increased intra-abdominal pressure with adverse physiologic consequences. Abdominal compartment syndrome caused by perforated peptic ulcer is rare owing to early diagnosis and management. Delayed recognition of perforated peptic ulcer with pneumoperitoneum, bowel distension, and decreased abdominal wall compliance can make up a vicious circle and lead to ACS. We report a case of perforated peptic ulcer associated with ACS. A 74-year-old man with old stroke and dementia history was found to have distended abdomen, edema of bilateral legs, and cyanosis. Laboratory tests revealed deterioration of liver and kidney function. Abdominal compartment syndrome was suspected, and image study was arranged to find the cause. The study showed pneumoperitoneum, contrast stasis in heart with decreased caliber of vessels below the abdominal aortic level, and diffuse lymphedema at the abdominal walls. Emergent laparotomy was performed. Perforated peptic ulcer was noted and the gastrorrhaphy was done. The symptoms, and liver and kidney function improved right after emergent operation. PMID:19091294
Lynn, Jiun-Jen; Weng, Yi-Ming; Weng, Chia-Sui
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
Opinion statement Patients with severe ulcerative colitis should be hospitalized and treated with intravenous corticosteroids for 7 to 10 days.\\u000a Patients who fail to respond may be offered colectomy or rescue therapy with intravenous cyclosporine. Risks of cyclosporine\\u000a therapy, including a 1% to 2% risk of death from opportunistic infection and a 50% failure rate after 6 months of follow-up,\\u000a should
William J. Sandborn
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.
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.
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, Benoit G.
We report a case of triple acid-base disorder with metabolic alkalosis as the primary disorder in a 65-year-old man due to ingestion and application to leg ulcers of baking soda (calcium bicarbonate). The blood pH was 7.65 with hypochloremia, hypokalemia, and prerenal azotemia. He was treated with isotonic saline with K replacement, and the patient improved without any adverse clinical consequences. We discuss the causes, mechanisms, and management of Cl-responsive (depletion) metabolic alkalosis. PMID:21185672
John, Ruby Samuel; Simoes, Sonia; Reddi, Alluru S
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
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-
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
People with diabetes develop foot ulcers because of neuropathy (sensory, motor, and autonomic deficits), ischaemia, or both. The initiating injury may be from acute mechanical or thermal trauma or from repetitively or continuously applied mechanical stress. Patients with clinically significant limb ischaemia should be assessed by a vascular surgeon to determine the need for angioplasty, stenting, or femorodistal bypass. When infection complicates a foot ulcer, the combination can be limb or life-threatening. Infection is defined clinically, but wound cultures reveal the causative pathogens. Tissue specimens are strongly preferred to wound swabs for wound cultures. Antimicrobial therapy should be guided by culture results, and should aim to cure the infection, not to heal the wound. Alleviation of the mechanical load on ulcers (off-loading) should always be a part of treatment. Neuropathic ulcers typically heal in 6 weeks with total contact casting, because it effectively relieves pressure at the ulcer site and enforces patient compliance. The success of other approaches to off-loading similarly depends on the patients' adherence to the effectiveness of pressure relief. Surgery to heal ulcers and prevent recurrence can include tenotomy, tendon lengthening, reconstruction, or removal of bony prominences. However, these procedures may result in secondary ulceration and other complications. Ulcer recurrence rates are high, but appropriate education for patients, the provision of posthealing footwear, and regular foot care can reduce rates of re-ulceration. PMID:16291067
Cavanagh, Peter R; Lipsky, Benjamin A; Bradbury, Andrew W; Botek, Georgeanne
The mechanism of action of ulcer drugs without acid inhibition appears to involve improvement of defensive factors of the gastroduodenal mucosa. The concept of ulcer healing without acid inhibition is attractive for theoretical reasons, because doubts have arisen about the safety of elevation of intragastric pH, especially in long-term treatment of peptic ulcer disease. Ulcer drugs that do not affect gastric acidity may therefore be preferred, provided they compare favorably to the best acid inhibitors available in terms of efficacy, adverse effects and other requirements. Among these drugs, sucralfate fulfills these criteria to a large extent. PMID:6547542
Koelz, H R
This paper discusses the range of recurrent oral ulceration which affects the oral mucosa. Types of ulceration covered in this paper include traumatic, infective, aphthous, ulceration related to the oral dermatoses, drug-induced, ulceration as a manifestation of systemic disease and ulceration indicating malignancy. Aspects of the aetiology, diagnosis and management of common oral recurrent ulcerative conditions are reviewed from a clinical perspective as an aid to practising dentists. PMID:20553241
Talacko, A A; Gordon, A K; Aldred, M J
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
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 histologically recognizable. The condition is essentially benign and may persist for many years unchanged. It has not responded satisfactorily to medical or surgical methods of treatment. The cause of solitary ulcer is unknown. Different views on the pathogenesis are discussed. ImagesFIG. 1FIG. 2FIGS. 3 and 4FIG. 5FIG. 6FIG. 7FIG. 8FIG. 9FIG. 10FIG. 11FIG. 12FIG. 13FIG. 14FIG. 15FIG. 16 PMID:5358578
Madigan, M. R.; Morson, B. C.
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)
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.
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.
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.
We report the case of a 68-year-old woman with autoimmune hepatitis (AIH) who had leg ulcers induced by disseminated cryptococcosis. She had received prednisolone for her AIH at 20 mg/day for maintenance. On the initial visit, she complained of a painful ulcer that had round, shallow pockets with erythema and erythematous subcutaneous indurations on the right thigh. Several metacarpophalangeal joints and wrist joints were swollen, with tenderness and stiffness in the morning for over 3 h. Her serum rheumatoid factor was high. Since other autoimmune disorders such as rheumatoid arthritis can present with AIH, it was necessary to distinguish it from ulcers due to rheumatoid arthritis, although the characteristic features of these ulcers seemed to be different. A biopsy specimen from the erythematous skin showed globe-shaped organisms in the dermis and subcutaneous tissues; vasculitis and phlebostasis were not observed. The results from computed tomography scans and sputum culture led to the diagnosis of disseminated cryptococcosis. The administration of fluconazole, fosfluconazole, and voriconazole for about 2 months improved the cryptococcal pneumonia, but the size of the skin ulcer enlarged. The administration was changed to itraconazole, which reduced the size. Cryptococcal infections occur more commonly in immunocompromised hosts, including patients under immunosuppressive therapies such as corticosteroids. The possibility that the skin ulcers in immunocompromised hosts may be caused by cryptococcosis should be considered. PMID:24761142
Ikeda, Takaharu; Kaminaka, Chikako; Yamamoto, Yuki; Furukawa, Fukumi
This chapter reviews 218 published and unpublished research reports of pressure ulcer prevention and management by nurse researchers and researchers from other disciplines. The electronic databases MEDLINE (1966-July 2001), CINAHL (1982-June 2001), AMED (1985-July 2001), and EI Compedex Plus (1980-June 2001) were selected for the searches because of their focus on health and applied research. Moreover, evaluations of previous review articles and seminal studies that were published before 1966 are also included. Research conducted worldwide and published in English between 1930 and 2001 was included for review. Studies using descriptive, correlational, longitudinal, and randomized control trials were included. This review found that numerous gaps remain in our understanding of effective pressure ulcer prevention and management. Moreover, the majority of pressure ulcer care is derived from expert opinion rather than empirical evidence. Thus, additional research is needed to investigate pressure ulcer risk factors of ethnic minorities. Further studies are needed that examine the impact of specific preventive interventions (e.g., turning intervals based on risk stratification) and the cost-effectiveness of comprehensive prevention programs to prevent pressure ulcers. Finally, an evaluation is needed of various aspects of pressure ulcer management (e.g., use of support surfaces, use of adjunctive therapies) and healing of pressure ulcers. PMID:12092517
Lyder, Courtney H
Pressure ulcers are chronic and difficult to heal. Pressure-reducing devices are clearly superior to a standard hospital mattress in preventing pressure ulcers, but only limited evidence and clinical intuition supports pressure-reducing devices in improving the healing rate of pressure ulcers. Local wound treatment should aim at maintaining a moist wound environment. The choice of a particular dressing depends on wound characteristics, such as the amount of exudate, dead space, or wound location. Nutritional status should be addressed as a process of good care. Debridement may improve time to a clean wound bed, but no clearly superior approach has been demonstrated. PMID:23571035
Thomas, David R
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
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.
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.
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.
Antonelli, Elisabetta; Villanacci, Vincenzo; Baldoni, Monia; Dore, Maria Pina
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.
OCEAN DRILLING PROGRAM LEG 132 ENGINEERING PROSPECTUS WESTERN AND CENTRAL PACIFIC Mr. Michael A Institutions, Inc., under contract with the National Science Foundation. Funding for the program is provided, or Texas A & M Research Foundation. #12;Leg 132 Engineering Prospectus page 3 INTRODUCTION Leg 132
tendon system, 2) a partially damaged tendon system, and 3) a completely damaged tendon system. The four different types of TLP chosen for this study are 1) a conventional four-leg TLP, 2) three-leg mini TLP, 3) extended four-leg TLP and 4) mini four...
AIMS—(1) To validate a leg to leg bioimpedance analysis (BIA) device in the measurement of body composition in children by assessment of its agreement with dual energy x ray absorptiometry (DXA) and its repeatability. (2) To establish a reference range of percentage body fat in Hong Kong Chinese children.?METHODS—Sequential BIA and DXA methods were used to determine body composition in 49 children aged 7-18 years; agreement between the two methods was calculated. Repeatability for the BIA method was established from duplicate measurements. Body composition was then determined by BIA in 1139 girls and 1243 boys aged 7-16 years, who were randomly sampled in eight local primary and secondary schools to establish reference ranges.?RESULTS—The 95% limits of agreement between BIA and DXA methods were considered acceptable (?3.3 kg to ?0.5 kg fat mass and ?3.9 to 0.6% body fat). The percentage body fat increased with increasing age. Compared to the 1993 Hong Kong growth survey, these children had higher body mass index. Mean (SD) percentage body fat at 7years of age was 17.2% (4.4%) and 14.0% (3.4%) respectively for boys and girls, which increased to 19.3% (4.8%) and 27.8% (6.3%) at age 16.?CONCLUSION—Leg to leg BIA is a valid alternative method to DXA for the measurement of body fat. Provisional reference ranges for percentage body fat for Hong Kong Chinese children aged 7-16 years are provided.?? PMID:11517118
Sung, R; Lau, P; Yu, C; Lam, P; Nelson, E
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
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
The purpose of the study was to evaluate the frequency of restless legs syndrome in 30 patients with multiple system atrophy. Eight patients complained from restless legs syndrome, their severity score was 19.4 ± 4.1. Pittsburgh Sleep Quality Index scores were significantly higher in patients with restless legs syndrome than those without (9.3 ± 3.7 vs. 4.8 ± 2.9, p = 0.00165). Periodic limb movements were found in 75 % of patients with restless legs syndrome. Restless legs syndrome is more prevalent in multiple system atrophy as compared to the acknowledged prevalence in the general population. PMID:24818598
Ghorayeb, Imad; Dupouy, Sandrine; Tison, François; Meissner, Wassilios G
The pathogenesis of restless legs syndrome (RLS) is not yet completely understood. However, recent research addressed the\\u000a hypothesis that dopaminergic pathways are involved in the mechanisms responsible for the syndrome both for sensory and motor\\u000a symptoms. Different aspects of RLS physiopathogenesis are discussed: the genetic components indicating different chromosomes\\u000a are responsible for the heterogeneity in the phenotypic expression of the
M. Zucconi; M. Manconi; L. Ferini Strambi
Between 1972 and 1980 Hospital Activity Analysis from 5 Northern Ireland Hospitals demonstrated a gradual increase in the number of patients discharged for all diagnoses whilst there was a decline in discharges for peptic ulcer related disease, (duodenal ulcer, gastric ulcer, gastrojejunal ulcer, peptic ulcer site unspecified and hiatal hernia). The mean number of peptic ulcer related disease discharges per
P. C. O'Connor; K. Griffiths; R. G. Shanks
The medical and endoscopic treatment of duodenal ulcer are decreasing the frequency of surgical treatment in this disease. The authors study the operations performed for duodenal ulcer within the period 1989-1999 in the County Hospital Baia Mare. The decrease of the rate of surgical interventions is the pure effect of the medical treatment, as long as the endoscopic treatment is not yet available in our service. The rate of ulcer--induced perforations remained, however, unmodified (48% of total operatory indications), as well as the postoperative morbidity and--mortality (18% respectively 9%). The last category seems not to be influenced by the type of chosen surgical procedure, but by the patient's age, duration of the disease, and associated pathology. PMID:12731191
Lese, M; Naghi, I; Pop, C
Summary \\u000a \\u000a \\u000a \\u000a 1. \\u000a \\u000a Ulcerative colitis is frequently due to food allergy—in at least sixty-six per cent of cases.\\u000a \\u000a \\u000a \\u000a \\u000a 2. \\u000a \\u000a The resemblance between the mucosal lesions of ulcerative colitis and allergic reactions in the skin is quite obvious.\\u000a \\u000a \\u000a \\u000a \\u000a 3. \\u000a \\u000a The pathological findings in early ulcerative colitis are identical with those demonstrated in allergy experiments in humans\\u000a and animals. Their progression would produce
Albert P. R Andresen
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
Raynaud, digital ulcers and calcinosis are frequent manifestations of patients with systemic sclerosis. Digital ulcers are seen in more than half of the patients with scleroderma. Hospitalizations, ischemic complications and impairment of hand function are frequently observed in patients with digital ulcers, especially if treatment is delayed. Rapid and intensive treatment escalation in patients with scleroderma and refractory Raynaud's phenomenon is one of the most effective preventive action available in order to avoid the development of digital ulcers and tissue loss. PMID:22835924
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.
Heels are the second most common anatomical location for pressure ulcers. A combination of risk factors, including pressure, may cause ulceration. Heel pressure ulcers are a particular concern for surgical patients. A review of the literature, including poster presentations, shows that controlled clinical studies to assess the effectiveness and cost-effectiveness of available interventions are not available. Case series (with or
Evonne Fowler; Suzy Scott-Williams; James B. McGuire
Summary A treatment of Chronic Ulcerative Colitis in which diet, rest and treatment with Anayodin (iodoxyquinoline sulfonic acid)\\u000a has been described. Anayodin was administered orally and by enema with good results.\\u000a \\u000a Three case histories, one acute, one chronic and one recurrent have been related.
Charles J. Drueck
The role of diet in the aetiology and pathogenesis of ulcerative colitis (UC) remains uncertain. Impaired utilization by colonocytes of butyrate, a product of bacterial fermentation of dietary carbohydrates escaping digestion, may be important. Sulphur-fermenting bacteria may be involved in this impaired utilization. Oxidative stress probably mediates tissue injury but is probably not of causative importance. Patients with UC are
John L. Rombeau; Gary R. Lichtenstein
Venous ulceration is caused by the disorganization of the microcirculation that is induced by prolonged venous hypertension. The most common cause of calf pump inefficiency that permits superficial venous hypertension during exercise is deep vein thrombosis. Venous hypertension causes venular dilatation and an increased capillary permeability. Fibrin is deposited around the capillaries and not removed because of a vein wall
N. L. Browse
Oesophageal injury is a well recognized complication of certain oral medications but warfarin has not been implicated previously. We present a case of an oesophageal ulcer occurring in a patient with mitral regurgitation taking warfarin, and demonstrate a delayed oesophageal tablet transit time. PMID:2594605
Loft, D. E.; Stubington, S.; Clark, C.; Rees, W. D.
Ulcerative colitis (UC) is an inflammatory destructive disease of the large intestine occurred usually in the rectum and lower part of the colon as well as the entire colon. Drug therapy is not the only choice for UC treatment and medical management should be as a comprehensive whole. Azulfidine, Asacol, Pentasa, Dipentum, and Rowasa all contain 5-aminosalicylic acid (5-ASA), which
Chang-Tai Xu; Shu-Yong Meng; Bo-Rong Pan
2 different over-the-counter medications for the prevention of exercise-induced stomach ulcers in racing sled dogs. The two medications (famotidine - trade name Pepcid, given at a dose of 40 mg twice daily; and omeprazole - trade name Prilosec, given at a dose of 20 mg once daily on an empty stomach and approximately 30 min before a meal) were tested
Karen Ramstead; Jane Fuerstenau; Jolene Giese; Donna Quante; Thomas Swan; TC Wait; Jackie Wepruk; Ben Woodard
Exertional leg pain is a common condition seen in athletes and the general population. Although the differential diagnosis of exertional leg pain is broad, this article focuses on the incidence, anatomy, pathophysiology, clinical presentation, diagnostic evaluation, management, and return-to-play guidelines of chronic exertional compartment syndrome and vascular and nerve entrapment etiologies. PMID:23245661
Rajasekaran, Sathish; Kvinlaug, Kylie; Finnoff, Jonathan T
OCEAN DRILLING PROGRAM LEG 202 SCIENTIFIC PROSPECTUS SOUTHEAST PACIFIC PALEOCEANOGRAPHIC TRANSECTS 1000 Discovery Drive College Station TX 77845-9547 USA _____________________ Dr. Peter Blum Leg Project the international Ocean Drilling Program, which is managed by Joint Oceanographic Institutions, Inc., under contract
OCEAN DRILLING PROGRAM LEG 201 SCIENTIFIC PROSPECTUS CONTROLS ON MICROBIAL COMMUNITIES IN DEEPLY Discovery Drive College Station TX 77845-9547 USA _____________________ Dr. D. Jay Miller Leg Project the international Ocean Drilling Program, which is managed by Joint Oceanographic Institutions, Inc., under contract
OCEAN DRILLING PROGRAM LEG 111 SCIENTIFIC PROSPECTUS DSDP HOLE 504B REVISITED Keir Becker Japan Russell B. Merrill Staff Scientist, Leg 111 Ocean Drilling Program Texas ASM University College., under contract with the National Science Foundation. Funding for the program is provided
July 2002 OCEAN DRILLING PROGRAM LEG 206 SCIENTIFIC PROSPECTUS AN IN SITU SECTION OF UPPER OCEANIC -------------------------------- Dr. Gary D. Acton Leg Project Manager and Staff Scientist Ocean Drilling Program Texas A&M University the international Ocean Drilling Program, which is managed by Joint Oceanographic Institutions, Inc., under contract
OCEAN DRILLING PROGRAM LEG 196 SCIENTIFIC PROSPECTUS LOGGING WHILE DRILLING AND ADVANCED CORKS College Station TX 77845-9547 USA _____________________ Dr. Adam Klaus Leg Project Manager and Staff Program, which is managed by Joint Oceanographic Institutions, Inc., under contract with the National
OCEAN DRILLING PROGRAM LEG 178 SCIENTIFIC PROSPECTUS ANTARCTIC PENINSULA Antarctic Glacial History and Sea-level Change Dr. Peter Barker Co-Chief Scientist, Leg 178 British Antarctic Survey High Cross of the University of Tokyo (Japan) National Science Foundation (United States) Natural Environment Research Council
1. Variations in the frequency of the motor discharges to the leg muscles of Periplaneta americana are followed in the intact animal under different types of sensory stimulation by electrical recording from the muscles.2. Two main reflexes are described: the depressor reflex, evoked by stimulation of the campaniform sensilla on the legs, and a levator response to touch on the
J. W. S. Pringle
RIDGE Paul T. Robinson Co-Chief Scientist, Leg 118 Centre for Marine Geology Dalhousie University Program consisted of: Paul T. Robinson, Co-Chief Scientist (Centre for Marine Geology, Dalhousie Halifax, Nova Scotia B3H 3J5 Canada Richard P. Von Herzen Co-Chief Scientist, Leg 118 Woods Hole
This report investigates shield mechanics by describing the elastic response and interaction of shield components to applied vertical and horizontal displacements for various canopy and base contact configurations. This research provides information on generalized shield mechanics, which is applicable in describing the behavior of all two-leg shield supports. Utilizing mechanics of materials concepts and known kinematic relationships for two-leg shield
T. M. Barczak; D. E. Schwemmer
Background: Despite of all the problems caused by lymphedema, this disease continues to affect millions of people worldwide. Thus, the identification of the most efficacious forms of treatment is necessary. Aim: The aim of this study was to evaluate a novel intensive outpatient treatment for leg lymphedema. Methods: Twenty-three legs of 19 patients were evaluated in a prospective randomized study. The inclusion criteria were patients with Grade II and III lymphedema, where the difference, measured by volumetry, between the affected limb below the knee and the healthy limb was greater than 1.5 kg. Intensive treatment was carried out for 6- to 8-h sessions in the outpatient clinic. Analysis of variance was utilized for statistical analysis with an alpha error of 5% (P-value <0.05) being considered significant. Results: All limbs had significant reductions in size with the final mean loss being 81.1% of the volume of edema. The greatest losses occurred in the first week (P-value <0.001). Losses of more than 90% of the lymphedema occurred in 9 (39.13%) patients; losses of more than 80% in 13 (56.52%), losses of more than 70% in 17 (73.91%) and losses of more than 50% were recorded for 95.65% of the patients; only 1 patient lost less than 50% (37.9%) of the edema. Conclusion: The intensive treatment of lymphedema in the outpatient clinic can produce significant reductions in the volume of edema over a short period of time and can be recommended for any grade of lymphedema, in particular the more advanced degrees. PMID:20606882
Pereira de Godoy, Jose Maria; Azoubel, Lina M O; de Fatima Guerreiro de Godoy, Maria
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; Calio, Francesco Giuseppe; Amato, Bruno; Ceglia, Simona; Spaziano, Giuseppe; Scaramuzzino, Luca; Ferrarese, Alessia Giovanna; Grande, Raffaele; de Franciscis, Stefano
This is a qualitative study that aims to discuss the trajectories of people with chronic sores on the lower limbs,focusing on their affective and sexual experiences. Fifty-one adult outpatients participated and they received care at the infirmary of a public hospital in Salvador-Bahia, between 2008 and 2009. Data was collected through techniques that included themed-story drawings and in-depth interviews, during therapeutic listening sessions,followed by an analysis of the content and an analysis of the drawing contents. Three categories emerged solitary sexual-affective trajectory, fragmented sexual-affective trajectory, and continuous or linear sexual-affective trajectory. It was concluded that the limitations imposed by sores influence the subjectivity of these people, leading them to processes of loss of self-confidence, self-deprecation and fear of sexual- affective demands. It becomes clear, therefore, for the need to promote, not only curative interventions for the body, but also to include therapeutic listening and psychological support in the assistance offered to these people. PMID:24344599
Carvalho, Evanilda Souza de Santana; Paiva, Mirian Santos; Aparício, Elena Casado; Rodrigues, Gilmara Ribeiro Santos
A new method for surgical wound debridement is the Versajet hydrosurgery technique. This technique uses a high velocity jet of sterile saline with a speed up to 1,078 km/h (670 miles/h). By using the Venturi effect (fluid speeds up in a restriction, reducing its pressure and producing a partial vacuum), a simultaneous vacuum is created across the operating window of the handpiece. The application of this high velocity fluid jet to a chronic wound enables precise debridement without collateral tissue damage. The vacuum-assisted closure (V.A.C.) therapy is used for chronic wounds to induce faster wound healing. This system creates a vacuum-induced negative pressure to a specific wound area resulting in an accelerated formation of granulation tissue in the wound bed. We present a patient who experienced rapid wound healing when both of these techniques were combined to clean the wound. After split-thickness skin grafting, V.A.C. therapy was continued. The result was excellent graft acceptance with complete wound healing. This case is unique in that a combination of both therapies resulted in complete wound healing. PMID:16928242
Stetter, Christoph; Plaza, Tobias; von den Driesch, Peter
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
Ulcerative colitis (UC) is a chronic and relapsing inflammation limited to the colonic mucosa and always involving the rectum with variable extension towards the cecum. The aim of medical treatment is to induce and maintain clinical remission. In contrast to Crohn’s disease for which a ‘top-down’ or ‘early aggressive’ therapy is discussed, in UC the concept of a step-up treatment
One hundred and thirty Tanzanian children with corneal ulceration were clinically examined to determine the cause of the ulceration. 37% of the ulcers were associated with recent measles infection and 38% of the children had bilateral ulceration. Herpes simplex virus infection was the commonest cause of ulceration in the series, but vitamin A deficiency was the major cause of bilateral
A Foster; A Sommer
... person's back appear where blisters (bullae) caused by Erythema multiforme have ruptured and the overlying skin removed ( ... The resulting lesions are yellow-crusted ulcers (erosions). Erythema multiforme may be associated with herpes simplex infection, ...
