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Legulcer is a leading cause of morbidity among older subjects, especially women in the Western world. About 400 years BC, Hippocrates wrote, “In case of an ulcer, it is not expedient to stand, especially if the ulcer be situated on the leg”. Hippocrates himself had a legulcer. The best treatment of any legulcer depends upon the accurate
Legulcers 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.
Venous disease and venous legulcers are frequently painful. The pain experienced may be constant or intermittent. Constant pain can originate from vascular structures (superficial, deep phlebitis), pitting edema, collagen (lipodermatosclerosis), infection, or scarring (atrophie blanche). Ulcer region pain is often episodic and may be due to surgical or other debridement procedures. Intermittent pain is often related to dressing removal or recent applications of new dressings. An approach to pain control will consider the cause of pain and utilize local measures, regional approaches to edema control, and systemic medication aimed at constant, episodic, or intermittent pain triggers. PMID:12856289
Legulcerations associated with livedoid vasculitis may undergo a benign or very serious course depending on the presence of underlying disease. The disease has fairly distinctive clinical and histopathologic features, and it should be considered in cases of ulcerations refractory to conventional treatment. Most of these cases may eventually heal after a long course of intermittent eruptions and ulcerations. However, in rare instances, the loss of limbs may be unavoidable. PMID:3889951
In 1837, Piorry, a French professor of medicine stated, "It is rather difficult to understand why the investigation of veins has been passed over almost in silence, while such a great diagnostic value has been attached to the investigation of arteries." Even today, our understanding of venous disease pales in comparison to our understanding of arterial disease. This is despite the fact that millions of Americans are afflicted with chronic venous insufficiency and hundreds of thousands suffer from debilitating lower extremity venous ulcers. A better understanding of the pathophysiology of venous disease is necessary to provide appropriate and efficient medical care for patients suffering from lower extremity venous ulcerations. PMID:14614698
Coexisting peripheral arterial disease is not uncommon (15 - 21 %) in patients with ulcera cruris primarily based on a venous etiology. Patient's history, clinical examination and detection of ABI as well as duplex scan will establish diagnosis of mixed arterial-venous ulcera. Clinical significance of coexisting arterial disease is often difficult to define and should be evaluated by a vascular specialist. The concept of treatment of mixed ulcers should always include the arterial component. Frequently peripheral arterial perfusion and healing can be improved by minimal invasive, endovascular revascularization. Compression therapy is the corner stone in treatment of venous disease and should be complemented by contemporary two piece graduated compression systems if ulcera are present. According to circumstances ablation of varicose veins must be considered. PMID:21360460
Six hundred patients with chronic legulcers 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
Sickle cell disease is a genetic disorder of hemoglobin synthesis leading to a deformation of the red blood cell. This disorder is associated with painful, slow-to-heal legulcers. This article discusses the wound bed preparation paradigm as a guide to the treatment of sickle cell-associated legulcers. PMID:22914039
Ladizinski, Barry; Bazakas, Andrea; Mistry, Nisha; Alavi, Afsaneh; Sibbald, R Gary; Salcido, Richard
Venous ulcers are the most common form of legulcers. Venous disease has a significant impact on quality of life and work productivity. In addition, the costs associated with the long-term care of these chronic wounds are substantial. Although the exact pathogenic steps leading from venous hypertension to venous ulceration remain unclear, several hypotheses have been developed to explain the
Isabel C. Valencia; Anna Falabella; Robert S. Kirsner; William H. Eaglstein
Background Identification of factors associated with healing can help in understanding the causes of delayed healing in chronic legulceration, and can allow for programmes to be developed to modify these factors to improve patient outcomes. Objectives To determine factors associated with healing in patients with chronic legulceration of all types within a defined patient population. Methods The patients were identified within the combined acute/community legulcer service within Wandsworth Primary Care Trust. All identified patients agreed to be interviewed and those who were able underwent clinical and noninvasive testing to determine the cause of the ulceration. Follow ups were to a maximum of 48 weeks, with time to healing given as the principal outcome measure. Analysis was by the Cox proportional hazards model for both univariate and multivariate analysis. Results were expressed as hazard ratio with 95% confidence intervals derived from the models. Results In total, 113 patients took part in this study. Univariate analysis revealed statistically significant differences for delayed healing according to the ulcer duration (P = 0.002), complexity of the ulcer aetiology (P = 0.035), presence of lipodermatosclerosis (P = 0.02), history of deep vein thrombosis (DVT) (P = 0.03) and thrombophlebitis (P = 0.03). Multivariate analysis showed that ulcer duration (P = 0.014), DVT (P = 0.008) and a lack of Pseudomonas on wound swab (P = 0.005) were independently associated with delayed healing. Conclusions The results indicate the complexity of determining risk factors for poor healing in patients with chronic legulceration. There appears to be little scope for interventions to improve healing from the factors identified. PMID:19785616
Moffatt, C J; Doherty, D C; Smithdale, R; Franks, P J
Family physicians often are the first contact for patients with venous legulcerations (VLUs). A random survey of 2,000 family physicians was conducted to determine patterns for diagnosis and treatment of VLUs, including type of legulcer (arterial, venous, diabetic), whether compression therapy was ordered, whether a Doppler system was available to aide in diagnosis, and which health care professional ultimately cared for the patient. Of the 325 family physicians who participated, 96% (311/325) see patients with VLUs, averaging 1.5 VLUs per week. Compression therapy is prescribed by 96% of family physicians, and 83% (259/325) refer these patients to other health care professionals. Only 27% (89/325) have a Doppler system in the office to measure the ankle-brachial index (ABI). These findings document for the first time in the United States the large number of patients with VLUs seen by family physicians. PMID:10326351
Opinion statement Selecting the appropriate treatment for venous legulcerations is essential for optimal wound healing and patient quality\\u000a of life. Compression therapy remains the mainstay of treatment for these wounds. Compression methods should be carefully selected\\u000a and tailored for compatibility with patients’ daily life. Pain management should not be neglected. When response to compression\\u000a therapy is limited, adjuvant therapy such
We report a case of legulceration occurring in a patient without mucosal ulcers, in whom nicorandil appeared to be the main aetiological factor. Having failed to heal on compression therapy, the ulcer rapidly improved and healed after the discontinuation of nicorandil. Most cases of nicorandil-induced ulcers reported in the literature develop on mucosal surfaces, including oral, vulval, perianal and peristomal ulcers. There are rare reports of cutaneous ulceration attributable to nicorandil, occurring concurrently with mucosal ulcers. To our knowledge, this is the first case of nicorandil-induced legulceration affecting the skin without mucosal involvement. PMID:21564175
Low energy laser therapy (LELT) was used to treat chronic legulcers. Seven patients, aged 59 to 96 years, with 11 legulcers 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
Jacqui Telfer; Natalia Filonenko; Norman M. Salansky
OBJECTIVE--To determine the effect of oxpentifylline on the healing of venous ulcers of the leg. DESIGN--Double blind, randomised, prospective, placebo controlled, parallel group study. SETTING--Four outpatient clinics treating legulcers in England and the Republic of Ireland. PATIENTS--80 Consecutive patients with clinical evidence of venous ulceration of the leg in whom appreciable arterial disease was excluded by the ratio of
M P Colgan; J A Dormandy; P W Jones; I G Schraibman; D G Shanik; R A Young
Summary Background: Current prevalence estimates of chronic legulceration are frequently based on studies from the 1980s. During the last decade, major changes have occurred in the application of evidence-based practice to this condition. Aim: To determine the prevalence and cause of legulceration in a defined geographical population after 8 years of providing standardized evidence based protocols of care.
C. J. Moffatt; P. J. FRANKS; D. C. DOHERTY; R. MARTIN; R. BLEWETT; F. ROSS
Background: Venous legulcer is a disease most common in those aged 65 years and older. However, the incidence and prevalence have not been well established. Objective: Our purpose was to estimate the prevalence and incidence of venous legulcers in the elderly. Methods: We studied the General Practice Research Database, validated our case ascertainment strategy, and estimated the annual
David J. Margolis; Warren Bilker; Jill Santanna; Mona Baumgarten
The management of venous legulcers is an important issue for many healthcare professionals. However, the care and management does not stop when the ulcer has healed. Prevention of recurrence and lifelong compression is an important issue that is often neglected. This article reviews the anatomy and physiology of the venous system, investigates the causes of venous legulcers and describes the principles of graduated compression. Compression hosiery and its role in the treatment of varicose veins is also looked at as well as deep vein thrombosis and preventing recurrence of the venous legulcer. PMID:11261055
This study aimed to explore the relationship between pain mechanism, pain intensity, and legulcer characteristics using a 6-month longitudinal cohort study in a community setting in the north of England. Patients with legulceration referred consecutively to district nurses were invited to participate (n=96). The main outcome measures were pain intensity using daily visual analogue scores, legulcer characteristics (etiology, size, location, duration), and LANSS (Leeds Assessment of Neuropathic Symptoms and Signs). Results suggested that type, duration, position, and size of the legulcer had no effect on average daily pain scores. Using the LANSS questionnaire, 43.5% of respondents reported symptoms suggestive of a neuropathic mechanism to their pain. Patients with neuropathic symptoms had higher average daily pain scores (p<0.001). Fewer people had healed ulcers at 6 months with neuropathic symptoms compared with those with no neuropathic symptoms (30.8 vs. 52.1%). It would seem that the severity of pain can not be predicted by the type, size, position, or duration of ulceration. Patients who scored positively for neuropathic symptoms had higher average daily pain scores and fewer had healed legulcers at 6 months compared with those who did not experience neuropathic signs and symptoms. PMID:17352749
Briggs, Michelle; Bennett, Michael I; Closs, S José; Cocks, Kim
Martorell hypertensive ischemic legulcer represents rapidly progressive and extremely painful ulcers that are frequently underdiagnosed. These occur most commonly on the lateral-dorsal calf and are associated with hypertension and diabetes. This article will synthesize a review of the literature for the accurate diagnosis and treatment of this painful debilitating condition. PMID:23151767
Alavi, Afsaneh; Mayer, Dieter; Hafner, Jürg; Sibbald, R Gary
INTRODUCTION Most legulcers are vascular based. Only if vascular therapy fails other causes are considered. We report the case of a female with incapacitating legulcers 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 legulcers 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.
van Rijssen, L.B.; Brenninkmeijer, E.E.A.; Nieveen van Dijkum, E.J.M.
OBJECTIVE: To estimate the clinical and cost effectiveness of compression systems for treating venous legulcers. 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 legulcers. 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 legulcers 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 legulcers.
OBJECTIVE--To determine the effect of oxpentifylline on the healing of venous ulcers of the leg. DESIGN--Double blind, randomised, prospective, placebo controlled, parallel group study. SETTING--Four outpatient clinics treating legulcers in England and the Republic of Ireland. PATIENTS--80 Consecutive patients with clinical evidence of venous ulceration of the leg in whom appreciable arterial disease was excluded by the ratio of ankle to brachial systolic pressure being greater than 0.8. INTERVENTIONS--All patients received either oxpentifylline 400 mg three times a day by mouth or a matching placebo for six months (or until their reference ulcer healed if this occurred sooner) in addition to a locally standardised method of compression bandaging. MAIN OUTCOME MEASURES--The primary end point was complete healing of the reference ulcer within six months. The secondary end point was the change in the area of the ulcer over the six month observation period. RESULTS--Complete healing of the reference ulcer occurred in 23 of the 38 patients treated with oxpentifylline and in 12 of the 42 patients treated with a placebo. Life table analysis showed that the proportion of ulcers healed at six months was 64% in the group treated with oxpentifylline compared with 34% in the group treated with a placebo (log rank test chi 2 = 4.78, p = 0.03), which was significant (odds ratio = 1.81, 95% confidence interval 1.20 to 2.71). CONCLUSION--Oxpentifylline used in conjunction with compression bandaging improves the healing of venous ulcers of the leg.
Colgan, M P; Dormandy, J A; Jones, P W; Schraibman, I G; Shanik, D G; Young, R A
A number of legulcer specialist/tissue viability specialists from across the UK were invited to evaluate PICO (Smith and Nephew, Hull) as a treatment for venous legulcers also in conjunction with a variety of compression bandages and garments. Patients across 5 sites had PICO applied in conjunction with compression therapy. This group of treating clinicians were then asked to give feedback on the outcome of the patients on whom they had used the new device. All feedback was recorded at a meeting and this was used to create a guideline for use. PMID:24156166
Objectives: The management of intractable legulcers requires a team approach which includes vascular surgeons and plastic surgeons. We retrospectively reviewed the results of the management of intractable legulcers by plastic surgeons. Patients and Methods: A total of 73 patients with intractable legulcers, (79 limbs) were treated at the Department of Plastic Surgery at our institution. Skin perfusion pressure (SPP) around the ulcer on the limb was measured before and after arterial reconstructive procedures. Local ulcer management involved intra-wound continuous negative pressure and irrigation therapy or negative pressure wound therapy. We examined the rates of wound healing and associated prognostic factors. Results: There were 21 limbs without ischemia (non-peripheral arterial disease [Non-PAD] group) and 58 limbs with ischemia (PAD group). The healing rates were 66% in the PAD group and 81% in the Non-PAD group, but the difference between the groups was not significant. A total of 41 limbs in the PAD group underwent revascularization, which involved bypass surgery in 18 limbs and endovascular therapy in 23 limbs. The salvage rate of the revascularized limbs was 83% at 1 year. The primary patency rates at 1 year were 87% for bypass surgery and 58% for endovascular therapy. The healing rate of the revascularized limbs was 66%, and the presence of concomitant hemodialysis, infected ulcers, and limbs without improved SPP were shown to be poor prognostic factors. Limbs treated with bypass surgery had a better healing rate than limbs treated with endovascular therapy, but the difference was not significant. Conclusion: Good ulcer-healing rates were achieved by effective revascularization and aggressive local management. These results suggest that a team approach is useful for the management of intractable legulcers. (English translation of Jpn J Vasc Surg 2011; 20: 913-920)
Legulcers 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 legulcers 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 legulcers. Providers reported a total of 185 patients with active legulcers 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 legulcers 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
Objectives: The objectives of this study were to (1) determine how congruent community-provided legulcer care was with best practice for venous legulcers and (2) identify organizational and clinical factors associated with the provision of best practice for venous legulcers. 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
Chronic legulcers are typically wounds that do not heal at a normal rate. Impaired healing appears to be due to primary microvascular changes and it is aggravated by ongoing bacteria-driven vasculitis. The various cytokines identified in experimental wounds are also present in legulcers. VEGF is strongly implicated as a promoter of blood vessel growth in patients with venous disease. In addition, there is good evidence of increased expression of bFGF, TGF-beta1, and PDGF in lipodermatosclerosis. All of these growth factors are involved in wound healing. Upregulated TGF-beta1 is probably one of the main causes of the fibrosis observed in lipodermatosclerosis. In legulcers, cytokines appear to be trapped in the perivascular fibrinoid deposits. It is not the nature and amount of cytokines that are inadequate in legulcers, but rather their spatial distribution. Dermal dendrocytes (DD) are resident factor XIIIa-enriched macrophages. They likely play a role in tissue repair when boosted adequately. New therapies aiming at helping the release of cytokines by DD apparently promote and improve the healing phase. PMID:12632091
Low energy laser therapy (LELT) was used to treat chronic legulcers. Seven patients, aged 59 to 96 years, with 11 legulcers 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.
Werner syndrome (WS; MIM#277700) or adult progeria, is a rare disease, associated with mutations of a single gene (RECQL2 or WRN), located on chromosome 8 (8p12). It codes a DNA-helicase, whose defects cause genomic instability. The highest incidences are reported in Japan and Sardinia (Italy). On this major island of the Mediterranean Basin, the WS cases have been observed in the northern areas. The authors describe the apparently first case reported in southern Sardinia, a 51-year-old woman, who was born in and resides in the province of Cagliari. She presented with a 9-year history of an intractable legulcer and other characteristic symptoms, including "bird-like" face, high-pitched voice, premature greying, short stature, abdominal obesity in contrast with thin body type, scleroderma-like legs, decreased muscle mass, diabetes, atherosclerosis, and premature menopause. A specialized genetic Institute of Research (IRCCS-IDI, Rome) confirmed the clinical diagnosis. There is no cure or specific treatment and patients must be periodically screened for an increased risk of cardiovascular and cerebrovascular disease and malignancies. Among the many findings, legulcers significantly affect the patient's quality of life. This problem may send the patient to the dermatologist, who finally suspects the diagnosis. Poor response to medical treatment may require aggressive repeated surgery, with poor or temporary results. PMID:23552003
Fumo, Giuseppe; Pau, Monica; Patta, Federico; Aste, Nicola; Atzori, Laura
Chronic legulcers are a debilitating complication of sickle cell disease, associated with increased morbidity and perhaps mortality that affect 8 to 50% of patients. We evaluated the characteristics of SCD patients with a history of legulceration, including hemolytic rate, estimated pulmonary artery systolic pressure, and other parameters in a cohort of 505 adults with SCD. Ninety four subjects (18%) had either active ulcers at enrollment or history of legulceration. Patients affected were older and predominantly had homozygous SS, lower body mass index, and pulse oximetry, higher tricuspid regurgitation velocities, markers of hemolysis, serum uric acid and serum NT-proBNP, when compared to subjects without such history. In this prospective cohort of adults with SCD, we confirm that legulcers are still frequent and are associated with elevated TRVand markers of hemolysis. We describe a novel association of legulcer with hyperuricemia and oxygen desaturation and suggest potential implications for uric acid as a marker of vascular dysfunction.
Minniti, Caterina P.; Taylor, James G.; Hildesheim, Mariana; O'Neal, Patricia; Wilson, Jonathan; Castro, Oswaldo; Gordeuk, Victor; Kato, Gregory J.
BACKGROUND: A systematic review was conducted to analyse journal articles that describe or measure the impact of legulceration on patients' quality of life (QoL) in order to improve the content of an educational programme that aims to enhance self-care agency in legulcer patients. METHOD: Original articles published in English and German between 1990 and 2006 were included if
Oliver R Herber; Wilfried Schnepp; Monika A Rieger
Background: Venous legulcers afflict a significant por- tion of the population. The most popular form of therapy for venous legulcers is a compression bandage (eg, Unna boot), a therapy that is frequently unsuccessful. Objective: To describe risk factors associated with the failure of a wound to heal when treated with a limb- compression bandage for 24 weeks. Design:
David J. Margolis; Jesse A. Berlin; Brian L. Strom
Venous legulcers represent a significant public health problem that will increase as the population ages. Numerous herbs and their extracts are potentially conducive to wound healing, including the ability to serve as an antimicrobial, antifungal, astringent, etc. A total of 32 patients with venous legulcers were randomized into two groups: a group with herbal therapy treatment (PT) (17 patients) and a control group (C) (15 patients). The investigation focused on five controls of parameter changes important for ulcer healing and the control of microbiological flora. Within-treatment analysis of the PT group showed that, following herbal therapy treatment, there was a significant decrease in the scores of surface legulcer and venous legulcer after week 7 of treatment (p < 0.05). In group C following topical antibiotic treatment there was no significant decrease in the surface legulcer. Comparing the results of decreased venous legulcer surface of the) PT group with the C group showed a significant difference at p < 0.05 after week 7 of treatment. The number of different types of isolated bacterial species decreased significantly (p < 0.05) after the use of herbal preparations. The results of this pilot study demonstrate the healing and antimicrobiological effects of herbal therapy on non-infected venous legulcer. PMID:19610037
We report a patient with a 6-year history of recalcitrant painful ulceration of both lower legs, diagnosed as being due to livedoid vasculitis. The lesions healed rapidly and remained healed on treatment with oral ketanserin. PMID:2638912
Non healing legulcers are becoming a major public health problem. The high prevalence of legulcer directly affects patients' quality of life because it produces psychological (anxiety, depression), social and physical (amputation) handicap. Most legulcers 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
Treatment of venous legulcers (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
STUDY OBJECTIVE--The aim was to establish legulcer point prevalence, basal patient characteristics, and level of caretaking. DESIGN--The study was a postal cross sectional survey. The validity was ensured by examining a randomly selected sample of reported patients. Responding health care officials were asked to report all patients with an open wound below knee (including foot ulcer) which did not
Legulceration is a debilitating condition which compromises the quality of life of the sufferer, owing to factors such as pain, exudate, odour and social isolation. As nurses, much of the daily care provided for such patients focuses on the provision of wound care; often failing to fully address the wide ranging effects that the ulceration is having on the life of the sufferer. This article reviews the quantitative studies that have explored the health-related quality of life of patients with chronic venous legulceration and presents a synthesis of their findings. PMID:20220639
This case study features a 37-year-old drug user with a chronic legulcer caused by injecting Heroin into his leg veins. The case study demonstrates collaborative working between two specialist services based in Leicester. This joint working and knowledge sharing has allowed for appropriate legulcer management in this erratic and vulnerable group of mainly young people. Many factors need to be taken into account when prescribing a dressing regimen for this group, and the successes and complications encountered are described. PMID:17551426
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 legulcers. A 72-year-old man presented with a rapidly progressing legulcer. 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
Patients living with chronic legulceration may frequently experience moderate to severe wound-related pain, which may not be alleviated by oral analgesics alone. Poorly controlled legulcer pain can prevent timely and effective wound management strategies being implemented, and increase wound healing times. Furthermore, patients with poorly controlled legulcer pain can experience continuous pain, which significantly affects quality of life. This case report introduces an innovative way of using the eutectic mixture of local anaesthetics (EMLA) 5% cream to reduce wound-related pain, reduce oral analgesic intake, and improve health-related quality of life for a patient with a painful, chronic lower legulcer. PMID:22886329
Legulcers are a frequent and serious complication of polycythemia vera (PV). They are caused by a synergic action of vascular, neurological and infectious physiopathologic mechanisms. Furthermore, cytostatic therapies commonly employed to control the myeloproliferative disease negatively interfere on the development of granulation tissue, slowing down the recovery of the ulcer. We describe the case of a 70 years old woman with PV, who had calcaneous and perimalleolar ulcers. They were so painful that they made it almost impossible for her to sleep and walk normally. These ulcers were particularly resistant to common topical therapy. Further and accurate investigations showed that these ulcers were a complication of hydroxycarbamide therapy employed and they were not a complication of the ematologic disease. Legulcers during hydroxycarbamide therapy are a relatively frequent but underestimated condition. Pathogenesis is bound to numerous factors, i.o. cellular damage and tissutal hypoxia, consequent of drug induced macroerythrosis. In our patient drug substitution and prosecution of topic therapies allowed the recovery of the legulcers, particularly serious for both, extensiveness and symptoms. PMID:20426925
Subfascial perforant veins dissection (SPVD) of the lower leg was performed in patients with chronic venous insufficiency CEAP class 5 and 6. 252 operations were performed in 236 patients. All patients had trophic lesions (skin hyperpigmentation and lipodermatosclerosis) 218 (92,4%) patients had trophic lower legulcer to the time of operation. 30 patients had earlier performed phlebectomy. Open SPVD was performed in 122 cases, endoscopic technique was used in 114 patients. Comparative analysis of these two methods was performed. Long-term results were accessed with the use of SF-36 questionnaire. Efficacy, pathogenetic validity and economic expedience of SPVD by large trophic lower legulcers are confirmed by the decrease of postoperative complications and recurrence rate. The horizontal venous reflux elimination and trophic ulcer dissection with intraoperative skin plasty allow a significant improvement of treatment results. PMID:20032933
OBJECTIVE--To evaluate the prognostic factors in uncomplicated venous legulcer healing. DESIGN--Randomised parallel group controlled trial with subjects stratified by initial ulcer diameter and four months' maximum duration of follow up. SETTING--Assessment at Northwick Park Hospital vascular unit with community based treatment. PATIENTS--200 patients with clinical and objective evidence of uncomplicated venous legulceration and an initial ulcer diameter > 2 cm. MAIN OUTCOME MEASURE--Time to complete healing of the ulcer. RESULTS--In the presence of graduated compression healing occurred more rapidly in patients with a smaller initial ulcer area (relative risk of healing 1.92 associated with halving of ulcer area (95% confidence interval 1.58 to 2.33)), shorter duration of ulceration (relative risk 1.35 associated with halving duration (1.17 to 1.56)), younger age (relative risk 1.34 associated with 10 year decrease (1.12 to 1.59)), and no deep vein involvement (relative risk 1.8 (1.19 to 2.78)). CONCLUSION--These prognostic factors used in a simple scoring system predict time to healing.
Skene, A. I.; Smith, J. M.; Dore, C. J.; Charlett, A.; Lewis, J. D.
Purpose: We assessed the etiology and the prevalence of peripheral arterial and venous disease in legulcers in patients with rheumatoid arthritis and systemic sclerosis and analyzed the outcome after treatment of macrovascular disease. Methods: A clinical study on 15 consecutive patients with chronic legulcers in collagen vascular disease (nine patients with rheumatoid arthritis, six patients with systemic sclerosis)
Jürg Hafner; Ernst Schneider; Günter Burg; Paolo C. Cassina
Venous legulcers are a prevalent nonhealing wound of the lower extremity. Although topically applied growth factors successfully improve wound repair in animal studies, similar studies on humans with venous legulcers have not been successful. This study was designed to evaluate the acute safety and biologic feasibility of peri-ulcer injection of a replication-incompetent adenoviral construct expressing platelet-derived growth factor-? (PDGF-?). In this phase I study, we demonstrate the initial safety, feasibility, and biologic plausibility of using H5.020CMV.PDGF-? to treat venous legulcer disease.