Application of autologous platelet-rich plasma (PRP) has been used for chronic wound healing. The aim of this study was to evaluate the effect of PRP on the wound healing processes of both acute and chronic ulcers and the underlying molecular mechanisms involved. We treated 16 patients affected by various acute and chronic ulcers with PRP. We performed molecular studies of cell proliferation, migration assays, immunoblotting and chloramphenicol acetyltransferase (CAT) assays in PRP-treated HaCaT keratinocyte cells. PRP treatment induced increased rates of cell proliferation and cell migration of HaCaT cells. In addition, the expression of cyclin A and cyclin dependent kinase (CDK) 4 proteins was markedly increased with a low concentration (0.5%) of PRP treatment in HaCaT cells. In 11 patients with chronic ulcers, including stasis ulcers, diabetic ulcers, venous leg ulcers, livedoid vasculitis, claw foot and traumatic ulcers, 9 patients showed 90-100% epithelization after 15.18 days. In 5 patients with acute ulcers, such as dehiscence, open wound and burn wound, 80-100% epithelization was achieved between 4 to 20 days. Topical application of PRP to acute and chronic skin ulcers significantly accelerated the epithelization process, likely through upregulation of the cell cycle regulatory proteins cyclin A and CDK4. PMID:23242428
Kim, Sung-Ae; Ryu, Han-Won; Lee, Kyu-Suk; Cho, Jae-We
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
Chronic ulcers of the oral mucosa are the lesions which a physician comes across frequently. "Eosinophilic Ulcer" is a rare variety of that. Eosinophilic ulcer or traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is a chronic benign lesion of the oral mucosa and is a relatively recent delineated entity. Its etiopathogenesis is still uncertain but trauma seems to play a fundamental role. Clinically the lesion manifests as an isolated ulcer, showing a raised and indurated border in addition to a white or yellowish bed. Microscopically, it is characterized by diffuse polymorphic inflammatory infiltrate, rich in eosinophils, involving the superficial mucosa and the deeper muscle layer with epitheliod cells. Hereby, reporting a case of a 60-year-old female patient who presented with a chief complaint of non-healing painful ulcer on the tongue. PMID:24444070
Chandra, Sunira; Raju, Srinivasa; Sah, Kunal; Anand, Prachi
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
We investigated the associations between leg length and specific ballet movements in different skill groups. Volunteers were from an undergraduate dance programme (n=18), a pre-professional school (n=43) and from an elite classical ballet company (n=45). Individual data were collected for anthropometry, vertical jump, leg dexterity, and leg active and passive ROM. ANCOVA identified both main effects as significant with regard to vertical jump (gender P<0.001 and skill P=0.017); leg length was also identified as a significant covariate (P=0.023). Analysis of leg dexterity identified no significant effects with gender, skill or leg length. Active and passive range of motion noted gender (P=0.001) and skill (P<0.001) differences. Leg length was found to be negatively associated with both active and passive ROM (P=0.002). In conclusion, the present data highlight the diverse and conflicting effects of leg length on fundamental ballet skills. The longer legs that benefit vertical jump have a negative influence on range of motion and leg dexterity except for highly skilled dancers, who through skill, seem to have overcome the effects of some of these dichotomies. PMID:20589589
Wyon, M A; Nevill, A M; Dekker, K; Brown, D D; Clarke, F; Pelly, J; Koutedakis, Y
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
Significant among the medical findings following prolonged space flight are reduced orthostatic tolerance and ergometric work capacity. Changes in hemodynamics of the legs with increased blood pooling and reduction in cardiac output must be considered one of the most probable causes of these effects. Concern for the above plus the observed marked tissue changes occurring in the legs during flight prompted the addition of several procedures to evaluate hemodynamic changes in the leg; resting arterial blood flow, venous compliance and muscle pumping were investigated. In so far as possible, the initial reaction to pressure in the smallest possible vein segment was examined.
Thornton, W. E.; Hoffler, G. W.
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.
One of the least remembered eponyms associated with Harvey Cushing is "Cushing's ulcer." The basis of this credit is a paper published in 1932 in which Cushing describes patients who postoperatively and unexpectedly died of perforated peptic ulcers. It is one of the first descriptions of a stress ulcer and a treatise on the brain-stomach connection. Harvey Cushing was puzzled by the pathogenesis of these peptic ulcerations and perforations and advanced several theories. The least plausible included the bile-vomiting theory suggesting that hemorrhagic ulceration could be produced by a combination of bile and acid in a patient recovering from the anesthetic. Other theories were stimulation of a parasympathetic center in the diencephalon or a disturbance of vagal centers in the brainstem. Quite surprisingly to Cushing, the Boston Herald implicitly insinuated that Cushing found the cause of ulcers and this claim upset him greatly. It is ironic that Harvey Cushing, in his later years with failing health, developed an ulcer himself. Cushing noted in his correspondence that he felt the agitation over this newspaper clipping caused his later ulcer. The first description of a neurogenic ulcer remains an important medical observation and is a testament to Cushing's broad accomplishments. PMID:21346647
Wijdicks, Eelco F M
Heels are the second most common anatomical location for pressure ulcers. A combination of risk factors, including pressure, may cause ulceration. Heel pressure ulcers are a particular concern for surgical patients. A review of the literature, including poster presentations, shows that controlled clinical studies to assess the effectiveness and cost-effectiveness of available interventions are not available. Case series (with or without historical controls) as well as pressure ulcer guideline recommendations suggest the most important aspect of heel ulcer prevention is pressure relief (offloading). It also has been documented that the incidence of heel ulcers can be reduced using a total-patient care approach and heel offloading devices. Guidelines, observational studies, and expert opinion intimate that reducing heel ulceration rates can be expected to improve patient outcomes, decrease costs associated with their care, and avoid costs related to hospital-acquired pressure ulcers. The heel pressure ulcer prevention strategies reviewed should be implemented until the results of prospective, randomized controlled studies to compare the effectiveness and cost-effectiveness of these strategies are available. PMID:18927483
Fowler, Evonne; Scott-Williams, Suzy; McGuire, James B
Post-bulbar ulceration is uncommon, but a pilot study in Hyderabad showed a high incidence. We therefore carried out a prospective endoscopic study of the distribution of peptic ulceration and its relation to symptoms and demography. Of the 360 consecutive patients referred for endoscopy, 113 (92 men, 21 women) had peptic ulceration. Median age 35 years, median duration one year. Five
S S Rao; K V Murthy
In order to identify the risk factors affecting the healing of duodenal ulcer, a clinical trial with effective dose of antacid was carried out in 53 patients. Duration of ulcer history, number of relapses, duration of the last and present relapse, number, duration and severity of pain attacks in the present ulcer relapse, pain radiation to back, vomiting, appetite, smoking
S Massarrat; H G Müller; P Schmitz-Moormann
Quality of ulcer healing (QOUH) is defined as ideal ulcer healing featuring with the fine granular ulcer scar, high functional restoration and the resistance to recurrence. This study was designed to compare the rates of QOUH achievement in rat gastric ulcer model between acid suppressant treated group and gastroprotectant treated group accompanied with elucidations of molecular mechanisms. Serosal injection of acetic acids for generating gastric ulcer and intraperitoneal (ip) injection of recombinant interleukin 1-beta (IL-1?) for recurring healed ulcer was done in SD rats. The 72 rats were divided into three groups according to treatment as follows; Group I, no further treatment, Group II, 8 weeks treatment of omeprazole, and Group III, 8 weeks of gastroprotectant treatment. IL-1? was administered for ulcer recurrence after 28 weeks of acetic acid injection. At four weeks after gastric ulcerogenesis, 58.3% (7/12) of active gastric ulcer were converted to healing stage in Group III, but 16.7% (2/12) in Group II and none in Group I, for which significant levels of epidermal growth factor, mucin, and pS2/trefoil peptide1 were contributive to these accelerated healings of Group III. ip injections of rIL-1? (200 µg/kg) at 28 weeks after acetic acid injection led to 100% of ulcer recurrence in Group I and 75.0% in Group II, but only 16.7% of Group III rats showed ulcer recurrence. Significantly attenuated levels of inflammatory cytokines including IL-2, transforming growth factor-alpha (TNF-?), cyclooxygenase-2 (COX-2), nitrotyrosine were responsible for the resistance to ulcer recurrence in Group III. Conclusively, gastroprotectant might be prerequisite in order to achieve ideal QOUH through significant inductions of remodeling. PMID:18545642
Young Oh, Tae; Ok Ahn, Byung; Jung Jang, Eun; Sang Park, Joo; Jong Park, Sang; Wook Baik, Hyun; Hahm, Ki-Baik
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).
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
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.
... new ulcers (see “How do you prevent pressure ulcers? ”). In addition, the doctor or nurse may suggest ... recommendations: Relieve pressure on the area near the ulcer • Do not allow the person to lie or ...
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....
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)
A dynamic control scheme for a three degree-of-freedom robot leg, which has been interfaced to a PDP-11\\/70 minicomputer, is developed and implemented. A CSMP (Continuous System Modeling Program) simulation is also used to study the dynamic characteristics of the leg off-line. The results of the work show that the dynamic equations of motion are valuable in robotic systems to develop
David E. Orin; Chi-Keng Tsai; Fan-Tien Cheng
Bipedal walking could be implemented into a robot by mimicking spring-like leg behaviour. The fundamental model, describing human-like leg function in walking is the bipedal spring-mass model which was investigated in this study. We identified several types of walking patterns, e.g. symmetric and asymmetric walking, that accounts for high variability of gait. The aim of this study is the identification
Juergen Rummel; Yvonne Blum; Horst Moritz Maus; Christian Rode; André Seyfarth
Colonoscopic evaluation is an important tool in the evaluation of ulcerative colitis (UC). UC is divided by disease extent into proctitis, proctosigmoiditis, left-sided colitis, and pan-colitis. In addition, a cecal or peri-appendiceal patch and backwash ileitis are associated with UC. The extent and behavior of UC has been characterized further using various indices and scoring systems; among these systems is the Mayo Score, which is widely used in current clinical trials for new medications. As these medical therapies for UC have developed, achieving mucosal healing with medications has become an important therapeutic objective. PMID:24879406
Paine, Elizabeth R.
Pressure ulcers remain a significant secondary complication for many individuals with spinal cord injury (SCI). Technological advances have the potential to affect both the prevention and treatment of pressure ulcers. The focus of this article is hi-tech devices and methodologies. The current state-of-the-art methods are discussed and conceptual approaches are presented. PMID:17543771
Ho, Chester H; Bogie, Kath
Treatment of patients with ulcerative colitis (UC) has tra- ditionally focused on improving symptoms, with the mainobjective of inducing and maintaining symptomatic remission. However, new evi- dence suggests that concentrating exclusively on clinical outcome measuresmay notbeadequatetoachievelong-termtreatmentsuccess. Indeed, physicians should also be assessing the reduction of endo- scopicactivity,withtheintentionofachievingcompletemucosal heal- ing (defined as the absence of all mucosal ulceration, both microscopic and
Gary R. Lichtenstein; Paul Rutgeerts
Pressure ulcers are widely considered to be a critical problem in rehabilitation since they result in severe discomfort and high healthcare cost. The prevention of pressure ulcers is a constant preoccupation for every nursing team. This paper introduces a novel handheld instrument that can detect subtle changes in the skin biomechanical properties by measuring its biomechanical response. This could be
Qi Wang; Linghua Kong; Stephen Sprigle; Vincent Hayward
Acute corneal ulceration in malnourished children is the commonest cause of childhood blindness in Northern Nigeria and usually develops after measles. Other severe diseases in malnourished children rarely precipitate corneal ulceration. A survey in a school for blind children showed that 69% of the children were blind from corneal disease, and a survey of children with corneal scars showed that
J H Sandford-Smith; H C Whittle
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
The demography of peptic ulcer changed greatly and uniformly in western countries until the middle of this century. The demographic pattern reversed at about the turn of the century, duodenal ulcer becoming the predominant lesion, males the most often affected, and age-distribution shifting towards senior citizens. These changes have not continued beyond the 1950s, in fact a decline in the
Healing is slow in neuropathic diabetic foot ulcers, using conventional medical treatment. This delayed wound healing is caused mainly by the pressure damages of weight bearing, and sometimes by a tight dressing, on the painless ulcer. In our study, we used the dehydrating action of ethyl alcohol to reduce the oedema in the tissue compartments of the foot. This, in
Aziz Fatima; Faisal Masud
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
To assess the magnitude of the Buruli ulcer (BU) problem in Cameroon, we conducted a cross-sectional survey in the Nyong River basin and identified on clinical grounds a total of 436 cases of active or inactive BU (202 and 234, respectively). Swab specimens were taken from 162 active cases with ulcerative lesions and in 135 of these (83.3%) the clinical
JURGEN NOESKE; CHRISTOPHER KUABAN; SIMONA RONDINI; PHILIPPE SORLIN; LAURA CIAFFI; JOSEPHINE MBUAGBAW; FRANCOISE PORTAELS; GERD PLUSCHKE
Rectal biopsies of active untreated ulcerative colitis and treated cases with positive or negative sigmoidoscopic findings were analyzed to evaluate responses to medical therapy. Effects of the administration of salicylazosulfapyridine, prednisone, and 6-mercaptopurine, singly and in combinations, were investigated by mucosal cell counts, comparing ulcerative colitis and noncolitis control groups statistically. Active disease was associated with decreased epithelial goblet cells
B. I. Korelitz; S. C. Sommers
Stress-induced ulcers of the stomach and duodenum in massively burned patients, otherwise known as Curling's ulcers, result from a defect in the mucosal barrier to secreted acid. The etiology of this defect is related, at least in part, to mucosal ischemia, which is aggravated by hypotension, sepsis, and hypoxia. Early prophylactic administration of antacids and cimetidine, either singly or in
Basil A. Pruitt; Cleon W. Goodwin
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
In this study, we examined rabbit gastric ulcer models that can serve as more clinically relevant models. Two types of ulcer model were studied: acetic acid-induced ulcers (AAU) and mucosal resection-induced ulcers (MRU). For AAU, rabbit gastric mucosa was exposed by median laparotomy and treated with bottled acetic acid. MRU was examined as a model for endoscopic mucosal resection (EMR). Normal saline was injected into the submucosal layer and the swollen mucosa was resected with scissors. Endoscopic mucosal resection (EMR) is frequently performed for treatment of early gastric cancers. This procedure inevitably leads to ulcers and bleeding. Bleeding control is the major concern in endoscopic mucosectomy, and some endoscopic hemostatic agents are currently under clinical and preclinical studies. MRU was developed as a model for these induced ulcers and the evaluation of the healing process. The clinical relevancy of those models was compared with that of rat models. Progressive healing was observed for 7 days based on histology. Rabbit models demonstrate round, deep ulcers with clear margins and well-defined healing stages that were difficult to define in rat models. PMID:23825482
Maeng, Jin Hee; Lee, Eunhye
Summary The purpose of this investigation was to study the effect of one-legged exercise on the strength, power and endurance of the contralateral leg. The performance of the knee extensor and flexor muscle of 20 healthy young adults (10 men and 10 women) was first tested by Cybex II+ and 340 dynamometers. Then 10 subjects were chosen at random to train
P. Kannus; D. Alosa; L. Cook; R. J. Johnson; P. Renström; M. Pope; B. Beynnon; K. Yasuda; C. Nichols; M. Kaplan
LETTER Larval Legs of Mulberry Silkworm Bombyx mori Are Prototypes for the Adult Legs Amit Singh,1; silkworm; limb development; lepidoptera; imaginal disc; drosophila INTRODUCTION During evolution there has during pupal metamorphosis to give rise to adult derivatives (Cohen, 1993). The mulberry silkworm Bombyx
AIM: To evaluate the omeprazole maintenance therapy in patients with recurrent ulcer bleeding after surgery for duodenal ulcer. METHODS: We studied 15 consecutive patients with recurrent ulcer bleeding after surgery for duodenal ulcer. Omeprazole (20 mg/d) maintenance therapy was given after ulcer healing. In addition to clinical follow-up, ambulatory 24-h gastric pH assay was performed before and during omeprazole therapy in those patients and controls with previous duodenal ulcer surgery but no ulcer recurrence. RESULTS: All the 15 ulcers were healed after being treated with omeprazole (40 mg/d) for 2 mo. Eleven patients with two (1-9) episodes of recurrent ulcer bleeding completed the follow-up (43, 12-72 mo). None of them had a bleeding episode while on omeprazole. One patient discontinued the therapy and had recurrent bleeding. The median 24-h fraction time of gastric pH <4 in patients was 80, 46-95%, and was reduced to 32, 13-70% by omeprazole (P?=?0.002). CONCLUSION: Long-term maintenance therapy with omeprazole (20 mg/day) is effective in preventing recurrent ulcer bleeding. PMID:16521197
Demertzis, Konstantinos; Polymeros, Dimitrios; Emmanuel, Theodoros; Triantafyllou, Konstantinos; Tassios, Pericles; Ladas, Spiros D
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.
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
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.
Summary \\u000a \\u000a \\u000a \\u000a 1. \\u000a \\u000a The intestinal tract in ulcerative colitis patients is more sensitive to carbon dioxide gas than that in normal individuals.\\u000a \\u000a \\u000a \\u000a \\u000a 2. \\u000a \\u000a Carbon dioxide producing carbohydrate foods are markedly restricted in the acute stage.\\u000a \\u000a \\u000a \\u000a \\u000a 3. \\u000a \\u000a Carbon dioxide producing foods are added to the diet in the order described, always within the tolerance of the patient, as\\u000a clinical experience has dictated.
M. B. Levin; B. A. Gwynn
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
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
A 5-month-old boy was observed in our department presenting with an ulcerated infantile hemangioma on the right buttock. This lesion appeared during the first week of life and had been growing progressively, showing ulceration for 3 weeks. We started treatment with corticosteroids, first with the association of betametasone and fusidic acid topically, and then systemically. After 6 weeks of oral treatment as there was no significant improvement, corticosteroid therapy was slowly tapered and local application of imiquimod 5 percent cream, on alternate days, was started. After 12 weeks of therapy with imiquimod there was complete resolution of the ulceration. There were no side effects. PMID:21971278
Mascarenhas, Rosa; Guiote, V; Agro, J; Henrique, M
Background and aims Long-term course of peptic ulcer bleeding is unclear. Because of a more aged and more diseased ulcer population, the long-term\\u000a prognosis may be expected as poor.\\u000a \\u000a \\u000a \\u000a Materials and methods In a prospective study, all patients with peptic ulcer bleeding treated at the Department of Surgery of the Heinrich-Heine-University\\u000a in Düsseldorf were included between 1986 and 1995. Follow-up covered hospital
M. Imhof; S. Epstein; C. Ohmann; H.-D. Röher
Background The long-term course after peptic ulcer perforation is unclear, but because the ulcer population is generally older and has\\u000a concomitant disease, the long-term prognosis may be expected to be poor.\\u000a \\u000a \\u000a \\u000a Methods In a study based on prospective data collection, all patients with peptic ulcer perforation treated at the Department of Surgery\\u000a at the Heinrich-Heine-University in Dusseldorf, Germany, were documented between 1986
Michael Imhof; Stefan Epstein; Christian Ohmann; Hans-Dietrich Röher
The diagnosis and treatment of acute bleeding caused by peptic ulcer disease has been greatly facilitated by fiberoptic endoscopy. The basic differentiation between malignant and benign gastric ulcer requires endoscopic confirmation with biopsy. The management of bleeding from peptic ulceration can be enhanced by endoscopic examination as can the prediction of risk for recurrent bleeding or need for surgical intervention. Various therapeutic maneuvers can be performed endoscopically, including monopolar and multipolar cautery, laser and heater probe therapy, and injection of vasoconstrictors to control bleeding. Endoscopic balloon dilation for the management of gastric outlet obstruction is often effective. PMID:2072790
Mamel, J J
The management of diabetic foot ulcers can be optimized by using an interdisciplinary team approach addressing the correctable risk factors (ie, poor vascular supply, infection control and treatment, and plantar pressure redistribution) along with optimizing local wound care. Dermatologists can initiate diabetic foot care. The first step is recognizing that a loss of skin integrity (ie, a callus, blister, or ulcer) considerably increases the risk of preventable amputations. A holistic approach to wound assessment is required. Early detection and effective management of these ulcers can reduce complications, including preventable amputations and possible mortality. PMID:24355276
Alavi, Afsaneh; Sibbald, R Gary; Mayer, Dieter; Goodman, Laurie; Botros, Mariam; Armstrong, David G; Woo, Kevin; Boeni, Thomas; Ayello, Elizabeth A; Kirsner, Robert S
Within chronic wounds, the relationship between the clinical diagnosis of infection and bacterial/immuno-inflammatory responses is imprecise. This study prospectively examined the interrelationship between clinical, microbiological, and proinflammatory biomarker levels between chronic venous leg ulcers (CVLUs) and diabetic foot ulcers (DFUs). Wound swabs and fluids were collected from CVLUs (n?=?18) and DFUs (n?=?15) and diagnosed clinically as noninfected or infected; and qualitative/quantitative microbiology was performed. CVLU and DFU fluids were also analyzed for cytokine, growth factor, receptor, proteinase/proteinase inhibitor; and oxidative stress biomarker (protein carbonyl, malondialdehyde, and antioxidant capacity) levels. While no correlations existed between clinical diagnosis, microbiology, or biomarker profiles, increasing bacterial bioburden (?10(7) colony-forming unit/mL) was associated with significant alterations in cytokine, growth factor, and receptor levels. These responses contrasted between ulcer type, with elevated and decreased cytokine, growth factor, and receptor levels in CVLUs and DFUs with increasing bioburden, respectively. Despite proteinase biomarkers exhibiting few differences between CVLUs and DFUs, significant elevations in antioxidant capacities correlated with increased bioburden in CVLU fluids, but not in DFUs. Furthermore, oxidative stress biomarker levels were significantly elevated in all DFU fluids compared with CVLUs. This study provides further insight into the contrasting disease-specific host responses to bacterial challenge within infected CVLUs and DFUs. PMID:24354589
McInnes, Rachael L; Cullen, Breda M; Hill, Katja E; Price, Patricia E; Harding, Keith G; Thomas, David W; Stephens, Phil; Moseley, Ryan
Kaposi's sarcoma is a vascular tumor caused by human herpesvirus-8 infection. Iatrogenic Kaposi's sarcoma often occurs in patients receiving immunosuppressive therapy. To date, a few cases of colonic Kaposi's sarcoma have been reported in ulcerative colitis patients treated with immunomodulators. We describe a 65-year-old male diagnosed with left-sided ulcerative colitis who was treated with methotrexate and low-dose steroids for greater than 6 years. He presented with several papular, violet lesions on both legs. Colonoscopy revealed the presence of multiple reddish, elevated lesions in the sigmoid colon and rectum. Histological evaluation of skin and colonic biopsies showed findings suggestive of Kaposi's sarcoma; immunohistochemistry for human herpesvirus-8 was positive in the colonic lesions. To avoid the need for further immunosuppressive treatment, the patient underwent a colectomy. Following immunomodulator discontinuation, the patient experienced spontaneous regression of his skin lesions. With the present case, we wish to stress the important interaction of immunosuppressive therapy (mainly corticosteroids) used in ulcerative colitis patients in relation to the development of colonic Kaposi's sarcoma. Human herpesvirus-8 infection should be recognized as a possible opportunistic infection in patients with inflammatory bowel disease. PMID:21122564
Rodríguez-Peláez, María; Fernández-García, María Soledad; Gutiérrez-Corral, Natalia; de Francisco, Ruth; Riestra, Sabino; García-Pravia, Carmen; Rodríguez, José Ignacio; Rodrigo, Luis
Background. Spasticity of the legs is common in multiple sclerosis (MS), but there has been limited research examining its association with ambulatory outcomes. Objective. This study examined spasticity of the legs and its association with multiple measures of ambulation in persons with MS. Methods. The sample included 84 patients with MS. Spasticity of the legs was measured using a 5-point rating scale ranging between 0 (normal) and 4 (contracted). Patients completed the 6-minute walk (6?MW), timed 25 foot walk (T25FW), and timed up-and-go (TUG), and O2 cost of walking was measured during the 6?MW. The patients undertook two walking trials on a GAITRite (CIR systems, Inc.) for measuring spatial and temporal parameters of gait. The patients completed the Multiple Sclerosis Walking Scale-12 (MSWS-12) and wore an accelerometer over a seven-day period. Results. 52% (n = 44) of the sample presented with spasticity of the legs. Those with leg spasticity had significantly worse ambulation as measured by 6?MW (P = 0.0001, d = ?0.86), T25FW (P = 0.003, d = 0.72), TUG (P = 0.001, d = 0.84), MSWS-12 (P = 0.0001, d = 1.09), O2 cost of walking (P = 0.001, d = 0.75), average steps/day (P < 0.05, d = ?0.45), and walking velocity (P < 0.05, d = ?0.53) and cadence (P < 0.05, d = ?0.46). Conclusion. Leg spasticity was associated with impairments in ambulation, including alterations in spatiotemporal parameters and free-living walking. PMID:24999434
Balantrapu, Swathi; Sosnoff, Jacob J.; Pula, John H.; Sandroff, Brian M.; Motl, Robert W.
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)
PATIENTS 'AT risk' of developing pressure ulcers should be repositioned at least every six hours and those 'at high risk' should have their position changed at least every four hours, according to new guidance. PMID:24874616
During a controlled clinical trial of various diets in ulcerative colitis the levels of circulating eosinophils in the peripheral blood and infiltration of rectal biopsy specimens with eosinophils were studied.
Ralph Wright; Sidney C. Truelove
... ERIES About Crohn’s Disease About Ulcerative Colitis Medications Maintenance Therapy Diet and Nutrition Emotional Factors Complications Understanding Colorectal Cancer Surgery Women's Issues A Parent’s Guide A Teacher’s Guide ...
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 Falcao, 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, Petronio Filgueiras; Batista, Leonia Maria
Pressure ulcers are complex chronic wounds for which no gold standard for prevention or treatment has yet been established. Several attempts at developing guidelines has been undertaken by different organizations. Pressure ulcers are devastating comorbidities for patients and difficult to prevent or manage. Whether or not pressure ulcers are preventable remains controversial. The strategy for prevention includes recognizing the risk, decreasing the effects of pressure, assessing nutritional status, avoiding excessive bed rest and prolonged sitting, and preserving the integrity of the skin. The principles of treatment of pressure ulcers include assessing severity, reducing pressure, friction and shear forces, optimizing local wound care, removing necrotic debris, managing bacterial contamination, and correcting nutritional deficits. PMID:16413435
Thomas, David R
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
Differences in muscle dynamics between the preferred and nonpreferred jumping legs of subjects in maximal, explosive exercise were examined. Eight subjects performed nonfatiguing bouts of single-legged drop jumps and rebound jumps on a force sledge apparatus. Measures of flight time, reactive strength index, peak vertical force, and vertical leg-spring stiffness were obtained for 3 drop jumps and 3 rebound jumps on both legs. Subjects utilized a stiffer leg spring and a more explosive jumping action in the nonpreferred leg when performing a cyclical rebound jumping task in comparison to a single drop jump task (observed through differences in vertical leg-spring stiffness, peak vertical force, and reactive strength index, p < 0.05). The preferred leg performed equally well in both tasks. Between-leg analysis showed no differences in dependent variables between the preferred and the nonpreferred leg in the rebound jumping protocol. However, the drop jump protocol showed significant performance differences, with flight time and reactive strength index greater in the preferred leg than the nonpreferred leg (p < 0.05). We hypothesize that, throughout the lifespan, both legs are equally trained in cyclical rebound jumping tasks through running. However, because a preferred leg must be selected when performing any one-off, single-legged jump, imbalances in this specific task develop over time with consistent selection of a preferred jumping leg. The data demonstrate that the rebound jump protocol is representative of the symmetrical mechanics of forward running and that leg-spring stiffness is modulated depending on the demands of the specific task involved. Strength and conditioning practitioners should give careful consideration to appropriate jump protocol selection and should exercise caution when comparing laboratory results to data gathered in field testing. PMID:17313262
Flanagan, Eamonn P; Harrison, Andrew J
Forty homosexual men with painful anal ulceration were studied. Two patients had primary syphilis; sixteen men had primary anal herpes and twenty-two men had traumatic ulceration of the anal canal. The clinical features of the men with primary herpes were compared with those of the group with traumatic anal fissures. Fever, paraesthesiae in the buttocks and lower limbs, and difficulty in initiating micturition were found significantly more frequently in the former group of patients. PMID:6697127
McMillan, A; Smith, I W
A young woman with persistent postprandial vomiting was found to have a high-grade proximal jejunal stricture. The stricture was surgically excised, and histopathological examination showed gastric heterotopia with localised ulceration and fibrosis. Symptomatic gastric heterotopia in the small bowel is rare, and to our knowledge this is the first report of jejunal gastric heterotopia resulting in ulceration with subsequent stricturing and obstruction. PMID:24209701
Chinnery, Galya E; Bernon, Marc M; Banderker, M Asief; Roberts, Riyaad; Krige, Jake E J
Fifty-nine per cent of a series of patients with ulcerative colitis were found to have lactose intolerance by a lactose-tolerance test. It appears likely that the inflamed, irritated bowel of patients with ulcerative colitis cannot handle the osmotic-acid load and that lactose intolerance imposes an extra burden upon the inflamed bowel. Therefore, a lactose-free diet is advisable in patients with
Henry J. Binder; Joyce D. Gryboski; Walter R. Thayer; Howard M. Spiro
. This report describes four patients with NSAID-induced esophageal ulcers documented by endoscopy. The cause of injury was\\u000a ibuprofen alone in two patients, aspirin in one patient, and a combination of aspirin and ibuprofen in one patient. The most\\u000a common findings were anemia, retrosternal pain, and dysphagia. Three patients had bleeding esophageal ulcers requiring blood\\u000a transfusions. One patient had massive
C. Sugawa; Y. Takekuma; C. E. Lucas; H. Amamoto
The epithelial cells of the stomach and duodenum are normally protected from the damaging effects of acid and pepsin by a balancing mechanism of mucosal resistance. If an imbalance occurs, peptic ulcer may result. Traditional teaching has emphasized the importance of acid (and pepsin) as the cause of this imbalance; however, it is clear that acid and pepsin are not the only important factors in the pathogenesis of peptic ulcer. More recent investigative efforts have been directed at what constitutes mucosal resistance and how it can be disrupted to produce, in the presence of gastric acid, a peptic ulcer. Depletion of endogenous prostaglandins and Helicobacter pylori gastritis have emerged as prominent theories. As evidence exists both to support and refute these theories in humans, any definitive conclusions cannot be made at this time. The acute management of peptic ulcer disease is directed at relieving pain, accelerating ulcer healing, and preventing complications. Peptic ulcers can be healed with antisecretory agents (i.e., H2-receptor antagonists, omeprazole), antacids, prostaglandins, and sucralfate. Because they are effective, safe, and convenient, the H2-receptor antagonists are the most widely used agents for the management of peptic ulcer disease. Because the H2-receptor antagonist agents are equally effective in their indicated uses and are equally safe based on scientifically valid data, selection should be based primarily on cost. Omeprazole is the newest antisecretory agent: a single morning dose of 20 mg suppresses acid secretion for 24 h. The agent offers little advantage over H2-receptor antagonists for the majority of patients with peptic ulcer.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1978840
Peterson, W L
Marjolin's ulcers are rare cutaneous malignancies that most commonly present as squamous cell carcinomas in previously injured, chronically inflamed, or scarred skin. Acute and chronic types have been distinguished by the length of latency; by definition, the acute type occurs within 12 months of injury whereas the chronic type appears over 12 months after injury. In this report, 3 cases of acute Marjolin's ulcers are described and questions are raised about the diagnosis of acute Marjolin's ulcer. Other than a discrepancy in lag time, it is unclear if there is any difference in clinical or histological characteristics or even prognosis between acute and chronic Marjolin's ulcers. In fact, the acute type may simply be a preemptive diagnosis that conveniently describes a carcinoma associated with a nonhealing wound and discovered within a short time span. Moreover, the rarity of the diagnosis and the relatively rapid rate of malignant degeneration from the inciting injury lead one to question whether the injury may have simply revealed or accelerated a previously existing occult cutaneous malignancy. With no definitive clinical, histological, or prognostic distinction between acute and chronic Marjolin's ulcers, the use of such terminology may not benefit a clinician's understanding or practice. In fact, it merely supports the clinical guideline that any nonhealing wound, acute or chronic, should be biopsied and sent for pathologic examination to ensure that it does not represent a Marjolin's ulcer. PMID:24691319
Chang, Jessica B; Kung, Theodore A; Cederna, Paul S
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
Context: Chronic lower leg pain in athletes can be a frustrating problem for patients and a difficult diagnosis for clinicians. Myriad approaches have been suggested to evaluate these conditions. With the continued evolution of diagnostic studies, evidence-based guidance for a standard approach is unfortunately sparse. Evidence Acquisition: PubMed was searched from January 1980 to May 2011 to identify publications regarding chronic lower leg pain in athletes (excluding conditions related to the foot), including differential diagnosis, clinical presentation, physical examination, history, diagnostic workup, and treatment. Results: Leg pain in athletes can be caused by many conditions, with the most frequent being medial tibial stress syndrome; chronic exertional compartment syndrome, stress fracture, nerve entrapment, and popliteal artery entrapment syndrome are also considerations. Conservative management is the mainstay of care for the majority of causes of chronic lower leg pain; however, surgical intervention may be necessary. Conclusion: Chronic lower extremity pain in athletes includes a wide differential and can pose diagnostic dilemmas for clinicians. PMID:23016078
Brewer, Rachel Biber; Gregory, Andrew J. M.
OCEAN DRILLING PROGRAM LEG 178 PRELIMINARY REPORT ANTARCTIC GLACIAL HISTORY AND SEA-LEVEL CHANGE Dr Antarctic Survey Osservatorio Geofisico Sperimentale High Cross, Madingley Road P.O. Box 2011 Cambridge CB3 States) Natural Environment Research Council (United Kingdom) European Science Foundation Consortium
Consider a legged robot at fixed foot placements. Where can the robot move its center of mass (CM) while remaining in static equilibrium? If the terrain is flat, the CM must lie above the convex hull of the robot's feet. If the terrain is not flat, this often-used approximation can be arbitrarily bad. Instead, the CM must lie above the
Timothy Bretl; Sanjay Lall
-1197 Surat (Shiri) Srivastava Co-Chief Scientist, Leg 105 Atlantic Geoscience Centre Bedford Institute (Shiri), Co-Chief Scientist (Bedford Institute of Oceanography, Dartmouth, Nova Scotia, Canada) Aksu, Ali-Palaontologisches Institut, Kiel, FRG) Busch, William (University of New Orleans, New Orleans, LA) Cederberg, Tommy
OCEAN DRILLING PROGRAM LEG 195 SCIENTIFIC PROSPECTUS MARIANA CONVERGENT MARGIN/ WEST PHILIPPINE SEA Publications homepage on the World Wide Web at: http://www-odp.tamu.edu/publications This publication mud volcano on the forearc of the Mariana subduction system. The second segment is devoted to coring
SummaryBack pain and back-related leg pain respond surprisingly often to simple acupuncture even if there has been no benefit from standard, conventional treatment. Three case histories are discussed, with the acupuncture points used in each case. Often painful conditions are associated with psychological “stress” states. It may be that some of the benefit derived from acupuncture treatment is through altering
Abstract—This paper discusses current wheeled mobility work on a hybrid wheeled-leg robot called PAW. In addition to providing design details, controllers are proposed for inclined turning and sprawled braking which take advantage of the hybrid nature of the platform and improve stability. Power consumption values for a number of its basic behaviours are given, as is the range of the
James Andrew Smith; Inna Sharf; Michael Trentini
OCEAN DRILLING PROGRAM LEG 133 SCIENTIFIC PROSPECTUS NORTHEAST AUSTRALIAN MARGIN Dr. Peter J Australia: the platforms of the Great Barrier Reef and the Queensland and Marionplateaus, and the basins of carbonate platforms, particularly the Great Barrier Reef. This information will have a substantial impact
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
This review summarizes diagnostic problems, challenges and advances in ulcerative colitis (UC). It emphasizes that, although histopathological examination plays a major role in the diagnosis and management of UC, it should always be interpreted in the context of clinical, endoscopic, and radiological findings. Accurate diagnosis requires knowledge of the classic morphological features of UC, as well as a number of atypical pathological presentations that may cause mis-classification of the disease process, either in resection or biopsy specimens. These atypical pathological presentations include rectal sparing and patchiness of disease at initial presentation of UC in pediatric patients or in the setting of medically treated UC, cecal or ascending colon inflammation in left-sided UC, and backwash ileitis in patients with severe ulcerative pancolitis. Loosely formed microgranulomas, with pale foamy histiocytes adjacent to a damaged crypt or eroded surface, should not be interpreted as evidence of Crohn’s disease. Indeterminate colitis should only be used in colectomy specimens as a provisional pathological diagnosis. Patients with UC are at risk for the development of dysplasia and carcinoma; optimal outcomes in UC surveillance programs require familiarity with the diagnostic criteria and challenges relating to UC-associated dysplasia and malignancy. Colon biopsy from UC patients should always be evaluated for dysplasia based on cytological and architectural abnormalities. Accurate interpretation and classification of dysplasia in colon biopsy from UC patients as sporadic adenoma or UC-related dysplasia [flat, adenoma-like, or dysplasia-associated lesion or mass (DALM)] requires clinical and endoscopic correlation. Isolated polypoid dysplastic lesions are considered to be sporadic adenoma if occurring outside areas of histologically proven colitis, or adenoma-like dysplasia if occurring in the diseased segment. Recent data suggest that such lesions may be treated adequately by polypectomy in the absence of flat dysplasia in the patient. UC patients with DALM or flat high-grade dysplasia should be treated by colectomy because of the high probability of adenocarcinoma. The natural history of low-grade dysplasia (LGD) is more controversial: while multifocal LGD, particularly if detected at the time of initial endoscopic examination, is treated with colectomy, unifocal flat LGD detected during surveillance may be managed by close follow-up with increased surveillance. The surveillance interval and treatment options for UC patients with dysplasia are reviewed in detail. PMID:24942757
DeRoche, Tom C.; Xiao, Shu-Yuan; Liu, Xiuli
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.