Margolis, David J; Morris, Lee M; Papadopoulos, Maryte; Weinberg, Linda; Filip, Jennifer C; Lang, Stephanie A; Vaikunth, Sachin S; Crombleholme, Timothy M
Vasculitic lesions are not generally associated with eosinophilic fasciitis. Eosinophilic fasciitis is reported to be a syndrome distinct from progressive systemic sclerosis (PSS). More recent studies, however, note overlapping features in the clinical, pathologic, and laboratory findings of eosinophilic fasciitis and scleroderma. We report a typical presentation of eosinophilic fasciitis that developed vasculitic-like legulcerations as seen in scleroderma. PMID:8467618
Wong, A L; Anderson-Wilms, N; Mortensen, S E; Colburn, K K
Myeloid sarcoma (MS) is an extramedullary tumour consisting of myeloblasts or immature myeloid cells located in an extramedullary site. It may occur at presentation of AML, at relapse, or prior to the onset of frank leukemia. We report a rare case of MS developing in prexisting Hydroxyurea-induced legUlcer in a 70-year-old woman.
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 (legulcer) 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
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
The cortex of Mimosa tenuiflora is a popular remedy utilized in Mexico for the treatment of skin lesions. Modern studies support the existence in this cortex of compounds with cicatrizing properties. In the present study the therapeutic effectiveness of an extract elaborated with this bark in the treatment of venous legulceration disease was explored. A randomized, double-blind, placebo-controlled clinical
Erika Rivera-Arce; Marco Antonio Chávez-Soto; Armando Herrera-Arellano; Silvia Arzate; Juan Agüero; Iris Angélica Feria-Romero; Angélica Cruz-Guzmán; Xavier Lozoya
Shewanella algae is an emerging seawater-associated bacterium. In immunocompromised patients, infections may result in bacteremia, osteomyelitis, and necrotizing fasciitis. Our patient, suffering from autoimmune vasculitis and myasthenia gravis, developed typical hemorrhagic bullae and legulcers because of S algae. She was treated efficiently with a combination of ciprofloxacin and piperacillin. PMID:23809079
Wagner, Nicola; Otto, Lisa; Podda, Maurizio; Schmitt, York; Tappe, Dennis
Chronic legulcers in patients with rheumatological diseases can cause significant morbidity. We performed a retrospective case review to describe the epidemiology, clinical features and outcome of chronic legulcers in this group of patients. Twenty-nine patients with underlying rheumatological conditions, namely, rheumatoid arthritis (15 patients), systemic lupus erythematosus (8 patients), overlap syndromes (3 patients), systemic sclerosis (1 patient) and ankylosing spondylitis (1 patient) were included. The ulcers were mostly located around the ankle (55·2%) and calves (37·9%). The predominant aetiology of the ulcers, in decreasing order of frequency, was venous disease, multifactorial, vasculitis or vasculopathy, infective, pyoderma gangrenosum, ischaemic microangiopathy and iatrogenic. Treatment modalities included aggressive wound bed preparation, compression therapy (17 patients), changes in immunosuppressive therapy (15 patients), hyperbaric oxygen therapy (4 patients) and cellular skin grafting (2 patients). Management of chronic legulcers in rheumatological patients is challenging and the importance of careful clinicopathological correlation and treatment of the underlying cause cannot be overemphasised. PMID:23237056
BackgroundIt is commonly reported that chronic venous disease (CVD) increases the skin iron content in which the excess is stored as haemosiderin. Despite increasing interest in the role of haemosiderin in venous ulceration, no study has systematically evaluated the occurrence of iron overload in the limbs of patients with CVD.
A. Caggiati; C. Rosi; A. Casini; M. Cirenza; V. Petrozza; M. C. Acconcia; P. Zamboni
Ulceration of the leg is often associated with significant consequences for both the individual and society. The diagnosis of chronic legulcer is not appropriate. Primary cutaneous diffuse large B-cell lymphoma (PCLBCL), leg type, is a distinct clinicopathological entity. Chemotherapy in the form of R-CHOP (rituximab, cyclophosphamide, hydroxydaunorubicin, Oncovin and prednisolone) is considered to be the first line of treatment for these lymphomas. We report a 69-year-old man who presented with chronic legulcer with a first negative biopsy and a diagnosis of PCLBCL, leg type, verified on the subsequent biopsy. This case report emphasises the importance of differential diagnosis of lymphoma in non-healing ulcers and also the value of repeat tissue biopsy in cases with a negative initial result but strong clinical suspicion. PMID:21944785
Khan, Junaid Alam; Usman, Farooq; Abbasi, Shaista; Shoab, Syed Sulaiman
Skin equivalents, consisting of a non-contracted collagen gel populated with allogeneic fibroblasts and covered with autologous cultured keratinocytes were used for grafting of venous legulcers. The results were compared in the same patient with those ob...
M. A. E. Mol B. P. Nanninga J. P. van Eendenburg W. Westerhof C. J. W. van Ginkel
Impaired wound healing is a feature of Werner's syndrome. Treatment of one such patient with painful chronic legulcers included topical application of PDGF-BB. Granulation increased slightly, enabling full-thickness skin grafting to take place. PMID:15575568
Wollina, U; Gruner, M; Koch, A; Köstler, E; Hubl, W; Hanson, N B; Oshima, J
Hepatitis C virus (HCV) is the major cause of cryoglobulinemia. Skin lesions are frequent and can be cured from the removal of cryoglobulins by therapeutic apheresis. We describe a case of HCV-positive type I cryoglobulinemia with severe legulcers, not responsive to antiviral and immunosuppressive treatment. Thirty sessions of double filtration plasmapheresis were performed, over a period of 6 months, with no other associated treatment. Before and after each session an assessment of immunoglobulins, complement, cryocrit, and fibrinogen was made. HCV RNA levels were determined in serum cryoprecipitate, supernatant before and after each session, and in the collection bag. No differences in pre and postapheresis values were observed in the serum concentrations and the supernatant, whereas the postapheresis cryoprecipitate showed a significantly reduced viral load (P < 0.02) as compared with the preapheresis values. There was improvement in the condition of ulcers in the leg during apheresis and had completely regressed by the end of the cycle. PMID:18484642
Ramunni, A; Lauletta, G; Brescia, P; Saliani, M T; Montrone, M; Chironna, M; Sansonno, D; Dammacco, F; Coratelli, P
Background Venous legulcers 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 legulcers 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 legulcers.
This article examines the issues that influence patients' concordance with legulcer treatment regimens and the effect this may have on quality of life. Nurses need to have a good understanding of the physical and psychosocial factors that affect patients' concordance with treatment and how any issues can be resolved to enable successful patient-professional partnership, effective care planning and delivery, and better patient outcomes. PMID:20701054
Necrobiotic xanthogranuloma is a progressive histiocytic granulomatous disease with frequent extracutaneous involvement. We have documented an unusual case of necrobiotic xanthogranuloma in a 58-year-old man with a history of recalcitrant and chronic arm and legulcerations in the absence of characteristic periorbital involvement. Our patient demonstrates a therapeutic challenge and may display a new necrobiotic inflammatory disorder not previously characterized. PMID:23222162
Ghiasi, Nazli; Alavi, Afsaneh; Coutts, Patricia M; Ghazarian, Danny; Sibbald, R Gary
Vasculitic legulcers are a cutaneous manifestation of hepatitis C virus (HCV) infection often associated with cryoglobulinemia. Their treatment is difficult and is based on steroids and immunosuppressive drugs with an erratic response and a high probability of adverse reaction. We report three patients with vasculitic legulcers associated with hepatitis C virus infection who were treated successfully with rituximab. The pain control and healing were achieved quickly. No adverse effects with rituximab in these patients were presented.
Bonilla-Abadia, Fabio; Echeverri, Andres F.; Izquierdo, Jorge H.; Canas, Felipe; Canas, Carlos A.
Chronic wounds, including diabetic foot ulcers, pressure ulcers and venous legulcers, represent a significant cause of morbidity in developed countries, predominantly in older patients. The aetiology of these wounds is probably multifactorial, but the role of bacteria in their pathogenesis is still unclear. Moreover, the presence of bacterial biofilms has been considered an important factor responsible for wounds chronicity. We aimed to investigate the laser action as a possible biofilm eradicating strategy, in order to attempt an additional treatment to antibiotic therapy to improve wound healing. In this work, the effect of near-infrared (NIR) laser was evaluated on mono and polymicrobial biofilms produced by two pathogenic bacterial strains, Staphylococcus aureus PECHA10 and Pseudomonas aeruginosa PECHA9, both isolated from a chronic venous legulcer. Laser effect was assessed by biomass measurement, colony forming unit count and cell viability assay. It was shown that the laser treatment has not affected the biofilms biomass neither the cell viability, although a small disruptive action was observed in the structure of all biofilms tested. A reduction on cell growth was observed in S. aureus and in polymicrobial biofilms. This work represents an initial in vitro approach to study the influence of NIR laser treatment on bacterial biofilms in order to explain its potentially advantageous effects in the healing process of chronic infected wounds. PMID:22182280
Purpose: The purpose of this study was to investigate the efficacy of subfascial endoscopy by use of a mediastinoscope in the identification and ligation of incompetent perforating veins in patients with venous ulceration of the lower leg.Methods: All patients who underwent subfascial endoscopy for venous ulceration between Jan. 1, 1994, and Mar. 1, 1995, at the Sint Franciscus Gasthuis in
We report on a 74-year-old female patient with a primary cutaneous CD20+, diffuse large cell B-cell lymphoma of the lower leg resembling a chronic non-healing legulcer. There was no evidence of systemic involvement on computed tomography (CT) scans of the chest, abdomen and pelvis; a slightly enlarged lymph node in the right groin showed dermatopathic lymphadenopathy on histology and immunohistochemistry. Involvement of the bone marrow and peripheral blood was ruled out by punch biopsy and fluorescent activated cell sorter (FACS) analysis of the blood, respectively. Therapeutic anti-CD20 monoclonal antibody rituximab was given at 375 mg m(-2) i.v. once weekly for 7 weeks, without adverse effects, resulting in a minor improvement in the centre of the ulcerated tumour. Unfortunately, the response was not maintained, and after 7 weeks of treatment the patient started to develop new tumour lesions at the border of the ulcer. Local radiotherapy was started and combined photon and electron beam irradiation induced complete remission of the B-cell lymphoma. PMID:11841383
Essential thrombocythemia (ET) is a clonal stem-cell disorder characterized by persistent thrombocytosis. Patients with ET and risk factors for thrombotic complications have been shown to benefit from cytoreductive therapy, the most common agent used being, hydroxycarbamide. Although this agent is usually well-tolerated, one of the recognized adverse effects is the development of legulcers. We undertook retrospective analysis of consecutive ET patients treated with hydroxcarbamide and identified several specific features for this complication including advanced age, female preponderance, reduced overall survival, tendency to develop future vascular events and intolerance to the second line agent, anagrelide. PMID:22196956
An 80-year-old man presented with painful legulceration due to steal phenomenon from a groin arteriovenous fistula (AVF) 10 years following a coronary angiogram. The diagnosis of the AVF was confirmed by duplex examination of the groin vessels which demonstrated characteristic flow pattern in the femoral arterial and venous system. Angiography further confirmed the site of the fistulous communication and this was managed by a covered stent graft. We discuss the incidence of AVF, risk factors for its development, relevant diagnostic investigations and management options along with strategies to reduce the incidence of AVF following percutaneous punctures.
Mylankal, Kurian J; Johnson, Brian; Ettles, Duncan F
An 80-year-old man presented with painful legulceration due to steal phenomenon from a groin arteriovenous fistula (AVF) 10 years following a coronary angiogram. The diagnosis of the AVF was confirmed by duplex examination of the groin vessels which demonstrated characteristic flow pattern in the femoral arterial and venous system. Angiography further confirmed the site of the fistulous communication and this was managed by a covered stent graft. We discuss the incidence of AVF, risk factors for its development, relevant diagnostic investigations and management options along with strategies to reduce the incidence of AVF following percutaneous punctures. PMID:23555445
Mylankal, Kurian J; Johnson, Brian; Ettles, Duncan F
Background: Therapeutic low-frequency ultrasound (US) has been used for many years to improve wound healing in chronic wounds like venous legulcers. No human data are available for the possible effects of single US applications on microcirculation and their frequency-dependency. Aims: To investigated the role of therapeutic low-frequency US on microcirculation of venous legulcers in vivo. Patients and Methods: This is a pilot study on an inpatient basis. We use a newly developed low-frequency continuous-wave US-equipment composed of a US transducer based on piezo-fiber composites that allow the change of frequency. In this study, we apply US of 34 kHz, 53.5 kHz, and 75 kHz respectively. Twelve patients with chronic venous legulcers are analyzed. As an adjunct to good ulcer care, therapeutic US is applied, non-contacting, once a day, in a subaqual position for 10 minutes. Microcirculation is assessed in the ulcers adjacent to skin before US-therapy, immediately after the treatment and 30 minutes later. We use a micro-light guide spectrophotometer (O2C, LEA Medizintechnik GmbH, Gie?en, Germany) for calculation of blood flow velocity, hemoglobin oxygen saturation (SCO2) and relative hemoglobin concentration (rHb) in 2 and 8 mm depth. Contact-free remission spectroscopy (SkinREM3, Color Control Chemnitz GmbH, Chemnitz, Germany) allows contact free measurements in the VIS-NIR range of the spectrum (400 ± 1600 nm). Results: It is seen that therapeutic US is well tolerated. One patient dropped out from a treatment series since he developed erysipelas responding to standard antibiotic. Effects were seen at 34 kHz only. The SO2 values increased after single US application. The values for rHb were higher in the superficial layer of the wound bed (depth 2 mm) compared to deeper parts (8 mm depth). US treatment did not result in significant changes of rHb and blood cell velocity. The data obtained by remission spectroscopy disclose an increase of oxygenized hemoglobin. Conclusions: The major findings are that continuous-wave low-frequency US of 34 kHz, but not, 53.5 kHz or 75 kHz, has a temporary stimulatory effect on microcirculation mainly due to an improved oxygenation. Further studies with treatment series are necessary.
Background: Rheumatoid arthritis (RA) is a systemic inflammatory disease which may present with extra-articular symptoms, including cutaneous manifestations. Ulcerated rheumatoid nodules, necrotic vasculitic lesions and pyoderma gangrenosum are fairly characteristic and well-recognized causes of skin ulcers in RA. However, most RA patients develop legulcers due to other pathophysiological factors posing a diagnostic and therapeutic challenge and leading to considerable
Cornelia S. Seitz; Nikolaus Berens; Eva-B. Bröcker; Axel Trautmann
BACKGROUND: International studies report that nurse clinics improve healing rates for the legulcer population. However, these studies did not necessarily deliver similar standards of care based on evidence in the treatment venues (home and clinic). A rigorous evaluation of home versus clinic care is required to determine healing rates with equivalent care and establish the acceptability of clinic-delivered care.
Margaret B Harrison; Ian D Graham; Karen Lorimer; Elizabeth VandenKerkhof; Maureen Buchanan; Phil S Wells; Tim Brandys; Tadeusz Pierscianowski
We present the case of a 63-year-old white male with bilateral chronic legulcers due to polycythemia vera and hydroxyurea therapy who demonstrated dramatic healing of his wounds in response to ruxolitinib (Jakafi(®), Novartis), a novel Janus kinase-1 and -2 inhibitor. This patient's wound had previously been refractory to multiple surgical interventions and immunosuppression. After the initiation of ruxolitinib, the patient underwent successful split-thickness skin grafting, with resultant healing of his wounds. He was stable without prednisone and other immunosuppressant therapy and had healed at 6 months. Ruxolitinib therapy could represent a novel option for patients who develop persistent inflammatory wounds in the setting of polycythemia vera and hydroxyurea therapy. PMID:23953278
Shanmugam, Victoria K; McNish, Sean; Shara, Nawar; Hubley, Katherine J; Kallakury, Bhaskar; Dunning, David M; Attinger, Christopher E; Steinberg, John S
Background:A major feature of chronic wounds is the loss of tissue, with the exposure of dermal components preventing primary closure and leading to bacterial colonization. Bacterial colonization has been proposed as one of the common underlying pathologies present in chronic wounds. The objective of this exploratory study was to identify bacteria cultured from chronic venous legulcers and test for proteolytic activity that degrades matrix substrates.Method:Bacteria were isolated, cultured, and identified from six subjects (average age = 62.8 years) over 2-10 months under an approved protocol using swabs and microbiological culture media. Proteolytic activity against (a) gelatin, (b) an elastin substrate, and (c) a serine/trypsin-sensitive substrate was determined using a colorimetric plate assay with an ELISA plate reader and zymography.Results:We identified 13 bacteria that expressed proteolytic activity against one or more of the tested substrates. Of these, six were Gram-positive (Staphylococcus aureus, Enterococcus faecalis, Staphylococcus epidermidis, Streptococcus agalactiae, Corynebacterium, and Streptococcus bovis) and seven were Gram-negative (Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis, Morganella morganii, Klebsiella pneumoniae, Bacteroides fragilis, and Serratia marcescens) organisms. Two of these, S. aureus and P. aeruginosa, are recognized wound pathogens.Conclusions:Multiple bacteria species isolated from colonized venous legulcers have the capacity to secrete proteases capable of degrading components of the extracellular matrix important for wound healing. Matrix degradation by bacteria may contribute to delays in tissue deposition and repair, suggesting that treatment of chronic wounds should include appropriate management of colonizing bacteria. PMID:23118301
Wysocki, Annette B; Bhalla-Regev, Sandhya K; Tierno, Philip M; Stevens-Riley, Marla; Wiygul, Ryan-Claire
Introduction The aim of the study was to assess the influence of a supervised programme of exercises on ankle joint mobility in patients with venous legulcerations. Material and methods The study was carried out between 2008 and 2009 at the Venous Ulcer Treatment Outpatient Clinic and Clinic of General and Vascular Surgery of the Dr Jan Biziel University Hospital no. 2 in Bydgoszcz. It was a randomized control study in which 32 patients with venous legulcerations were qualified. Patients with ulcerations were randomized to 2 groups – 16 patients were included in the group with a supervised programme of exercises and the other 16 patients were included in the control group performing physical exercises by themselves, without supervision. The ranges of ankle joint mobility were assessed before, during and after the end of the 9-week exercise programme. A 32 cm goniometer with a scale from 0° to 180° with accuracy to 1° was used for measurements. Results In both groups a substantial increase of ankle joint mobility (p < 0.05) was observed. The total ankle joint mobility after completion of the exercises was significantly higher in the group performing exercises under the supervision of a nurse. Having a significant effect on the mobility of the ankle were the ulceration area, the extent of lipodermatosclerosis, and the intensity of symptoms and signs of CVI (p < 0.05). Conclusions Supervised physical exercises broaden the range of ankle joint mobility. They should constitute an integral part of a holistic model of care for patients with venous legulcerations.
In a multicenter trial, the effect of a commercially available combination of autologous keratinocytes (3-6 x 10(6)/mL) with fibrin sealant (Tissucol Duo S Immuno, Baxter Hyland Immuno) on the healing of recalcitrant venous legulcers (duration >3 months) was compared with standard care. The primary endpoint was time to healing, and the secondary endpoint was number of healed ulcers in both groups. Both groups received compression therapy with short-stretch bandages. Forty-four (38.3%) of the 116 patients who had BioSeed-S treatment achieved complete healing of the target ulcer compared with 24 (22.4%) of 109 patients who received standard treatment. The advantage for treatment with BioSeed-S over standard treatment was statistically significant (chi-square test: p=0.0106). Time to complete healing of ulcers: the log-rank test for equality over strata revealed a superiority of treatment with BioSeed-S+compression (median: 176 days) over compression+standard care (median >201 days) (p<0.0001). This study, to date the largest multicenter study with autologous keratinocytes, provides evidence for its efficacy in the treatment of patients with therapy-resistant chronic venous legulcers. PMID:17537117
Chronic venous disease with skin changes of the leg is a common condition affecting up to 1 in 20 people in westernized countries. The causes of this problem are not fully understood, although research in recent years has revealed a number of important mechanisms that contribute to the disease process. Patients with chronic venous disease suffer persistently raised pressures in their deep and superficial veins in the lower limb. Leucocytes become "trapped" in the circulation of the leg during periods of venous hyper-tension produced by sitting or standing. Studies of the plasma levels of neutrophil granule enzymes shows that these are increased during periods of venous hypertension, suggesting that this causes activation of the neutrophils. Investigation of the leucocyte surface ligands CD11b and CD62L shows that the more activated neutrophils and monocytes are sequestered during venous hypertension. Measurement of plasma levels of the soluble parts of the endothelial adhesion molecules VCAM, ICAM, and ELAM show that these are all elevated in patients with chronic venous disease compared to controls. Following 30 minutes of venous hypertension produced by standing, these levels are further increased. These data suggest that venous hypertension causes neutrophil and monocyte activation, which in turn causes injury to the endothelium. Chronic injury to the endothelium leads to a chronic inflammatory condition of the skin that we know clinically as lipodermatosclerosis. This is mediated by perivascular inflammatory cells, principally macrophages, in the skin microcirculation. These stimulate fibroblasts in the skin leading to tissue remodeling and laying down of fibrous tissue. Vascular endothelial growth factor stimulates proliferation of capillaries within the skin. Skin in this state has the potential to ulcerate in response to minor injury. PMID:16928672
The management of non-healing legulcers in patients with CREST syndrome and subdermal calcification is rarely reported in medical literature. Only one similar case was found in the literature (1). Dealing with such patients can be a challenge for wound specialists. In this article, we discuss the clinical progress of an interesting case of extensive non-healing legulcers in a CREST patient with dystrophic calcification. The combination of systemic physiological deficits and immune compromise, along with the local physical abnormalities associated with the wound pose a complex multifactorial aetiological mix. There is no conclusive data on the optimal management of these wounds in CREST patients. It seems that ablation of the calcific deposits may offer some hope. PMID:21827631
Patients with legulceration 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 legulcers 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
newsletter | contact Share | Stasis Ulcer Information for adults A A A This image displays a patient with chronic leg swelling with stasis dermatitis and a stasis ulcer. Overview A stasis ulcer is a breakdown of ...
Apligraf® (Organogenesis, Canton, MA) is a bi-layered bioengineered skin substitute and was the first engineered skin US Food and Drug Administration (FDA)-approved to promote the healing of ulcers that have failed standard wound care. Constructed by culturing human foreskin-derived neonatal fibroblasts in a bovine type I collagen matrix over which human foreskin-derived neonatal epidermal keratinocytes are then cultured and allowed to stratify, Apligraf provides both cells and matrix for the nonhealing wound. Its exact mechanism of action is not known, but it is known to produce cytokines and growth factors similar to healthy human skin. Initially approved by the FDA in 1998 for the treatment of venous ulcers greater than one-month duration that have not adequately responded to conventional therapy, Apligraf later received approval in 2000 for treatment of diabetic foot ulcers of greater than three weeks duration. Herein, we review the use of Apligraf in the treatment of chronic venous legulcers and diabetic foot ulcers. Our goal is to provide a working understanding of appropriate patient selection and proper use of the product for any physician treating this segment of the aging population.
We have established a specific bioreactor microcarrier cell culture system using porcine gelatin microbeads as carriers to produce autologous keratinocytes on a large scale. Moreover, we have shown that autologous keratinocytes can be cultured on porcine collagen pads, thereby forming a single cell layer. The objective of this study was to compare efficacy and safety of autologous cultured keratinocytes on microbeads and collagen pads in the treatment of chronic wounds. Fifteen patients with recalcitrant venous legulcers were assigned to three groups in a single-center, prospective, uncontrolled study: five underwent a single treatment with keratinocyte monolayers on collagen pads (group 1); another five received a single grafting with keratinocyte-microbeads (group 2); and the last five received multiple, consecutive applications of keratinocyte-microbeads 3 days apart (group 3). All patients were followed for up to 12 weeks. By 12 weeks, there was a mean reduction in the initial wound area of 50, 83, and 97 percent in the three groups, respectively. The changes in wound size were statistically significant between the first and third groups (p= 0.0003). Keratinocyte-microbeads proved to be more effective than keratinocyte monolayers on collagen pads when the former were applied every 3 days. Rapid availability within 10-13 days after skin biopsy and easy handling represent particular advantages. PMID:15086765
Chronic venous legulcers (CVLUs) affect approximately 600,000 people annually in the United States and accrue yearly treatment costs of US$2.5–5 billion. As the population ages, demands on health care resources for CVLU treatments are predicted to drastically increase because the incidence of CVLUs is highest in those ?65 years of age. Furthermore, regardless of current standards of care, healing complications and high recurrence rates prevail. Thus, it is critical that factors leading to or exacerbating CVLUs be discerned and more effective, adjuvant, evidence-based treatment strategies be utilized. Previous studies have suggested that CVLUs’ pathogenesis is related to the prolonged presence of high numbers of activated neutrophils secreting proteases in the wound bed that destroy growth factors, receptors, and the extracellular matrix that are essential for healing. These events are believed to contribute to a chronically inflamed wound that fails to heal. Therefore, the purpose of this project was to review studies from the past 15 years (1996–2011) that characterized neutrophil activity in the microenvironment of human CVLUs for new evidence that could explicate the proposed relationship between excessive, sustained neutrophil activity and CVLUs. We also appraised the strength of evidence for current and potential therapeutics that target excessive neutrophil activity.
McDaniel, Jodi C.; Roy, Sashwati; Wilgus, Traci A.
Background: A granulating surface is important for skin grafting and healing of legulcers. Mechanical debridement to remove necrotic tissue often must be stopped before completion because of pain. Objective: Our purpose was to assess the effect of EMLA cream on the number of debridements required to obtain a clean ulcer and on pain during debridement and to determine its
Catherine Lok; Carle Paul; Pierre Amblard; Didier Bessis; Clélia Debure; Brigitte Faivre; Bernard Guillot; Jean Paul Ortonne; Gunilla Huledal; Bernard Kalis
The objective of this study was to evaluate the effect of sharp debridement on the progression of recalcitrant chronic venous legulcers (CVLU) and to assess the feasibility of performing this procedure in an outpatient setting. We performed a prospective study of 55 CVLU (53 patients) over a 12-month period. The study group, which underwent debridement, contained 28 CVLU whose wound beds had slough, nonviable tissue, and no granulation tissue. The control group was 27 CVLU with minimal (15-20%) granulation tissue, but no slough or nonviable tissue. Treatments were otherwise similar. Age, body mass index, mean ulcer surface area (MSA) and mean ulcer duration were comparable in both groups. Ulcer measurements were taken at 4 weeks before debridement, at the time of debridement, and 4 and 20 weeks post-debridement. There was no change in the MSA from 4 weeks before to the time of debridement in either group. At 4 weeks post-debridement, the study ulcers showed a 6 cm(2) reduction in the MSA vs. a 1 cm(2) reduction in controls (P = 0.02). By week 20 post-debridement, the study ulcers achieved a 7.4 cm(2) reduction in the MSA vs. an increase of 1.3 cm(2) in controls (P = 0.008). Between weeks 8 and 20 post-debridement, 16% of study ulcers vs. 4.3% of control ulcers achieved complete healing. Infection rates and antimicrobial usage were similar. We conclude that sharp debridement is effective in stimulating healing of recalcitrant CVLU. It is safe, well tolerated, and can be performed in an outpatient setting. PMID:15828937
Williams, Dean; Enoch, Stuart; Miller, David; Harris, Karen; Price, Patricia; Harding, Keith G
Background Chronic legulcers cause long term ill-health for older adults and the condition places a significant burden on health service resources. Although evidence on effective management of the condition is available, a significant evidence-practice gap is known to exist, with many suggested reasons e.g. multiple care providers, costs of care and treatments. This study aimed to identify effective health service pathways of care which facilitated evidence-based management of chronic legulcers. Methods A sample of 70 patients presenting with a lower limb leg or foot ulcer at specialist wound clinics in Queensland, Australia were recruited for an observational study and survey. Retrospective data were collected on demographics, health, medical history, treatments, costs and health service pathways in the previous 12 months. Prospective data were collected on health service pathways, pain, functional ability, quality of life, treatments, wound healing and recurrence outcomes for 24 weeks from admission. Results Retrospective data indicated that evidence based guidelines were poorly implemented prior to admission to the study, e.g. only 31% of participants with a lower limb ulcer had an ABPI or duplex assessment in the previous 12 months. On average, participants accessed care 2–3 times/week for 17 weeks from multiple health service providers in the twelve months before admission to the study clinics. Following admission to specialist wound clinics, participants accessed care on average once per week for 12 weeks from a smaller range of providers. The median ulcer duration on admission to the study was 22 weeks (range 2–728 weeks). Following admission to wound clinics, implementation of key indicators of evidence based care increased (p?0.001) and Kaplan-Meier survival analysis found the median time to healing was 12 weeks (95% CI 9.3–14.7). Implementation of evidence based care was significantly related to improved healing outcomes (p?0.001). Conclusions This study highlights the complexities involved in accessing expertise and evidence based wound care for adults with chronic leg or foot ulcers. Results demonstrate that access to wound management expertise can promote streamlined health services and evidence based wound care, leading to efficient use of health resources and improved health.
Background International studies report that nurse clinics improve healing rates for the legulcer population. However, these studies did not necessarily deliver similar standards of care based on evidence in the treatment venues (home and clinic). A rigorous evaluation of home versus clinic care is required to determine healing rates with equivalent care and establish the acceptability of clinic-delivered care. Methods Health Services RCT was conducted where mobile individuals were allocated to either home or nurse clinic for legulcer management. In both arms, care was delivered by specially trained nurses, following an evidence protocol. Primary outcome: 3-month healing rates. Secondary outcomes: durability of healing (recurrence), time free of ulcers, HRQL, satisfaction, resource use. Data were collected at base-line, every 3 months until healing occurred, with 1 year follow-up. Analysis was by intention to treat. Results 126 participants, 65 randomized to receive care in their homes, 61 to nurse-run clinics. No differences found between groups at baseline on socio-demographic, HRQL or clinical characteristics. mean age 69 years, 68% females, 84% English-speaking, half with previous episode of ulceration, 60% ulcers at inclusion < 5 cm2 for < 6 months. No differences in 3-month healing rates: clinic 58.3% compared to home care at 56.7% (p = 0.5) or in secondary outcomes. Conclusion Our findings indicate that organization of care not the setting where care is delivered influences healing rates. Key factors are a system that supports delivery of evidence-based recommendations with care being provided by a trained nursing team resulting in equivalent healing rates, HRQL whether care is delivered in the home or in a community nurse-led clinic. Trial registration ClinicalTrials.gov Protocol Registration System: NCT00656383
Harrison, Margaret B; Graham, Ian D; Lorimer, Karen; VandenKerkhof, Elizabeth; Buchanan, Maureen; Wells, Phil S; Brandys, Tim; Pierscianowski, Tadeusz
Objective To assess the clinical effectiveness of weekly delivery of low dose, high frequency therapeutic ultrasound in conjunction with standard care for hard to heal venous legulcers. Design Multicentre, pragmatic, two arm randomised controlled trial. Setting Community and district nurse led services, community legulcer clinics, and hospital outpatient legulcer clinics in 12 urban and rural settings (11 in the United Kingdom and one in the Republic of Ireland). Participants 337 patients with at least one venous legulcer of >6 months’ duration or >5 cm2 area and an ankle brachial pressure index of ?0.8. Interventions Weekly administration of low dose, high frequency ultrasound therapy (0.5 W/cm2, 1 MHz, pulsed pattern of 1:4) for up to 12 weeks plus standard care compared with standard care alone. Main outcome measures Primary outcome was time to healing of the largest eligible legulcer. Secondary outcomes were proportion of patients healed by 12 months, percentage and absolute change in ulcer size, proportion of time participants were ulcer-free, health related quality of life, and adverse events. Results The two groups showed no significant difference in the time to healing of the reference legulcer (log rank test, P=0.61). After adjustment for baseline ulcer area, baseline ulcer duration, use of compression bandaging, and study centre, there was still no evidence of a difference in time to healing (hazard ratio 0.99 (95% confidence interval 0.70 to 1.40), P=0.97). The median time to healing of the reference legulcer was inestimable. There was no significant difference between groups in the proportion of participants with all ulcers healed by 12 months (72/168 in ultrasound group v 78/169 in standard care group, P=0.39 for Fisher’s exact test) nor in the change in ulcer size at four weeks by treatment group (model estimate 0.05 (95% CI –0.09 to 0.19)). There was no difference in time to complete healing of all ulcers (log rank test, P=0.61), with median time to healing of 328 days (95% CI 235 to inestimable) with standard care and 365 days (224 days to inestimable) with ultrasound. There was no evidence of a difference in rates of recurrence of healed ulcers (17/31 with ultrasound v 14/31 with standard care, P=0.68 for Fisher’s exact test). There was no difference between the two groups in health related quality of life, both for the physical component score (model estimate 0.69 (–1.79 to 3.08)) and the mental component score (model estimate –0.93 (–3.30 to 1.44)), but there were significantly more adverse events in the ultrasound group (model estimate 0.30 (0.01 to 0.60)). There was a significant relation between time to ulcer healing and baseline ulcer area (hazard ratio 0.64 (0.55 to 0.75)) and baseline ulcer duration (hazard ratio 0.59 (0.50 to 0.71)), with larger and older ulcers taking longer to heal. In addition, those centres with high recruitment rates had the highest healing rates. Conclusions Low dose, high frequency ultrasound administered weekly for 12 weeks during dressing changes in addition to standard care did not increase ulcer healing rates, affect quality of life, or reduce ulcer recurrence. Trial registration ISRCTN21175670 and National Research Register N0484162339
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.
Aim: This paper reports one aspect of a study concerning management of chronic legulcers by nurses working in the community in Kronoberg County, Sweden (KC) and the East Riding & Hull, UK (ER). Our study focus was to describe reported evidence-based practice in legulcer care in two samples of nurses from two countries. The paper describes the overall
BACKGROUND: Tissue engineering is an emerging field. Novel bioengineered skin substitutes and genetically derived growth factors offer innovative approaches to reduce the burden of diabetic foot and venous legulcers for both patients and health care systems. However, they frequently are very costly. Based on a systematic review of the literature, this study assesses the cost-effectiveness of these growth factors
Background Venous legulcers 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 legulcers 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 legulcers 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 legulcers, by acting at least in part through distinct contributions of cell adhesion, migration, proliferation and cytoskeletal dynamics.
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 This article describes the challenges a research team experienced recruiting physicians within a randomised controlled trial about legulcer care that seeks to foster the cooperation between the medical and nursing professions. Community-based physicians in North Rhine-Westphalia, Germany, were recruited for an interdisciplinary intervention designed to enhance legulcer patients' self-care agency. The aim of this article is to investigate the success of different recruitment strategies employed and reasons for physicians' non-participation. Methods The first recruitment phase stressed the recruitment of GPs, the second the recruitment of specialists. Throughout the recruitment process data were collected through phone conversations with GP practices who indicated reasons for non-participation. Results Despite great efforts to recruit physicians, the recruitment rate reached only 26 out of 1549 contacted practices (1.7%) and 12 out of 273 (4.4%) practices during the first and second recruitment phase respectively. The overall recruitment rate over the 16-month recruitment period was 2%. With a target recruitment rate of n = 300, only 45 patients were enrolled in the study, not meeting study projections. Various reasons for community physicians' non-participation are presented as stated spontaneously during phone conversations that might explain low recruitment rates. The recruitment strategy utilised is discussed against the background of factors associated with high participation rates from the international literature. Conclusion Time, money, and effort needed during the planning and recruitment phase of a study must not be underestimated to avoid higher than usual rates of refusal and lack of initial contact. Pilot studies prior to a study start-up may provide some evidence on whether the target recruitment rate is feasible. Trial registration Current Controlled Trials ISRCTN42122226.
Chronic venous disease with skin changes of the leg is a common condition affecting up to 1 in 20 people in westernized countries. The causes of this problem are not fully understood, although research in recent years has revealed a number of important mechanisms that contribute to the disease process. Patients with chronic venous disease suffer persistently raised pressures in
This study aimed to assess the feasibility of a home-based exercise programme and examine the effects on the healing rates of venous legulcers. A 12-week randomised controlled trial was conducted investigating the effects of an exercise intervention compared to a usual care group. Participants in both groups (n = 13) had active venous ulceration and were treated in a metropolitan hospital outpatients clinic in Australia. Data were collected on recruitment from medical records, clinical assessment and questionnaires. Follow-up data on progress in healing and treatments were collected fortnightly for 12 weeks. Calf muscle pump function data were collected at baseline and 12 weeks from recruitment. Range of ankle motion data were collected at baseline, 6 and 12 weeks from recruitment. This pilot study indicated that the intervention was feasible. Clinical significance was observed in the intervention group with a 32% greater decrease in ulcer size (P = 0·34) than the usual care group, and a 10% (P = 0·74) improvement in the number of participants healed in the intervention group compared to the usual care group. Significant differences between groups over time were observed in calf muscle pump function parameters [ejection fraction (P = 0·05), residual volume fraction (P = 0·04)] and range of ankle motion (P = 0·01). This pilot study is one of the first to examine and measure clinical healing rates for participants involved in a home-based progressive resistance exercise programme. Further research is warranted with a larger multi-site study. PMID:22697811
O'Brien, Jane; Edwards, Helen; Stewart, Ian; Gibbs, Harry
Chronic age-related degenerative disorders, including the formation of chronic leg wounds, may occur due to aging of the stromal tissues and ensuing dysfunctional cellular responses. This study investigated the impact of environmental-driven cellular aging on wound healing by conducting a comprehensive analysis of chronic wound fibroblast (CWF) behavior in comparison with patient-matched healthy skin normal fibroblasts (NF). The dysfunctional wound
Ivan B Wall; Ryan Moseley; Duncan M Baird; David Kipling; Peter Giles; Iraj Laffafian; Patricia E Price; David W Thomas; Phil Stephens
Objective: To investigate the effectiveness of an innovative electrical stimulation (ES) therapy as adjuvant treatment for chronic wounds of various aetiology, in terms of pain and ulcer healing. Method: Patients with chronic limb ulcers were enrolled for the study and randomised into the intervention or control group. The intervention group received conventional treatment plus ES therapy (FREMS; Lorenz Lifetech) while the control group received only conventional treatment. Each ES treatment cycle consisted of 12 sessions performed in 4 weeks (three sessions/week). All patients were treated until full wound healing occurred, or for a maximum of 9 ES cycles, with a 2-week rest between each cycle. Results: A total of 60 patients were enrolled in the study and randomised into the two groups: the intervention group (n=30) and the control group (n=30). During follow-up, some patients terminated the protocol because they reached the ulcer closure before the maximum of 9 cycles. The analysis of the effect of ES on pain and ulcer healing was performed on all patients who underwent at least two consecutive clinical evaluations (two cycles), in order to reach a compatible sample size with the primary objective (one patient withdrew). In both groups, there was a significant reduction of pain compared with baseline (p < 0.05), starting from T6 visit in the first cycle. In particular, there was a significant reduction of pain in the intervention group compared with the control group after 14 days, and this reduction continued until the end of the second cycle. Similarly, there was a significant reduction of PUSH tool score in the intervention group compared with the control group after 14 days, and this reduction continued until the end of the second cycle. Conclusion: Data collected in this study support data in the literature. Analysis of longitudinal data analysed by simple models and complex models suggest that the ES therapy had a positive and significant effect on pain reduction (VAS) and on the improvement of ulcer healing process in terms of the PUSH tool total index compared with conventional treatment, and may have induced a significant acceleration of the wound-healing process. Declaration of interest: There were no external sources of funding for this trial. The authors have no financial, commercial or social conflicts of interest to declare regarding the article or its content. PMID:24142074
Background Objective: To determine the relative effectiveness of evidence-informed practice using two high compression systems: four-layer (4LB) and short-stretch bandaging (SSB) in community care of venous legulcers. Design and Setting: Pragmatic, multi-centre, parallel-group, open-label, randomized controlled trial conducted in 10 centres. Cognitively intact adults (?18 years) referred for community care (home or clinic) with a venous ulceration measuring ?0.7cm and present for ?1 week, with an ankle brachial pressure index (ABPI) ?0.8, without medication-controlled Diabetes Mellitus or a previous failure to improve with either system, were eligible to participate. Methods Consenting individuals were randomly allocated (computer-generated blocked randomization schedule) to receive either 4LB or SSB following an evidence-informed protocol. Primary endpoint: time-to- healing of the reference ulcer. Secondary outcomes: recurrence rates, health-related quality of life (HRQL), pain, and expenditures. Results 424 individuals were randomized (4LB n = 215; SSB n = 209) and followed until their reference ulcer was healed (or maximum 30 months). An intent-to-treat analysis was conducted on all participants. Median time to ulcer healing in the 4LB group was 62 days [95% confidence interval (CI) 51 to 73], compared with 77 days (95% CI 63 to 91) in the SSB group. The unadjusted Kaplan-Meier curves revealed the difference in the distribution of cumulative healing times was not significantly different between group (log rank ?2 = 0.001, P = 0.98) nor ulcers recurrence (4LB, 10.1%; SSB, 13.3%; p = 0.345). Multivariable Cox Proportional Hazard Modeling also showed no significant between-bandage differences in healing time after controlling for significant covariates (p = 0.77). At 3-months post-baseline there were no differences in pain (no pain: 4LB, 22.7%; SSB, 26.7%; p = 0.335), or HRQL (SF-12 Mental Component Score: 4LB, 55.1; SSB, 55.8; p = 0.615; SF-12 Physical Component Score: 4LB, 39.0; SSB, 39.6; p = 0.675). The most common adverse events experienced by both groups included infection, skin breakdown and ulcer deterioration. Conclusions The Canadian Bandaging Trial revealed that in the practice context of trained RNs using an evidence-informed protocol, the choice of bandage system (4LB and SSB) does not materially affect healing times, recurrence rates, HRQL, or pain. From a community practice perspective, this is positive news for patient-centred care allowing individual/family and practitioner choice in selecting compression technologies based on circumstances and context. Trial registration clinicaltrials.gov Identifier: NCT00202267
Topical hyaluronic acid (HA) is routinely used in the local treatment of chronic wounds, but few data have been reported to date. A 60-day double-blind, randomised, controlled superiority trial was designed to investigate the efficacy and safety of a gauze pad containing HA in local treatment of venous legulcers, compared with its neutral vehicle. The primary endpoint was the percentage of wound size reduction after 45 days. Totally 89 patients were included. At day 45, the percentage of ulcer surface reduction was significantly greater in the HA group (73 ± 4·6%) versus neutral vehicle group (46 ± 9·6%) (P = 0·011). The number of healed ulcers was significantly higher in the HA group at day 45 (31·1% versus 9·3% respectively) and day 60 (37·8% versus 16·3% respectively; P < 0·05). At day 30, pain intensity based on visual analogue scale was significantly lower in the HA group (12·4 mm ± 2·6 versus 22·8 mm ± 3·8; P = 0·026). Tolerance of both treatments was comparable in the two groups. HA gauze pad, in local treatment of venous legulcers, was significantly more effective than the neutral vehicle on wound size reduction, healed ulcers rate and pain management with a good safety profile. PMID:22405094
The last years of research have proposed that bacteria might be involved in and contribute to the lack of healing of chronic wounds. Especially it seems that Pseudomonas aeruginosa play a crucial role in the healing. At Copenhagen Wound Healing Centre it was for many years clinical suspected that once chronic venous legulcers were colonized (weeks or months preoperatively) by P. aeruginosa, the success rate of skin grafting deteriorated despite aggressive treatment. To investigate this, a retrospective study was performed on the clinical outcome of 82 consecutive patients with chronic venous legulcers on 91 extremities, from the 1st of March 2005 until the 31st of August 2006. This was achieved by analysing the microbiology, demographic data, smoking and drinking habits, diabetes, renal impairment, co-morbidities, approximated size and age of the wounds, immunosuppressive treatment and complicating factors on the clinical outcome of each patient. The results were evaluated using a Student T-test for continuous parameters, chi-square test for categorical parameters and a logistic regression analysis to predict healing after 12 weeks. The analysis revealed that only 33,3% of ulcers with P. aeruginosa, isolated at least once from 12 weeks prior, to or during surgery, were healed (98% or more) by week 12 follow-up, while 73,1% of ulcers without P. aeruginosa were so by the same time (p?=?0,001). Smoking also significantly suppressed the outcome at the 12-week follow-up. Subsequently, a logistic regression analysis was carried out leaving P. aeruginosa as the only predictor left in the model (p?=?0,001). This study supports our hypothesis that P. aeruginosa in chronic venous legulcers, despite treatment, has considerable impact on partial take or rejection of split-thickness skin grafts.
H?gsberg, Trine; Bjarnsholt, Thomas; Thomsen, Jens Schiersing; Kirketerp-M?ller, Klaus
Amelogenins are extracellular matrix proteins that, under physiological conditions, self-assemble into globular aggregates up to micron-sizes. Studies with periodontal fibroblasts indicate that attachment to these structures increases the endogenous secretion of multiple growth factors and cell proliferation. Pre-clinical and clinical studies indicate that cutaneous wounds benefit from treatment with amelogenins. A randomized controlled trial (RCT) involving patients with hard-to-heal venous legulcers (VLUs) (ie, ulcers with a surface area ?10 cm2 and duration of ?6 months) showed that the application of amelogenin (Xelma®, Molnlycke Health Care, Gothenburg, Sweden) as an adjunct treatment to compression results in significant reduction in ulcer size, improvement in the state of ulcers, reduced pain, and a larger proportion of ulcers with low levels of exudate, compared with treatment with compression alone. Amelogenin therapy was also shown to be safe to use in that there were no significant differences in adverse events noted between patients treated with amelogenin plus compression and those treated with compression alone. Case study evaluations indicate that the benefits of amelogenin therapy demonstrated in the RCT are being repeated in “real life” situations and that amelogenin therapy may also have a role to play in the treatment of other wound types such as diabetic foot ulcers.
Romanelli, Marco; Dini, Valentina; Vowden, Peter; Agren, Magnus S
Chronic legulcers influence the daily lives of patients. Besides the burden of therapy, research results in the field of quality of life indicate constraints in the psychological, physiological, occupational and social parts of life. In order to take an active role in coping with the chronic disease, patients need knowledge and information that account for individual needs. Therefore our study had the objective to describe the lived experience of patients with legulcer and their corresponding needs for patient education. We used a qualitative study design. In a first step we made five narrative interviews. In a second step we made seven interviews using an interview guide that was based on results of the narrative interviews. Participants were recruited in two regions in Germany via two specialist practices and a hospital. We used a purposeful sampling strategy in order to account for the heterogenity of the patient group. Data was analysed using the content analysis approach by Mayring. Our analysis identified 4 interconnected main categories: living with the illness, experiences of wound care, being an expert, and educational needs. Patients are trying to integrate their illness into daily life and maximize their independence. They prefer individual counselling during regulartreatment to group counselling or meetings with other legulcer patients. Overall the described problems and solutions illustrate the complexities of the disease and its care. PMID:23951685
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.
... kissing may be one way. They also may be spread through food, water, or contact with vomit (puke) that has been infected with the bacteria. The best advice in ulcer prevention is to always wash your hands after you use the bathroom and before ...
The aim of this study was to evaluate the cytotoxic effect of octenidine dihydrochloride/phenoxyethanol (OHP) found in vitro by conducting a randomized, double-blind controlled clinical study focusing on its safe and effective use in chronic venous legulcers. In total, 126 male and female patients were treated with either OHP (n = 60) or Ringer solution (n = 66). The treatment lasted over a period of maximum 12 weeks. For the assessment of the wound-healing process, clinical outcome parameters were employed, that is, time span until 100% epithelization, wound status and the wound surface area were analysed. Side effects were recorded during the study period. The median time to complete ulcer healing was comparable between the OHP and Ringer solution groups (92 versus 87 days; P = 0·952), without being influenced by wound size or duration of the target ulcer (P-values: 0·947/0·978). In patients treated with OHP, fewer adverse events (AEs) were observed compared with the Ringer group (17% versus 29% of patients reported 20 versus 38 AEs). OHP is well suitable for the treatment of chronic wounds without cytotoxic effects. Furthermore, OHP does not impair the wound healing in chronic venous ulcers. PMID:22074592
In 1837, Piorry, a French professor of medicine stated, “It is rather difficult to understand why the investigation of veins has been passed over almost in silence, while such a great diagnostic value has been attached to the investigation of arteries.” Even today, our understanding of venous disease pales in comparison to our understanding of arterial disease. This is despite
Chronic wounds like venous calf and diabetic foot ulcers are frequently contaminated and colonized by bacteria and it remains unclear whether there is sufficient expression of defensins and recruitment of epidermal Langerhans cells in the margin of ulcer compared to normal skin. The aim of this study was to examine immunohistochemically the expression of ?-defensin-2 (hBD2), GM-CSF, VEGF growth factors
Hanna Galkowska; Waldemar L. Olszewski; Urszula Wojewodzka
Bacterial infection impairs the healing process, promoting the chronicity of inflammation and wounds. Because antibiotics fail to eradicate bacteria, especially in biofilm form, new therapeutic modalities may be required. In the present study, the effectiveness of bacteriotherapy with Lactobacillus plantarum on infected chronic venous ulcers was investigated and its effects on interleukin (IL)-8 production by cells from the ulcer bed and neutrophils isolated from peripheral blood that were previously challenged in vitro with Pseudomonas aeruginosa and L. plantarum were studied. Topical application of L. plantarum culture to lesions (25-60 cm(2)) of 14 diabetic and 20 non-diabetic patients induced debridement, granulation tissue formation and total healing after 30 days in 43% diabetics and in 50% non-diabetics. No significant differences between the groups were observed. The cells from ulcer beds collected after treatment with L. plantarum for 10 days showed a decrease in the percentage of polymorphonuclear, apoptotic and necrotic cells and an enhancement of IL-8 production. IL-8 production by isolated neutrophils from these patients was compared with that in diabetics without ulcers, as well as normal subjects under basal conditions, and after infection of polymorphonuclear cells with P. aeruginosa preincubated either with or without L. plantarum. The basal values in diabetic and ulcer patients were higher than normal (p <0.001) and were increased by P. aeruginosa infection in normal, diabetics (p <0.001) and non-diabetics with ulcers (p <0.01). Preincubation with L. plantarum decreased IL-8 production in patients with ulcers non-diabetic and diabetic (p <0.001). Lactobacillus plantarum treatment reduced wound bacterial load, neutrophils, apoptotic and necrotic cells, modified IL-8 production and induced wound healing. PMID:19519855
Peral, M C; Rachid, M M; Gobbato, N M; Huaman Martinez, M A; Valdez, J C
Background Approximately 1 out of every 100 individuals has some form of venous insufficiency, which can lead to chronic venous disease and Venous LegUlcer (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 infections are polymicrobial with no single bacterium colonizing the wounds. The most ubiquitous and predominant organisms include a previously uncharacterized bacteroidales, various anaerobes, Staphylococcus, Corynebacterium, and Serratia. Topological analysis of VLU show some notable differences in bacterial populations across the surface of the wounds highlighting the importance of sampling techniques during diagnostics. Metagenomics provide a preliminary indication that there may be protozoa, fungi and possibly an undescribed virus associated with these wounds. Conclusion The polymicrobial nature of VLU and previous research on diabetic foot ulcers and surgical site infections suggest that the future of therapy for such wounds lies in the core of the logical and proven multiple concurrent strategy approach, which has been termed "biofilm-based wound care" and the use of individualized therapeutics rather than in a single treatment modality.