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
... legs syndrome Diagnosis Talk to a board certified sleep medicine physician if you think you have restless legs ... He or she can refer you to a sleep medicine physician if necessary. The sleep physician may ask ...
Leg volume changes were studied in six subjects during 150 min of horizontal, 6 deg headdown tilt and supine immersion. Results were compared to previously obtained space flight data. It is found that, at equivalent study times, the magnitude of the leg volume changes during the simulations was less than one half that seen during space flight. Relative and absolute losses from the upper leg were greater during space flight, while relative losses were greater from the lower leg during simulations.
Thornton, William E.; Uri, John J.; Hedge, Vickie; Coleman, Eugen; Moore, Thomas P.
Ferris, Daniel P., and Claire T. Farley. Interaction of leg stiffness and surface stiffness during human hopping. J. Appl. Physiol. 82(1): 15±22, 1997.DWhen mammals run, the overall musculoskeletal system behaves as a single linear ``leg spring.''We used force platform and kinematic measurements to determine whether leg spring stiffness (kleg) is adjusted to accommodate changes in surface stiffness (ksurf) when hu-mans
DANIEL P. FERRIS; CLAIRE T. FARLEY
Pyoderma gangrenosum is a rare dermatosis of unknown etiology and variable clinical presentation. The disease is challenging for the medical staff, from the frequent diagnostic difficulties to the lack of scientific evidence with a good level to support the management of extensive and refractory cases. Our patient is a 50 year-old man with an extensive and deep ulcer on the left leg, which exemplifies the therapeutic difficulties inherent to the disease and who, fortunately, has progressed with excellent result after association of hyperbaric oxygen therapy and skin grafting to the immunosuppression therapy initially proposed. PMID:24346912
Araujo, Fernanda Mendes; Kondo, Rogerio Nabor; Minelli, Lorivaldo
We compared periodic and non-periodic leg movements during sleep and polysomnography in patients with narcolepsy with cataplexy (NC) with or without restless legs syndrome (RLS) with matched idiopathic RLS (iRLS) and control subjects. We enrolled 100 patients with NC: 17 having RLS were compared with 34 sex- and age-matched patients without RLS and with 17 normal controls and 17 iRLS subjects. Periodic leg movements were highest in iRLS and lowest in controls, with those in NC with RLS very close to iRLS, but higher than those in NC without RLS. The periodicity indexes showed the highest value in iRLS followed by NC with or without RLS and, finally, by controls. The inter-leg movement intervals peaked between 10 and 50?s in NC with RLS and in iRLS, the former did not display the nocturnal gradual decrease of periodic leg movements typical of iRLS. Periodic leg movements during sleep and polysomnography displayed specific features in RLS and NC, respectively, with NC with RLS showing an intermediate pattern. Even if RLS is only detected by targeted interview in NC, its frequency and impact on night-time sleep architecture and continuity suggest that this condition should be routinely searched for in NC. PMID:21827556
Plazzi, Giuseppe; Ferri, Raffaele; Franceschini, Christian; Vandi, Stefano; Detto, Stefania; Pizza, Fabio; Poli, Francesca; De Cock, Valérie C; Bayard, Sophie; Dauvilliers, Yves
In this paper, we focus on a problem of how to confirm a feasible condition of applied force to a multi-legged robot on rough terrain. The problem often appeals as a subject of walking stability criterion for a legged robot. ZMP (zero moment point) is one of the well-known criteria. It shows the condition as footprints of a legged robot,
Takao Saida; Yasuyoshi Yokokohji; Tsuneo Yoshikawa
OCEAN DRILLING PROGRAM LEG 142 ENGINEERING AND SCIENTIFIC PROSPECTUS EAST PACIFIC RISE Mr. Michael Institutions, Inc., under contract with the National Science Foundation. Funding for the program is provided AT THE EAST PACIFIC RISE Leg 142 (Engineering Leg III) is the third of a series of cruises designed to support
It has been known for some time that, if curved legs rather than the usual straight ones are used in the spider that supports the secondary optics in certain telescopes, the visible diffraction effect is reduced. Fraunhofer theory is used to calculate the diffraction effects due to the curved leg spider. Calculated and photographic diffraction patterns are compared for straight and curved leg spiders.
The muscles proximal to the autotomy plane in the walking legs of two crab species,Eriphia spinifrons andCarcinus maenas, are innervated by the common inhibitory neuron (CI). Thus, CI is truly common to all 11 leg muscles. It is suggested that CI has the essential function in all leg muscles of preventing the tonic muscle fibers from participating in rapid contraction
W. Rathmayer; M. Bevengut
challenging task for a legged robot to negotiate unknown terrain. Control systems for legged robots nominal periodic trajectories for legged robots that maximize a measure of robustness against uncertainty compass gait walker, resulting in a dramatic increase in the number of steps taken over moderate terrain
OBJECTIVES: To evaluate the validity of a leg-to-leg bioimpedance analysis (BIA) system in predicting body composition as measured by dual-energy X-ray absorptiometry (DXA) in postmenopausal women.SUBJECTS AND METHODS: Body fat mass (FM), %Fat and fat free mass (FFM) were measured in 124 postmenopausal women (age: 51–63 y, body mass index (BMI): 17–38 kg\\/m2) first by the leg-to-leg BIA system, and
X Xie; N Kolthoff; O Bärenholt; SP Nielsen
Treatment of chronic leg ulcers remains a major health care issue. Although many reports have examined different topical dressings, none have specifically looked at microcrystalline cellulose (MCC). We aimed to evaluate in a prospective, open study the safety and performance of a MCC membrane (Veloderm) in a series of chronic leg wounds of different aetiology. Fifty-five patients participated in this study. The membrane was applied every 5-10 days for 1 month, immediately after surgical debridement. The wound bed was assessed on days 7, 15 and 30 for erythema, pain, exudate level and infection. The wound size change at 30 days was the primary efficacy parameter and any adverse events were collected and analysed. A wound size change of 55% was achieved at the end of follow-up, with an improvement in all the collected parameters, but the erythema, which showed a mild increase. To date, this is the largest experience with a MCC product in chronic wounds. Our study suggests that this treatment may be safe and useful and deserves further investigation. PMID:20659185
Ricci, Elia B; Cassino, Roberto; Di Campli, Cristiana
Pressure ulcers represent a major health problem causing a considerable amount of suffering for patients and a high financial burden for healthcare systems. The geriatric population with an increased risk of pressure ulcer development is rising constantly as a result of chronic degenerative diseases that can lead to prolonged immobilization and poor nutrition. Evidence clearly indicates that preventive measures are essential to reduce the prevalence rates of pressure ulcers; therefore healthcare professionals must be able to identify the appropriate strategies to adopt, in order to meet the individual patient's requirements. Important advances have taken place in the world of pressure ulcer treatment during the past decade. These advances are reflected in the high rate of cures being obtained. This, together with the implementation of prevention guidelines, the excellent cost/effectiveness relationship of the techniques described, and other factors, means that the field of pressure ulcers management is no more an isolated and self-administered issue in medical practice. The areas discussed here are those in which there will be linear or, in some cases, exponential growth in the decades to come. PMID:17199678
Dini, Valentina; Bertone, MariaStefania; Romanelli, Marco
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: (1) measurement of the wound by planimetry; (2) optimal glucose control; (3) surgical debridement of all hyperkeratotic, infected, and nonviable tissue; (4) systemic antibiotics for deep infection, drainage, and cellulitis; (5) offloading; (6) moist-wound environment; and (7) treatment with growth factors and/or cellular therapy if the wound is not healing after 2 weeks with this protocol and a new epithelial layer is not forming. In addition, the pathogenesis of diabetic foot ulcers is discussed, as well as the associated costs and complications, including amputation. Debridement, wound-bed preparation, antibiotics, various types of dressings, biological therapies, growth factors, and offloading are described as treatment modalities for patients with diabetic foot ulcers. In diabetic foot ulcers, availability of the above modalities, in combination with early recognition and comprehensive treatment, ensure rapid healing and minimize morbidity, mortality, and costs, as well as eliminate amputation in the absence of ischemia and osteomyelitis. PMID:15147985
Brem, Harold; Sheehan, Peter; Boulton, Andrew J M
Pressure ulcers in elderly individuals can cause significant morbidity and mortality and are a major economic burden to the health care system. Prevention should be the ultimate objective of pressure ulcer care, and it requires an understanding of the pathophysiology leading to pressure ulcers and the means of reducing both intrinsic and extrinsic risk factors. Clinical examination often underestimates the degree of deep-tissue involvement, and its findings are inadequate for the detection of associated osteomyelitis. Microbiological data, if obtained from deep-tissue biopsy, are useful for directing antimicrobial therapy, but they are insufficient as the sole criterion for the diagnosis of infection. Imaging studies, such as computed tomography and magnetic resonance imaging, are useful, but bone biopsy and histopathological evaluation remain the "gold standard" for the detection of osteomyelitis. The goals of treatment of pressure ulcers should be resolution of infection and promotion of wound healing. A combination of surgical debridement and medical interventions may be required. Systemic antimicrobial therapy should be used for patients with serious pressure ulcers infections, including those with spreading cellulitis, bacteremia or osteomyelitis. PMID:20428024
Iori, Ido; Pizzini, Attilia Maria; Arioli, Dimitriy; Favali, Davide; Leone, Maria Cristina
Tissues such as skin and muscle have a limited repertoire of morphological response to injury. The two most important phenomena that determine the outcome of cell injury appear to be a) critical cell membrane damage, with associated fluid and ionic imbalances; and b) inability of mitochondria, the powerhouse of the cell, to restart ATP synthesis. In fish, skin ulcers can have many different etiologies, including infectious agents, toxins, physical causes, immunologic causes, and nutritional and metabolic perturbations. This article is concerned primarily with the possible pathways of disease involved in ulcerative lesions of fish. In particular, the high prevalence of ulcerative lesions in Atlantic menhaden found along the mid-Atlantic coast, especially in North Carolina estuarine waters, has received much recent attention. These ulcerative lesions are likely to be initiated by a series of factors that lead ultimately to a breach of the normal barrier function of the skin. Bioassays that attempt to define the role of individual etiologic agents such as fungi (oomycetes) or putative Pfiesteria toxin(s) should recognize this multiplicity of factors and should include appropriate quality control measures for water quality parameters (temperature, dissolved oxygen, nitrogenous wastes, etc.) as well as bacterial and other contaminants that may confound bioassay results and their interpretation. Consideration of these factors along with the whole animal in the context of its environment can only advance the science, perhaps provide clues to the causative pathways of skin ulcers in fish, and give us keener insight into the health of the aquatic environment. PMID:11677175
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
Presented are the description and advantages of a unique compression device in the form of a legging for the treatment of venous and lymphatic insufficiency. It consists of a number of pliable, unyielding, adjustable compression bands, from the knee to the instep. The bands are easily closed, tightened, and opened, which is particularly useful for the physically handicapped patient for whom the commonly prescribed elastic stocking is inappropriate because of the difficulty in putting it on and removing it. The effectiveness of the legging is enhanced by its nonelasticity, as has been long proven by the Unna boot, and its ability to maintain an unreduced compression level throughout its lifetime, regardless of edema changes. PMID:3606372
Vernick, S H; Shapiro, D; Shaw, F D
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
A multileg heat pipe evaporator facilitates the use and application of a monogroove heat pipe by providing an evaporation section which is compact in area and structurally more compatible with certain heat exchangers or heat input apparatus. The evaporation section of a monogroove heat pipe is formed by a series of parallel legs having a liquid and a vapor channel and a communicating capillary slot therebetween. The liquid and vapor channels and interconnecting capillary slots of the evaporating section are connected to the condensing section of the heat pipe by a manifold connecting liquid and vapor channels of the parallel evaporation section legs with the corresponding liquid and vapor channels of the condensing section.
Alario, J. P.; Haslett, R. A. (inventors)
The University of Pittsburgh School of Medicine's Department of Pathology has compiled a series of case studies to help both students and instructors. In this particular study, a 48 year-old man is admitted to the hospital with Ã¢ÂÂa three week history of back pain, progressive right leg weakness and bilateral lower leg numbness.Ã¢ÂÂ A detailed patient history and account of the attending doctorÃ¢ÂÂs examination is provided in the Ã¢ÂÂPatient HistoryÃ¢ÂÂ section. MRI and CT images of the patient, as well as gross and microscopic descriptions of the condition are included as well. Clicking on the Ã¢ÂÂFinal DiagnosisÃ¢ÂÂ provides a thorough explanation of the diagnosis and treatment.
Goldberg, Herbert; Lavi, Ehud; Mourelatos, Zissimos; Quan, Dianna; Sinson, Grant
Study Objectives: Dopaminergic hypofunction in the central nervous system may contribute to restless legs syndrome (RLS) and erectile dysfunction (ED). We therefore examined whether men with RLS have higher prevalences of ED. Design: RLS was assessed using a set of standardized questions. Men were considered to have RLS if they met 4 RLS diagnostic criteria recommended by the International RLS Study Group, and had restless legs ? 5 times/month. Erectile function was assessed by a questionnaire. Setting: Community-based. Participants: 23,119 men who participated in the Health Professional Follow-up Study free of diabetes and arthritis. Results Multivariate-adjusted odds ratios for ED were 1.16 and 1.78 (95% confidence interval: 1.4, 2.3; P trend < 0.0001) for men with RLS symptoms 5–14 times/mo, and 15+ times/mo, respectively, relative to those without RLS, after adjusting for age, smoking, BMI, antidepressant use, and other covariates. The associations between RLS and ED persisted in subgroup analysis according to age, obesity, and smoking status. Conclusions: Men with RLS had a higher likelihood of concurrent ED, and the magnitude of the observed association was increased with a higher frequency of RLS symptoms. These results suggest that ED and RLS share common determinants. Citation: Gao X; Schwarzschild MA; O'Reilly EJ; Wang H; Ascherio A. Restless legs syndrome and erectile dysfunction. SLEEP 2010;33(1):75-79. PMID:20120623
Gao, Xiang; Schwarzschild, Michael A.; O'Reilly, Eilis J.; Wang, Hao; Ascherio, Alberto
... Men’s Health Heart & Circulatory Health contact us Peptic Ulcer Disease Questions to Discuss with Your Doctor: Do ... Do you have a family history of peptic ulcer disease? Your Doctor Might Examine the Following Body ...
Ulcerative colitis is a chronic inflammatory disease of the large intestine that often develops in the young. A few new treatment options have become available in the past decade, but management of a large proportion of patients still remains challenging because of side effects, unresponsiveness and cost. A novel strategy targeting trafficking of immune cells to the sites of inflammation involves reducing expression or binding of adhesion molecules to integrins. Natalizumab was the first therapeutic antibody blocking infiltration of leukocytes, but because of lack of selectivity to the gut and associated risk of progressive multifocal leukoencephalopathy, it will probably never be tested in ulcerative colitis. In this article we discuss molecules that block leukocyte trafficking to inflamed bowel that have been tested in ulcerative colitis. Because of favourable efficacy and safety data, we will review the development, pharmacology and clinical data of vedolizumab, a gut-selective ?4?7 antibody, in depth. PMID:24802046
Rietdijk, Svend T; D'Haens, Geert R
Developments in therapeutic endoscopy over the last decade have made it possible to perform endoscopic hemostasis for bleeding peptic ulcers. This review traces the developments in this field in the Department of Surgery of the National University of Singapore. A recently conducted prospective randomized controlled trial using intralesional adrenaline and heater probe demonstrated that initial hemostasis could be achieved in 100% of patients with actively bleeding ulcers or stigmata of recent hemorrhage. The rebleed rate was 6.6% compared with 20.3% in a well-matched control group. The recent advent of laparoscopic vagotomy and laparoscopic Billroth II gastrectomy offers a low-morbidity surgical option to long-term medical treatment for the follow-up management of patients with bleeding ulcers. PMID:8222304
Goh, P; Tekant, Y
Treatment of diabetic foot ulceration continues to be a challenge to healthcare professionals. Wound healing can be affected in a number of ways, and it is of paramount importance that wound healing is achieved as quickly as possible to minimize the risk of amputation. One key aspect of management is wound debridement. A number of techniques can be employed, including, in severe cases, surgical debridement. These case histories illustrate where the novel Versajet hydroscalpel (Smith & Nephew) would be a useful tool for debriding a foot ulcer effectively without the patient undergoing orthopaedic surgery. The Versajet debrides quickly and efficiently, and a pink and granulating wound base was achieved in all cases. It should be considered for use in specialist centres where complex diabetic foot ulcers are treated and the expertise is available to use it. PMID:16936595
McCardle, Joanne E
. The decline in duodenal ulcer disease and the established relation of peptic ulcer to Helicobacter pylori have virtually abolished the need for elective ulcer surgery. However, a substantial proportion of the population around\\u000a retirement age has previously been subjected to partial gastric resection due to peptic ulcer, and the long-term outcome of\\u000a these patients is of continuing relevance. Patients
Christer Staël von Holstein
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
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, UniversitÃ© de
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
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
During a survey of yaws prevalence in the Solomon Islands, we collected samples from skin ulcers of 41 children. Using PCR, we identified Haemophilus ducreyi infection in 13 (32%) children. PCR-positive and PCR-negative ulcers were phenotypically indistinguishable. Emergence of H. ducreyi as a cause of nongenital ulcers may affect the World Health Organization’s yaws eradication program. PMID:25271477
Chi, Kai-Hua; Vahi, Ventis; Pillay, Allan; Sokana, Oliver; Pavluck, Alex; Mabey, David C.; Chen, Cheng Y.; Solomon, Anthony W.