Silver-based dressings have been used extensively in wound management in recent years, but data on their antimicrobial activity in the clinical setting are limited. In order to explore their effects on chronic legulcer flora, 14 ulcers were cultured after at least 3 weeks treatment with Aquacel Ag(®) or Acticoat(®). Phenotypic and genetic silver resistance were investigated in a total of 56 isolates. Silver-based dressings had a limited effect on primary wound pathogens, which were present in 79% of the cultures before, and 71% after, treatment. One silver-resistant Enterobacter cloacae strain was identified (silver nitrate minimal inhibitory concentration (MIC)?>?512 mg/l, positive for silE, silS and silP). Further studies in vitro showed that inducible silver-resistance was more frequent in Enterobacteriaceae with cephalosporin-resistance and that silver nitrate had mainly a bacteriostatic effect on Staphylococcus aureus. Monitoring of silver resistance should be considered in areas where silver is used extensively. PMID:22215013
Wound pain is a serious problem for elderly patients suffering from chronic legulcers, 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
Tepescohuite is an extract obtained from the bark of the Mimosa tenuiflora tree and is used as an empirical treatment in wounds for its healing and antiseptic properties. Venous legulcers (VLUs) are a common health care problem in most countries with a high rate of morbidity. The standard of care is moist interactive healing and compression; however, the ideal topical treatment is yet to be established. This study is designed to evaluate the effectiveness and safety of M. tenuiflora cortex extract (MTC-2G) in the treatment of VLUs in an Interdisciplinary Wound and Ostomy Care Center (IWOCC). A randomised, placebo-controlled, double blind clinical trial was conducted to compare the use of a hydrogel containing MTC-2G with the hydrogel alone in VLUs. The study included all patients with venous ulcers referred to the IWOCC. Laboratory tests and tissue biopsies were performed at the beginning and at the end of the study. The patients were instructed to daily cleansing followed by topical application of the hydrogel and compression. Forty-one patients were included, 22 patients received the MTC-2G and 19 patients received the hydrogel only. Of the 41 patients, 32 completed the study, 18 in the experimental arm and 14 in the control group, 19 were women and 13 men. The mean age of the subjects was 60 years. The mean time from presentation was 38 months. The mean surface reduction was 6·29 cm(2) [confidence interval (IC) 95%: 3·28-9·29] (P = 0·0001) in the MTC-2G group and 5·85 cm(2) (95% CI: 3·58-8·12) (P = 0·001) in the hydrogel group. There was no significant difference between the groups (P = 0·815). No changes in the laboratory parameters were noted. In the histology, there were not any differences between groups either. A hydrogel containing MTC-2G was not superior to a hydrogel alone in the treatment of VLUs. PMID:22128789
Lammoglia-Ordiales, Lorena; Vega-Memije, Maria Elisa; Herrera-Arellano, Armando; Rivera-Arce, Erika; Agüero, Juan; Vargas-Martinez, Felipe; Contreras-Ruiz, José
The aim of this analysis was to examine the cost-effectiveness of Contreet Foam (A) in comparison with three other commonly used venous legulcer treatment protocols: Aquacel Ag (B), Actisorb Silver (C) and Iodoflex (D). A health-economic analysis reflecting the UK treatment practice and cost structure was performed. The analysis was set up to assess the cost of relative wound area reduction over a 4-week treatment period. The model was validated by a UK expert panel consisting of four wound care specialists. To assure that the 4-week model had a realistic link to cost-effectiveness of complete wound healing, a Markov analysis was also performed. Sensitivity analyses were carried out to ensure validity. Protocol A and C proved to be the most effective treatments. The mean relative reduction in wound area after 4 weeks of treatment was 50.2% (protocol A), 23.9% (protocol B), 44.6% (protocol C) and 36.0% (protocol D). Cost-effectiveness ratios showed that protocol A proved to be the most cost-effective treatment, and protocol B the least. The cost per percentage reduction in wound area was 9.50 UK pounds for protocol A, compared to 16.50-17.60 UK pounds for the other treatment options. The cost-effectiveness of complete healing (Markov analysis) and sensitivity analyses confirmed these results. Using Contreet Foam instead of the other dressing alternatives may imply savings of 2.2-4.4 million UK pounds per year to the National Health Service. PMID:16722864
Scanlon, Elizabeth; Karlsmark, Tonny; Leaper, David J; Carter, Kate; Poulsen, Peter B; Hart-Hansen, Kristian; Hahn, Tina W
Venous legulcers are arguably the most common type of venous ulcers seen in clinical practice. Compression therapy is the essential intervention in venous legulcer treatment, but coexisting arterial vascular insufficiency must be excluded before compression is initiated. No single topical dressing has been shown to be superior for all wounds. Venous legulcers are chronic and often difficult to heal, with only 40% to 70% healing after 6 months of treatment. Surgical procedures to reduce venous hypertension do not accelerate healing of a chronic ulcer, but trials suggest a decreased rate of future recurrence after surgery. PMID:23571036
This study compared wound healing efficacy of two silver dressings, AQUACEL(®) Ag and Urgotul(®) Silver, against venous ulcers at risk of infection, over 8 weeks of treatment. The primary objective was to show non inferiority of AQUACEL(®) Ag to Urgotul(®) Silver. Patients (281) were randomised into two groups. The AQUACEL(®) Ag group had 145 patients treated with AQUACEL(®) Ag for 4 weeks followed by AQUACEL for another 4 weeks. TheUrgotul(®) Silver group had 136 patients treated with Urgotul(®) Silver for 4 weeks followed by Urgotul(®) for another 4 weeks. In both groups, ulcer size and depth, safety events and ulcer healing were compared. After 8 weeks of treatment, the AQUACEL(®) Ag group had a relative wound size reduction (49·65% ± 52·53%) compared with the Urgotul(®) Silver group (42·81% ± 60·0%). The non inferiority of the AQUACEL(®) Ag group to the Urgotul(®) Silver group was established based on the difference between them (6·84% ± 56·3%, 95% confidence interval -6·56 to 20·2) and the pre-defined non inferiority margin (-15%). Composite wound healing analysis showed that the AQUACEL(®) Ag group had statistically higher percentage of subjects with better wound progression (66·9% versus 51·9%, P = 0·0108). In general, both dressings were effective at promoting healing of venous ulcers. PMID:22066961
Ulcerated necrobiosis lipoidica is one of the differential diagnoses in legulcers. The diagnosis is confirmed by histopathology. The authors report on a 68-year-old female patient with a history of chronic venous insufficiency who developed a chronic legulcer that did not respond to good ulcer care and compression bandaging. Skin biopsies revealed necrobiosis lipoidica. The patient was recently discovered
... age — even children — can develop ulcers. About Peptic Ulcers An ulcer is a sore, which means it's ... people can be cured. Continue Causes of Peptic Ulcers in Kids Although stress and certain foods may ...
The basis for the new procedure is the simultaneous transcutaneous measurement of the peri-ulceral oxygen partial pressure (tcPO(2)), using a minimum of 4 electrodes which are placed as close to the wound margin as possible, additionally, as a challenge the patient inhales pure oxygen for approximately 15 minutes. In order to evaluate the measurement data and to characterise the wounds, two new oxygen parameters were defined: (1) the oxygen characteristic (K-PO(2)), and (2) the oxygen inhomogeneity (I-PO(2)) of a chronic wound. The first of these is the arithmetic mean of the two lowest tcPO(2) measurement values, and the second is the variation coefficient of the four measurement values. Using the K-PO(2) parameter, a grading of wound hypoxia can be obtained. To begin with, the physiologically regulated (and still compensated) hypoxia with K-PO(2) values of between 35 and 40 mmHg is distinguished from the pathological decompensated hypoxia with K-PO(2) values of between 0 and 35 mmHg; the first of these still stimulates self-healing (within the limits of the oxygen balance). The decompensated hypoxia can be (arbitrarily) divided into "simple" hypoxia (Grade I), intense hypoxia (Grade II) and extreme hypoxia (Grade III), with the possibility of intermediate grades (I/II and II/III).Measurements were carried out using the new procedure on the skin of the right inner ankle of 21 healthy volunteers of various ages, and in 17 CVI (chronic venous insufficiency) wounds. Sixteen of the 17 CVI wounds (i.e., 94%) were found to be pathologically hypoxic, a state which was not found in any of the healthy volunteers. The oxygen inhomogeneity (I-PO(2)) of the individual chronic wounds increased exponentially as a function of the hypoxia grading (K-PO(2)), with a 10-fold increase with extreme hypoxia in contrast to a constant value of approximately 14% in the healthy volunteers. This pronounced oxygen inhomogeneity explains inhomogeneous wound healing, resulting in the so-called mosaic wounds. The hypoxia grades found in all of the chronic wounds was seen to be evenly distributed with values ranging from 0 to 40 mmHg, and therefore extremely inhomogeneous. In terms of oxygenation, chronic wounds are therefore inhomogeneous in two respects: (1) within the wound itself (intra-individual wound inhomogeneity) and (2) between different wounds (inter-individual wound inhomogeneity). Due to the extreme oxygen inhomogeneity, single measurements are not diagnostically useful. In healthy individuals the oxygen inhalation challenge (see above) results in synchronised tcPO(2) oscillations occurring at minute rhythms, which are not seen in CVI wounds. These oscillations can be interpreted as a sign of a functioning arterial vasomotor system.The new procedure is suitable for the routine characterisation of chronic wounds in terms of their oxygen status, and correspondingly, their metabolically determining (and limiting) potential for healing and regeneration. The oxygen characteristic K-PO(2) can furthermore be used as a warning of impending ulceration, since the oxygen provision worsens over time prior to the demise of the ulcerated tissue, thus making a controlled prophylaxis possible. PMID:22737104
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).
Hunner's Ulcers Hunner's ulcers, also called "Hunner’s lesions" or "Hunner's patches," are a subtype of interstitial cystitis (also called IC) and are not ulcers in the usual sense. They are distinctive areas ...
Objective: To assess the efficacy of a micronized purified flavonoid fraction (Daflon 500 mg = Dios) in venous legulcer healing, in addition to compression therapy and standardized local care. Design: Double-blind, multicentre, randomized, parallel groups, controlled versus placebo trial; stratification according to ulcer size. Subjects: 107 patients, with venous ulcer of the leg for at least 3 months, and
J.-J. Guilhou; F. Février; C. Debure; D. Dubeaux; M.-N. Gillet-Terver; B. Guillot; H. Levesque; L. Marzin; J. Mignot; P. Ouvry; G. Pillion; H. Van Landuyt; F. Zuccarelli; A. N. Nicolaïdes
Venous ulcer, also known as stasis ulcer, is the most common etiology of lower extremity ulceration, affecting approximately 1 percent of the U.S. population. Possible causes of venous ulcers include inflammatory processes resulting in leukocyte activation, endothelial damage, platelet aggregation, and intracellular edema. The primary risk factors for venous ulcer development are older age, obesity, previous leg injuries, deep venous thrombosis, and phlebitis. On physical examination, venous ulcers are generally irregular, shallow, and located over bony prominences. Granulation tissue and fibrin are typically present in the ulcer base. Associated findings include lower extremity varicosities, edema, venous dermatitis, and lipodermatosclerosis. Venous ulcers are usually recurrent, and an open ulcer can persist for weeks to many years. Severe complications include cellulitis, osteomyelitis, and malignant change. Poor prognostic factors include large ulcer size and prolonged duration. Evidence-based treatment options for venous ulcers include leg elevation, compression therapy, dressings, pentoxifylline, and aspirin therapy. Surgical management may be considered for ulcers that are large in size, of prolonged duration, or refractory to conservative measures. PMID:20387775
Chronic wounds or ulcers are wounds that do not heal in the usual manner. This type of wound is most common in the elderly and in paraplegic patients with an estimated 1% of the population suffering from legulcers and the costs adding up to 4% of the annual National Health Service budget in the U.K. There is an identified
Sonja A. Weber; Niall Watermann; Jacques Jossinet; J. Anthony Byrne; Jonquille Chantrey; Shabana Alam; Karen So; Jim Bush; Sharon O'Kane; Eric T. McAdams
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
Foot ulceration with infection is one of the leading causes of hospitalization for patients with diabetes mellitus. Although\\u000a solid data on the true incidence and prevalence of diabetic foot ulcerations do not exist, it is believed that approx 15%\\u000a of patients with diabetes will develop a foot or legulceration in their lifetime (1). The rate of recidivism is also
... failure, especially in the elderly or persons with diabetes who take the medicines Glucophage or metformin Worsening of a clot in the leg vein There is low radiation exposure; however, most experts feel that the risk ...
Like many areas of the body, the legs contain bones, muscles, tendons, and ligaments. All of these are needed for movement. Muscles contract and lengthen as movement occurs. Muscles become shorter when they contract.
Foot and leg cramps are among the most frequent complaints presented by patients of both sexes, especially older persons. Similar cramping may occur in the thighs or in other skeletal muscles of the extremities and trunk. Foot and leg cramps usually occur after unusual exertion or during sleep. “Nocturnal leg cramps” may be of sufficient intensity to prevent sleep. “Pregnancy cramps” are particularly distressing. Effective treatment of foot and leg cramps requires an understanding of the etiology, pathophysiology and diagnostic techniques. Weight reduction and improved diet are essential. Among the useful supplementary medications are calcium lactate or gluconate, vitamin-mineral supplements, sympathetic blocking agents, vasodilators, ataraxics, muscle relaxants, quinine, hydrochloride, antihistamines, and nonmercurial diuretics. Improved foot care and correction of foot imbalance is usually required. Edema and venous insufficiency are improved by elastic support, by repeated foot elevation for massages, by manipulations and exercises and by the use of diuretics. There may be need for operations on the veins and for sclerotherapy. Patients with arterial insufficiency are often benefited by lumbar sympathetic blocks with long-acting anesthetics and intra-arterial injections with relaxants, vasodilators, thrombolytic enzymes and anticoagulants. Sympathectomy, angiography and reconstructive arterial operations are indicated in only a small proportion of patients with foot and leg cramps.
A peptic ulcer is a sore in the lining of your stomach or your duodenum, the first part of your small ... and goes for several days or weeks Peptic ulcers happen when the acids that help you digest ...
Patients with Werner's syndrome frequently develop chronic legulcers that heal poorly. We present a patient who suffered from this rare syndrome and developed typical heel ulcers. Treatment of the ulcer is challenging, as flap options are limited over the lower third of the leg and skin grafting is not easy as there is a lack of healthy granulations. We successfully treated the ulcer with osteomyelitis by drilling the bone and applying an ultrathin split thickness skin graft with the thigh skin as the donor site.
Sarcoidosis is a multi-system, granulomatous disease, which affects the skin in approximately 20 to 30 percent of cases. Recognition of cutaneous sarcoidosis can be challenging because of the wide range of skin lesion morphologies. Ulcerative sarcoidosis is uncommon. We present a 35-year-old woman with pretibial ulcerative sarcoidosis, indurated tattoos, and hilar lymphadenopathy. PMID:23286819
Hunt, Raegan D; Gonzalez, Mercedes E; Robinson, Maria; Meehan, Shane A; Franks, Andrew G
Heel ulcers are a costly and preventable complication of lower-extremity immobilization, but they still occur with some regularity. A technique using a short leg posterior splint that suspends the heel away from the splint is described. This modification completely removes pressure the heel to prevent decubitus ulcer formation. This technique is simple, inexpensive, and effective. PMID:23276331
Hsu, Raymond Y; Lareau, Craig R; Born, Christopher T
This Report tells about operational and engineering procedures used aboard D/V Glomar Challenger from Leg 45 through Leg 54. This Technical Report, the first covering some of the International Phase of Ocean Drilling (IPOD) cruises, gives performance achi...
Explains that the ulcer is a disease of modern man. Dr. Dennis McCarthy, Specialist with the National Institute of Arthritis, Metabolism, and Digestive Diseases, discusses the reasons for its prevalence. He analyzes the differences between gastric and duo...
NINDS Restless Legs Syndrome Information Page Condensed from Restless Legs Syndrome Fact Sheet Table of Contents (click to jump to sections) ... Trials Organizations Additional resources from MedlinePlus What is Restless Legs Syndrome? Restless legs syndrome (RLS) is a neurological disorder ...
Purpose: It has been suggested that leukocyte trapping and activation in the microcirculation of the leg skin causes lipodermatosclerosis and ulceration in patients with chronic venous disease. Ambulatory venous hypertension is accepted as the physiologic factor that leads to ulceration. We investigated leukocyte endothelial adhesion in patients who were subjected to short-term venous hypertension.Methods: Two groups of patients with venous
Mrinal Saharay; David A. Shields; John B. Porter; John H. Scurr; Philip D. Coleridge Smith
... the leg, the tibia and the femur. Surgical treatment may be recommended for severe unequal leg lengths caused by: poliomyelitis and cerebral palsy small, weak (atrophied) muscles or short, tight (spastic) ...
Though vehicles that use legs for locomotion promise superior mobility and versatility, very little is known about their design and control. Balance, resonance, and dynamic control are key issues underlying high performance legged systems, both man-made a...
M. H. Raibert H. B. Brown M. Chepponis E. Hastings S. E. Shreve
... page from the NHLBI on Twitter. What Is Restless Legs Syndrome? Restless legs syndrome (RLS) is a disorder that causes a strong ... and to find better treatments. Rate This Content: Restless Legs Syndrome Clinical Trials Clinical trials are research studies that ...
Humans and animals use their legs to locomote with great mobility, but we do not yet have a full understanding of how they do so. One sign of our ignorance is the lack man-made vehicles that use legs to obtain high mobility. A legged vehicle might someday...
M. H. Raibert H. B. Brown M. Chepponis E. Hastings S. S. Murthy
Ulcerative colitis is an idiopathic, chronic inflammatory disorder of the colonic mucosa, which starts in the rectum and generally extends proximally in a continuous manner through part of, or the entire, colon; however, some patients with proctitis or left-sided colitis might have a caecal patch of inflammation. Bloody diarrhoea is the characteristic symptom of the disease. The clinical course is unpredictable, marked by alternating periods of exacerbation and remission. In this Seminar we discuss the epidemiology, pathophysiology, diagnostic approach, natural history, medical and surgical management, and main disease-related complications of ulcerative colitis, and briefly outline novel treatment options. Enhanced understanding of how the interaction between environmental factors, genetics, and the immune system results in mucosal inflammation has increased knowledge of disease pathophysiology. We provide practical therapeutic algorithms that are easily applicable in daily clinical practice, emphasising present controversies in treatment management and novel therapies. PMID:22914296
Ordás, Ingrid; Eckmann, Lars; Talamini, Mark; Baumgart, Daniel C; Sandborn, William J
Up to 60 percent of adults report that they have had nocturnal leg cramps. The recurrent, painful tightening usually occurs in the calf muscles and can cause severe insomnia. The exact mechanism is unknown, but the cramps are probably caused by muscle fatigue and nerve dysfunction rather than electrolyte or other abnormalities. Nocturnal leg cramps are associated with vascular disease, lumbar canal stenosis, cirrhosis, hemodialysis, pregnancy, and other medical conditions. Medications that are strongly associated with leg cramps include intravenous iron sucrose, conjugated estrogens, raloxifene, naproxen, and teriparatide. A history and physical examination are usually sufficient to differentiate nocturnal leg cramps from other conditions, such as restless legs syndrome, claudication, myositis, and peripheral neuropathy. Laboratory evaluation and specialized testing usually are unnecessary to confirm the diagnosis. Limited evidence supports treating nocturnal leg cramps with exercise and stretching, or with medications such as magnesium, calcium channel blockers, carisoprodol, or vitamin B(12). Quinine is no longer recommended to treat leg cramps. PMID:22963024
Ulcerative colitis (UC) is a prevalent inflammatory bowel disease of the colonic mucosa affecting approximately 20,000-25,000 Danes. Apart from subgroups with early onset, extensive and long-standing inflammation, or primary sclerosing cholangitis the risk of developing colorectal cancer is of the same magnitude as in the background population. The symptoms are usually diarrhoea including bloody stools, rectal tenesmi, anaemia, and fatigue. This review is an update on diagnostics and treatment strategies of relevance for clinicians, and as UC often affects patients during their peak reproductive years, emphasis is additionally put on the management of pregnant patients with UC. PMID:23663396
Nielsen, Ole Haagen; Jess, Tine; Bjerrum, Jacob Tveiten; Seidelin, Jakob B
The treatment of venous ulcers of the leg often fails to heal because venous ulcers are mostly associated with severe lipodermatosclerosis. These complicated ulcers may require correction of local hemodynamics, excision of ulcer with surrounding lipodermatosclerotic skin, and replacement of the defect with healthy tissue. We present our experience with the use of the distally based sural flaps for the reconstruction of soft-tissue defects of the distal region of the lower limb in patients with chronic venous ulcer. Between 2001 and 2003, 12 patients with venous ulceration were treated with distally based sural flaps. At operation, the ulcer and its surrounding lipodermatosclerotic skin were excised. The defects after excision ranged from 3 x 3 to 11 x 17 cm. The distally based sural artery flap was inset within the defect. In all patients, the flap survived completely, and in only 1 patient, distal venous congestion was seen and was treated successfully with leeches. There was donor site skin graft loss in 2 patients. Two flaps had minor local complications that healed with local wound care. No recurrent ulcers were identified after average 19.7 months. In conclusion, the distally based sural flaps can be used reliably for treatment of venous ulcers. Our approach in treatment of chronic venous ulcers improves venous hemodynamics and provides local flap alternative that should be considered prior to a free-flap transfer for closure of the defect. PMID:16034246
Top, Husamettin; Benlier, Erol; Aygit, A Cemal; Kiyak, Medeni
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
Chronic lower extremity ulcers are a significant burden on patients and health care systems worldwide. Although relatively common, these wounds can be difficult to treat and present a challenge to physicians. Treatment has often been based on anecdotal accounts; however, there is a growing emphasis on using evidence-based conclusions to guide clinical decisions. In this review article, the standard of care and adjuvant therapies of venous legulcers and diabetic foot ulcers are presented from an evidence-based perspective. PMID:23742279
Richmond, Nicholas A; Maderal, Andrea D; Vivas, Alejandra C
This report documents our progress over the past three years in exploring active balance for dynamic legged systems. The purpose of this research is to build a foundation of knowledge that can lead both to the construction of useful legged vehicles and to...
H. B. Brown J. Hodgins J. Koechling M. Chepponis M. H. Raibert
This report documents our study of active balance in dynamic legged systems. The purpose of this research is to build a foundation of knowledge that can lead both to the construction of useful legged vehicles and to a better understanding of animal locomo...
H. B. Brown J. Koechling J. K. Hodgins M. Chepponis M. H. Raibert
Factor V Leiden is the most common genetic thrombophilia in people of European descent, and is important to recognize as it can have significant implications in dermatology. We report a case of a 30-year-old man who presented for evaluation and treatment of a chronic ulceration on the site of his stump following a below the knee amputation which had been performed for non-healing ulcerations. Despite a variety of treatments, his ulcer persisted. He was referred to a dermatologist who performed a biopsy that was interpreted ass non-specific, and treatment was started for pyoderma gangrenosum. Further investigation revealed a homozygous factor V Leiden mutation and cryofibrinogenemia. He was tapered off of the methylprednisolone and was improving on stanozolol. He healed well after surgery and no new ulcerations have developed. This case highlights the importance of considering this mutation in a non-healing legulcer. PMID:15577768
Barrio, Victoria R; Sanfilippo, Angela M; Malone, Janine C; Callen, Jeffrey P
The physical aids of a one-legged male farmhand, a cane, a crutch and two wooden legs, are preserved at the local history museum Hnjótur in the West Fjords of Iceland, along with a number of his everyday possessions. The older wooden leg was made by a farmer in the year 1910 and the younger by a machinist in 1935. There is no proof that either of the builders had any special knowledge or a model to follow but comparison with similar wooden legs in use on the Continent indicates some foreign influence on the construction of the Icelandic wooden legs. Each leg was used for at least 25 years, one after the other. The older leg shows signs of much wear but the younger one is in good shape. Most important for the life-time of an artificial leg is that the body weight should rest in balance over the centre of the wooden peg and that the weight does not fall outside the longitudinal axis of the peg. The medical history of the patient concerned was investigated, and compared with the tale which circulated locally, which claimed that wearing fisherman's boots which were too tight had caused the injury to his foot. The medical records of the hospital reveal, however, that the ankle was infected with tuberculosis. An attempt was made to treat this by resecting the ankle joint, which is likely to have been only the second time that such an operation was performed in Iceland. Gangrene developed in the surgical area and the leg had to be amputated. PMID:20065443
USGS scientists found this adult mountain yellow-legged frog on June 10 in Tahquitz Creek, a rediscovered population of the endangered frog in the San Jacinto Wilderness, San Bernardino National Forest, California....
... leg cramps are likely to be related to muscle fatigue and nerve problems. The risk of having night ... lowering drugs (statins) Dialysis Other conditions Dehydration Diarrhea Muscle fatigue Nerve damage, as from cancer treatments Osteoarthritis Parkinson's ...
Asymmetric leg function is often an undesired side-effect in artificial legged systems and may reflect functional deficits or variations in the mechanical construction. It can also be found in legged locomotion in humans and animals such as after an accident or in specific gait patterns. So far, it is not clear to what extent differences in the leg function of
\\u000a Superficial varicosity is a common medical condition that is symptomatic in 20-30% of the US population. Classic symptoms\\u000a of venous insufficiency are ankle edema, leg fatigue, aching, discomfort, and muscle cramps. Some patients develop associated\\u000a complications, including stasis dermatitis, lipodermatosclerosis, skin atrophy, superficial thrombophlebitis, and venous ulcers.\\u000a The treatment of varicose veins reduces symptoms and complications of chronic venous insufficiency
Primary, isolated deep venous incompetence is rare, difficult to diagnose, and can lead to the development of venous stasis ulcers. We herein report a case demonstrating chronic venous stasis ulcers due to primary, isolated deep venous incompetence, which was misdiagnosed as vasculitis ulcers associated with systemic lupus erythematosus (SLE). Although primary, isolated deep venous incompetence is rare, it is important to bear this possibility in mind when a patient presents with legulcers. PMID:12376799
Solitary rectal ulcer syndrome Basics Multimedia Resources Reprints A single copy of this article may be reprinted for personal, noncommercial use only. Solitary rectal ulcer syndrome By Mayo Clinic staff Original Article: http:// ...
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
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,
Restless legs syndrome (RLS) is a common neurological sensory-motor disorder that is characterized by intense restlessness and unpleasant creeping sensations deep inside the lower legs. Symptoms appear when the legs are at rest and are worst in the evening and at night. They force patients to keep moving their legs, and often to get out of bed and wander about. Periodic limb movements (PLMS) are also common during sleep amongst those suffering from RLS, and sleep efficiency is severely reduced. There are idiopathic as well as symptomatic forms of RLS, the latter being associated with e.g. pregnancy, iron deficiency and chronic renal failure. A family history of RLS is very common and pedigrees in these cases suggest an autosomal-dominant transmission with high penetrance. Genetic investigations have been performed in order to identify genes associated with RLS. Several loci have been found (on chromosomes 12q, 14q, 9p, 2q, 20p and 16p). Pathophysiology of RLS remains incompletely understood. However, advanced brain imaging studies and positive results of dopaminergic treatment suggest that RLS may be generated by dopamine dysfunction locally within the central nervous system. At present, there is a wide range of treatment options including levodopa, dopamine agonists, opioids, benzodiazepines, antiepileptic drugs and iron supplements. PMID:19817966
This report documents recent progress in exploring active balance for dynamic legged systems. Balance in 3D can be achieved with a very simple control system. The control system has three separate parts, one that controls forward running velocity, one tha...
M. H. Raibert H. B. Brown M. Chepponis E. Hastings J. Koechling
Restless Legs Syndrome - Causes & Symptoms Causes What causes of restless legs syndrome varies from person to person. In some cases ... with brain cell communication that can lead to restless legs syndrome. If you think you have restless legs syndrome ...
Twenty-five cases of benign giant duodenal ulcer have been studied. In every case a barium meal examination showed an ulcer crater with a radiographic diameter of at least 2 centimetres. Abdominal pain was the commonest symptom but less than half of the patients had had pain characteristic of chronic peptic ulcer. Haemorrhage from the ulcer occurred in a large majority of them. The radiological appearances are described, and it has been shown that the giant ulcer may be missed through being mistaken for the duodenal cap or else misdiagnosed. It appears that the death rate in this condition has been falling but it is still high. The management of patients with giant ulcers is discussed. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5Fig. 6
In a survey of outpatients at the Denver Veterans Affairs Medical Center for common leg symptoms--515 questionnaires returned in a 3-week period--56% reported nocturnal leg cramps, 29% reported the restless leg syndrome, and 49% reported symptoms of peripheral neuropathy. Only 33% of patients had no symptoms relating to their legs. Patients often did not report these symptoms to their physician but were more likely to do so if the symptoms were frequent. Conditions especially related to leg symptoms were hypertension, peripheral vascular disease, coronary artery disease, cerebrovascular disease, kidney disease, and hypokalemia. Most patients did not receive effective therapy for these symptoms.
We present a case of an extensive, purpuric eruption on the lower leg with peculiar clinical findings in 55-year-old woman with rheumatoid arthritis. The purpuric lesions were present unilaterally on the left lower leg, where prominent varices and telangiectasia were noted. Histological examination revealed a perivascular infiltration of lymphocytic cells and eosinophils and extravasation of erythrocytes in the upper and middle dermis. There was no evidence of vasculitis. The eruption responded well to treatment with hemostatic agents and elastic stockings. Based on the clinical and histological findings, we concluded that the main pathophysiology of the purpuric eruption is an extravasation of erythrocytes related to increased venous pressure secondary to venous stasis. PMID:23374958
The restless legs syndrome (RLS) is a chronic sensori-motor disorder characterized by a complaint of an irresistible urge to move the legs. This urge can often be accompanied by pain or other unpleasant sensations, it either occurs or worsens with rest, particularly at night, and temporarily improves with activity. Prevalence estimates vary between 7.2% and 11.5% of the Caucasian adult population. RLS prevalence increases with age, and women are more frequently affected than men. In France, a prevalence rate of 8.5% was estimated. Although RLS is mainly idiopathic, several clinical conditions have been associated with it, mainly pregnancy, iron deficiency with or without anemia, end-stage renal disease and peripheral neuropathy. RLS is often underdiagnosed and there is a clear need for complementary education to improve the accurate diagnosis of RLS. Indeed, a better knowledge of this syndrome is a prerequisite to prompt an appropriate therapeutic management. PMID:20334990
In this problem students practice counting by twos as they explore the natural phenomenon that legs on creatures always come in pairs, laying the foundation for doubling and halving. A set of cards can be downloaded (pdf) and matched. The Teachers' Notes page offers suggestions for implementation, discussion questions, ideas for extension and support, an expanded set of cards (pdf), and links to related activities (Noah and Number Tracks, both cataloged separately).
A surgeon faced with a patient presenting with an open tibial\\/fibular fracture in combination with severe damage of the surrounding soft tissues, has to make the difficult decision whether to attempt salvage or to perform an immediate amputation of the leg.\\u000a\\u000aUntil late in the nineteenth century the mortality from open fractures was high - mainly due to sepsis after
In this review, we describe the epidemiology, pathogenesis, and management of diabetic foot ulceration, and its effect on patients and society. The condition deserves more attention, both from those who provide care and those who fund research. Epidemiology Incidence and prevalence Although accurate figures are difficult to obtain for the prevalence or incidence of foot ulcers, the results of cross-
This study investigated the possibility that pericapillary fibrin deposition, found in the calf skin of patients with venous ulceration and lipodermatosclerosis, might already be present in the dermis of the gaiter area of apparently healthy limbs before any skin changes were visible. The apparently healthy limbs of 19 consecutive patients with a healed venous ulcer on one leg and no
M. C Stacey; K. G Burnand; B. S Bhogal; M. M Black
Textiloma is defined as a tumor formed due to retained gauze. It is rarely reported in the musculoskeletal system. We are presenting a case with a soft tissue swelling over the lateral aspect of the lower third of the leg, come for implant removal of the distal tibia and fibular fracture. We removed the soft tissue mass enbloc thinking it to be a benign tumor. On cutting the mass on the operation table, a gauze piece encased by fibrous tissue was found. Textiloma can present as tumoral forms and can mimic as a pseudo-tumor.
Patel, Amol C; Kulkarni, Govind S; Kulkarni, Sunil G
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
In recent years, infection of the stomach with the organism Helicobacter Pylori has been found to be the main cause of gastric ulcers, one of the common ailments afflicting humans. Excessive acid secretion in the stomach, reduction in gastric mucosal blood flow, constant intake of non-steroid anti-inflammatory drugs (NSAIDS), ethanol, smoking, stress etc. are also considered responsible for ulcer formation. The prevalent notion among sections of population in this country and perhaps in others is that "red pepper" popularly known as "Chilli," a common spice consumed in excessive amounts leads to "gastric ulcers" in view of its irritant and likely acid secreting nature. Persons with ulcers are advised either to limit or avoid its use. However, investigations carried out in recent years have revealed that chilli or its active principle "capsaicin" is not the cause for ulcer formation but a "benefactor." Capsaicin does not stimulate but inhibits acid secretion, stimulates alkali, mucus secretions and particularly gastric mucosal blood flow which help in prevention and healing of ulcers. Capsaicin acts by stimulating afferent neurons in the stomach and signals for protection against injury causing agents. Epidemiologic surveys in Singapore have shown that gastric ulcers are three times more common in the "Chinese" than among Malaysians and Indians who are in the habit of consuming more chillis. Ulcers are common among people who are in the habit of taking NSAIDS and are infected with the organism "Helicobacter Pylori," responsible for excessive acid secretion and erosion of the mucosal layer. Eradication of the bacteria by antibiotic treatment and avoiding the NSAIDS eliminates ulcers and restores normal acid secretion. PMID:16621751
We present the results obtained in a case of a 20-year-old Caucasian woman with a posttraumatic injury “hard-to-heal” of the left leg treated using autologous fat graft. Considering our experience in treatment of chronic posttraumatic ulcers by autologous fat graft, we decided to use this surgical technique to induce a regenerative effect in this young patient. We have had complete wound closure with only a single surgical procedure after 1 month; after the second intervention of autologous fat graft we observed an improvement in the quality of the scar tissue. The patient satisfaction was excellent. The results were long lasting and remained virtually unchanged after 1 year.
Caviggioli, Fabio; Klinger, Francesco Maria; Vinci, Valeriano; Cornegliani, Guido; Klinger, Marco
This book tells about the operational and engineering procedures used aboard D/V Glomar Challenger beginning with Leg 34 and continuing through Leg 44A. Other DSDP Technical Reports dealing with Operation Resumes were TR no. 1, published in October of 197...
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
Seven patients with scleroderma and either livedo reticularis or atrophie blanche lesions had ulcers of the lower extremity. Livedoid vasculitis, periarteritis nodosa, or endarteritis obliterans lesions were associated with the ulcers. Five patients had livedoid vasculitis, one patient had associated lupus panniculitis, and one patient had rheumatoid arthritis. Four patients had elevated ESRs, four had positive antinuclear antibody tests, and two had positive tests for rheumatoid factor. Patients with scleroderma and livedoid vasculitis or livedo reticularis and ulcers should be examined to rule out underlying vascular disease or endarteritis obliterans. PMID:6137196
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
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.
Maneuverability is essential for locomotion. For animals in the environment, maneuverability is directly related to survival. For humans, maneuvers such as turning are associated with increased risk for injury, either directly through tissue loading or indirectly through destabilization. Consequently, understanding the mechanics and motor control of maneuverability is a critical part of locomotion research. We briefly review the literature on maneuvering during locomotion with a focus on turning in bipeds. Walking turns can use one of several different strategies. Anticipation can be important to adjust kinematics and dynamics for smooth and stable maneuvers. During running, turns may be substantially constrained by the requirement for body orientation to match movement direction at the end of a turn. A simple mathematical model based on the requirement for rotation to match direction can describe leg forces used by bipeds (humans and ostriches). During running turns, both humans and ostriches control body rotation by generating fore-aft forces. However, whereas humans must generate large braking forces to prevent body over-rotation, ostriches do not. For ostriches, generating the lateral forces necessary to change movement direction results in appropriate body rotation. Although ostriches required smaller braking forces due in part to increased rotational inertia relative to body mass, other movement parameters also played a role. Turning performance resulted from the coordinated behavior of an integrated biomechanical system. Results from preliminary experiments on horizontal-plane stabilization support the hypothesis that controlling body rotation is an important aspect of stable maneuvers. In humans, body orientation relative to movement direction is rapidly stabilized during running turns within the minimum of two steps theoretically required to complete analogous maneuvers. During straight running and cutting turns, humans exhibit spring-mass behavior in the horizontal plane. Changes in the horizontal projection of leg length were linearly related to changes in horizontal-plane leg forces. Consequently, the passive dynamic stabilization associated with spring-mass behavior may contribute to stability during maneuvers in bipeds. Understanding the mechanics of maneuverability will be important for understanding the motor control of maneuvers and also potentially be useful for understanding stability. PMID:19566265
Restless-legs syndrome (RLS) is a sensorimotor disorder, characterized by an irresistible urge to move the legs usually accompanied or caused by uncomfortable and unpleasant sensations. It begins or worsens during periods of rest or inactivity, is partially or totally relieved by movements and is exacerbated or occurs at night and in the evening. RLS sufferers represent 2 to 3% of the general population in Western countries. Supportive criteria include a family history, the presence of periodic-leg movements (PLM) when awake or asleep and a positive response to dopaminergic treatment. The RLS phenotypes include an early onset form, usually idiopathic with a familial history and a late onset form, usually secondary to peripheral neuropathy. Recently, an atypical RLS phenotype without PLM and l-DOPA resistant has been characterized. RLS can occur in childhood and should be distinguished from attention deficit/hyperactivity disorder, growing pains and sleep complaints in childhood. RLS should be included in the diagnosis of all patients consulting for sleep complaints or discomfort in the lower limbs. It should be differentiated from akathisia, that is, an urge to move the whole body without uncomfortable sensations. Polysomnographic studies and the suggested immobilization test can detect PLM. Furthermore, an l-DOPA challenge has recently been validated to support the diagnosis of RLS. RLS may cause severe-sleep disturbances, poor quality of life, depressive and anxious symptoms and may be a risk factor for cardiovascular disease. In most cases, RLS is idiopathic. It may also be secondary to iron deficiency, end-stage renal disease, pregnancy, peripheral neuropathy and drugs, such as antipsychotics and antidepressants. The small-fiber neuropathy can mimic RLS or even trigger it. RLS is associated with many neurological and sleep disorders including Parkinson's disease, but does not predispose to these diseases. The pathophysiology of RLS includes an altered brain-iron metabolism, a dopaminergic dysfunction, a probable role of pain control systems and a genetic susceptibility with nine loci and three polymorphisms in genes serving developmental functions. RLS treatment begins with the elimination of triggering factors and iron supplementation when deficient. Mild or intermittent RLS is usually treated with low doses of l-DOPA or codeine; the first-line treatment for moderate to severe RLS is dopaminergic agonists (pramipexole, ropinirole, rotigotine). In severe, refractory or neuropathy-associated RLS, antiepileptic (gabapentin, pregabalin) or opioid (oxycodone, tramadol) drugs can be used. PMID:18656214
Maneuverability is essential for locomotion. For animals in the environment, maneuverability is directly related to survival. For humans, maneuvers such as turning are associated with increased risk for injury, either directly through tissue loading or indirectly through destabilization. Consequently, understanding the mechanics and motor control of maneuverability is a critical part of locomotion research. We briefly review the literature on maneuvering during locomotion with a focus on turning in bipeds. Walking turns can use one of several different strategies. Anticipation can be important to adjust kinematics and dynamics for smooth and stable maneuvers. During running, turns may be substantially constrained by the requirement for body orientation to match movement direction at the end of a turn. A simple mathematical model based on the requirement for rotation to match direction can describe leg forces used by bipeds (humans and ostriches). During running turns, both humans and ostriches control body rotation by generating fore-aft forces. However, whereas humans must generate large braking forces to prevent body over-rotation, ostriches do not. For ostriches, generating the lateral forces necessary to change movement direction results in appropriate body rotation. Although ostriches required smaller braking forces due in part to increased rotational inertia relative to body mass, other movement parameters also played a role. Turning performance resulted from the coordinated behavior of an integrated biomechanical system. Results from preliminary experiments on horizontal-plane stabilization support the hypothesis that controlling body rotation is an important aspect of stable maneuvers. In humans, body orientation relative to movement direction is rapidly stabilized during running turns within the minimum of two steps theoretically required to complete analogous maneuvers. During straight running and cutting turns, humans exhibit spring-mass behavior in the horizontal plane. Changes in the horizontal projection of leg length were linearly related to changes in horizontal-plane leg forces. Consequently, the passive dynamic stabilization associated with spring-mass behavior may contribute to stability during maneuvers in bipeds. Understanding the mechanics of maneuverability will be important for understanding the motor control of maneuvers and also potentially be useful for understanding stability.
... or aphthae, are the most common cause of periodic (recurring) ulcers inside the mouth and genital linings ( ... Dec 2008 Information for other ages: Child Teen Table of Contents: Overview Who's At Risk Signs and ...
... therapy will use acid suppression therapy with a proton pump inhibitor (PPI) along with antibiotic therapy and ... all peptic ulcers will be treated with a proton pump inhibitor (PPI). PPIs are powerful acid blocking ...
Preventing the occurrence of pressure ulcers requires multi-disciplinary care of the patient. Firstly, it is necessary to identify patients predisposed to developing pressure ulcers thanks to awareness of the risk factors and using where necessary adapted assessment scales. Preventative measures then comprise the suitable positioning of the patient, regularly changing their position, the use of special support equipment, nursing care and the treatment of undernutrition. PMID:23785858
In recent years, infection of the stomach with the organism Helicobacter Pylori has been found to be the main cause of gastric ulcers, one of the common ailments afflicting humans. Excessive acid secretion in the stomach, reduction in gastric mucosal blood flow, constant intake of non-steroid anti-inflammatory drugs (NSAIDS), ethanol, smoking, stress etc. are also considered responsible for ulcer formation.The
Venous ulcers are the most common ulcers of the lower limb. It has a high morbidity and results in economic strain both at a personal and at a state level. Chronic venous hypertension either due to primary or secondary venous disease with perforator paucity, destruction or incompetence resulting in reflux is the underlying pathology, but inflammatory reactions mediated through leucocytes, platelet adhesion, formation of pericapillary fibrin cuff, growth factors and macromolecules trapped in tissue result in tissue hypoxia, cell death and ulceration. Duplex scan with colour flow is the most useful investigation for venous disease supplying information about patency, reflux, effects of proximal and distal compression, Valsalva maneuver and effects of muscle contraction. Most venous disease can be managed conservatively by leg elevation and compression bandaging. Drugs of proven benefit in venous disease are pentoxifylline and aspirin, but they work best in conjunction with compression therapy. Once ulceration is chronic or the patient does not respond to or cannot maintain conservative regime, surgical intervention treating the underlying venous hypertension and cover for the ulcer is necessary. The different modalities like sclerotherapy, ligation and stripping of superficial varicose veins, endoscopic subfascial perforator ligation, endovenous laser or radiofrequency ablation have similar long-term results, although short-term recovery is best with radiofrequency and foam sclerotherapy. For deep venous reflux, surgical modalities include repair of incompetent venous valves or transplant or transposition of a competent vein segment with normal valves to replace a post-thrombotic destroyed portion of the deep vein.
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.
Stoffregen, Thomas A.; Chen, Fu-Chen; Varlet, Manuel; Alcantara, Cristina; Bardy, Benoit G.
The research (February 1969-January 1970) indicated the practical use of the functional long leg brace with patients requiring external support for a flaccid knee. A biomechanical analysis of the brace demonstrated that the brace is mechanically stable du...
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.
Endocrine tumors of the gastroenteropancreatic system associated with specific skin manifestations are rare. We report a 53-year-old female who presented with migratory annular and arcuate ulcers on her limbs. Histopathology was similar to necrolytic erythema family which includes necrolytic migratory erythema (NME). Though initial CT scans were normal, follow up scans revealed multiple mass lesions in the tail of pancreas. Her skin lesions responded to oral zinc sulphate and monthly injections of octreotide. Prior to planned FNAC from the mass lesion, patient developed altered sensorium and succumbed to the disease. This case report seems to differ from NME clinically, due to unique finding of deep migrating ulcers which heal with scarring. ‘Necrolytic migratory ulceration’ thus appears to be a new paraneoplastic manifestation, secondary to pancreatic malignancy.
Background: Venous ulcers can be difficult to heal, and prognostic factors for healing have not been fully elucidated. Objective: The objective of this study was to analyze the results of a large multicenter venous ulcer trial to retrospectively establish prognostic factors for venous ulcer healing. Methods: This study examined data from a previously published prospective randomized placebo-controlled trial of an
Tania J. Phillips; Fidelis Machado; Richard Trout; John Porter; Jeffrey Olin; Vincent Falanga
A protocol prescribing leg motion during the swing phase is developed for the planar lateral leg spring model of locomotion.\\u000a Inspired by experimental observations regarding insect leg function when running over rough terrain, the protocol prescribes\\u000a the angular velocity of the swing-leg relative to the body in a feedforward manner, yielding natural variations in the leg\\u000a touch-down angle in response
Several gastrointestinal peptides with proven or suggested endocrine or paracrine functions influence gastric acid secretion, gastrointestinal motility, and mucosal blood flow. Increased or decreased release of such factors could participate in the pathogenesis of duodenal ulcer disease by inducing increased gastric acid concentration in the duodenal bulb. To date, increased stimulation of parietal cells by gastrin has been demonstrated only
Introduction Most people with recurrent aphthous ulcers develop a few ulcers less than 1 cm in diameter, that heal after 5 to 14 days without scarring. The causes are unknown, but risks of recurrence may decrease if the person gives up smoking. Local physical trauma may trigger ulcers in susceptible people. In 10% of sufferers, lesions are more than 1 cm in diameter, and can cause scarring. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for recurrent aphthous ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2006 (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 18 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: analgesics (local), carbenoxolone mouthwash, chlorhexidine (and similar agents), corticosteroids (topical), and tetracycline antibiotic mouthwash.
The skin of elderly patients is very fragile and dry which impairs its function as a barrier and renders it more exposed to external attacks, perilesional complications around pressure ulcers are often linked to several interrelated mechanisms. These complications require, from the teams, in-depth knowledge of the care protocols. PMID:23785860
... swollen gums that are painful even if no pressure is placed on them Gums that bleed easily Bad breath or a bad taste in the mouth A gray film on the gums Sores (ulcers) on the gums Sore throat Fever (not often) ...
Giant duodenal ulcers (GDU) have been associated with a high incidence of morbidity and mortality unless early operative intervention is undertaken. There are few published reports of successful medical management of GDU. Therefore, we reviewed 14 consecutive patients with GDU at our institution. Excluding the following cases: Two patients who had elective surgery, two patients who died from unrelated causes,
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
Genetic parameters for different claw disorders, overall claw health and feet and leg conformation traits were estimated for Finnish Ayrshire cows. The merged data set with records of claw health and feet and leg conformation traits consisted of 105,000 observations from 52,598 Finnish Ayrshire cows between 2000 and 2010. The binary claw health data and the linearly scored conformation data were analysed using an animal model and restricted maximum likelihood method by applying the statistical package ASReml. Binomial logistic models with mixed effects were used to estimate genetic parameters for sole haemorrhages, chronic laminitis, white-line separation, sole ulcer, interdigital dermatitis, heel horn erosion, digital dermatitis, corkscrew claw and overall claw health. Estimated heritabilities for different claw disorders using a binomial logistic model ranged from 0.01 to 0.20. Estimated heritability for overall claw health using a binomial logistic model was 0.08. Estimated heritabilities for feet and leg conformation traits ranged from 0.07 to 0.39. The genetic correlations between claw health and feet and leg conformation traits ranged from -0.40 to 0.42. All phenotypic correlations were close to zero. The moderate genetic correlation, together with higher heritability of feet and leg conformation traits, showed that RLSV (rear leg side view) is a useful indicator trait to be used together with claw trimming information to increase the accuracy of breeding values for claw health in genetic evaluation. PMID:23496009
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.
Women are more commonly affected than men by restless legs syndrome, and prevalence is highest amongst those of northern European heritage. The motor manifestations include nonvolitional myoclonus (periodic leg movements). Disinhibition of spinal sensorimotor circuits may underlie these primary features and can be affected by peripheral as well as supraspinal networks. Insufficient mobilizable iron stores increase expressivity in some individuals. The sensorimotor features are relieved by dopamine, especially dopamine agonists, gabapentin and its derivatives, and opioids. A diagnosis relies on recognition of key primary and supportive features, and treatments are generally well tolerated, efficacious, and life-changing. PMID:23099132
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.
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.
Restless legs syndrome (RLS) is a neurological disorder related to abnormal and unpleasant sensations and movements in the legs. It usually occurs at nighttime and thus has a detrimental impact on the ability to sleep, leading to poor patient quality of life. UCB has been developing rotigotine transdermal patch system (Neupro; SPM-962) as a treatment for RLS. This system is designed to replace levels of dopamine in the body via once-daily application of the patch, in a bid to restore proper motor functioning. The rotigotine patch has been authorized for the treatment of RLS since August 2008. PMID:19956807
A 43-year-old male patient was admitted to our hospital because of left heel pain and fever. He had had swelling of the left ankle joint and pain 4 years prior to this, and 4 years later, he was admitted to another hospital when left heel ulcer and fever developed. The ulcer was diagnosed and treated as a diabetic ulcer because of hyperglycemia. In spite of good control of blood sugar, the ulcer became enlarged and the pain deteriorated, so he was transferred to orthopedics. Antibiotics produced no response, and culture from a specimen of the ulcer was negative. However, severe inflammatory response was seen in blood examination. MRI and scintigram of his left foot showed disseminated low intensity areas and accumulation in the tarsal bone area, so osteomyelitis was suspected. A biopsy of the ulcer showed infiltration of inflammatory cells into the dermis. We considered amputation of the left lower leg at first. However the biopsy result suggested an autoimmune mechanism, so prednisolone was administered. As a result, the ulcer and pain both diminished. This case was similar to pyoderma gangenosum, however this diagnosis cannot explain osteomyelitis or all its symptoms. We expect that there must be other case report with the same symptoms. PMID:10917019
Idogawa, M; Takahashi, H; Soma, T; Mihara, M; Mizukoshi, T; Murakami, R; Sugaya, T; Makiguchi, Y; Imai, K
In this review, we examined studies published on oral and topical formulations of budesonide (Entocort and Budenofalk, in Spain: Entocord and Intestifalk) for the treatment of ulcerative colitis. This glycocorticosteroid has a potent local action and an important first-pass liver metabolism. It has proven successful over the last years as a controlled-release formulation. It obtained results similar to prednisolone, without the latter s significant suppression of plasma cortisol. Many publications exist on the effects of oral budesonide for the treatment of Crohn s disease (CD). These have led to the registration of this drug for the treatment of CD. Studies on oral formulations of budesonide for the treatment of ulcerative colitis (UC) are scarce. After reviewing published evidence, we suggest the conduction of controlled trials for the treatment of UC to obtain evidence-based efficacy and safety results in order to benefit patients with this form of inflammatory bowel disease (IBD). PMID:16944997
The authors describe the case of a 39-year-old man who presented to our hospital with easy fatigability and malaise. On physical examination, hypertension was noted without any cushingoid appearance. Laboratory testing revealed normochromic-normocytic anaemia with positive results of occult blood in the stool, hyperglycaemia and hypokalemia. Upper endoscopy revealed active gastric ulcer with Helicobacter pylori infection, likely causing gastrointestinal bleeding. Endocrine examinations showed that both serum adrenocorticotropic hormone and cortisol were elevated with loss of diurnal variation. A diagnosis of Cushing’s disease secondary to pituitary adenoma was made as results of brain MRI and blood sampling from inferior petrosal sinus. In a patient with peptic ulcer disease, physician should be alert to the possible endocrine background.