Patients undergoing cardiac surgery have increased risks for developing pressure ulcers. The researchers conducted this study to identify preoperative, intraoperative, and postoperative factors associated with the development of pressure ulcers among patients undergoing cardiac surgery at the Cleveland Clinic Foundation. The significant factors associated with pressure ulcer development in the study patients were presence of diabetes mellitus and other significant
Linda J. Lewicki; Lorraine Mion; Karen G. Splane; Doris Samstag; Michelle Secic
This experimental study was designed to identify the etiology of pressure ulcers in a surgical sample and to evaluate a special OR mattress overlay in preventing pressure ulcer development. Surgical patients (N = 413) were randomized to receive “usual perioperative care” or the new mattress overlay. Over six postoperative days, 89 patients (21.5%) developed pressure ulcers, primarily stage I. Only
Alyce A. Schultz; Maureen Bien; Karen Dumond; Kathleen Brown; Amanda Myers
Bouten CV, Oomens CW, Baaijens FP, Bader DL. The etiology of pressure ulcers: skin deep or muscle bound? Arch Phys Med Rehabil 2003;84:616-9. Pressure ulcers are areas of soft tissue breakdown that result from sustained mechanical loading of the skin and underlying tissues; they can affect the quality of life of many individuals. Despite considerable efforts to prevent pressure ulcers,
Carlijn V. Bouten; Cees W. Oomens; Frank P. Baaijens; Daniel L. Bader
Marginal ulceration at the gastrojejunal anastomosis is a common complication following Roux-Y gastric bypass (RYGB). Hemodynamically significant hemorrhagic marginal ulcers are usually treated either endoscopically or surgically. We describe a unique case of life-threatening hemorrhagic marginal ulcer eroding into the main splenic artery. This condition was initially managed with angiographic embolization, followed by surgical intervention. PMID:23743389
Sidani, Shafik; Akkary, Ehab
Background: Diabetic foot ulcers are the single biggest risk factor for nontrau- matic foot amputations in persons with diabetes. Foot ulcers occur in 12 to 25 percent of persons with diabetes and precede 84 percent of all nontraumatic amputations in this growing population. Because of the high incidence of foot ulcers, amputations remain a source of morbidity and mortality in
Harold Brem; Peter Sheehan; Harvey J. Rosenberg; Jillian S. Schneider; Andrew J. M. Boulton
[Purpose] This study verified the leg muscle activities of elderly subjects performing leg cycle ergometer exercise. [Subjects] Forty-one elderly persons were the subjects of this study. [Methods] For the three distances corresponding to knee flexion angles of 15, 45, and 70, the muscle activities of the rectus femoris, biceps femoris, tibialis anterior and lateral gastrocnemius were measured while the subjects exercised on a cycle ergometer. [Results] The rectus femoris and biceps femoris showed statistically significant increases as the distance between the cycle ergometer and the body increased, and the lateral gastrocnemius muscle activation showed a statistically significant increase as the distance from the body to the cycle ergometer decreased. [Conclusion] When the elderly have limb muscle weakness, leg cycle ergometer distances should be adjusted. PMID:25364121
Kim, Seon-Chill; Lee, Sang-Yeol; Lee, Young-Ik
The development of functional legged robots has encountered its limits in human-made actuation technology. This paper describes research on the biomimetic design of legs for agile quadrupeds. A biomimetic leg concept that extracts key principles from horse legs which are responsible for the agile and powerful locomotion of these animals is presented. The proposed biomimetic leg model defines the effective leg length, leg kinematics, limb mass distribution, actuator power, and elastic energy recovery as determinants of agile locomotion, and values for these five key elements are given. The transfer of the extracted principles to technological instantiations is analyzed in detail, considering the availability of current materials, structures and actuators. A real leg prototype has been developed following the biomimetic leg concept proposed. The actuation system is based on the hybrid use of series elasticity and magneto-rheological dampers which provides variable compliance for natural motion. From the experimental evaluation of this prototype, conclusions on the current technological barriers to achieve real functional legged robots to walk dynamically in agile locomotion are presented. PMID:22247667
Garcia, Elena; Arevalo, Juan Carlos; Munoz, Gustavo; Gonzalez-de-Santos, Pablo
Fast-moving legged animals bounce along the ground with spring-like legs and agilely traverse variable terrain. Previous research has shown that hopping and running humans maintain the same bouncing movement of the body's centre of mass on a range of elastic surfaces by adjusting their spring-like legs to exactly offset changes in surface stiffness. This study investigated human hopping on damped surfaces that dissipated up to 72% of the hopper's mechanical energy. On these surfaces, the legs did not act like pure springs. Leg muscles performed up to 24-fold more net work to replace the energy lost by the damped surface. However, considering the leg and surface together, the combination appeared to behave like a constant stiffness spring on all damped surfaces. By conserving the mechanics of the leg-surface combination regardless of surface damping, hoppers also conserved centre-of-mass motions. Thus, the normal bouncing movements of the centre of mass in hopping are not always a direct result of spring-like leg behaviour. Conserving the trajectory of the centre of mass by maintaining spring-like mechanics of the leg-surface combination may be an important control strategy for fast-legged locomotion on variable terrain. PMID:12965003
Moritz, Chet T; Farley, Claire T
Background. Currently, there is no instrument that provides an accurate and simple method of monitoring pressure ulcer healing in clinical practice. This article reports the two studies that were conducted to assess the validity of the Pressure Ulcer Scale for Healing (PUSH) as a tool to monitor healing of stage II-IV pressure ulcers. Methods. Subjects in both studies ( N
Nancy A. Stotts; George T. Rodeheaver; David R. Thomas; Rita A. Frantz; Alfred A. Bartolucci; Carrie Sussman; Bruce A. Ferrell; Janet Cuddigan
ObjectiveTo evaluate the effectiveness of two pressure-ulcer screening tools against clinical judgement in preventing pressure ulcers.DesignA single blind randomised controlled trial.SettingA large metropolitan tertiary hospital.Participants1231 patients admitted to internal medicine or oncology wards. Patients were excluded if their hospital stay was expected to be 2 days or less.InterventionsParticipants allocated to either a Waterlow (n=410) or Ramstadius (n=411) screening tool group
Joan Webster; Kerrie Coleman; Alison Mudge; Louise Marquart; Glenn Gardner; Monica Stankiewicz; Julie Kirby; Catherine Vellacott; Margaret Horton-Breshears; Alice McClymont
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
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
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
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
Necrotizing Ulcerative Gingivitis (NUG) is an acute and rare (0.5-11% of the population) infectious disease of the gum tissue, which is characterized by ulceration and inflammation of the inter-dental gum tissue. NUG was documented by historians since the fourth century BC, most of the reports from the ancient world were in the context of illness among fighting troops, present studies of NUG in the modern world are still common among soldiers. NUG is associated with poor oral hygiene and weakening of the host, especially in immunocompromised patients, malnutrition and poor living conditions, as well as in the context of mental stress. NUG is more common in young adults, but reports of morbidity in young children with malnutrition in the background are not uncommon. NUG diagnosis is based on three essential symptoms: sore gums, bleeding gums and the most diagnostic characteristic, ulceration and necrosis of the interdental papillae. The disease is considered to have a clear initial infectious etiology, when the main bacteria, associated with the disease, include: Bacteroides intermedius and Fusobacterium sp. The infection involves anaerobic \\ aerobic bacteria with a majority of Gram-negative bacteria. The treatment of NUG is based on combining mechanical removal of tartar with local and systemic delivery of antimicrobial agents. Adequate treatment usually prevent the progression of the disease and ulcer healing is expected in a few days. Nevertheless, lack of treatment can lead to deterioration in the form NUP to Noma. PMID:25219100
A pressure ulcer is a localized injury to the skin or underlying tissue, usually over a bony prominence, as a result of unrelieved pressure. Predisposing factors are classified as intrinsic (e.g., limited mobility, poor nutrition, comorbidities, aging skin) or extrinsic (e.g., pressure, friction, shear, moisture). Prevention includes identifying at-risk persons and implementing specific prevention measures, such as following a patient repositioning schedule; keeping the head of the bed at the lowest safe elevation to prevent shear; using pressure-reducing surfaces; and assessing nutrition and providing supplementation, if needed. When an ulcer occurs, documentation of each ulcer (i.e., size, location, eschar and granulation tissue, exudate, odor, sinus tracts, undermining, and infection) and appropriate staging (I through IV) are essential to the wound assessment. Treatment involves management of local and distant infections, removal of necrotic tissue, maintenance of a moist environment for wound healing, and possibly surgery. Debridement is indicated when necrotic tissue is present. Urgent sharp debridement should be performed if advancing cellulitis or sepsis occurs. Mechanical, enzymatic, and autolytic debridement methods are nonurgent treatments. Wound cleansing, preferably with normal saline and appropriate dressings, is a mainstay of treatment for clean ulcers and after debridement. Bacterial load can be managed with cleansing. Topical antibiotics should be considered if there is no improvement in healing after 14 days. Systemic antibiotics are used in patients with advancing cellulitis, osteomyelitis, or systemic infection. PMID:19035067
Bluestein, Daniel; Javaheri, Ashkan
Summary We report the color Doppler ultrasonography features of arteriovenous malformation (AVM) of the pancreas, a very rare disease. The patient was a 52-year-old man with congenital AVM of the pancreas and a duodenal ulcer that had been resistant to medication. Endoscopic color Doppler ultrasonography (color Doppler EUS) revealed many abnormal color signals showing pulsatile wave form at the portion
Shigeo Tano; Norio Ueno; Tomio Ueno; Shin-Ichi Wada; Toshiyuki Aizawa; Ken Kimura
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
Background Patients with ulcerative colitis (UC) are at greater risk of developing colorectal cancer (CRC) than the general population. Both duration and extent of UC are important risk factors for CRC, as is the presence of primary sclerosing cholangitis, family history of CRC, and (in some studies) early age at diagnosis of UC. Efforts to reduce this risk have focused
Victoria J. Croog; Thomas A. Ullman; Steven H. Itzkowitz
Cytomegalovirus (CMV) is a common virus in patients with ulcerative colitis receiving immunosuppressive drugs. Many studies suggested that CMV infection is an exacerbating factor in patients with ulcerative colitis. The role of CMV in exacerbations of ulcerative colitis has been discussed. One of studies starting this discussion is an article entitled “CMV positive ulcerative colitis: A single center experience and literature review” by Kopylov et al. However, we think that there are some points that should be emphasized about the study. Especially, the small number of patients in the study has led to meaningless results. Large controlled prospective trials are needed to clarify the benefit of antiviral therapy for active ulcerative colitis patients.
Leg telangiectasias and reticular veins are a common complaint affecting more than 80% of the population to some extent. To date, the gold standard remains sclerotherapy for most patients. However, there may be some specific situations, where sclerotherapy is contraindicated such as needle phobia, allergy to certain sclerosing agents, and the presence of vessels smaller than the diameter of a 30-gauge needle (including telangiectatic matting). In these cases, transcutaneous laser therapy is a valuable alternative. Currently, different laser modalities have been proposed for the management of leg veins. The aim of this article is to present an overview of the basic principles of transcutaneous laser therapy of leg veins and to review the existing literature on this subject, including the most recent developments. The 532-nm potassium titanyl phosphate (KTP) laser, the 585-600-nm pulsed dye laser, the 755-nm alexandrite laser, various 800-983-nm diode lasers, and the 1,064-nm neodymium yttrium-aluminum-garnet (Nd:YAG) laser and various intense pulsed light sources have been investigated for this indication. The KTP and pulsed dye laser are an effective treatment option for small vessels (<1 mm). The side effect profile is usually favorable to that of longer wavelength modalities. For larger veins, the use of a longer wavelength is required. According to the scarce evidence available, the Nd:YAG laser produces better clinical results than the alexandrite and diode laser. Penetration depth is high, whereas absorption by melanin is low, making the Nd:YAG laser suitable for the treatment of larger and deeply located veins and for the treatment of patients with dark skin types. Clinical outcome of Nd:YAG laser therapy approximates that of sclerotherapy, although the latter is associated with less pain. New developments include (1) the use of a nonuniform pulse sequence or a dual-wavelength modality, inducing methemoglobin formation and enhancing the optical absorption properties of the target structure, (2) pulse stacking and multiple pass laser treatment, (3) combination of laser therapy with sclerotherapy or radiofrequency, and (4) indocyanin green enhanced laser therapy. Future studies will have to confirm the role of these developments in the treatment of leg veins. The literature still lacks double-blind controlled clinical trials comparing the different laser modalities with each other and with sclerotherapy. Such trials should be the focus of future research. PMID:24220848
Meesters, Arne A; Pitassi, Luiza H U; Campos, Valeria; Wolkerstorfer, Albert; Dierickx, Christine C
The search for signals of new physics at the forthcoming LHC experiments involves the analysis of final states characterised by a high number of hadronic jets or identified particles. Precise theoretical predictions for these processes require the computation of scattering amplitudes with a large number of external particles and beyond leading order in perturbation theory. The complexity of a calculation grows with the number of internal loops as well as with the number of external legs. Automatisation of at least next-to-leading order calculations for LHC processes is therefore a timely task. I will discuss various approaches.
Leg length inequality developed in 12 of 67 children who were treated with radiation therapy to the kidney, abdomen, pelvis, or lower extremities. All these children survived childhood cancer to the age of skeletal maturity. Of the 12 with anisomelia, seven were symptomatic. There were significant relationships between the development of leg length inequality and the total dose of radiation to the pelvic area, asymmetric irradiation to the pelvis, and high-dose irradiation to the leg.
Robertson, W.W. Jr.; Butler, M.S.; D'Angio, G.J.; Rate, W.R. (Univ. of Pennsylvania School of Medicine, Philadelphia (USA))
Identifying the major determinant of leg stiffness during hopping would be helpful in the development of more effective training\\u000a methods. Despite the fact that overall leg stiffness depends on a combination of the joint stiffness, it is unclear how the\\u000a major determinants of leg stiffness are influenced by hopping frequency. The purpose of this study was to identify the major
Hiroaki Hobara; Koh Inoue; Kohei Omuro; Tetsuro Muraoka; Kazuyuki Kanosue
As summer is upon us, we thought a discussion of tennis leg would be beneficial to our fellow clinicians. Tennis leg is a relatively common clinical condition, classically manifesting as acute, sports-related pain in the mid-calf. First described in 1883, the pathogenesis has been debated--tennis leg was first attributed to rupture of the plantaris tendon, though more recent investigations have implicated rupture of the medial head of the gastrocnemius at its myotendinous junction. For simplicity, many authors use the term tennis leg to describe all such acute muscle injuries in the superficial calf. PMID:24195182
Pacheco, Rafael A; Stock, Harlan
In recent decades, thermoelectricity has been widely studied as a potential new source of renewable energy. One of the major challenges to improve the efficiency of thermoelectric (TE) devices is to minimize the contact resistance between the active material and the electrodes, since this represents the major loss of charge in a TE module. This article describes the fabrication of an apparatus for TE leg characterization built with commercial and custom-made parts based on the analog one-dimensional transmission-line method. This device permits contact resistance measurements of bulk TE legs. p- and n-type TE materials, Mg2Si0.98Bi0.02 and MnSi1.75Ge0.02, respectively, were metallized with nickel foils and used as test materials for contact resistance characterization. Contact resistance values of 0.5 m? mm2 for Ni/Mg2Si0.98Bi0.02 junctions and 4 m? mm2 for Ni/MnSi1.75Ge0.02 junctions have been measured. Contact resistance measurements are discussed depending on materials processing and the experimental measurement conditions.
Thimont, Yohann; Lognoné, Quentin; Goupil, Christophe; Gascoin, Franck; Guilmeau, Emmanuel
The definition of the dominant leg (lateral dominance) is not clear, and there has been little reporting related to lateral dominance in the legs. To uncover the practical factors influencing which leg to use as the takeoff leg in 1-legged jumping movements, this study aimed to investigate the subjective dominance side of fundamental movements and to examine the lateral dominance of motor functions between the takeoff leg and non-takeoff leg. The subjects consisted of 27 young men who exercised regularly. They had not trained particularly on unilateral jumping. Fifteen men are the athlete group (left-legged jumpers group [LG]) using a left leg and 12 men are the athlete group (right-legged jumpers group [RG]) using a right leg as determined by a preliminary survey related to takeoff leg during high jump. The fundamental motions of the subjective dominant leg were investigated and the differences between the motor functions of takeoff and lead legs, such as sole shapes, single-leg vertical jump, 20-m hopping, ladder hopping, single-leg balance, and isokinetic strength were examined. It was found that many RG subjects (83%) tended to select the right leg for hopping, and many LG subjects (87%) tended to select the left leg for 1-legged balance. It was suggested that skilled movements show right-leg dominance in both takeoff leg groups. In the LG subjects, the left leg showed a higher value than the right leg in sole shape. The RG subjects showed a higher value in the right leg than in the left leg in a single-leg vertical jump. However, marked dominance was not found in the takeoff leg. The lower limbs may not show marked lateral dominance such as in the upper limbs. PMID:20802291
Miyaguchi, Kazuyoshi; Demura, Shinichi
During metamorphosis, the larval thoracic legs of the hawk moth Manduca sexta are replaced by a new set of adult legs. The larval leg motoneurons persist to innervate new adult muscles, and the motor terminals remain within the developing adult legs. Here we describe the fate of the larval leg muscles and the origin of new muscles within the adult
C. Consoulas; M. Anezaki; R. B. Levine
Aims Elevated dynamic plantar pressures are a consistent finding in diabetes patients with peripheral neuropathy with implications for plantar foot ulceration. This meta-analysis aimed to compare the plantar pressures of diabetes patients that had peripheral neuropathy and those with neuropathy with active or previous foot ulcers. Methods Published articles were identified from Medline via OVID, CINAHL, SCOPUS, INFORMIT, Cochrane Central EMBASE via OVID and Web of Science via ISI Web of Knowledge bibliographic databases. Observational studies reporting barefoot dynamic plantar pressure in adults with diabetic peripheral neuropathy, where at least one group had a history of plantar foot ulcers were included. Interventional studies, shod plantar pressure studies and studies not published in English were excluded. Overall mean peak plantar pressure (MPP) and pressure time integral (PTI) were primary outcomes. The six secondary outcomes were MPP and PTI at the rear foot, mid foot and fore foot. The protocol of the meta-analysis was published with PROPSERO, (registration number CRD42013004310). Results Eight observational studies were included. Overall MPP and PTI were greater in diabetic peripheral neuropathy patients with foot ulceration compared to those without ulceration (standardised mean difference 0.551, 95% CI 0.290–0.811, p<0.001; and 0.762, 95% CI 0.303–1.221, p?=?0.001, respectively). Sub-group analyses demonstrated no significant difference in MPP for those with neuropathy with active ulceration compared to those without ulcers. A significant difference in MPP was found for those with neuropathy with a past history of ulceration compared to those without ulcers; (0.467, 95% CI 0.181– 0.753, p?=?0.001). Statistical heterogeneity between studies was moderate. Conclusions Plantar pressures appear to be significantly higher in patients with diabetic peripheral neuropathy with a history of foot ulceration compared to those with diabetic neuropathy without a history of ulceration. More homogenous data is needed to confirm these findings. PMID:24915443
Fernando, Malindu Eranga; Crowther, Robert George; Pappas, Elise; Lazzarini, Peter Anthony; Cunningham, Margaret; Sangla, Kunwarjit Singh; Buttner, Petra; Golledge, Jonathan
Bed-bound patients with pressure ulcers are almost twice as likely to die as are those without pressure ulcers. If pressure ulcers are treated with a comprehensive regimen upon early recognition, nearly all stage IV ulcers can be avoided. Furthermore, such a regimen can significantly reduce the comorbidities, mortalities, and costs of treatments resulting from stage IV ulcers. The costs of treatments for comorbidities after the ulcer progresses to stage IV far outweigh the costs for early treatment of the ulcer before it progresses beyond the early stages. We describe herein the 4 stages of pressure ulcers, as well as the pathogeneses, costs, and complications associated with these wounds. A comprehensive 12-step detailed protocol for treatment of pressure ulcers is described; this includes recognizing that every patient with limited mobility is at risk for developing a sacral, ischial, trochanteric, or heel ulcer; daily assessment of the skin; objective measurement of every wound; immediate initiation of a treatment protocol; mechanical debridement of all nonviable tissue; establishment of a moist wound-healing environment; nutritional supplementation for malnourished patients; pressure relief for the wound; elimination of drainage and cellulitus; biological therapy for patients whose wounds fail to respond to more traditional therapies; physical therapy; and palliative care. Availability of the described treatment modalities, in combination with early recognition and regular monitoring, ensures rapid healing and minimizes morbidity, mortality, and costs. PMID:15223496
Brem, Harold; Lyder, Courtney
Colonic lipomas are relatively uncommon tumors of mesenchymal origin, composed of well-differentiated adipose tissue supported by fibrous tissue, that usually occur in cecum and ascending colon. Colonic lipomas rarely cause symptoms and are usually detected incidentally. However, if the lesion is large, it may produce symptoms, such as abdominal pain, rectal bleeding, obstruction, intussusception, and even weight loss. Large colonic lipomas can be mistaken for malignancy, which may result in extensive surgical operations. We report a large broad-based ulcerated cecal lipoma in a 68-year-old woman, who presented with abdominal pain and weight loss. The ulcerated lesion was highly suspicious for malignancy radiologically and endoscopically. The patient underwent laparoscopic right-hemicolectomy, and the lesion was diagnosed as a cecal submucosal lipoma. The surgical approach remains the treatment of choice for large and complicated cases. PMID:21160661
Zhang, Xuchen; Ouyang, Jie; Kim, Yong-Doo
This paper describes 110 cases of childhood duodenal ulcer, which were diagnosed over 26 years: 63 were diagnosed by barium meal examination; 47 by upper gastrointestinal endoscopy. The mean age at diagnosis was 11.2 years, with symptoms reported in 46% before 10 years and in 15% before 6 years of age. There was often a considerable delay in diagnosis, particularly in the younger age group. Nocturnal pain (61%) and a close family history of duodenal ulcer disease (62%) were the most valuable pointers to the diagnosis. Fifteen children had required surgery for persistent symptoms. Thirty four had received treatment with an H2 receptor antagonist, and all but four had had a satisfactory initial response. Seventy per cent relapsed within six months of discontinuing treatment, and long term maintenance treatment may therefore be necessary. PMID:3619471
Murphy, M S; Eastham, E J; Jimenez, M; Nelson, R; Jackson, R H
Gastric spiral organisms were first described in man in 1939 and identified as Helicobacter pylori causing peptic ulcers in the early 1980s. Surgical specimens of gastric resections from 1939 showed H. pylori to be present. Full-thickness sections of gastric mucosa from gastric specimens from the eighteenth-century Hunterian Collection at The Royal College of Surgeons of England were examined by histology for the presence of H. pylori. Four gastric ulcers and a section from an oesophageal varix showed remarkable preservation of the overall architecture, but surface autolysis did not allow identification of the bacteria. However, the presence of lymphoid aggregates in the Hunterian specimens suggests that H. pylori may have been present before autolysis. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 PMID:9326130
Walker, M. M.; Baron, J. H.