Background: Use of nerve decompression in diabetic sensorimotor polyneuropathy is a controversial treatment characterized as being of unknown scientific effectiveness owing to lack of level I scientific studies. Methods: Herein, long-term follow-up data have been assembled on 65 diabetic patients with 75 legs having previous neuropathic foot ulcer and subsequent operative decompression of the common peroneal and tibial nerve branches in the anatomical fibro-osseous tunnels. Results: The cohort's previously reported low recurrence risk of less than 5% annually at a mean of 2.49 years of follow-up has persisted for an additional 3 years, and cumulative risk is now 2.6% per patient-year. Nine of 75 operated legs (12%) have developed an ulcer in 4,218 months (351 patient-years) of follow-up. Of the 53 contralateral legs without decompression, 16 (30%) have ulcerated, of which three have undergone an amputation. Fifty-nine percent of patients are known to be alive with intact feet a mean of 60 months after decompression. Conclusions: The prospective, objective, statistically significant finding of a large, long-term diminution of diabetic foot ulcer recurrence risk after operative nerve decompression compares very favorably with the historical literature and the contralateral legs of this cohort, which had no decompression. This finding invites prospective randomized controlled studies for validation testing and reconsideration of the frequency and contribution of unrecognized nerve entrapments in diabetic sensorimotor polyneuropathy and diabetic foot complications. PMID:24072366
Executive Summary In April 2008, the Medical Advisory Secretariat began an evidence-based review of the literature concerning pressure ulcers. Please visit the Medical Advisory Secretariat Web site, http://www.health.gov.on.ca/english/providers/program/mas/tech/tech_mn.html to review these titles that are currently available within the Pressure Ulcers series. Pressure ulcer prevention: an evidence based analysis The cost-effectiveness of prevention strategies for pressure ulcers in long-term care homes in Ontario: projections of the Ontario Pressure Ulcer Model (field evaluation) Management of chronic pressure ulcers: an evidence-based analysis Objective The Medical Advisory Secretariat (MAS) conducted a systematic review on interventions used to treat pressure ulcers in order to answer the following questions: Do currently available interventions for the treatment of pressure ulcers increase the healing rate of pressure ulcers compared with standard care, a placebo, or other similar interventions? Within each category of intervention, which one is most effective in promoting the healing of existing pressure ulcers? Background A pressure ulcer is a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in conjunction with shear and/or friction. Many areas of the body, especially the sacrum and the heel, are prone to the development of pressure ulcers. People with impaired mobility (e.g., stroke or spinal cord injury patients) are most vulnerable to pressure ulcers. Other factors that predispose people to pressure ulcer formation are poor nutrition, poor sensation, urinary and fecal incontinence, and poor overall physical and mental health. The prevalence of pressure ulcers in Ontario has been estimated to range from a median of 22.1% in community settings to a median of 29.9% in nonacute care facilities. Pressure ulcers have been shown to increase the risk of mortality among geriatric patients by as much as 400%, to increase the frequency and duration of hospitalization, and to decrease the quality of life of affected patients. The cost of treating pressure ulcers has been estimated at approximately $9,000 (Cdn) per patient per month in the community setting. Considering the high prevalence of pressure ulcers in the Ontario health care system, the total cost of treating pressure ulcers is substantial. Technology Wounds normally heal in 3 phases (inflammatory phase, a proliferative phase of new tissue and matrix formation, and a remodelling phase). However, pressure ulcers often fail to progress past the inflammatory stage. Current practice for treating pressure ulcers includes treating the underlying causes, debridement to remove necrotic tissues and contaminated tissues, dressings to provide a moist wound environment and to manage exudates, devices and frequent turning of patients to provide pressure relief, topical applications of biologic agents, and nutritional support to correct nutritional deficiencies. A variety of adjunctive physical therapies are also in use. Method Health technology assessment databases and medical databases were searched from 1996 (Medline), 1980 (EMBASE), and 1982 (CINAHL) systematically up to March 2008 to identify randomized controlled trials (RCTs) on the following treatments of pressure ulcers: cleansing, debridement, dressings, biological therapies, pressure-relieving devices, physical therapies, nutritional therapies, and multidisciplinary wound care teams. Full literature search strategies are reported in appendix 1. English-language studies in previous systematic reviews and studies published since the last systematic review were included if they had more than 10 subjects, were randomized, and provided objective outcome measures on the healing of pressure ulcers. In the absence of RCTs, studies of the highest level of evidence available were included. Studies on wounds other than pressure ulcers and on surgical treatment of pressure ulcers were excluded. A total of 18 systematic reviews, 104 RCTs, and 4 observational
The Wagner system describes the diabetic foot ulcer as a full thickness wound extending to tendons or deeper subcutaneous\\u000a tissue but without bony involvement or osteomyelitis . The university of Texas system refers to levels of ischemia \\u000a and infection while the SAD system  attends to size, area, depth, arteriopathy and any neuropathic involvement. The breadth\\u000a of classification system
Opinion statement Although upper gastrointestinal (GI) bleeding from stress-related mucosal disease (SRMD) in critically ill patients is common,\\u000a significant bleeding with hemodynamic instability is not. Risk factor assessment can assist in identifying patients with a\\u000a greater likelihood of developing significant SRMD. Prophylaxis against stress ulcer bleeding with luminal agents (eg, antacids\\u000a and sucralfate) or drugs that inhibit acid secretion (eg, histamine
Background Although the clinicopathologic features of solitary rectal ulcer syndrome (SRUS) are well documented, the heterogeneous endoscopic appearance of lesions that the syndrome produces and its rare incidence may make for clinical confusion.Methods Together with a literature review, we describe the variety of lesions experienced in our hospital with a series of endoscopic and histological illustrations and emphasize the diagnostic dilemma both
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.
Four patients with nicorandil induced ulceration are described, and the literature on the subject is reviewed. Nicorandil induced ulcers are very painful and distressing for patients. Clinically they appear as large, deep, persistent ulcers that have punched out edges. They are poorly responsive to topical steroids and usually require alteration of nicorandil treatment. The ulceration tends to occur at high doses of nicorandil and all four cases reported here were on doses of 40 mg per day or greater. In these situations reduction of nicorandil dose may be sufficient to promote ulcer healing and prevent further recurrence. However, nicorandil induced ulcers have been reported at doses as low as 10 mg daily and complete cessation of nicorandil may be required.
Acute compartment syndromes in the lower leg are well recognized following major trauma. However, although rare, they may occur following seemingly minor sporting injury. A case of acute compartment syndrome, following a football game and affecting the peroneal or lateral compartment, is described, in which prompt diagnosis and treatment led to a satisfactory outcome. The diagnosis and surgical management of
We present the results obtained in a case of a 20-year-old Caucasian woman with a posttraumatic injury "hard-to-heal" of the left leg treated using autologous fat graft. Considering our experience in treatment of chronic posttraumatic ulcers by autologous fat graft, we decided to use this surgical technique to induce a regenerative effect in this young patient. We have had complete wound closure with only a single surgical procedure after 1 month; after the second intervention of autologous fat graft we observed an improvement in the quality of the scar tissue. The patient satisfaction was excellent. The results were long lasting and remained virtually unchanged after 1 year. PMID:23319957
Caviggioli, Fabio; Klinger, Francesco Maria; Vinci, Valeriano; Cornegliani, Guido; Klinger, Marco
Objective: To evaluate the characteristics of leg movements experienced by patients with the restless legs syndrome (RLS) during wakefulness using the suggested immobilization test (SIT).Methods: Forty patients with primary RLS who showed an index of leg movements greater than 40 during the SIT were selected for these analyses.Results: In general, Coleman's criteria for scoring PLMS were appropriate for scoring leg
Martin Michaud; Gaétan Poirier; Gilles Lavigne; Jacques Montplaisir
... page from the NHLBI on Twitter. How Is Restless Legs Syndrome Treated? Restless legs syndrome (RLS) has no cure. If a condition or ... to prevent these side effects. Rate This Content: Restless Legs Syndrome Clinical Trials Clinical trials are research studies that ...
LAFFAYE, G., B. G. BARDY, and A. DUREY. Leg Stiffness and Expertise in Men Jumping. Med. Sci. Sports Exerc., Vol. 37, No. 4, pp. 536-543, 2005. Purpose: The aim of the present study is to investigate: a) the leg spring behavior in the one-leg vertical jump, b) the contribution of impulse parameters to this behavior, and c) the effect of
The Carnegie Mellon University Planetary Rover project is developing a six-legged walking robot capable of autonomously navigating, exploring, and acquiring samples in rugged, unknown environments. This report describes an integrated software system capable of navigating a single leg of the robot over rugged terrain. The leg, based on an early design of the Ambler Planetary Rover, is suspended below a
This satellite broadcast will define pressure ulcers, describe the etiology of pressure ulcers, identify the effective prevention measures, and explain the rational for comprehensive nutrition intervention.
A 54-year-old man presented with progressive asymmetric leg pain and weakness. He had a history of invasive squamous cell carcinoma that was fully treated 2 years earlier. His leg symptoms progressed relentlessly during several months. Imaging studies demonstrated enhancement of the cauda equina and leptomeninges of the lower spinal cord. Initial cerebrospinal fluid examination showed an elevated protein concentration and lymphocytic pleocytosis with no malignant cells on cytological analysis. There was short-term improvement in symptoms and cerebrospinal fluid abnormalities with intravenous steroids. Two additional cerebrospinal fluid studies showed normal cytological findings, elevated IgG synthesis, and elevated antibody titers to varicella-zoster virus. Over time, the patient worsened, developed cranial neuropathies, and ultimately died. The pathological diagnosis and the approach to the clinical data are discussed. PMID:23440264
Navalkele, Digvijaya D; Georgescu, Maria-Magdalena; Burns, Dennis K; Greenberg, Tasha; Vernino, Steven
A 48-year-old female with an atypical plaque-like lesion of the lower leg is presented in this article. Histologic investigation revealed a rare low-grade fibromyxoid sarcoma (pT1a cN0 cM0; stage Ia) of suprafascial localization. Staging of the patient did not reveal metastatic spread. The tumor was surgically removed with wide safety margins. The defect was closed using a mesh graft transplant and vacuum-assisted closure. Healing was complete. Regular follow-up for at least 5 years is recommended. Besides the rareness of this tumor, this case is also remarkable because of the localization on the lower leg and the suprafascial soft tissue.
Shoes are necessary for protection and warmth. Normal children do not require shoes for support. There is no scientific evidence that shoes—‘orthopedic’ or otherwise—influence or alter the growth or shape of the normal child's foot except, perhaps, adversely if they fit poorly. Family physicians must understand common variations of normal foot and leg development if they are to effectively advise and reassure parents about appropriate footwear. Flat feet, knock knees, bow legs, in-toeing, and out-toeing in otherwise normal children can easily be distinguished from similar but more serious deformities associated with disease or congenital anomaly. ImagesFig. 1AFig. 1BFig. 2AFig. 2B
A 15-year-old female suffered from a persistent ulcer which developed in her knee. At the ninth operation, intraarticular knee arthrodesis was performed but the ulcer recurred. The most effective treatment was neither thorough debridement nor a free musculocutaneous flap covering, but the application of a plaster cast. The condition is thought to have been Munchausen syndrome. PMID:8012256
These observations support the theory that peptic ulceration results from failure of adequate local repair to mucosal injury. The resultant ulcer may be acute or chronic depending upon the duration of the stress or the mucosal contact of the irritative substance and on the ability of the local tissue to achieve cellular homeostasis. The role of acid and pepsin secretion
We report a prospective study of the causes and treatment of 26 long-standing neuropathic ulcers of the foot in 21 patients. The most important causal factor, well illustrated by pressure studies, was the presence of a dynamic or static deformity leading to local areas of peak pressure on insensitive skin. All but one of the 26 ulcers had healed after
A. I. LANG-STEVENSON; W. J. W. SHARRARD; R. P. BETTS; T. DUCKWORTH
The history of management of ulcer disease is one of the great stories in the history of general surgery. The surgeons who have helped elucidate the anatomy, physiology, biochemistry, and operative management of patients who have ulcers have earned their place in the historical ranks of our discipline. One is hard-pressed to find a vein of surgical thought with such
Acute compartment syndromes in the lower leg are well recognized following major trauma. However, although rare, they may occur following seemingly minor sporting injury. A case of acute compartment syndrome, following a football game and affecting the peroneal or lateral compartment, is described, in which prompt diagnosis and treatment led to a satisfactory outcome. The diagnosis and surgical management of acute compartment syndromes are discussed. Early recognition and treatment are important in the prevention of long-term disability. Images Figure 1
Acute compartment syndromes in the lower leg are well recognized following major trauma. However, although rare, they may occur following seemingly minor sporting injury. A case of acute compartment syndrome, following a football game and affecting the peroneal or lateral compartment, is described, in which prompt diagnosis and treatment led to a satisfactory outcome. The diagnosis and surgical management of acute compartment syndromes are discussed. Early recognition and treatment are important in the prevention of long-term disability. PMID:1810617
Leg soft tissue defects with bone or tendon exposure need to be covered with a flap. Various local and free flaps with more or less consistent donor site defects have been described in the past. After the introduction of the perforator-based flap concept, new flaps have also been described for the leg. An evolution and simplification of the perforator flap concept, together with the 'free style' flap harvesting method, are the propeller flaps, i.e. local flaps, based on a perforator vessel, which becomes the pivot point for the skin island that can, therefore, be rotated up to 180 degrees . In this prospective study, six consecutive patients, having post-traumatic soft tissue defects of the leg or knee prosthesis infection, with bone or tendon exposure, were treated with propeller flaps. Complete and stable coverage of the soft tissue losses was obtained in all cases with an inconspicuous, only cosmetic, donor site defect. No flap necrosis was observed, with the exception of a small superficial necrosis of the tip of one flap, due to the inclusion in the design of scarred tissue. In two cases, transient venous congestion was observed and resolved spontaneously. Mean operative time was 2 h (ranging from 60 min to 6 h when an orthopaedic procedure was also needed) and mean hospital stay after surgery was 10 days. Propeller flaps allow the coverage of wide defects, can be raised with a relatively simple surgical technique, have a high success rate and good cosmetic results without functional impairment. In the light of this they can be considered among the first surgical choices to resurface complex soft tissue defects of the leg. PMID:18450531
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
Malignant degeneration is the most serious complication of gastric ulcer. Its recognition is difficult both in the early stage and in advanced cases in which only the evidence of a previous ulcer-cavity, and the radiating folds of the mucous membrane indicate progressive development of carcinoma from an original ulcer. It is impossible to say how often gastric ulcer becomes malignant; one can only state the frequency of ulcer-carcinoma, found in gastric resections. One hundred and forty-one personal cases of ulcer-carcinoma are recorded, and are divided into three groups. Group I: 41 which were diagnosed clinically and at operation as cases of ulcer, but in which histological examination showed incipient cancer. Group II: 55 diagnosed clinically as cases of ulcer, but in which a diagnosis of ulcer-carcinoma was made during operation and afterwards histologically confirmed. Group III: 45 diagnosed both clinically and macroscopically (from the typical folding of the mucous membrane) as cases of ulcer-cancer, in which the cancer had entirely overgrown the ulcer. Therefore in the series of 532 resections for gastric ulcer the frequency of ulcer-carcinoma was 20.9%, or 15.2% if the third group is omitted. In a series of 718 resections for gastric cancer, the frequency of ulcer-carcinoma was 19.6% (or 14.2% if the third group is omitted). The mortality in simple two-third resection of the stomach is low (four deaths in 99 cases = 4%). When the pancreas, liver, colon, or œsophagus, is involved, the resection mortality is high (14 deaths in 42 cases = 33.3%), but even in these cases the operation is justifiable because permanent cures were achieved in a number of cases. The prognosis in cases of ulcer-cancer is very grave. In many cases, judging from the author's own experience, patients suffering from incipient ulcer-cancer—only histologically diagnosed as cancer—die from liver metastases, in spite of radical resection. It will thus be seen that the end-results of resection for ulcer-carcinoma are actually worse than those of resection for primary carcinoma. A. Ulcer-cancer: In Group I, 35 cases were operated on before 1933, and in 18 of these (51.4%) the patients have been free from symptoms for more than five years; in Group II, 27 cases were operated on before 1933, and in four of these (14.8%) the patients are still symptom-free. In Group III, out of 37 cases operated on, only two patients (5.4%) have been symptom-free for the same period. B. Primary cancer: Out of 260 cases of resection for primary cancer before 1933, 77 patients (29.6%) are permanently cured. If the ulcer-cancer is so far advanced that the diagnosis can be made clinically, or during operation, the prognosis is extremely bad (permanent cures having been only 9.3% in the series). In cases of gastric ulcer the best plan is to carry out resection before malignant degeneration begins. The result would then be that not merely 51% but at least 90% of the patients would be alive and well after five years. ImagesFig. 1Fig. 2
Due to its increased presence in the press and on television, the diagnosis of lipedema is on the way to becoming a trendy diagnosis for those with thick legs. Despite this, one must recognize that lipedema is a very rare disease. It is characterized by disproportional obesity of the extremities, especially in the region of the hip and the legs, hematoma development after minimal trauma, and increased pressure-induced or spontaneous pain. Aids for making the correct diagnosis are (duplex) sonography, the waist-hip index or the waist-height index and lymphoscintigraphy. Important differential diagnoses are constitutional variability of the legs, lipohypertrophy in obesity, edema in immobility, edema in chronic venous insufficiency and rheumatic diseases. The symptom-based therapy of lipedema consists of conservative (compression, manual lymphatic drainage, exercise) and surgical treatments (liposuction). Until now there is no curative therapy. Obesity is an important risk factor for the severity and prognosis of lipedema. Further studies for a better understanding of the pathogenesis of lipedema and in the end possible curative treatments are urgently needed. PMID:23231593
Reich-Schupke, Stefanie; Altmeyer, Peter; Stücker, Markus
In order to evaluate whether prepyloric ulcer (PPU) could be classified as an intermediate ulcer type between duodenal ulcer (DU) and gastric ulcer (GU), fasting serum gastrin as well as basal and pentagastrin-stimulated acid secretion were studied. The fasting serum gastrin values in the three groups were not significantly different. Patients with PPU and DU showed a higher basal acid
H. Stødkilde-Jørgensen; N. A. Løvgreen; J. Ørnsholt; E. Amdrup
The goal was to describe static one-legged balance during use of a lifted leg and to compare balance between the dominant and nondominant legs of soccer players. Participants were 17 male soccer players and 17 untrained male students (control). Balance ability was evaluated with four sway measures: sway velocity, anterior-posterior sway, medial-lateral sway, and high-frequency sway. Soccer players had smaller magnitude mean anterior-posterior and medial-lateral sway than untrained students. Although mean sway velocity and anterior-posterior sway were higher with the dominant leg than in the nondominant leg of the control group, there was no significant difference on any sway factor between the two legs of the soccer group. In conclusion, the soccer players were observed to have superior static one-legged balance during use of a lifted leg, and there is no difference in balance for the two legs in the soccer group. PMID:21058597
Stress ulcers are superficial mucosal lesions located predominantly in the fundus of the stomach. They occur mainly in the victims of severe trauma and sepsis and are to be clearly distinguished from Cushing's ulcers, ulcers induced by drugs and from activation of a preexistent ulcer. It is generally agreed that mucosal ischemia is the major inciting event in the pathogenesis
Nearly all peptic ulcers are caused by either Helicobacter pylori infection or non-steroidal inflammatory drug (NSAID) use, including aspirin. As H. pylori infection is becoming less prevalent in developed countries, NSAIDs are an increasingly important cause of ulceration, particularly ulcers complicated by bleeding. Only about 15% of H. pylori-infected people develop an ulcer in their lifetime; virulence of the H.
Idiopathic ulcerative colitis primarily affects young adults. Colonic symptoms are the most annoying. In severe colitis, systemic and extraintestinal inflammatory manifestations can be disabling. Proximal extension of colitis is demonstrated by double-contrast barium enema and total colonoscopy. Bacterial and parasitic colitis must be excluded by appropriate microbiological studies. Colonoscopy is recommended to screen for high-grade dysplasia or neoplasia in cases of chronic diffuse colitis (after seven years). Severe colitis can benefit from hospitalization, parenteral nutritional support, and high doses of corticosteroids that are progressively tapered. Mild or moderate cases or severe cases in remission respond well to rest, low-irritant diets, mild symptomatic medication, oral sulfasalazine, or more recent 5-acetylsalicylic derivatives. Long-term maintenance with reduced dosages will control more than 80% of cases.
Although upper gastrointestinal (GI) bleeding from stress-related mucosal disease (SRMD) in critically ill patients is common, significant bleeding with hemodynamic instability is not. Risk factor assessment can assist in identifying patients with a greater likelihood of developing significant SRMD. Prophylaxis against stress ulcer bleeding with luminal agents (eg, antacids and sucralfate) or drugs that inhibit acid secretion (eg, histamine 2-receptor antagonists and proton-pump inhibitors) can reduce major bleeding but has little or no effect on mortality. Currently, the mainstays of prophylactic therapy for SRMD are intravenously administered H2RAs and PPIs. Wider usage of PPIs reflects their enhanced efficacy in suppressing acid secretion as well as lack of tolerance for H2RAs. Guidelines for the prophylactic use of H2RAs or PPIs in treatment of SRMD will require large, randomized studies that also examine cost effectiveness of individual strategies. PMID:16539876
763 patients from the "Honorio Delgado" Regional Hospital of Arequipa city (2300 mts ht) are studied, all suffering of gastroduodenal peptic ulcer disease. A comparison between the principal clinical feactures of patients coming from the Coast and the Hights, is done. It is concluded that in patients from the Hights ulcer disease has an earlier beginning (third decade), clinical features are atypical; the incidence of complications are higher (59%) mainly hemorrhagic ones (53%); the occurrence of gastric ulcer is also higher (DU/GU = 2.5/1 against 5/1 seen in patients from the Coast) and mortality rate is greater (2.0%). PMID:2131004
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
Background: Stasis dermatitis with secondary ulcer formation is not only therapeutically challenging but also significantly decreases the quality of life for affected individuals. Recently, autologous platelet-rich plasma (PRP) has entered the therapeutic regimen for legulcers, while light-emitting diodes (LEDs) are now used to accelerate wound healing. Objective: To assess the efficacy and safety of autologous PRP with concomitant LED therapy for the treatment of venous stasis dermatitis with secondary ulceration. Methods and materials: In total, 16 Korean patients with ulcers secondary to venous stasis dermatitis were enrolled in this study. Each lesion was treated with autologous PRP weakly, and LED therapy three times per week. Treatments continued for 6 weeks or until the ulcer completely reepithelialized without evidence of drainage. Not only were subjects objectively evaluated by a study investigator, their own subjective satisfaction was also assessed. Results: The combined autologous PRP and LED therapy was well tolerated and safe. A statistically significant improvement was observed post-therapeutically in the clinical parameters of pain, itching, heaviness, paresthesia, cramps, and leg swelling. There was also a significant decrease in ulcer size. None of the patients showed worsening of their venous stasis ulcer. Regarding subject satisfaction with the regimen, 75.0% of participants reported being 'satisfied or very satisfied' with their overall improvement after treatment. No significant adverse effects were observed. Conclusion: Combined autologous PRP and LED therapy is a promising conservative combination regimen for treating recalcitrant ulcerating stasis dermatitis. Additional studies comparing combined autologous PRP and LED therapy directly with autologous PRP or LED monotherapies are needed to confirm the results reported here. PMID:23738854
Park, Kui Young; Kim, In Su; Yeo, In Kwon; Kim, Beom Joon; Kim, Myeung Nam
New models and theories of legged locomotion are needed to better explain and predict the robustly stable legged locomotion of animals and some bio-inspired robots. In this paper we observe that a hip-torque and leg-damping mechanism is fundamental to many legged robots and some animals and determine its affect on locomotion dynamics. We discuss why this hip-torque-and-leg-damping mechanism is not so easily understood. We investigate how hip-torque and leg-damping affect the stability and robustness of locomotion using a mathematical model: First, we extend the canonical spring-loaded-inverted-pendulum model to include constant hip torque and leg damping proportional to leg length speed. Then, we calculate the stability and robustness of locomotion as a function of increasing levels of torque and damping, starting from zero-the energy conserving and marginally stable special case-to high levels of torque and damping. We find that the stabilizing effects of hip-torque and leg-damping occur in the context of the piecewise-continuous dynamics of legged locomotion, and so linear intuition does not apply. We discover that adding hip torque and leg damping changes the stability of legged locomotion in an unexpected way. When a small amount of torque and damping are added, legged locomotion is initially destabilized. As more torque and damping are added, legged locomotion turns stable and becomes increasingly more stable and more robust the more torque and damping are added. Also, stable locomotion becomes more probable over the biologically-relevant region of the parameter space, indicating greater prediction and explanatory capabilities of the model. These results provide a more clear understanding of the hip-torque-and-leg-damping mechanism of legged locomotion, and extend existing theory of legged locomotion towards a greater understanding of robustly stable locomotion. PMID:22989956
In a consecutive series of 46 possible candidates for total colectomy, mucosal proctectomy, and ileal reservoir to an anal anastomosis, we have compared the clinical outcome of group I, with a long efferent leg (12 cm), and group II, with a short efferent leg (3-5 cm). The surgical procedure was done in three steps: first, a total colectomy; second, mucosal proctectomy and construction of an 'S-shaped' ileal reservoir with a temporary loop ileostomy; and, third, closing of the ileostomy. Nine patients with a long efferent leg and eight patients with a short leg were observed for 2-51 months with a functioning ileal reservoir. The overall mortality was zero. The results showed that the short efferent leg was important for low fecal urgency, spontaneous evacuation of stools, minimal soiling, independence of reservoir catheterization, and use of antidiarrheal drugs. The length of the efferent leg did not influence the function of the anal sphincter itself. The postoperative sexual life was unchanged, and all patients in group II had a better resocialization than those in group I. The selection of candidates for ileal reservoir operations from among patients with ulcerative colitis or familiar polyposis is most important because of a relatively long postoperative course and high incidence of surgical complications. PMID:4089520
This paper describes a six legged cube based robot named ‘Spike’, which uses three axes of symmetry with a collinear pair\\u000a of legs mounted on each axis. Spike is designed to implement a novel form of locomotion which uses a tilting and falling motion\\u000a as a result of leg movements to form its gait. Due to the triangular symmetry inherent
This report describes two episodes of significant uvular and oropharyngeal ulceration occurring during routine transoesophageal echocardiographic examination of the heart while intubated under general anaesthesia. Both patients were young and healthy and underwent anaesthesia without compromise, but experienced significant morbidity as a result of the ulceration. Uvular and oropharyngeal ulceration has been described following endoscopy and intubation, but there are few reports of ulceration following transoesophageal echocardiography. Operator skill is often a factor. Physical trauma and local ischaemia may play a role in aetiology. Patients experiencing sore throat following the procedure should be examined and observed in case of potentially fatal complications of airway compromise or uvular necrosis and infection. Particular care is required in patients undergoing day case procedures, as early discharge may lead to complications while the patient is at home.