The presence of stigmata of hemorrhage in a peptic ulcer indicate an increased risk of rebleeding and the need for endoscopic intervention. Clinical trials indicate that laser photocoagulation, multipolar and heater probe coagulation, and injection therapy are all effective in decreasing bleeding from peptic ulcer disease. The modality used for the individual patient depends on available resources and the experience of the endoscopist. Laser photocoagulation is used infrequently, not because of a lack of efficacy but because of its increased cost and impracticality, including its lack of portability. Multipolar coagulation and heater probe coagulation are commonly employed but may give way to injection therapy as first-line therapy, because it is equally effective, cost less, and is easy to implement in a variety of clinical settings. PMID:8307640
Oxygen transport to working skeletal muscles is challenged during whole-body exercise. In general, arm-cranking exercise elicits a maximal oxygen uptake (VO2max) corresponding to approximately 70% of the value reached during leg exercise. However, in arm-trained subjects such as rowers, cross-country skiers, and swimmers, the arm VO2max approaches or surpasses the leg value. Despite this similarity between arm and leg VO2max, when arm exercise is added to leg exercise, VO2max is not markedly elevated, which suggests a central or cardiac limitation. In fact, when intense arm exercise is added to leg exercise, leg blood flow at a given work rate is approximately 10% less than during leg exercise alone. Similarly, when intense leg exercise is added to arm exercise, arm blood flow and muscle oxygenation are reduced by approximately 10%. Such reductions in regional blood flow are mainly attributed to peripheral vasoconstriction induced by the arterial baroreflex to support the prevailing blood pressure. This putative mechanism is also demonstrated when the ability to increase cardiac output is compromised; during exercise, the prevailing blood pressure is established primarily by an increase in cardiac output, but if the contribution of the cardiac output is not sufficient to maintain the preset blood pressure, the arterial baroreflex increases peripheral resistance by augmenting sympathetic activity and restricting blood flow to working skeletal muscles. PMID:17019302
Secher, Niels H; Volianitis, Stefanos
Water striders (Gerris remigis) have remarkable non-wetting legs that enable them to stand effortlessly and move quickly on water, a feature believed to be due to a surface-tension effect caused by secreted wax. We show here, however, that it is the special hierarchical structure of the legs, which are covered by large numbers of oriented tiny hairs (microsetae) with fine
Xuefeng Gao; Lei Jiang
Leg contracture, defined as the difference in extensibility of the control and irradiated hind legs of mice, was found to correlate with single doses of radiation from about 20 to 80 Gy. The time of development of the early phase of the response coincided with that reported for the appearance of the acute skin response, and in some cases, partially
Helen B. Stone
MOTION PLANNING FOR LEGGED AND HUMANOID ROBOTS A DISSERTATION SUBMITTED TO THE DEPARTMENT and rescue. Humanoid robots have additional applications in homes and offices as personal assistants different robots: NASA's six-legged lunar vehicle ATH- LETE, AIST Japan's biped humanoid robot HRP-2
. As a specific example, consider the miniature sixÂ legged hexapod robot illustrated in Figure 1 (poten- tially it decreases the mechanical complexity of the robot. This hexapod requires only 12 degrees of freedom; whereas Figure 1. Simple hexapod robot. There is a vast literature on legged locomotion anal- ysis, control
Modern-day cricket has experienced a shift towards limited over games, where the emphasis is on scoring runs at a rapid rate. Although the use of protective equipment in cricket is mandatory, players perceive that leg guards, in particular, can restrict their motion. The aim of this study was to determine the influence of cricket leg guards on running performance. Initial
James Webster; Jonathan Roberts
Bill Goodwine and Joel Burdick Gait Controllability for Legged Robots Bill Goodwine Joel Burdick to the legged case, where the relevant mechanics are not smooth. #12;Bill Goodwine and Joel Burdick Introduction to a class of nonsmooth systems we call stratified. #12;Bill Goodwine and Joel Burdick Stratified Control
A gravity balancing lower extremity exoskeleton is a simple mechanical device composed of rigid links, joints and springs, which is adjustable to the geometry and inertia of the leg of a human subject wearing it. This passive exoskeleton does not use any motors or controllers, yet can still unload the human leg joints of the gravity load over the full
Sunil Kumar Agrawal; Sai K. Banala; Abbas Fattah
A formulation of reflex control is presented which has been developed and used in the control of a prototype leg of the adaptive suspension vehicle to implement reflex actions. In particular, the concept of reflex control has been demonstrated experimentally in high-speed contact and foot slippage. A constraint analysis of the leg-environment interaction is found to be especially useful in
Ho Cheung Wong; David E. Orin
Modeling techniques for animating legged figures are described which are used in the PODA animation system. PODA utilizes pseudoinverse control in order to solve the problems associated with manipulating kinematically redundant limbs. PODA builds on this capability to synthesize a kinematic model of legged locomotion which allows animators to control the complex relationships between the motion of the body of
Michael Girard; Anthony A. Maciejewski
Chronic exertional compartment syndrome (CECS) is an underdiagnosed cause of chronic exertional leg pain. The syndrome most commonly occurs in young adult recreational runners, elite athletes, and military recruits. CECS is caused by increased intracompartmental pressure within a fascial space; however, the mechanism of why pain occurs is unknown. Symptoms are classically pain in the affected compartment at the same time, distance, or intensity of exercise. CECS is a clinical diagnosis; however, it is confirmed by intracompartmental pressure testing. Fasciotomy is the treatment of choice for athletes who would like to maintain the same level of activity. Athletes who have a release of the anterior and lateral compartments have a high success rate. PMID:21063498
Tucker, Alicia K
Restless legs syndrome (RLS), also known as Ekbom syndrome, is a common movement disorder with sensorimotor symptoms occurring during sleep and quiet wakefulness. The underlying cause for RLS is unknown but genetic influences play a strong part in the pathogenesis of RLS, particularly when the condition starts at a young age. This review explores the genetic basis of RLS and related phenotypic variations. Recently, three loci showing vulnerability to RLS have been described in French?Canadian and Italian families in chromosomes 12q, 14q and 9q, emphasising on an autosomal dominant mode of inheritance. These have been labelled RLS1, RLS2 and RLS3, respectively. However, specific causative mutations remain elusive and no linkage analysis has been identified so far in the candidate genes investigated in RLS. PMID:17068272
Dhawan, V; Ali, M; Chaudhuri, K R
Although frequently underdiagnosed, several epidemiological studies have estimated the prevalence of restless legs syndrome (RLS) in western countries at 5-15% of the general population. The diagnosis is usually made on a clinical basis, according to the criteria established by the international RLS study group. There are case reports of transient RLS in opiate withdrawal. We describe three opiate (dextropropoxyphene (DPP)) dependent young male patients; two of them had DPP intoxication/withdrawal seizure developing RLS during opiate withdrawal. However, their RLS persisted even after the remission of other withdrawal symptoms. Thyroid function test, hemogram, serum ferritin were normal in all of them. The cases responded well to a treatment with ropinirole. Hence, there might be a causal association, which required further well-designed studies to substantiate. The sleep disturbances and use of benzodiazepines can be minimized by increasing clinician's sensitivity to diagnose RLS. PMID:24701019
Ghosh, Abhishek; Basu, Debasish
The article briefly summarizes the milestones leading to current knowledge and the possibility of treating one of the most widespread and perhaps least known diseases, restless legs syndrome (RLS). Until the mid-twentieth century, the syndrome first described by Willis (1685), was sporadically reported in medical literature and in most cases deemed a bizzare condition. It was only with Ekbom's detailed clinical description of the syndrome (1944) and the polygraphic recordings of Coccagna et al. (1962) that RLS became well-recognised clinical entity. Since then, almost all sleep laboratories have devoted much of their research to discovering the pathogenetic mechanisms underlying the disease and devise increasingly specific treatment. Major advances have been made in recent years, but a full understanding of RLS is still a long way off. PMID:15165536
Coccagna, Giorgio; Vetrugno, Roberto; Lombardi, Carolina; Provini, Federica
Conventional analysis of tension leg platform structures yields natural frequencies which are well separated from wave excitation frequencies. However, the results presented here show that the tethers can have lateral resonant frequencies in the wave frequency range if the platform is deployed in deep water. Analysis which ignores the lateral tether dynamics gives reasonable estimates of platform motions but can seriously underestimate tether displacements. It is usually assumed that tether tension does not vary with time. However, the vertical waves forces, reacted by the tethers, cause the tension to change with time and this can cause a Mathieu type of instability in the platform sway motion. This phenomenon is investigated using a simple energy balance technique and it is shown that square law fluid damping places an upper bound on oscillation amplitude; it is found that platform sway motions due to Mathieu excitation remain acceptable even in large waves.
Jefferys, E.R.; Patel, M.H.
This paper describes the main features of a concrete-hull tension-leg-platform (TLP) concept developed for the Heidrun field in the Haltenbanken area of the Norwegian sector of the North Sea. The hydrodynamic response and the methods adopted to optimize the hull dimensions, as well as the mooring system and hull mechanical outfitting, are discussed first. Then construction methods are briefly described. Inspection, maintenance, and repair are also addressed. Finally, the advantages of the concrete-hull TLP concept are summarized, including the concrete hull's adaptability to a large range of design requirements, low cost, and short construction time. This paper shows that the concrete-hull TLP is a very cost-efficient solution for the development of deepwater fields.
De Oliveira, J.G. (Conoco Norway, Inc., Oslo (Norway)); Fjeld, S. (Norwegian Contractors A/S (NO))
We report a case of diabetic foot ulcer caused by Scedosporium apiospermum in a seventy year old male patient with uncontrolled diabetes. Scedosporium apiospermum, the asexual phase of Pseudallescheria boydii a fungus isolated from a variety of natural substrates throughout the world including soil, polluted water, sewage and manure of poultry and cattle. P.boydii is now recognized as a medically important opportunistic fungus. This case has been reported for its rarity. PMID:24392407
D, Vijaya; T, Nagaratnamma; Jv, Sathish
We report a case of diabetic foot ulcer caused by Scedosporium apiospermum in a seventy year old male patient with uncontrolled diabetes. Scedosporium apiospermum, the asexual phase of Pseudallescheria boydii a fungus isolated from a variety of natural substrates throughout the world including soil, polluted water, sewage and manure of poultry and cattle. P.boydii is now recognized as a medically important opportunistic fungus. This case has been reported for its rarity. PMID:24392407
D., Vijaya; T., Nagaratnamma; JV., Sathish
Buruli ulcer disease (BUD), caused by Mycobacterium ulcerans, is a neglected bacterial infection of the poor in remote rural areas, mostly affecting children. BUD is a mutilating disease\\u000a leading to severe disability; it is the third most common mycobacterial infection in immunocompetent people after tuberculosis\\u000a and leprosy. It is most endemic in West Africa, but cases have been reported from
Kris Huygen; Ohene Adjei; Dissou Affolabi; Gisela Bretzel; Caroline Demangel; Bernhard Fleischer; Roch Christian Johnson; Jorge Pedrosa; Delphin M. Phanzu; Richard O. Phillips; Gerd Pluschke; Vera Siegmund; Mahavir Singh; Tjip S. van der Werf; Mark Wansbrough-Jones; Françoise Portaels
Patients with ulcerative colitis have traditionally relied on sulfasalazine, mesalamine, and corticosteroids as the mainstay\\u000a of medical therapy. Steroid-refractory, -dependent, or -intolerant patients have resorted to agents such as cyclosporine for\\u000a short-term efficacy and 6-mercaptopurine or azathioprine for long-term efficacy. The next generation of evolving therapies\\u000a includes many novel agents that target various aspects of the human immune response. Therapies
Phillip Y. Chung; Russell D. Cohen
Activation of ulcerative colitis with mesalamine has rarely been reported. In case 1, a 34-year-old man was treated with oral mesalamine, resulting in an exacerbation of colitis that rapidly improved with glucocorticoids and mesalamine withdrawal. Oral cromolyn sodium and occasional low-dose prednisone therapy has maintained long-term remission. In case 2, a 28-year-old man receiving prednisone treatment developed chest pain and
John B. Sturgeon; Paramjit Bhatia; Donald Hermens; Philip B. Miner
Therapies for patients with ulcerative colitis have, until recently, been limited in scope and efficacy. New formulations\\u000a of mesalamine and corticosteroids have challenged the older therapies with respect to both efficacy and safety. The application\\u000a of 6-mercaptopurine and azathioprine for steroid-refractory disease and maintenance of remission has resulted in studies of\\u000a other candidate immunomodulatory agents. Biologic therapies targeting tumor necrosis
Russell D. Cohen
Acute pericarditis occurs very rarely in association with inflammatory bowel disease (IBD). It has been described both as an extraintestinal manifestation of IBD and as an adverse drug reaction in IBD treatment. We present a case of a 26-year-old female patient with a severe exacerbation of ulcerative colitis, who was previously under long-term treatment with mesalazine and low-dose prednisone. The literature on pericardial involvement in IBD is reviewed. PMID:17343082
Virovic Jukic, L; Duvnjak, M; Barsic, N; Lerotic, I; Tomasic, V; Pavic, T
The aetiological aspects as well as postural attitude implications represent an open question in scoliosis evaluation and treatment. Leg length discrepancy (LLD) is often recognised in scoliotic patients, but surprisingly still controversial is the use of underfoot wedge corrections in order to compensate pelvis tilt. In fact, literature reports conflicting results on the efficacy of LLD equalization also given the argued uncertainty of LLD clinical assessment and limitations related to X-ray measurements. Moreover concern is about anatomic and functional LLD and associated estimation of the pelvic torsion. In such a topic, a significant helpful tool has been demonstrated to be 3D kinematic optoelectronic measurements and other useful data obtained from force platforms and/or baropodographic systems. 135 (94.4%) out of 143 Scoliotic patients sample (av. age 16.4±10.2 Y range 4-66 Y), have been found to improve posture when LLD was corrected. The 143 patients showed a mean lower limb discrepancy of ?=10.2±5.2mm associated to a mean main scoliotic curve ?=16.4°±9.4° Cobb (frontal plane), mean Spinal offset ?=7.5±5.5mm and mean Global offset ?=10.1±7.1mm. The applied paired t-test comparison (indifferent vs. corrected orthostasis) showed significant (p < 0.05) postural improvements could be obtained in the whole or in a part of the considered postural parameters, after the application of suitable under-foot wedge. The present investigation confirm results of a previous study demonstrating the efficacy of under-foot wedge use in leg asymmetry correction, posture re-balancing and spine deformities reduction, pointing out the significant contribution of the 3D opto-electronic measurement approach in the critical process of assessing the correct under-foot wedge size, therapy planning and monitoring. PMID:22744478
D'Amico, Moreno; Roncoletta, Piero; Di Felice, Francesca; Porto, Daniele; Bellomo, Rosagrazia; Saggini, Raoul
Treatment of patients with ulcerative colitis (UC) has traditionally focused on improving symptoms, with the main objective of inducing and maintaining symptomatic remission. However, new evidence suggests that concentrating exclusively on clinical outcome measures may not be adequate to achieve long-term treatment success. Indeed, physicians should also be assessing the reduction of endoscopic activity, with the intention of achieving complete mucosal healing (defined as the absence of all mucosal ulceration, both microscopic and macroscopic, providing a sigmoidoscopy score of 0, as assessed on the Ulcerative Colitis Disease Activity Index). As a consequence of the customary reliance on symptomatic outcome measures, relatively few clinical trials have used mucosal healing or a composite including mucosal healing as a primary endpoint. This situation may soon change as new guidelines recommend the incorporation of mucosal healing into the primary endpoint of all new clinical trials in patients with UC. These recommendations are derived, in part, from data that have illustrated a correlation between mucosal healing and several important factors including long-term remission rates, disease-related complications (e.g., risk of colorectal cancer), healthcare utilization (e.g., need for colectomy), and patient quality of life. We already have drugs available to us that can effectively induce and maintain complete mucosal healing over long periods of time. This review evaluates the effect of medical therapy on mucosal healing in patients with UC and explores the importance of this outcome measure, both from the patient's perspective and clinical trial experience. Inflamm Bowel Dis 2009. PMID:19637362
Lichtenstein, Gary R; Rutgeerts, Paul
A 28-year-old woman presented with diarrhoea, haematochezia, tenesmus and rectal pain for 2?months. She was diagnosed with systemic lupus erythematosus (SLE) 8?years ago and remained on prednisone, azathioprine and hydroxychloroquine. Blood work revealed a positive ANA (antinuclear antibody test), anti-dsDNA 749?IU/mL (0-300?IU/mL), C3 0.22?g/L (0.65-1.65?g/L) and C4 0.05?g/L (0.16-0.60?g/L). Stool studies were unremarkable. MRI of the pelvis showed a rectum with eccentric wall thickening. Flexible sigmoidoscopy showed severe proctitis with multiple deep ulcers and diffuse submucosal haemorrhage. Rectal biopsy revealed crypt architectural distortion and reactive fibrosis in the lamina propria. The patient was given mesalamine suppository for 2?weeks with minimal improvement. Repeat flexible sigmoidoscopy showed a coalesced 3×4?cm full-thickness rectal ulcer. Therefore, the patient was given intravenous methylprednisolone for 3?days, followed by intravenous cyclophosphamide for 2?weeks. Her symptoms resolved and repeat flexible sigmoidoscopy showed fibrotic healing of the rectal ulcers. PMID:25150239
Yau, Alan Hoi Lun; Chu, Karen; Yang, Hui Min; Ko, Hin Hin
A 52 year old male presented with peripheral ulcerative keratitis in the right eye. Patient's history included retinitis pigmentosa, pseudophakia (right eye), cataract (left eye), bilateral partial deafness, ischemic heart disease, hypertension, type 1 diabetes mellitus, depression, hyperparathyroidism, hypertriglycemia and renal failure. The patient was on weekly hemodialysis. The peripheral corneal ulceration remained stable until he developed sudden and rapid thinning after eight months of regular follow up and management. Laboratory investigations including immunological studies were negative and we had to rely on treatment based on clinical signs, including the visual acuity, size, depth and staining of the ulcer and perilimbal, episcleral, scleral, corneal and anterior chamber reactions. The patient was treated with medical and conservative approaches and the eye was protected with a plastic shield to avoid injury. Despite our efforts, the patient perforated his eye due to a trivial trauma during sleep. He was managed successfully with cyanoacrylate glue and a bandage contact lens. The anterior chamber reformed after the perforation was sealed and the patient is on a regular follow up with a multidisciplinary approach. PMID:25278804
Al-Qahtani, Bandar; Asghar, Salman; Al-Taweel, Hassan Mohammad; Jalaluddin, Imran
B-cell-depletion therapy with rituximab is efficacious against steroid-dependent nephrotic syndrome (NS) in children and adults. Safety data are limited. Results of small studies have suggested that rituximab is usually well tolerated but that adverse events (such as severe mucocutaneous reactions, fatal infusion reactions, progressive multifocal leukoencephalopathy, and bowel perforation) can occur. We report here the first case (to our knowledge) of a pediatric patient with refractory minimal-change NS who developed severe immune-mediated ulcerative gastrointestinal disease 42 days after rituximab therapy. The disease was characterized by deep ulcers throughout the intestines and predominantly affected the colon. The child presented with severe abdominal pain, bloody diarrhea, weight loss, and fever. Her inflammatory markers were significantly elevated. Extensive evaluation revealed no evidence of infections and no characteristics of defined inflammatory bowel disease or Behçet disease. Colonoscopy revealed severe intestinal inflammation with deep ulcers. Histology of the colonic biopsy specimens revealed extensive infiltrates predominantly composed of CD8(+) T lymphocytes and evidence of high forkhead box P3 (FOXP3) expression. During this significant gastrointestinal disease, the NS remained quiescent. Corticosteroid therapy successfully controlled the severe immune-mediated intestinal inflammation after rituximab therapy. NS relapsed subsequently when CD19(+) and CD20(+) B-cell populations recovered. PMID:20566611
Ardelean, Daniela S; Gonska, Tanja; Wires, Shannon; Cutz, Ernest; Griffiths, Anne; Harvey, Elizabeth; Tse, Shirley M L; Benseler, Susanne M
A 52 year old male presented with peripheral ulcerative keratitis in the right eye. Patient’s history included retinitis pigmentosa, pseudophakia (right eye), cataract (left eye), bilateral partial deafness, ischemic heart disease, hypertension, type 1 diabetes mellitus, depression, hyperparathyroidism, hypertriglycemia and renal failure. The patient was on weekly hemodialysis. The peripheral corneal ulceration remained stable until he developed sudden and rapid thinning after eight months of regular follow up and management. Laboratory investigations including immunological studies were negative and we had to rely on treatment based on clinical signs, including the visual acuity, size, depth and staining of the ulcer and perilimbal, episcleral, scleral, corneal and anterior chamber reactions. The patient was treated with medical and conservative approaches and the eye was protected with a plastic shield to avoid injury. Despite our efforts, the patient perforated his eye due to a trivial trauma during sleep. He was managed successfully with cyanoacrylate glue and a bandage contact lens. The anterior chamber reformed after the perforation was sealed and the patient is on a regular follow up with a multidisciplinary approach.