The definition of a pressure ulcer remains very academic. It results from tissue necrosis following ischemia through prolonged arteriolar constriction between two hard surfaces progressing in stages. The nursing care and the use of dressings are therefore adapted to each stage. Today, the treatment of pressure ulcers is complex due to the large number of categories of dressings available. Moreover, the choice of the dressing must take into account the specificities of elderly patients. However, certain basic principles remain essential. PMID:23785859
The purpose of this study was to relate leg strength and power to alpine skiing success as measured by FIS points. Isometric leg strength was represented by the knee extension test described by Clarke. Leg power was measured by the vertical jump test and the Margaria-Kalamen stair run. Results in the strength and power tests were correlated with…
Lamb carcass leg score (LS; 1 = low cull to 15 = high prime) is a subjective indicator of carcass muscling. Our objective for this study was to compare LS, live leg width (LL), and carcass leg width (LW) as single predictors, and in combination with live (LWT) or carcass weight (CWT), of harvested ...
Objective: The temporal evolution of periodic leg movements (PLM) and the relationship of their arousing effect on sleep episode has not been extensively investigated. We studied the nocturnal evolution of PLM associated or not with microarousal (MA) and associated with slow wave activity (PLM with slow wave activity) in 23 patients with PLM and\\/or restless legs syndrome (RLS).Methods: All subjects
Simple locomotion algorithms provide balance for machines that run on one leg. The generalization of these one-leg algorithms for control of machines with several legs is explored. The generalization is quite simple when muitilegged systems run with gaits that use the support legs one at a time. For these gaits the one-leg algorithms can be used to control multilegged running.
Opinion statement \\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a Fulminant ulcerative colitis necessitates immediate hospitalization.\\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a Supportive therapy such as aggressive rehydration, restriction of oral intake, and consideration of parenteral nutrition should\\u000a be initiated.\\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a High-dose intravenous steroids should be started in almost all cases.\\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a Antibiotics and cyclosporine should be considered, especially in disease refractory to steroid therapy.\\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a Indications for surgery should always be
Summary form only given. Only about half the Earth's landmass is accessible to wheeled and tracked vehicles, yet people and animals can go almost everywhere on foot. Our goal is to harness the power of legs to create robot vehicles that can go where legged animals and people can go. These systems combine dynamic control systems, actuated mechanisms and a
Purpose – The paper aims to present a new mechanical scheme for a leg to be included in legged vehicles that simplifies the control actuations along the stride. Design\\/methodology\\/approach – The scheme includes three four-bar links grouped in two mechanisms. The first one decouples the vertical and horizontal foot movements. The second one produces a constant horizontal foot velocity when
Antonio Gonzalez Rodriguez; Angel Gonzalez Rodriguez; Pierluigi Rea
... diagnostic test to ensure a patient truly has restless legs syndrome (RLS). Primarily, diagnosis is based on patient reports. ... and Manage Your RLS Understanding Possible “Mimics” of Restless Legs Syndrome 16 NightWalkers www.rls.org Akathisia Akathisia is ...
Polysomnographic recordings and the Suggested Immobilization Test (SIT) are frequently used to support the clinical diagnosis of restless legs syndrome (RLS). The present study evaluated the discriminant power of 5 different parameters: (1) index of periodic leg movements during sleep (PLMS), (2) index of PLMS with an associated microarousal (PLMS-arousal), (3) index of PLM during nocturnal wakefulness (PLMW), (4) SIT
Martin Michaud; Jean Paquet; Gilles Lavigne; Alex Desautels; Jacques Montplaisir
This report documents our study of active legged systems that balance actively and move dynamically. The purpose of this research is to build a foundation of knowledge that can lead both to the construction of useful legged vehicles and to a better unders...
M. Raibert R. Playter R. Ringrose D. Bailey K. Leeser
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
This paper describes a walking method and inclination control experiments of the new omni-directional walking robot, which has six legs and can move in any direction. The mechanism consists of a parallel link mechanism connecting the two frames with three linear actuators. Legs are attached to each frame. The relative position and angle of the two frames are selected arbitrarily
Restraint of rats in wire mesh for four hours produces ulcers histologically similar to human stress ulcers. Ketamine, alone, was incapable of producing ulcers. However, when given to rats prior to restraint, ketamine increased the incidence of ulcers fro...
Cryofibrinogenemia is due to the presence of reversibly cold-precipitating plasma proteins and material, consisting mostly of fibrinogen, fibronectin, and fibrin. This condition can be idiopathic or secondary to infection, thromboembolic states, neoplasm, or connective tissue disease. The characteristic lesions of cryofibrinogenemia include purpura and ulcerations. Histologically, the lesions of cryofibrinogenemia demonstrate fibrin thrombi within vessels, with no evidence of vasculitis. Treatment of cryofibrinogenemia should be directed at the underlying disease process, if one can be found. Other treatments have included the anabolic steroid stanozolol, which is presently unavailable, anticoagulants, immunosuppressive agents, plasmapheresis, and the combination of streptokinase and streptodornase. We report a case of a 61-year-old male smoker with a 10-year history of intermittent ulcerations of both legs and feet. Two separate biopsies showed epidermal ulceration and thrombi within superficial dermal vessels without evidence of vasculitis. These findings, together with the presence of elevated plasma cryofibrinogen, led to the diagnosis of cryofibrinogenemia. The patient continued to have ulcerations despite efforts to control his high blood pressure, cold avoidance, local wound care, and treatment with pentoxifylline 800 mg three times daily. However, when colchicine 0.6 mg twice daily was added to the patient's care, this led to rapid healing of his ulcerations. He has remained ulcer free for 2 years taking the combination of colchicine and high-dose pentoxifylline. Efforts to reduce the dose of these agents have repeatedly led to recurrences, and remission has promptly followed re-establishment of the combination. To our knowledge, this is the first report documenting use of the combination of colchicine and high-dose pentoxifylline to successfully treat ulcers due to cryofibrinogenemia. PMID:19170411
\\u000a Biped Robot with Heterogeneous Legs (BRHL) is a novel robot model, which consists of an artificial leg and an intelligent\\u000a bionic leg. The artificial leg is used to simulate the amputee’s healthy leg and the intelligent bionic leg works as the intelligent\\u000a artificial limb. This paper discusses how a BRHL robot imitates a person’s walking from the points of gait
Ulcerative colitis (UC) and Crohn's disease (CD) are related polygenic inflammatory bowel diseases (IBDs), with distinct and overlapping susceptibility loci. Recently, hypothesis-free genome-wide association (GWA) studies have revolutionized the field of complex disease genetics. Substantial advances have been achieved in defining the genetic architecture of IBD. To date, over 60 published IBD susceptibility loci have been discovered and replicated, of which approximately a third are associated with both UC and CD, although 21 are specific to UC and 23 to CD. In CD, the breakthrough identification of NOD2 as a susceptibility gene was followed by a rapid phase of gene discovery from GWA studies between 2006 and 2008. Progress in UC was slower; however, by initially testing hits for CD in UC, and later scanning larger UC cohorts, significant new loci for UC have been discovered, with exciting novel insights into disease pathogenesis. Notably, genes implicated in mucosal barrier function (ECM1, CDH1, HNF4?, and laminin B1) confer risk of UC; furthermore, E-cadherin is the first genetic correlation between colorectal cancer and UC. Impaired IL10 signaling has reemerged as a key pathway in intestinal inflammation, and is perhaps the most amenable to therapeutic intervention in UC. Collaborative international efforts with large meta-analyses of GWA studies and replication will yield many new UC genes. Furthermore, a large effort is required to characterize the loci found. Fine-mapping, deep resequencing, and functional studies will be critical to translating these gene discoveries into pathogenic insights, and ultimately into clinical insights and novel therapeutics. PMID:21319274
Background Oedema, commonly known as tissue swelling, occurs mainly on the leg and the arm. The condition may be associated with a range of causes such as venous diseases, trauma, infection, joint disease and orthopaedic surgery. Oedema is caused by both lymphatic and chronic venous insufficiency, which leads to pooling of blood and fluid in the extremities. This results in swelling, mild redness and scaling of the skin, all of which can culminate in ulceration. Methods We present a method to model a wide variety of geometries of limbs affected by oedema and venous ulcers. The shape modelling is based on the PDE method where a set of boundary curves are extracted from 3D scan data and are utilised as boundary conditions to solve a PDE, which provides the geometry of an affected limb. For this work we utilise a mixture of fourth order and sixth order PDEs, the solutions of which enable us to obtain a good representative shape of the limb and associated ulcers in question. Results A series of examples are discussed demonstrating the capability of the method to produce good representative shapes of limbs by utilising a series of curves extracted from the scan data. In particular we show how the method could be used to model the shape of an arm and a leg with an associated ulcer. Conclusion We show how PDE based shape modelling techniques can be utilised to generate a variety of limb shapes and associated ulcers by means of a series of curves extracted from scan data. We also discuss how the method could be used to manipulate a generic shape of a limb and an associated wound so that the model could be fine-tuned for a particular patient.
Cutaneous sensory nerves mediate inflammation and wound healing by releasing neuropeptides, such as substance P, which stimulates pro-inflammatory responses by keratinocytes, fibroblasts, and endothelial cells. The cell surface enzyme, neutral endopeptidase, degrades substance P, thereby regulating its biologic actions. We hypothesized that neutral endopeptidase enzymatic activity is increased in chronic wounds and skin from subjects with diabetes. We compared cutaneous neutral endopeptidase expression and enzymatic activity between normal controls and diabetic subjects with neuropathy and chronic wounds. Skin samples from subjects with diabetes were taken at the time of amputation for nonhealing ulcers. Skin taken from the ulcer margin, 1 cm from the ulcer (adjacent), and from the most proximal region of the amputated leg were studied. Skin biopsies from the leg of healthy control subjects were also studied. Neutral endopeptidase was localized by immunohistochemistry in all tissue sections. Neutral endopeptidase activity was measured using a fluorimetric assay. The median neutral endopeptidase activity of the ulcer margin was 1.21 x higher (p>0.2) than adjacent skin, 5.26 (p<0.001) than proximal skin, and 15.22 x higher (p<0.001) than control skin. Adjacent skin had a median neutral endopeptidase activity 4.34 x higher (p<0.001) than proximal skin and 12.58 x higher (p<0.001) than control skin. The median neutral endopeptidase activity of proximal skin was 2.90 x higher (p<0.001) than control skin. This elevated neutral endopeptidase activity in the skin and chronic ulcers of subjects with diabetes combined with peripheral neuropathy may contribute to deficient neuroinflammatory signaling and may impair wound healing in subjects with diabetes. PMID:12485446
The association between chronic ulcers and squamous cell carcinomas (SCCs) is well established. Their clinical presentations, however, are varied, ranging from innocously appearing lesions to overtly exophytic growths. We present a series of cases with heterogeneous clinical presentations and different treatment outcomes. Case series - patient 1 was a 69-year-old man with an 18-month history of static non healing venous legulcer, but no sinister features, biopsy was performed to rule out Marjolin's transformation, histology revealed SCC and treatment was simple excision and skin grafting; patient 2 was a 73-year-old lady with an 18-month history of non healing ulcer (innocuous appearance) over distal interphalangeal joint of index finger, histology revealed SCC with deeper extension and treatment was amputation of distal half of finger; patient 3 was a 73-year-old lady with a 12-month history of non healing fungating legulcer with irregular borders and everted edges, histology revealed SCC (tumour eroding tibia and distant metastasis) and treatment was above-knee amputation, radiotherapy and palliation. Whilst SCC is amenable to simple excision in the early stages, delay in diagnosis could result in loss of the affected digit or limb; an SCC which has metastasised is also life threatening. Therefore, a low threshold to biopsy static non healing ulcers or ulcers in unusual sites should be adopted even in those not manifesting any evidence of malignancy. PMID:16722875
Enoch, Stuart; Miller, David R; Price, Patricia E; Harding, Keith G
Duodenal and gastric ulcer are chronic often recurring conditions that in the past were grouped together as peptic ulcer. Many diverse environmental and genetic factors, which create an imbalance between secretion of acid and pepsin by by the stomach and ...
Pressure ulcers are also called bedsores, or pressure sores. They can form when your skin and soft tissue press ... damaged or die. When this happens, a pressure ulcer may form. Below are some questions you may ...
BackgroundThe mechanism of marginal ulceration after laparoscopic gastric bypass surgery is poorly understood. We reviewed the incidence, presentation, and outcome of ulcer disease in consecutive patients undergoing laparoscopic gastric bypass surgery.
Classic types of anal ulcers are acute and chronic anal fissure. Characteristic symptoms of chronic fissures are severe pain during defecation accompanied by the triad of ulceration, hypertrophic anal papilla and external skin tag. If the symptoms deviate other causes of ulceration must be considered. Primarily, malignancies should be excluded. The special setting in the anal fold, especially with concurrent immunosuppression, could lead to nonspecific manifestations of different proctological, dermatological and infectious diseases, which can only be clarified by further diagnostic workup and histopathology. Only the correct diagnosis will lead to causal and effective therapy. Successfully treated inflammatory dermatoses and precancerous lesions require regular follow-up because a recurrent or persistent course of the disease may result in malignant transformation. PMID:19997893
An 18-year-old male presented with a nonhealing wound on left lower limb, pain and swelling over multiple joints, weight loss, and yellowish discoloration of eyes and urine for the past 4 years. On examination, the patient had pallor, icterus, and generalized lymphadenopathy with a nonhealing unhealthy ulcer over left medial malleolus. He had deformed joints with hepatomegaly and splenomegaly. His laboratory investigations were positive for antinuclear antibody (ANA) and anticardiolipin antibody (ACLA). Synovial fluid analysis showed inflammatory findings. Biopsy of margin of the ulcer showed findings consistent with Acroangiodermatitis of Mali. The patient was treated with disease-modifying antirheumatic drugs (DMARDs) and aspirin for juvenile idiopathic arthritis and secondary antiphospholipid antibody syndrome (APS), respectively. The ulcer was managed conservatively with systemic antibiotics and topical steroids along with limb elevation and compression elastic stockings. The patient's symptoms improved significantly, and he is in our followup.
Lipodermatosclerosis refers to skin induration of the lower extremities characterized by tortuous, hyperpermeable vessels preceding venous legulcerations. Protein ligands and receptor tyrosine kinases that specifically regulate endothelial cell function are mainly involved in physiological as well as in disease-related angiogenesis. These ligand/receptor systems include the vascular endothelial growth factor (VEGF) and the angiopoietin (Ang) families and their receptor the tyrosine kinase with immunoglobulin-like domains (Tie-2) as well as the VEGF receptor family (VEGF-R1 and VEGF-R2). In the present study, the contribution of these endothelium-specific ligand/receptor systems in tissue samples of lipodermatosclerosis was evaluated. Our results provide evidence, that the mRNA-transcripts of VEGF (p<0.01), Ang-1 (p<0.1), Ang-2 (p<0.1) and VEGF-R1 (p<0.01) were significantly upregulated in all samples of lipodermatosclerosis in comparison with healthy skin by using reverse transcriptase-polymerase chain reaction. On protein level VEGF (p<0.01), Ang-1 (p<0.1), Ang-2 (p<0.1) and VEGF-R1 (p<0.01) were significantly elevated as well. Solely for Tie-2 and for VEGF-R2 no statistical difference could be detected on mRNA and protein level in patients with lipodermatosclerosis in comparison with healthy skin. By immunohistochemistry we confirmed upregulated protein expression for VEGF, Ang-1, Ang-2 and VEGF-R1 compared with healthy skin. Our findings strongly suggest that an imbalance between these ligand/receptor systems might contribute to the pathophysiology of advanced stages of chronic venous insufficiency. Inhibition of angiogenesis could significantly impact the tissue breakdown in lipodermatosclerosis and could hereby enable the formation of venous legulcerations. PMID:19787198
Nearly all peptic ulcers are caused by either Helicobacter pylori infection or non-steroidal inflammatory drug (NSAID) use, including aspirin. As H. pylori infection is becoming less prevalent in developed countries, NSAIDs are an increasingly important cause of ulceration, particularly ulcers complicated by bleeding. Only about 15% of H. pylori-infected people develop an ulcer in their lifetime; virulence of the H. pylori
This article is a review of larval therapy and includes a case study that uses larval therapy in the treatment of complex legulcer wounds. Complex wounds require careful management from the multidisciplinary team and present clinicians with intricate challenges to save the limb. Wound-bed preparation and debridement needs to be as effective and non-traumatic as possible for the patient. Larval therapy removes the devitalised tissue effectively with minimal tissue trauma. This case study reports on a patient with a non-progressing, full-thickness wound with exposed tendon following reconstructive surgery at a local vascular unit. The patient was left with very limited treatment options, as traditional dressings for the arterial ulcer nearly resulted in amputation due to the deterioration in the wound. As part of the patient's management, she was treated with larval therapy in an attempt to salvage her limb. This article follows the progress of complex legulcer wounds employing BioFoam® dressing (BioMonde, Bridgend) for larvae debridement therapy over a 4-week period and incorporating five applications of three BioFoam dressing bags. This care pathway ensured the patient's safety by promoting effective wound healing with the larval therapy leading to excellent clinical patient outcomes. PMID:23587971
Poor rates of healing and high rates of re-ulceration are characteristic of venous legulcer. The performing of special health-deviation self-care is important for the successful treatment and prevention of this chronic disease. This study aimed to validate a newly designed instrument for the measurement of specific self-care. The "Wittener Aktivitätenkatalog der Selbstpflege bei venös bedingten offenen Beinen" (WAS-VOB) (a catalogue containing self-care activities for venous legulcer) was conceptualized on the basis of Orem's theory and on pathophysiological processes. The items were created by using patient interviews (n = 20) and a literature review. An analysis of the reliability was used to reduce the raw scale. The quality of the WAS-VOB was assessed for face-validity (n = 6), feasibility (n = 8), test-retest-reliability (n = 60) and the internal consistency (n = 234). The involvement of patients was based on an informed consent. The WAS-VOB is a self-describing instrument, includes 59 self-care activities and describes those in eight scales which deal with "general compression", "wearing compression bandages", "wearing compression hosiery", "mobility", "temperature", "overload of the venous system", "prevention of skin damage" and "wound healing". The WAS-VOB is practicable and has good psycho-metric characteristics. The test-retest-coefficient (Kendall's tau b) is 0.58, Cronbach's alpha 0.72. The instrument WAS-VOB is suitable for the assessment of self-care deficits. PMID:15040244
Panfil, Eva-Maria; Mayer, Herbert; Evers, Georges C
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.
Background: How do we know when an intervention has altered the natural history of a developing pressure ulcer? Objectives: To determine the fate of 2574 pressure-ulcer free subjects admitted to hospitals in the UK and US. Method: Prospective observation of a cohort of hospital patients. Results: 108 subjects developed pressure ulcers. The incidence (among the high to very-high risk group),
Decubitus pressure ulcers are a worldwide health crisis and their prevention and treatment has become a national priority. The National Pressure Ulcer Advisory Board estimates that as many as three million people in the United States have pressure ulcers. The causes of the ailment include both extr...
OBJECTIVE To provide family physicians with an approach to managing skin ulcers in older patients. SOURCES OF INFORMATION Clinical practice guidelines and best practice guidelines were summarized to describe an evidence-based approach. MAIN MESSAGE Preventing ulcers is important in frail older patients. Using guidelines can help prevent ulcers in institutions. Clarifying the cause and contributing factors is the fi rst
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
A distinctive clinical entity of acute genital ulcers occurring in adolescents, with nonvenereal infectious etiology was described by Lipschütz in 1913. We describe four puberal virgin girls who developed fever and painful genital ulcers. The main causes infectious and noninfectious of ulceration were rejected. Although the etiology is unknown, recent cases related with Epstein-Barr virus acute infection have been reported. PMID:18577045
A 24-hour-old colt presented with clinical signs consistent with gastric ulceration. Treatment was initiated with a histamine type-2 receptor antagonist and clinical signs resolved. Gastroscopy at 16 d confirmed the presence of a gastric ulcer. Although gastric ulceration is common in foals, it is rarely reported in foals this young. PMID:12757136
The purpose of this study was to explore characteristics of patients admitted to an acute care facility with a pressure ulcer and to determine whether the Braden Scale accurately identifies patients with pressure ulcers as at-risk for ulcer development. T...
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).
This study examined the laterality of the supporting leg in postural stability during a one-leg stance test on an unstable moving platform and its practice effect. 30 male university students were evaluated using the omnidirection stability index (OSI) during a one-leg stance test on an unstable moving platform (three trials). The leg used when kicking a ball was defined as the manipulation leg (ML) and the supporting leg was defined as the non-manipulation leg (NML). According to the two-way repeated measures analysis of variance (ANOVA; trials x legs), a statistically significant difference was observed only on the leg factor, and OSI values of the second and third trials were less for the ML than the NML. The correlation between both legs was statistically significant but not high. The ML was superior to NML with regard to stability, and no practice effect with trials was evident in either leg. PMID:24032330
This paper documents near-autonomous negotiation of synthetic and natural climbing terrain by a rugged legged robot,achieved through sequential composition of appropriate perceptually triggered locomotion primitives. The first, simple composition achieves...
A. M. Johnson D. E. Koditschek G. C. Haynes M. T. Hale
Restless legs syndrome has attracted increasing interest as a clinically significant, common and treatable disorder. Good evidence suggests that dopaminergic drugs are the most effective first-line agents when symptoms are severe. PMID:20393432
This is a typical early appearance of a poison ivy rash, located on the leg. These early lesions ... line where the skin has brushed against the poison ivy plant. The rash is caused by skin contact ...
Forward propulsion is a central task of walking that depends on the generation of appropriate anterior-posterior ground reaction forces (AP GRFs). The AP impulse (i.e., time integral of the AP GRF) generated by the paretic relative to non-paretic leg is a quantitative measure of the paretic leg’s contribution to forward propulsion and is variable across hemiparetic subjects. The purpose of this study was to investigate the underlying mechanisms of propulsion generation in hemiparetic walking by identifying the biomechanical predictors of AP impulses. Three-dimensional kinematics and GRFs were recorded from 51 hemiparetic and 21 age-matched control subjects walking at similar speeds on an instrumented treadmill. Hierarchical regression models were generated for each leg to predict the AP impulse from independent biomechanical variables. Leg extension was a significant predictor and positively related to the propulsive impulse in the paretic, non-paretic and control legs. Secondarily, the hip flexor impulse was negatively related to the propulsive impulse. Also, the relationship of paretic and non-paretic ankle moments with the propulsive impulse depended on the paretic step ratio, suggesting the plantar flexor contribution to the propulsive impulse depends on leg angle. These results suggest that increasing paretic leg extension will increase propulsion. Increasing paretic leg plantar flexor output and decreasing paretic leg hip flexor output could also increase paretic leg propulsion. While increased pre-swing hip flexor output has been suggested to compensate for decreased plantar flexor output, such output may further impair propulsion by the paretic leg if it occurs too soon in the gait cycle.
Peterson, Carrie L.; Cheng, Jing; Kautz, Steven A.; Neptune, Richard R.
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.
Ulcerative colitis (UC) is an idiopathic, chronic inflammation of the colon which may present with a range of mild to severe symptoms. The disease may be localized to the rectum or can be more extensive and involve the left side of the colon or the whole colon. Treatment in UC is directed towards inducing and maintaining remission of symptoms and
Paolo Gionchetti; Fernando Rizzello; Flavio Habal; Claudia Morselli; Cristina Amadini; Rossella Romagnoli; Massimo Campieri
Reaginic hypersensitivity in ulcerative colitis has been investigated in respect of a hypersensitivity to the cow's milk proteins and the frequency of atopic asthma, hay fever, and eczema. Intradermal tests were frequently positive, especially to casein, but the results did not differ from those found in healthy individuals and in groups of patients with Crohn's disease, hypolactasia, and the irritable
Repositioning is an effective way to prevent pressure ulcers, but it must be combined with sitting and lying positions in\\u000a which the pressure is as low as possible. There are many opinions but little actual research on the frequency of position\\u000a changes.