Al-Qahtani, Bandar; Asghar, Salman; Al-Taweel, Hassan Mohammad; Jalaluddin, Imran
For mobile robots, the essential units of actuation, computation, and sensing must be designed to fit within the body of the robot. Additional capabilities will largely depend upon a given activity, and should be easily reconfigurable to maximize the diversity of applications and experiments. To address this issue, we introduce a modular architecture originally developed and tested in the design and implementation of the X-RHex hexapod that allows the robot to operate as a mobile laboratory on legs. In the present paper we will introduce the specification, design and very earliest operational data of Canid, an actively driven compliant-spined quadruped whose completely different morphology and intended dynamical operating point are nevertheless built around exactly the same "Lab on Legs" actuation, computation, and sensing infrastructure. We will review as well, more briefly a second RHex variation, the XRL platform, built using the same components.
Haynes, G. Clark; Pusey, Jason; Knopf, Ryan; Johnson, Aaron M.; Koditschek, Daniel E.
To evaluate differences in surface electromyography (EMGs) activity of lumbar, pelvic and leg muscles in adolescents with and without LLD. EMGs activity records were taken during rest and maximal isometric voluntary contractions (MIVC). Peak to peak amplitude (PPA), mean rectified voltage (MRV) and root mean square (RMS), were analyzed. Statistical differences between short and large sides of LLD adolescents, were found (p<0.05). Higher values occurred in shorter limb muscles. No significative differences were found between left and right legs of the control subjects. When EMGs values were compared between short and large sides of LLD subjects with ipsilateral sides of controls, selective, statistically different EMGs values were exhibited. It is suggested that adaptative behavior to secondary biomechanical and/or neural changes occurred, even when none clinical symptoms were reported. The observations were remarked by the absence of EMGs differences between right and left sides of control subjects.
Sotelo-Barroso, Fernando; Márquez-Gamiño, Sergio; Caudillo-Cisneros, Cipriana
Diffuse gastroduodenitis resembling ulcerative colitis in respect to macro- and microscopic findings occurs in ulcerative colitis, although it is rare. Reports of gastroduodenitis associated with ulcerative colitis treated with infliximab are rare. A 58-year-old man had tarry stool in March 2011. He had a history of ulcerative colitis that was diagnosed in 1984. He underwent subtotal colectomy in 1991. Endoscopy and radiography revealed diffuse friable mucosa throughout the duodenum and an ulcer in the middle of the descending portion, resulting in a narrow portion.In the stomach, numerous small aphthae were observed in the antrum. Biopsy specimens of the duodenum and antrum showed marked inflammatory cell infiltration in both areas and cryptitis in the duodenum. Standard induction therapy of infliximab was started in April. The ulcer in the descending portion became a scar without diffuse mucosal friability in September 2011. PMID:24164601
Chiba, Mitsuro; Ono, Iwao; Wakamatsu, Hideki; Wada, Isao; Suzuki, Katsuhiko
Restless legs syndrome (RLS) is a common neurological disorder. Dementia with Lewy bodies (DLB) is the second most common form of neurodegenerative dementia after Alzheimer's disease. Both RLS and DLB can be effectively treated by dopaminergic medications, suggesting the role of dopamine dysfunction in the pathogenesis of both diseases. Here, I report on a Japanese woman with probable DLB and RLS who was treated with gabapentin enacarbil, a non-dopaminergic agent. Because a dopamine agonist, a first-line therapy for moderate to severe RLS, caused the occurrence of metamorphopsia, an alternative treatment of gabapentin enacarbil was used; this treatment improved the patient's RLS without worsening her psychiatric symptoms. An alternative treatment is desirable for DLB patients with RLS because they often experience intolerable side-effects with a dopamine agonist, especially visual hallucinations. Administering gabapentin enacarbil also improved the continuous leg pain that occurred in conjunction with the development of RLS. Although the neurobiological mechanism in the development of pain remains unclear, a range of non-dopaminergic structures likely mediated pain processing in DLB in the present case based on neuropharmacological results. This is the first report reporting the effects of gabapentin enacarbil for RLS and leg pain in a DLB patient with psychiatric symptoms. PMID:24528871
The high blood pressure in giraffe leg arteries renders giraffes vulnerable to edema. We investigated in 11 giraffes whether large and small arteries in the legs and the tight fascia protect leg capillaries. Ultrasound imaging of foreleg arteries in anesthetized giraffes and ex vivo examination revealed abrupt thickening of the arterial wall and a reduction of its internal diameter just below the elbow. At and distal to this narrowing, the artery constricted spontaneously and in response to norepinephrine and intravascular pressure recordings revealed a dynamic, viscous pressure drop along the artery. Histology of the isolated median artery confirmed dense sympathetic innervation at the narrowing. Structure and contractility of small arteries from muscular beds in the leg and neck were compared. The arteries from the legs demonstrated an increased media thickness-to-lumen diameter ratio, increased media volume, and increased numbers of smooth muscle cells per segment length and furthermore, they contracted more strongly than arteries from the neck (500 ± 49 vs. 318 ± 43 mmHg; n = 6 legs and neck, respectively). Finally, the transient increase in interstitial fluid pressure following injection of saline was 5.5 ± 1.7 times larger (n = 8) in the leg than in the neck. We conclude that 1) tissue compliance in the legs is low; 2) large arteries of the legs function as resistance arteries; and 3) structural adaptation of small muscle arteries allows them to develop an extraordinary tension. All three findings can contribute to protection of the capillaries in giraffe legs from a high arterial pressure. PMID:24005251
Petersen, Karin K; Hørlyck, Arne; Ostergaard, Kristine H; Andresen, Joergen; Broegger, Torbjoern; Skovgaard, Nini; Telinius, Niklas; Laher, Ismael; Bertelsen, Mads F; Grøndahl, Carsten; Smerup, Morten; Secher, Niels H; Brøndum, Emil; Hasenkam, John M; Wang, Tobias; Baandrup, Ulrik; Aalkjaer, Christian
...2012-07-01 2012-07-01 false Marco Polo Tension Leg Platform safety zone...ACTIVITIES SAFETY ZONES § 147.837 Marco Polo Tension Leg Platform safety zone. (a) Description. Marco Polo Tension Leg Platform, Green...
...2010-07-01 2010-07-01 false Marco Polo Tension Leg Platform safety zone...ACTIVITIES SAFETY ZONES § 147.837 Marco Polo Tension Leg Platform safety zone. (a) Description. Marco Polo Tension Leg Platform, Green...
...2011-07-01 2011-07-01 false Marco Polo Tension Leg Platform safety zone...ACTIVITIES SAFETY ZONES § 147.837 Marco Polo Tension Leg Platform safety zone. (a) Description. Marco Polo Tension Leg Platform, Green...
...2013-07-01 2013-07-01 false Marco Polo Tension Leg Platform safety zone...ACTIVITIES SAFETY ZONES § 147.837 Marco Polo Tension Leg Platform safety zone. (a) Description. Marco Polo Tension Leg Platform, Green...
...2010-07-01 2010-07-01 false Sir Douglas Morpeth Tension Leg Platform safety...ACTIVITIES SAFETY ZONES § 147.817 Sir Douglas Morpeth Tension Leg Platform safety zone. (a) Description. The Sir Douglas Morpeth Tension Leg Platform...
...2011-07-01 2011-07-01 false Sir Douglas Morpeth Tension Leg Platform safety...ACTIVITIES SAFETY ZONES § 147.817 Sir Douglas Morpeth Tension Leg Platform safety zone. (a) Description. The Sir Douglas Morpeth Tension Leg Platform...
as "Ninja legs") that enable amphibious operation, both walking and swimming, for use on a class of hexapod encompassing both those that are on the ground as well as underwater. In this paper we work with a hexapod for a hexapod walking robot. Legged mobility has often been envisioned as the most versatile loco- motion
This paper reviews the remarkable impact of H2-receptor antagonists on duodenal ulcer management. The development and the scientific rationale of these agents are presented, and efficacy and safety aspects in the short- and long-term treatment of duodenal ulcer disease discussed. Attention is focused on the possible role of "acid rebound" in ulcer relapse following the withdrawal of therapy and on the clinical relevance of prolonged suppression of acid secretion in patients on long-term therapy. PMID:1364125
Marks, I. N.
OBJECTIVE--To study the microbial aetiology of genital ulcer disease (GUD) in women. DESIGN--Microbial and clinical assessment of genital ulcers in women. SETTING--City Health sexually transmitted diseases clinic, King Edward VIII Hospital, Durban, South Africa. PARTICIPANTS--100 Zulu women with genital ulceration who had not received antibiotics in the previous two weeks. RESULTS--Syphilis was diagnosed in 40%, genital herpes in 18%, donovanosis
N OFarrell; A A Hoosen; K D Coetzee; J van den Ende
OBJECTIVE--To study the microbial aetiology of genital ulcer disease (GUD) in men. DESIGN--Microbiological and clinical assessment of genital ulcers in men. SETTING--City Health sexually transmitted diseases clinic, King Edward VIII Hospital, Durban, South Africa. PARTICIPANTS--100 Zulu men with genital ulcers who had not received antibiotics in the previous four weeks. RESULTS--Syphilis was diagnosed in 42%, chancroid in 22%, donovanosis (granuloma
N OFarrell; A A Hoosen; K D Coetzee; J van den Ende
There is now substantial evidence that diabetic neuropathy is a major etiologic factor for diabetic foot ulcers. Epidemiologic\\u000a data show a very strong association between foot ulcers and indicators of sensorimotor neuropathy. Additionally, a causal\\u000a pathway (sensorimotor neuropathy, which leads to increased pressures at foot surfaces, which then leads to foot ulcers) has\\u000a been postulated. Evidence suggests that other factors
•PRESSURE ULCERS, regardless of their origin, represent negative outcomes for patients, including pain, additional treatments and surgery, longer hospital stays, disfigurement or scarring, increased morbidity, and increased costs.•THE OR IS A HIGH-RISK environment for the development of pressure ulcers. Preoperative identification of patients at risk for pressure ulcer development is imperative if cost-effective, evidence-based preventive measures are to be implemented.•THIS
A 7 year old boy was admitted to hospital with gastroenteritis, which was complicated by an acute perforated duodenal ulcer. After oversewing of the perforation he made an uncomplicated recovery. Peptic ulceration is under-diagnosed in childhood and this leads to delay in diagnosis and appropriate management. Ulceration is associated with severe illness and viral infections, but perforation is rare. Images p991-a PMID:2221974
Wilson, J M; Darby, C R
endoscopically documented gastroduodenal ulcers. RESULTS: Pooled rate ratios (RRs) relative to placebo for endoscopic ulcers at 12 weeks were 1.96 (95% CI 0.85 to 4.55) for celecoxib 100 mg twice daily and 2.35 (95% CI 1.02 to 5.38) for celecoxib 200 mg twice daily. There was no significant difference in gastroduodenal ulcers at 12 weeks between celecoxib 200 mg twice
Darren M Ashcroft; Stephen R Chapman; Wendy K Clark; David S Millson
Peptic ulcer disease, lower abdominal colicky pain, increasing diarrhea, and ulcers of the colon and rectum developed in a\\u000a patient more than one year after he had an extensive resection of the small bowel. Parenteral adinistration of cimetidine,\\u000a with blood levels of 2.00 mg\\/ml, caused resolution of the colonic ulcerations and other symptoms, after orally administered\\u000a cimetidine had failed to
Louis F. Martin; James P. Moss; James P. Welch; Samuel H. Cheng
Currently, no instrument is available to provide an accurate and simple method of monitoring venous ulcer healing in clinical practice. The Pressure Ulcer Scale for Healing (PUSH) tool was developed and validated to monitor the healing of pressure ulcers. During a 2-month study involving 27 venous ulcer patients visiting a chronic wound clinic of a major university, the feasibility of using the PUSH tool to monitor healing was evaluated. The patients were assessed by two Wound Ostomy Continence Nurses using the PUSH tool, where 0 = healed and 17 = worst possible score. The mean score at the initial clinic visit was 12. One month and 2 months later, the mean scores were 9 and 8, respectively. Of the 27 participating patients, 23 had a decrease in their PUSH score over the 2-month period of the study; four of the 23 patients had PUSH scores of zero after 2 months because their venous ulcers had healed. One ulcer did not change and three ulcers worsened and their PUSH scores increased. Based on this study, the PUSH tool appears to be an effective way to monitor healing trends in venous ulcers as well as pressure ulcers. PMID:16014985
Ratliff, Catherine R; Rodeheaver, George T
Pressure ulcers are common in frail, disabled, or acutely ill older patients in the home, hospital, or nursing home. Prevention is the most important aspect of pressure ulcer care, and physician and nurse share in this responsibility. A nosocomial pressure ulcer adds significantly to mortality, morbidity, and hospital length-of-stay. Risk factor assessment scales can help identify patients who need prevention efforts, such as pressure relief, incontinence care, and nutritional supplements. When an ulcer does occur, careful documentation is required, including staging, size and depth description, and review of the interdisciplinary care plan. Knowledge of wound biology and cost-effectiveness should guide the choice of wound healing products. PMID:7821827
Levine, J M; Totolos, E
We report a 47 year old man who presented with painful non-healing tongue ulcers of 3 months duration. Examination revealed an additional buccal ulcer that he was unaware of. Histopathology of the ulcers showed caseation necrosis. Following this report, chest radiography and sputum microscopy performed revealed pulmonary tuberculosis. From this case-study, one should be aware of coexisting pulmonary tuberculosis in patients with chronic non-healing oral ulcers, both for diagnosis as well as prevention of transmission through respiratory droplets. PMID:24883035
Nagaraj, Vezhavendhan; Sashykumar, Shanthi; Viswanathan, Stalin; Kumar, Sathish
The present paper compares the temporal changes of cigarette consumption with those of peptic ulcer mortality in the United Kingdom. Cumulative cigarette consumption increased in men born between 1845 and 1915 and remained constant or decreased in all subsequent generations. It increased in women born between 1835 and 1955. In contrast, both male and female mortality from gastric and duodenal ulcer were highest in those born around 1875-1885. From the lack of coincidence in the trends of peptic ulcer mortality and cumulative cigarette consumption it is concluded that changing smoking habits were not responsible for the birth cohort patterns of the death rates from gastric and duodenal ulcer. PMID:3792919
Cursorial ground birds are paragons of bipedal running that span a 500-fold mass range from quail to ostrich. Here we investigate the task-level control priorities of cursorial birds by analysing how they negotiate single-step obstacles that create a conflict between body stability (attenuating deviations in body motion) and consistent leg force–length dynamics (for economy and leg safety). We also test the hypothesis that control priorities shift between body stability and leg safety with increasing body size, reflecting use of active control to overcome size-related challenges. Weight-support demands lead to a shift towards straighter legs and stiffer steady gait with increasing body size, but it remains unknown whether non-steady locomotor priorities diverge with size. We found that all measured species used a consistent obstacle negotiation strategy, involving unsteady body dynamics to minimise fluctuations in leg posture and loading across multiple steps, not directly prioritising body stability. Peak leg forces remained remarkably consistent across obstacle terrain, within 0.35 body weights of level running for obstacle heights from 0.1 to 0.5 times leg length. All species used similar stance leg actuation patterns, involving asymmetric force–length trajectories and posture-dependent actuation to add or remove energy depending on landing conditions. We present a simple stance leg model that explains key features of avian bipedal locomotion, and suggests economy as a key priority on both level and uneven terrain. We suggest that running ground birds target the closely coupled priorities of economy and leg safety as the direct imperatives of control, with adequate stability achieved through appropriately tuned intrinsic dynamics. PMID:25355848
Birn-Jeffery, Aleksandra V.; Hubicki, Christian M.; Blum, Yvonne; Renjewski, Daniel; Hurst, Jonathan W.; Daley, Monica A.
Cursorial ground birds are paragons of bipedal running that span a 500-fold mass range from quail to ostrich. Here we investigate the task-level control priorities of cursorial birds by analysing how they negotiate single-step obstacles that create a conflict between body stability (attenuating deviations in body motion) and consistent leg force-length dynamics (for economy and leg safety). We also test the hypothesis that control priorities shift between body stability and leg safety with increasing body size, reflecting use of active control to overcome size-related challenges. Weight-support demands lead to a shift towards straighter legs and stiffer steady gait with increasing body size, but it remains unknown whether non-steady locomotor priorities diverge with size. We found that all measured species used a consistent obstacle negotiation strategy, involving unsteady body dynamics to minimise fluctuations in leg posture and loading across multiple steps, not directly prioritising body stability. Peak leg forces remained remarkably consistent across obstacle terrain, within 0.35 body weights of level running for obstacle heights from 0.1 to 0.5 times leg length. All species used similar stance leg actuation patterns, involving asymmetric force-length trajectories and posture-dependent actuation to add or remove energy depending on landing conditions. We present a simple stance leg model that explains key features of avian bipedal locomotion, and suggests economy as a key priority on both level and uneven terrain. We suggest that running ground birds target the closely coupled priorities of economy and leg safety as the direct imperatives of control, with adequate stability achieved through appropriately tuned intrinsic dynamics. PMID:25355848
Birn-Jeffery, Aleksandra V; Hubicki, Christian M; Blum, Yvonne; Renjewski, Daniel; Hurst, Jonathan W; Daley, Monica A
Solanum nigrum, an herbal plant which is recommended in ayurveda for the management of gastric ulcers. Therefore, the purpose of the study was to investigate the antiulcer effect of Solanum nigrum fruits extract (SNE) on cold restraint stress (CRU), indomethacin (IND), pyloric ligation (PL) and ethanol (EtOH) induced gastric ulcer models and ulcer healing activity on acetic acid induced ulcer
Mallika Jainu; Chennam Srinivasulu Shyamala Devi
Mycolactone Diffuses into the Peripheral Blood of Buruli Ulcer Patients - Implications: Mycobacterium ulcerans, the causative agent of Buruli ulcer (BU), is unique among human pathogens in its candidate target for diagnosis and disease monitoring. Whether mycolactone diffuses from ulcerated lesions
...Information Request on Chronic Venous Ulcers Treatments AGENCY: Agency for Healthcare...submissions from manufacturers of chronic venous ulcer treatment medical devices. Scientific...solicited to inform our Chronic Venous Ulcers: A Comparative Effectiveness Review...
Understanding the degree of leg stiffness during human movement would provide important information that may be used for injury prevention. In the current study, we investigated bilateral differences in leg stiffness during one-legged hopping. Ten male participants performed one-legged hopping in place, matching metronome beats at 1.5, 2.2, and 3.0 Hz. Based on a spring-mass model, we calculated leg stiffness, which is defined as the ratio of maximal ground reaction force to maximum center of mass displacement at the middle of the stance phase, measured from vertical ground reaction force. In all hopping frequency settings, there was no significant difference in leg stiffness between legs. Although not statistically significant, asymmetry was the greatest at 1.5 Hz, followed by 2.2 and 3.0 Hz for all dependent variables. Furthermore, the number of subjects with an asymmetry greater than the 10% criterion was larger at 1.5 Hz than those at 2.2 and 3.0 Hz. These results will assist in the formulation of treatment-specific training regimes and rehabilitation programs for lower extremity injuries. PMID:23462443
Hobara, Hiroaki; Inoue, Koh; Kanosue, Kazuyuki
We compared the rate of perceived exertion for respiratory (RPE,resp) and leg (RPE,legs) muscles, using a 10-point Borg scale, to their specific power outputs in 10 healthy male subjects during incremental cycle exercise at sea level (SL) and high altitude (HA, 4559 m). Respiratory power output was calculated from breath-by-breath esophageal pressure and chest wall volume changes. At HA ventilation was increased at any leg power output by ? 54%. However, for any given ventilation, breathing pattern was unchanged in terms of tidal volume, respiratory rate and operational volumes of the different chest wall compartments. RPE,resp scaled uniquely with total respiratory power output, irrespectively of SL or HA, while RPE,legs for any leg power output was exacerbated at HA. With increasing respective power outputs, the rate of change of RPE,resp exponentially decreased, while that of RPE,legs increased. We conclude that RPE,resp uniquely relates to respiratory power output, while RPE,legs varies depending on muscle metabolic conditions. PMID:21435397
Aliverti, A; Kayser, B; Lo Mauro, A; Quaranta, M; Pompilio, P; Dellacà, R L; Ora, J; Biasco, L; Cavalleri, L; Pomidori, L; Cogo, A; Pellegrino, R; Miserocchi, G
Both spatial and temporal variation in environmental conditions can favour intraspecific plasticity in animal form. But how precise is such environmental modulation? Individual Balanus glandula Darwin, a common northeastern Pacific barnacle, produce longer feeding legs in still water than in moving water. We report here that, on the west coast of Vancouver Island, Canada, the magnitude and the precision of this phenotypic variation is impressive. First, the feeding legs of barnacles from protected bays were nearly twice as long (for the same body mass) as those from open ocean shores. Second, leg length varied surprisingly precisely with wave exposure: the average maximum velocities of breaking waves recorded in situ explained 95.6-99.5% of the variation in average leg length observed over a threefold range of wave exposure. The decline in leg length with increasing wave action was less than predicted due to simple scaling, perhaps due to changes in leg shape or material properties. Nonetheless, the precision of this relationship reveals a remarkably close coupling between growth environment and adult form, and suggests that between-population differences in barnacle leg length may be used for estimating differences in average wave exposure easily and accurately in studies of coastal ecology. PMID:11600079
Arsenault, D J; Marchinko, K B; Palmer, A R
Peptic ulcer occurs with different frequencies in the three main racial groups in Singapore. This study aimed firstly to determine the prevalence of Helicobacter pylori in peptic ulcer and non-ulcer dyspepsia patients of the different races and secondly, to assess the relation between H pylori, histological gastritis, patient diagnosis, and race. Gastric antral biopsy specimens from 1502 patients undergoing gastroduodenoscopy were studied and 892 (59%) were positive for H pylori. H pylori was strongly associated with gastritis: 873 of 1197 (73%) patients with gastritis were positive compared with 19 of 305 (6%) without gastritis (p less than 0.0001). The prevalences of H pylori and gastritis were similar in peptic ulcer patients of different races. Malay patients with non-ulcer dyspepsia, however, were less likely to be positive for H pylori (10 of 46 (22%] or to have antral gastritis (17 of 46 (37%] than Chinese (292 of 605 (48%) were positive for H pylori and 421 of 605 (70%) had gastritis) and Indians (35 of 61 (57%) were H pylori positive and 42 of 61 (69%) had gastritis). Patients with duodenal ulcer were more likely to be positive for H pylori than those with non-ulcer dyspepsia, even when subjects with gastritis were considered separately. While our results do not help to explain the observed racial differences in peptic ulcer frequency it may be that the pathophysiology of non-ulcer dyspepsia is different in the different races in Singapore. PMID:2387503
Kang, J Y; Wee, A; Math, M V; Guan, R; Tay, H H; Yap, I; Sutherland, I H
The epidemics we have observed, were due to the presence and growth in the frogs of Bacillus hydrophilus fuscus. This was proved by recovering the bacillus in pure culture from the body fluids of frogs sick or dead of the disease, and the inoculation of healthy frogs with an emulsion of the pure culture, and by obtaining the same clinical picture and pathological findings as in the original diseased frogs; and, finally, by recovering the bacillus in pure culture from frogs inoculated and sick or dying as a result of the inoculation. The disease is widely distributed throughout North America and Europe, and in this country and Canada is known as "red-leg." It has been observed by us chiefly in the warm weather of September and October. The disease is characterized by congestion of the ventral surfaces of the body, with more or less ulceration in, and hæmorrhage beneath, the skin, bloating due to serous exudation into the lymph sacs, gradual failure to respond to stimuli, which symptoms are followed by coma and death, the last being occasionally preceded by tetanic seizures. After death hæmorrhages into the muscles and degenerative changes in the muscles, spleen, liver, and, to a slight degree, in the intestinal tract, are found. The blood shows an advanced degree of anæmia and leucocytosis. Predisposing causes of the disease are lesions of the skin, which seem to be the usual portal of entry of the infection, and lowered resistance from heat and from anæmia. By a series of controlled experiments with inoculated frogs we have shown that, while temperatures a little above freezing have no harmful effect upon the frogs, they completely control all manifestations of the disease in inoculated or diseased frogs, if the frogs are left in the cold for a period as long as seven days; and, further, that even short periods in the cold chamber will bring about a delay of the fatal results in diseased or inoculated frogs. The anæmia so often found in apparently healthy frogs seems in many cases to be due to the presence in the lungs of the frog of a parasite, the Distomum cylindraceum, which, occurring in sufficiently large numbers in an individual frog, is capable of materially diminishing the available supply of red corpuscles. Severe laking of the blood, the presence of numerous isolated red-cell nuclei, and great diminution in the number, or almost total absence of the red cells in the diseased frogs, are in proportion to the severity of the infection and due to bacterial action. The presence of the hæmatozoan parasite, the Drepanidium, does not play any part as a predisposing or exciting cause of the disease. The ascarid Rhabdomena nigrovenosum, although frequently present as a parasite in the lungs of the frogs, plays no part in causing or promoting the disease. PMID:19866986
Emerson, Haven; Norris, Charles
In this paper, the problem of determining optimal booking policy for multiple fare classes in a pool of identical seats for multi-leg flights is considered. For large commercial airlines, efficiently setting and updating seat allocation targets for each passenger category on each multi-leg flight is an extremely difficult problem. This paper presents static and dynamic policies of allocation of airline seats for multi-leg flights with multiple fare classes, which allow one to maximize an expected contribution to profit. The dynamic policy uses the most recent demand and capacity information and allows one to allocate seats dynamically with anticipation over time. A numerical example is given.
Nechval, Nicholas A.; Rozite, Kristine; Strelchonok, Vladimir F.
This report summarizes technical information gained from an investigation into utilizing SMA actuators as muscle components for the biologically based lobster system to be developed under this project. In order for the SMA actuators to be of value in controlling leg motion of the lobster they must be able to contract and relax in a controlled manner much like muscles. SMA wires made of Nitinol do contract when heated and relax when cooled. The heating mechanism in this application is directly related to current density passed through the wire. If a large number of cycles are required, as in our application, the contraction should be limited to about 3 percent. This can provide a cycle life of millions provided that proper protection from overstressing, overstraining, and overheating are designed into the system. SMA contraction time can be quite fast (0.1 seconds or less) depending on the current pulse amplitude and width. SMA wires are very strong relative to their size. A 4 percent contraction can exert stresses of 25,000 psi. Control of each actuator requires that current pulses of proper amplitude and duration be applied at the correct times in order to not overheat the wires. Proper control of SMA wires for this application will require sensory feedback.
Jalbert, Jim; Ayers, Joseph
Augmentation is the main complication of long-term dopaminergic treatment of restless legs syndrome (RLS). Although augmentation was first described in 1996 and is characterized by an overall increase in severity of RLS symptoms (earlier onset of symptoms during the day, faster onset of symptoms when at rest, spreading of symptoms to the upper limbs and trunk, and shorter duration of the treatment effect), precise diagnostic criteria were not established until 2003. These criteria were updated in 2007 to form a new definition of augmentation based on multicenter studies. Augmentation should be differentiated from early morning rebound, natural progression of the disease, tolerance, and neuroleptic-induced akathisia. Treatment strategies will depend on the degree of clinical significance but will be based on the use of longer-acting drugs and a reduction or substitution of the dopaminergic agents. The most effective preventive measure is to keep the dose of the dopaminergic medication as low as possible, ensuring that it does not exceed the dose recommended by regulatory authorities. RLS augmentation needs to be treated only if it is clinically relevant-that is, if it has a significant impact on the patient's daily activities. Mild cases should be followed closely, however. In severe cases, a change of treatment (sometimes even within the same class of drugs) can be effective, although before taking this step, it should be verified that all factors that may affect augmentation (changes in lifestyle, iron deficiency, serotonin reuptake inhibitors) have been excluded. PMID:19744398
Williams, Anne-Marie; Garcia-Borreguero, Diego
Dopaminergic agents are the first-line treatment of restless legs syndrome (RLS), and have been used for the treatment of this disorder since the 1980s. The major issue with this class of drugs is augmentation of RLS symptoms during treatment. The first report of augmentation found an occurrence among 73% of patients treated with levodopa. Subsequent studies have reported somewhat lower incidences, but augmentation remains a clinically significant issue with all dopaminergic agents. It was not until 2007 that an operational, empirical definition of augmentation (Max Planck Institute Criteria) was made. This late development and the fact that studies have not been specifically designed to assess augmentation, have made it particularly difficult to compare the incidence rates for the different RLS treatments. As the primary neural and molecular substrates underlying idiopathic RLS are not known, the pathophysiology of augmentation remains unclear, however there are several hypotheses that concern the role of dopaminergic hyperstimulation, of iron deficiency, the genetic component, the effect of a reduction in responsiveness of tubero-infundibular dopamine receptors, and the role of chronobiotic mechanisms. RLS is treated by maintaining low doses of dopaminergic agents and ensuring iron sufficiency. Non-dopaminergics and opiates can be used when patients experience augmentation with more than one dopaminergic agent. PMID:20219397
García-Borreguero, Diego; Williams, Anne-Marie
This patent describes a tension leg platform, comprising: a foundation element secured to an ocean bottom location; a plurality of elongate, substantially vertical tethers, each of the tethers having a lower end secured to the foundation element and an upper end which reaches a position a preselected vertical distance below the ocean surface; a buoyant hull positioned at the ocean surface above the tethers, the hull having a free floating draft which is less than the preselected vertical distance, whereby the tethers can be preinstalled and the hull can subsequently be positioned over the tethers without interference between the tethers and the hull, the hull defining a plurality of recesses extending vertically upward into the hull from a lower surface of the hull; a plurality of rigid tether extenders, each positioned within a corresponding one of the recesses; means for controllably fixing the vertical position of each tether extender within the corresponding one of the recesses; and means for connecting and disconnecting each tether extender to the corresponding one of the tethers while the corresponding tether is secured to the foundation element.
All animals capable of legged locomotion execute fast, adaptive compensatory movements in response to perturbation of a step cycle. In terms of motor control, such adaptive behaviour typically involves changes in the kinematics of the perturbed limb as well as changes in coordination between legs. Moreover, the unpredictable variety of real life situations implies that compensatory responses should be sensitive to the behavioural context of the animal. We have investigated the extent to which the compensatory response of a walking stick insect (Carausius morosus) adapts in parallel to strong context-dependent adaptation of step kinematics and inter-leg coordination. The behavioural contexts we chose were straight walking and visually induced curve walking, for both of which the steady state limb kinematics and inter-leg coupling strengths were known. In case of curve walking, we further distinguished contexts according to whether the inner or the outer leg was perturbed. The three contexts differed strongly with respect to the set of joint actions before perturbation. Upon mechanical perturbation of front leg protraction, we studied context-dependent differences in a local avoidance reflex of the perturbed leg, as well as in coordination mechanisms that couple the step cycles of the perturbed leg to its unperturbed neighbours. In all three walking contexts, obstacle contact caused an avoidance movement of the front leg that deviated from the unperturbed swing trajectory. Swing duration was increased while step distance was decreased; however, both effects vanished in the subsequent unperturbed step. The prevailing immediate reaction of the three leg joints were retraction of the coxa (>76%), levation of the femur (>80%), and flexion of the tibia (>80%), regardless of the behavioural context and, therefore, joint action prior to perturbation. Moreover, activation of each one of these joint actions was shown to be independent of the other two. Thus, local avoidance reflexes are not modulated by the descending visual information that causes transition from straight to curve walking, but are composed of context-independent joint actions. Perturbation of the front leg also caused significant shifts of the touch-down position of the perturbed leg and of its unperturbed neighbours. If the inner front leg was perturbed, this shift could persist until the subsequent step. Perturbation affected both the spatial location and the timing of touch-down and lift-off transitions in unperturbed neighbouring legs. These effects on inter-leg coordination were context-dependent. For example, time delay to lift-off of the contralateral neighbour was shortened in inner and straight walking legs, but not in outer legs. Finally, a targeting mechanism that determines foot placement in stick insects was shown to be affected by perturbation in a context-dependent manner. We conclude that the immediate compensatory response of the perturbed leg is not adapted to the behavioural context in spite of strongly differing step kinematics, whereas the compensatory effect on inter-limb coupling is context-dependent. PMID:16709921
Ebeling, Wiebke; Dürr, Volker
Patient: Female, 60 Final Diagnosis: Corneal ulceration Symptoms: Blurred vision Medication: Abatacept Clinical Procedure: — Specialty: Ophthalmology Objective: Management of emergency care Background: To report a case of a patient with rheumatoid arthritis (RA) and associated peripheral corneal ulceration. Case Report: A 60-year-old woman with RA diagnosed 15 years ago, under immunosuppressive therapy (IV abatacept 250 mg/month), demonstrated blurring of vision in her RE (right eye). Visual acuity was 6/10 in the RE and 10/10 in the LE. Slit lamp examination revealed a paracentral superior corneal melt in the RE. Anterior chamber reaction was 2+. Laboratory investigations revealed positive anti-Ro and anti-La, anti-Extractable Nuclear Antigens (anti-ENA, ELISA), while anti-Sm, anti-Rnp, anti-Jo1 and anti-Scl70 were found negative. IgG and IgA serum immunoglobulins were found elevated, but IgE and IgM were within normal levels. Further evaluation for the underlying disease revealed highly elevated rheumatoid factor and C-reactive protein. The patient, who had been receiving anti-TNF during the last 6 months, underwent treatment with topical tobramycin and lubricants and oral prednisone 60 mg/day with tapering doses, to which methotrexate p.os. 15 mg/week was added. The condition improved within a few days after the initiation of prednisone treatment. Re-epithelization occurred 1 week after the onset of the immunosuppressive treatment. Only punctate fluorescein dye uptake was detected in the margins of the lesion. Conclusions: The effective control of the underlying disease and early diagnosis of the dry eye syndrome in RA patients may prevent serious corneal complications such as corneal ulceration. The initiation of treatment with steroids and immunosuppresants was found to halt the progression of keratolysis, and assisted re-epithelization. PMID:23986797
Karampatakis, Vasileios; Konidaris, Vasileios; Michailidou, Maria; Gerofotis, Antonios; Daniilidis, Michail
A Mediterranean Spanish woman, aged 56 years and in good health, presented with a nodule above her upper lip, which had rapidly evolved to central ulceration with crusting. As part of the work-up, samples were taken for microbiological and histopathological investigation. At the follow-up appointment the lesion had almost disappeared and a small fibrotic area of scarring remained. The diagnostic procedure to distinguish between localised cutaneous leishmaniasis and keratoacanthoma, both characterised by rapidly growing nodules on the face, is presented in this case-based article. PMID:25114993
Molina-Levya, Alejandro; Crespo-Lora, Vicente; Ruiz-Carrascosa, Jose; Naranjo-Sintes, Ramon
Cutaneous metastasis from an internal organ malignancy is rare and as, the presenting sign of malignancy is an uncommon phenomenon. Their presence, signals a poor prognosis. We report a case of 50-year-old female who was referred to sexually transmitted diseases - out patient department, with complaints of multiple genital ulcers to rule out sexually transmitted infections. After thorough evaluation, she was found to be a case of carcinoma cervix with metastatic squamous cell carcinomatous deposits on external genitalia. This case was unique because of relatively asymptomatic nature of internal malignancy and atypical presentation of carcinoma cervix as cutaneous metastasis. PMID:24958986
Vasuki, S.; Durgalakshmi, J.; Latha, J.
Documented cases of malignant transformation of foot ulcer in a diabetic patient in medical literature are very few. This study presents 2 interesting cases of long-standing diabetic foot ulcer, which were subsequently diagnosed to have squamous cell carcinoma on histopathological examination.
S. Panda; Seema Khanna; S. K. Singh; S. K. Gupta
This study is an attempt to determine whether ulcer patients in psychotherapy exhibit personality trends measurably different from those of neurotic patients in psychotherapy. The research was suggested by previous reports in which ulcer patients, in contrast to normal or other psychosomatic patients, were said to have a specific psychological conflict or to comprise a special personality type. The present
The United States has seen an increase in management of pressure ulcers in extended care. The experiences of an expert wound care nurse providing consultation in an extended care facility are described. As a result of this consultation and implementation of protocols, pressure ulcer prevalence rate decreased from 12% to 4%. PMID:7582341
An adaptation of a clinical study of 130 patients at risk of developing a pressure ulcer on the heels was performed using Canadian costs. The aim of the study was to compare the cost effectiveness of a specially shaped hydrocellular dressing (Allevyn Heel) versus that of a protective heel bandage (Soffban and gauze) in pressure ulcer prevention over an 8-week period. PMID:19873692
Torra I Bou, Joan-Enric; Rueda López, Justo; Camañes, Gemma; Herrero Narváez, Elias; Blanco Blanco, Joan; Ballesté Torralba, Jordi; Martinez-Esparza, Elvira Hernández; García, Lorena San Miguel; Soriano, José Verdú
Purpose To report on corneal ulceration in ocular graft-versus-host disease (GVHD). Methods This was a retrospective, observational case series investigating corneal ulceration and perforation in a cohort of ocular GVHD patients seen between June 2007 and October 2012. Results Four of 243 ocular GVHD patients developed corneal ulcerations attributable to ocular GVHD, and all four cases involved bilateral corneal ulceration. The median length of time from the diagnosis of ocular GVHD to the diagnosis of the first corneal ulceration was 317 days (range 168–434). The median length of time between the diagnosis of corneal ulceration in each patient’s first and second eye was 248 days (range 9–645). Outcomes varied from complete resolution with medical treatment to corneal perforation necessitating penetrating keratoplasty. In cases of corneal perforation, the median length of time from the diagnosis of corneal ulceration to perforation was 10 days (range 0–20). Common clinical features included: centrally or paracentrally located ulcerations and perforations, concomitant dry eye, and the use of topical or systemic corticosteroids. Conclusion Frequent follow-up and bilateral monitoring are highly recommended in cases of ocular GVHD-associated stromal thinning, as bilateral involvement or rapid progression to corneal perforation can occur. PMID:24204119
Stevenson, William; Shikari, Hasanain; Saboo, Ujwala S; Amparo, Francisco; Dana, Reza
Aim: To describe the clinical characteristics at presentation of a large cohort of patients with Mooren's ulcer in South India. Methods: The medical records of patients with Mooren's ulcer examined in the cornea clinic at Aravind Eye Hospital Madurai, Tamil Nadu, India, over a 10-year period were reviewed in this retrospective observational case series. Results: The cohort contained 242 eyes
Muthaiah Srinivasan; Michael E Zegans; Joseph R Zelefsky; Arunava Kundu; Thomas Lietman; John P Whitcher; Emmett T Cunningham Jr
Crohn's disease and ulcerative colitis are idiopathic, chronic, relapsing, inflammatory conditions that are immunologically mediated. Although their exact etiologies remain uncertain, results from research in animal models, human genetics, basic science and clinical trials have provided important new insights into the pathogenesis of chronic, immune-mediated, intestinal inflammation. These studies indicate that Crohn's disease and ulcerative colitis are heterogeneous diseases characterized
R Balfour Sartor
Various treatment policies and clinical disciplines compete for the treatment of bleeding peptic ulcer. In a prospective multicenter and interdisciplinary study performed during a 1-year period at ten hospitals in Düsseldorf, all patients admitted for peptic ulcer bleeding were recorded. The characteristics of patients admitted to surgical and to medical departments, the distribution of endoscopic treatment, indications for surgery, type
K. Thong; C. Ohmann; K. J. Hengels; M. Imhof; H.-D. Röher
The frequency of life events during the two years before an exacerbation of ulcer in a duodenal ulcer population was compared with the frequency of these events over the same time period in an age-sex matched probability sample of the community population. The mean number of events and the associated distr