Tom Defloor; Katrien Vanderwee; Doris Wilborn; Theo Dassen
Objective: To evaluate in an open-label clinical series the occurrence of restless legs syndrome (RLS) augmentation in 60 consecutive RLS patients treated with pramipexole (PPX) for at least 6 months.Background: In patients with restless legs syndrome (RLS), augmentation is most commonly seen with long-term use of levodopa and pergolide.Method: Open-label clinical series in 60 consecutive RLS patients treated with PPX
The oral administration to guinea-pigs of an aqueous solution of carrageenan derived from the red seaweed, Eucheuma spinosum, provides a useful, readily available experimental model for the study of ulcerative disease of the colon. Two types of ulcerative disease can be produced within a 4-6 week period, viz., ulceration localised mainly to the caecum by using 1% undegraded carrageenan in the drinking fluid, and extensive ulceration involving caecum, colon, and rectum by using 5% degraded carrageenan. Ulceration is probably due to the local action of carrageenan in the bowel. PMID:1202321
Pressure ulcers are associated with reduced quality of life, affecting individuals physically, socially and emotionally. The financial cost to the NHS of preventing and treating such ulcers is substantial. Although largely preventable, pressure ulcers are still common. The Department of Health is committed to eliminating all avoidable pressure ulcers in NHS-provided care. This article explores methods of preventing pressure ulcers, with particular focus on risk assessment, skin inspection, pressure-relieving measures, nutrition and hydration, and patient and carer education. PMID:24044860
A 77-year-old man with a 5-year history of mycosis fungoides (MF) who had received several lines of therapy, including intravenous courses of Methotrexate (MTX) for the past 2 years, went on to develop several ulcerated cutaneous nodules on the left leg. Biopsy revealed diffuse sheets of EBV-positive large B cells (CD20+ CD30 ± IgM Lambda), with an angiocentric distribution and a monoclonal IGH gene rearrangement. Although the pathological features were diagnostic for an EBV-positive diffuse large B-cell lymphoma (DLBCL), several possibilities could be considered for assignment to a specific entity: EBV-positive DLBCL of the elderly, methotrexate-induced lymphoproliferative disorder (LPD), lymphomatoid granulomatosis, or the more recently described EBV-positive mucocutaneous ulcer. The development of EBV+ lymphoproliferations has been reported in two other patients with MF under MTX, and occurred as skin lesions of the leg in one of these and in the current case, which may question the relatedness to primary cutaneous DLCBL, leg-type. PMID:23031074
The Passive-legged, Multi-segmented, Robotic Vehicle concept is a simple legged vehicle that is modular and scaleable, and can be sized to fit through confined areas that are slightly larger than the size of the vehicle. A specific goal of this project was to be able to fit through the opening in the fabric of a chain link fence. This terrain agile robotic platform will be composed of multiple segments that are each equipped with appendages (legs) that resemble oars extending from a boat. Motion is achieved by pushing with these legs that can also flex to fold next to the body when passing through a constricted area. Each segment is attached to another segment using an actuated joint. This joint represents the only actuation required for mobility. The major feature of this type of mobility is that the terrain agility advantage of legs can be attained without the complexity of the multiple-actuation normally required for the many joints of an active leg. The minimum number of segments is two, but some concepts require three or more segments. This report discusses several concepts for achieving this type of mobility, their design, and the results obtained for each.
We report here the possible effect of opiates on a patient exhibiting particularly severe restless legs syndrome (RLS) and periodic leg movemets in sleep (PLMS). This patient was investigated in the sleep laboratory under three conditions, namely, unmedicated (baseline), medicated with codeine sulfate, and medicated with both codeine sulfate and pimozide. Codeine sulfate dramatically improved abnormal motor behavior in this
Jacques Montplaisir; Dominique Lorrain; Roger Godbout
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
Diabetic foot complications are the largest nontraumatic cause of lower extremity amputations, accounting for almost 90,000\\u000a amputations per year. Most of these amputations are the result of infections caused by ulcerations of the foot that are not\\u000a recognized or treated in an appropriate and timely fashion. Often, cultures are taken when not warranted and antibiotics are\\u000a administered when no infection
Foot ulcers and infections are common in diabetic patients. A 30-month-long descriptive study was conducted in our hospital in which we analyzed microbiological isolates of all patients admitted with diabetic foot infections. The predominant flora identified were Staphylococcus aureus and coagulase-negative Staphylococcus, followed by Enterococcus spp., Streptococcus spp., and enterobacteriaceaes. In 27 positive cultures (42%) polymicrobial flora were found. There
F. J. Candel González; M. Alramadan; M. Matesanz; A. Diaz; F. González-Romo; I. Candel; A. Calle; J. J. Picazo
Much has been written on perforated peptic ulcer (PPU) during the last hundred years.\\u000aIn 1500, when necropsies were first allowed, often a small hole was found in the\\u000aanterior wall of the stomach, giving an explanation for symptoms of acute abdominal\\u000apain, nausea, vomiting which often led to death within a few hours or days.\\u000aLaparoscopic surgery, also called
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
AIM: This paper is a report of a study of the inter-observer reliability of the European Pressure Ulcer Advisory Panel pressure ulcer classification system and of the differential diagnosis between moisture lesions and pressure ulcers. BACKGROUND: Pressure ulcer classification is a valuable tool to provide a common description of ulcer severity for the purposes of clinical practice, audit and research.
Dimitri Beeckman; Lisette Schoonhoven; Jacqui Fletcher; Kátia Furtado; Lena Gunningberg; Hilde Heyman; Christina Lindholm; Louis Paquay; J. Verdu; Tom Defloor
Objective. To compare the prevalence of pressure ulcers and prevention before and after a quality improvement program; determine whether patient characteristics differed for those who did and did not develop pressure ulcers; identify pressure ulcer prevention implemented at admission and whether prevention and risk factors varied by pressure ulcer severity. Design. Descriptive comparative study based on two cross-sectional pressure ulcer
OBJECTIVE To review the diagnosis and management of infected chronic skin ulcers. SOURCES OF INFORMATION Cochrane database, MEDLINE, and Google were searched for clinical practice guidelines (CPGs) for wound care. Most recommendations found in the CPGs had level II or III evidence. Expert and consensus opinion from the Canadian Chronic Wound Advisory Board and the International Wound Bed Preparation Advisory Board were also used. MAIN MESSAGE Bacteria in skin ulcers act along a continuum from contamination through colonization and critical colonization to infection. Critical colonization is not always associated with overt signs of infection but can result in failure to heal, poor-quality granulation tissue, increased wound friability, and increased drainage. Good-quality swab samples should be an adjunct to clinical acumen, not a primary strategy for diagnosis. Iodine and silver-based dressings, topical antibiotics, and systemic antibiotics can be helpful. CONCLUSION Diagnosis of chronic wound infection is based on clinical signs and a holistic approach to patients. More research into assessment and treatment of skin ulcer infection is needed.
Deficiencies in the current pressure ulcer classification system create the impetus for the current discourse on the clinical, legal, and economic implications of staging and considering shifting the paradigm in pressure ulcer description and assessment. PMID:22101483
This article reports on the successful work undertaken within one NHS trust to reduce the incidence of pressure ulcers. The tissue viability nursing team at Medway NHS Foundation Trust devised, implemented and evaluated a strategy to reduce the incidence of pressure ulcers. This involved devising a comprehensive database, intensive monitoring using root cause analysis, writing action plans using high-impact actions (HIAs) and innovative thinking to address and reduce the incidence of pressure ulcers and staff training in the use of the SKIN acronym. This work identified pressure ulcers on the ears of patients receiving oxygen therapy as a particular problem. An evidence-based and multiprofessional strategy was devised to deal with this particular problem, which resulted in no further incidence of pressure ulcers on the ears of patients receiving oxygen therapy. The entire pressure ulcer reduction strategy was positively evaluated and proved to be sustainable. PMID:23587976
OBJECTIVE: To provide family physicians with an approach to managing skin ulcers in older patients. SOURCES OF INFORMATION: Clinical practice guidelines and best practice guidelines were summarized to describe an evidence-based approach. MAIN MESSAGE; Preventing ulcers is important in frail older patients. Using guidelines can help prevent ulcers in institutions. Clarifying the cause and contributing factors is the first step in management. Pressure and venous ulcers are common in elderly people. Poor nutrition, edema, arterial insufficiency, and anemia often impair wound healing. Adequate debridement is important to decrease risk of infection and to promote healing. There are guidelines for cleaning ulcers. Choice of dressings depends on the circumstances of each wound, but dressings should provide a moist environment. Options for dressings are summarized. CONCLUSION: Family physicians can manage skin ulcers effectively by applying basic principles and using readily available guidelines.
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.
\\u000a Peptic ulcers are defects in the gastrointestinal mucosa that extend through the muscularis mucosae. They persist as a function\\u000a of the acid or peptic activity in gastric juice. The natural history of peptic ulcer disease (PUD) ranges from resolution\\u000a without intervention to the development of complications with potential for significant morbidity and mortality, such as bleeding\\u000a and perforation. Peptic ulcer
Although it is well recognized that pressure-induced ischemia initiates the formation of pressure ulcers, the many complex mechanisms responsible for the pathogenesis of these ulcers remain poorly understood. It has been reported that chronic ulcers contain an elevated level of proteolytic enzymes, especially neutrophil-derived matrix metalloproteinase-8 and elastase. This evidence suggests that neutrophils are a major component in the pathogenesis of chronic pressure ulcers. Therefore, this study characterized the cellular components of chronic pressure ulcers. Three-millimeter biopsies (6 mm deep) from granulation tissue in pressure ulcers were obtained from 11 patients. A total of 14 biopsies were obtained from these 11 patients for analysis. A portion of each specimen was fixed in formalin for routine histology. Other portions of biopsies were frozen for analysis of myeloperoxidase activity. In addition, cells on the surfaces of the ulcers were collected by lavage for histologic characterization. Routine histologic analysis of all 14 biopsies of the pressure ulcers showed regions near the surface of each that contained dense neutrophil infiltration associated with edema and apparent marked matrix dissociation. In the deeper regions there was an increased density of blood vessels, and many contained rounded endothelial cells surrounded by migrating neutrophils. Cells collected by lavage from the ulcer surface were prepared by Cytospin and found to be greater than 95% neutrophils with occasional large macrophages actively phagocytosing depleted neutrophils. In addition, there was a significant correlation of myeloperoxidase activity with actual neutrophil counts in the ulcer biopsies further confirming the dense presence of neutrophils. These studies directly show that there is extensive neutrophil infiltration in chronic pressure ulcer granulation tissue. Furthermore, the persistence of neutrophils and their destructive enzymes appears responsible for the extensive matrix dissociation and thus contributes to the chronicity of these ulcers. PMID:14617291
Antacids can reduce gastroduodenal acidity for long periods if taken in substantial quantities after food. Their healing effect on gastric ulcer is minimal, if present at all, and easily overwhelmed by the benefit obtained from admission to hospital. Intensive antacid therapy appears effective in healing duodenal ulcer and preventing haemorrhage from stress ulcer, and is comparable in these respects with cimetidine but with a higher incidence of side-effects. Clinical impression strongly suggests that antacids relieve pain in peptic ulcer but objective confirmation is lacking.
Aims: The objective of this study was to assess the significance of ulcer size for the survival of gastric cancer patients. Methods: A total of 260 patients with ulcerative gastric cancer who had undergone curative resection were reviewed. The diameter of the malignant ulcer was measured. Patients were divided into group U1 (?3 cm) and group U2 (>3 cm) according
C. Y. Xu; J. G. Shen; J. Y. Shen; W. J. Chen; L. B. Wang
Hospice patients may be particularly at risk for pressure ulcer development due to several factors. Identifying populations at risk for pressure ulcer development, such as hospice patients, and providing prevention and risk protocols for these populations can substantially reduce the prevalence and incidence of pressure ulcers. However, are hospice patients prone for skin break-down despite prevention and treatment efforts? This
Darlene S. Hanson; Diane Langemo; Bette Olson; Susan Hunter; Christine Burd
We describe a 78-year-old gentleman who, following bilateral above-knee amputations, developed symptoms of restless legs syndrome in the absent portions of his lower extremities. These symptoms improved with dopamine agonist therapy. In addition, he later developed parkinsonism with prominent rest tremor on metoclopramide. This suggests that this individual had a dopamine-deficient state which predisposed him to both restless legs syndrome and drug-induced or drug-exacerbated parkinsonism. We propose expanding the spectrum of phantom limb phenomena to include phantom restless legs. PMID:15252270
Hanna, Philip A; Kumar, Sanjeev; Walters, Arthur S
This study examined sociocultural features of help-seeking for Buruli ulcer–affected persons with pre-ulcers and ulcers in a disease-endemic area in Ghana. A sample of 181 respondents were purposively selected. Fisher's exact test was used to compare help-seeking variables for pre-ulcers and ulcers. Qualitative phenomenologic analysis of narratives clarified the meaning and content of selected quantitative help-seeking variables. For pre-ulcers, herbal dressings were used to expose necrotic tissues and subsequently applied as dressings for ulcers. Analgesics and left-over antibiotics were used to ease pain and reduce inflammation. Choices for outside-help were influenced by the perceived effectiveness of the treatment, the closeness of the provider to residences, and family and friends. Health education is required to emphasize the risk of self-medication with antibiotics and the importance of medical treatment for pre-ulcers, and to caution against the use of herbs to expose necrotic tissues, which could lead to co-infections.
Ackumey, Mercy M.; Gyapong, Margaret; Pappoe, Matilda; Weiss, Mitchell G.
The performance of highly dynamic robotic machines is directly associated with both the actuation means and the specific mechanical properties\\/configuration of the system. Hydraulic actuation demonstrates significant competitive advantages when minimum weight and volume, large forces and wide range of speeds are required and this makes it very suitable for systems such as legged robots. The geometry and design of
Yousheng Yang; Claudio Semini; Nikolaos G. Tsagarakis; Emanuele Guglielmino; Darwin G. Caldwell
Introduction: Recent clinical and functional imaging data suggest impaired central dopaminergic transmission in restless legs syndrome (RLS). As RLS responds to dopaminergic medications, an etiologic link between RLS and Parkinson's disease (PD) has been proposed. However, few studies have examined this association. Objective: To investigate the prevalence of RLS amongst PD outpatient population. Method: The prevalence of RLS was determined
Functional neuroimaging studies may contribute to elucidate pathophysiological mechanisms of the restless legs syndrome (RLS) which still remain unclear. Studies in patients with RLS have been performed using functional magnetic resonance imaging (fMRI), single photon emission computed tomography (SPECT) and, more recently, positron emission tomography (PET). SPECT and PET studies revealed some controversial results of the pre- and postsynaptic dopaminergic
Thomas C Wetter; Ilonka Eisensehr; Claudia Trenkwalder
Running animals and robots can save energy and reduce unwanted heat production by bouncing along on springs, using the principle of the pogo stick. (The principal springs in animals are tendons.) They can make further energy savings by using return springs to halt the legs at the end of each foward or backward swing and start them swinging the other
In this paper, we are presenting a method to estimate terrain properties (such as small-scale geometry or surface friction) to improve the assessment of stability and the guiding of foot placement of legged robots in rough terrain. Haptic feedback, expressed through joint motor currents and ground contact force measurements that arises when prescribing a predefined motion was collected for a
Mark A. Hoepflinger; C. David Remy; Marco Hutter; Luciano Spinello; Roland Siegwart
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
This paper discusses the use of fitness biasing to alter the control of a seven-microprocessor robot as it shifts from one environment to another. The robot was initially using a gait evolved to work on a smooth surface (tile). When tested on a rough surface (carpet) the learned gait was found to be inappropriate because the legs were causing drag
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
Giorgio Coccagna; Roberto Vetrugno; Carolina Lombardi; Federica Provini
Exoskeleton systems that can enhance people's performance or assist disabled people have been investigated in recent years. However, most exoskeletons utilize DC motors with batteries as the driving source. While the motors require a lot of power, the working time of the exoskeletons is a limiting factor for the implementation of mobile exoskeletons. This paper proposes a new leg exoskeleton
There is a need for quantitative investigations in the vascular laboratory to manage lower extremity ulcers. The majority of legulcers are of venous (45%-60%) or arterial origin (10%-20%). Despite the increasing complexity of new devices used in vascular surgical practice, the anklebrachial pressure index (ABPI) remains the cornerstone for the differential diagnosis of ischemic ulcers. The toe-brachial pressure index and the pole test represent attractive alternative tests especially in patients with diabetes. Color flow Doppler imaging (CFDI) is advantageous over ABPI in cases in which wounds and ulcers prevent the use of a cuff by virtue of their size or location; additionally CFDI technology can detect nonflow limiting lesions, lesions to nonaxial arteries such as the deep femoral artery, or lesions limited to a single tibial artery. Continued improvements in the accuracy of CFDI have prompted some vascular surgeons to replace contrast arteriography in distal bypass procedures. Transcutaneous partial oxygen tension measurement (TcPO(2)) is another noninvasive method that is reliable to select the level of amputation and recommended to determine tissue viability in critically ischemic limbs and in the management of the diabetic foot. CFDI has revolutionized the diagnostic approach to venous disorders and it is considered the gold standard for the assessment of the venous system of the lower limb, causes minimal inconvenience to patients, and is easily repeatable, but it is considered highly operator dependent. Various plethysmography techniques are of limited application in ulcer investigations, because of their difficulty to calibrate signal, unless time measurements such as the postexercise refilling time are used. PMID:18048871
Sections Brain, Spinal Cord, and Nerve Disorders Chapters Sleep Disorders Periodic Limb Movement Disorder and Restless Legs Syndrome ... leg movement disorder is common among people with narcolepsy and rapid eye movement (REM) behavior disorder. Both ...
Two legged and four legged walking are the most versatile forms of land locomotion in the sense of maneuverability and the ability to traverse irregular terrain. Unfortunately, the problem of practical bipedal walking with dynamic balance has so far elude...
\\u000a Restless legs syndrome (RLS) is a sensorimotor disorder with the cardinal symptoms consisting of an urge to move the legs\\u000a because of unpleasant sensations, appearing during rest or inactivity, worsening at evening or during the night, which are\\u000a partially or totally recovered by movement . Depending on the severity and frequency of the symptoms, RLS is often associated\\u000a with insomnia
Foot ulcers are a significant complication of diabetes mellitus and often precede lower- extremity amputation. The most frequent underlying etiologies are neuropathy, trauma, deformity, high plantar pressures, and peripheral arterial disease. Thorough and systematic evaluation and categorization of foot ulcers help guide appropriate treatment. The Wagner and University of Texas systems are the ones most frequently used for classification of
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:
Lower extremity ulcers represent a major concern for patients with diabetes and for those who treat them, from both a quality of life and an economic standpoint. Studies to evaluate quality of life have shown that patients with foot ulcers have decreased physical, emotional, and social function. Analyses of economic impact have shown (1) the majority of costs occur in
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
... and increases the risk of infection and amputation. PREVENTION • Diabetic foot ulcers can often be prevented by careful control of ... sign of a foot problem. • Avoid putting any pressure on the foot wound. • Keep the ulcer clean and change the dressings regularly, as instructed ...
Purpose: Helicobacter pylori infection plays a crucial role in pathogenesis of peptic ulcers; however, among infected individuals only a small percentage will develop peptic ulcers at any time during their life. This low virulence suggests that many additional factors beside H. pylori are implicated in patho- genesis of the disease. The aim of the study was to determine whether there
Namiot DB; Namiot Z; Kemona A; J. Gastroenterology
Plantar ulcers occur in patients with Hansen's disease not because of the disease but because of its neuropathic effects on the skin over the feet. This enhances the risk of trauma to patients' feet, leading to the development of ulcers. This short article reviews the current management of leprosy on the basis of World Health Organization guidelines and the complexities
Vesicular, ulcerative, and necrotic dermatologic conditions are common in captive reptiles. Although these conditions have distinct differences histologically, they are commonly sequelae to each other. This article examines the anatomy and physiology of reptile skin; discusses reported causes of vesicular, ulcerative, and necrotic dermatologic conditions; and reviews various management options. PMID:24018035
Stump ulcers are common problems in amputees. Temporary discontinuation of prosthetic limb use is frequently employed to facilitate healing. Inevitably, this limits activity and may, for instance, prevent an amputee from going to work. A survey of clinical practice was carried out based on the premise that controlled continued prosthetic limb use in patients with stump ulcers will not adversely
A. SALAWU; C. MIDDLETON; A. GILBERTSON; K. KODAVALI; V. NEUMANN
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
Background: Restless legs syndrome is a common yet frequently undiagnosed sensorimotor disorder. In 1995, the International Restless Legs Syndrome Study Group developed standardized criteria for the diagnosis of restless legs syndrome. Since that time, additional scientific scrutiny and clinical experience have led to a better understanding of the condition. Modification of the criteria is now necessary to better reflect that
Richard P Allen; Daniel Picchietti; Wayne A Hening; Claudia Trenkwalder; Arthur S Walters; Jacques Montplaisi
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.
Recurrent aphthous stomatitis (RAS) is a disorder characterized by recurrent ulcerations limited to the oral mucosa. Many specialists and researchers in the domain of oral medicine and other fields do not recognize a single disease in RAS, but several pathologic states with similar clinical characteristics. Even though the real cause is unknown, there are some predisposing factors such as anemia caused by the lack of iron, folic acid and vitamin B, neutropenia, local trauma, emotional stress, metabolic disorders, hormonal disorders and chronic diseases, which cause immunodeficiency. This disease can appear in three clinical forms: small aphthous ulcers, large aphthous ulcers and herpetiform aphthous ulcers. The treatment of this type of disorder involves local or systemic use of corticosteroids, immunostimulants and vitamin therapy. Due to the association of aphthous ulcers with various other diseases, cooperation among multiple fields of medicine and a multidisciplinary approach are necessary. PMID:24053082
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
A common challenge for primary care physicians is to determine the cause and find an effective treatment for leg edema of unclear etiology. We were unable to find existing practice guidelines that address this problem in a comprehensive manner. This article provides clinically oriented recommendations for the management of leg edema in adults. We searched on-line resources, textbooks, and MEDLINE (using the MeSH term, "edema") to find clinically relevant articles on leg edema. We then expanded the search by reviewing articles cited in the initial sources. Our goal was to write a brief, focused review that would answer questions about the management of leg edema. We organized the information to make it rapidly accessible to busy clinicians. The most common cause of leg edema in older adults is venous insufficiency. The most common cause in women between menarche and menopause is idiopathic edema, formerly known as "cyclic" edema. A common but under-recognized cause of edema is pulmonary hypertension, which is often associated with sleep apnea. Venous insufficiency is treated with leg elevation, compressive stockings, and sometimes diuretics. The initial treatment of idiopathic edema is spironolactone. Patients who have findings consistent with sleep apnea, such as daytime somnolence, loud [corrected] snoring, or neck circumference >17 inches, should be evaluated for pulmonary hypertension with an echocardiogram. If time is limited, the physician must decide whether the evaluation can be delayed until a later appointment (eg, an asymptomatic patient with chronic bilateral edema) or must be completed at the current visit (eg, a patient with dyspnea or a patient with acute edema [<72 hours]). If the evaluation should be conducted at the current visit, the algorithm shown in Figure 1 could be used as a guide. If the full evaluation could wait for a subsequent visit, the patient should be examined briefly to rule out an obvious systemic cause and basic laboratory tests should be ordered for later review (complete blood count, urinalysis, electrolytes, creatinine, blood sugar, thyroid stimulating hormone, and albumin). PMID:16513903
Ely, John W; Osheroff, Jerome A; Chambliss, M Lee; Ebell, Mark H
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; Lee, Don Haeng; Yang, Su-Geun
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.
Previous studies in insects demonstrated that leg coordination changes following complete ablation of distal limb segments. However, normal coordination was restored when small 'peg leg' prostheses were attached to leg stumps to permit substrate contact. We have adapted this paradigm to preserve appropriate leg mass and inertia by severing all nerves and muscle tendons in the femur of the cockroach hind leg and converting the animal's own limb into a peg leg. Recordings of muscle activities and leg movements before and after denervation showed that: (1) the 'peg leg' is actively used in walking and regular bursts occur in motoneurons to leg extensor muscles; (2) driving of motoneuron activity is sufficient to produce 'fictive' bursting in a muscle whose tendon (apodeme) is cut in the ablation; and (3) similar motoneuron activities are found in walking on an oiled glass surface, when the effects of body weight and mechanical coupling are minimized. When distal segments were completely severed in these preparations, leg use and muscle bursting were disrupted but could be restored if the stumps were pressed against the substrate. These results support the hypothesis that feedback from receptors in proximal leg segments indicating forces allows for active leg use in walking. PMID:14727135
This paper discusses how a biped robot with heterogeneous legs imitates a person's walking from gait design, gait planning and gait control. A biped robot with heterogeneous legs (BRHL) robot consists of an artificial leg and an intelligent bionic leg. The purpose of this robot's design is to make the intelligent bionic leg follow the artificial leg's movement, which provides
The paper reports a case of painful-legs-and-moving-toes syndrome in a 75-year-old woman who developed it after a paralytic ischias attack at the age of 70. The syndrome was characterized by persistent pains in distal parts of the legs and feet and constant involuntary flexion-extension wave-like toe movements. SSEP studies revealed a defect of conduction in high-speed myelinated fibers of the lumbo-sacral radices of both sides. A cortical motor potential corresponding to the toe hyperkinetic movement was present. It the base of the hyperkinesis a reflectory mechanism may underlie initiated from radiculo-spinal nociceptive systems disinhibited in consequence of the deficiency of inhibitory control from high speed rear column afferents. Neurophysiological data suggest participation of cerebral mechanisms in realization of the hyperkinesis. PMID:8122474
Aver'ianov, Iu N; Zenkov, L R; Golubev, V L; Toropina, G G
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.
Forty patients were studied prospectively for complications of ascending phlebography. The commonest immediate complication was pain at the site of injection and the commonest delayed complication pain in the foot or calf. Out of 30 patients with pain in the foot and calf, 15 had venous thrombosis. Review of 200 case notes disclosed only one recorded complication--namely, necrosis of the dorsal skin of the foot. Complications of the procedure reported by referring clinicians over 10 years comprised four cases of necrosis of the dorsum of the foot and two of gangrene of the foot, in one of which the gangrene spread to the leg. Major complications of ascending phlebography are rare, though when they occur may cause serious morbidity. If a scrupulous technique is used contrast phlebography remains the most accurate method of diagnosing venous disease of the leg.
As part of the 4800-mile Alaska Natural Gas Transportation System (ANGTS), the 823-mile eastern US leg will stretch from Morgan, Montana, to Ventura, La., and eventually will extend another 308 miles to Dwight, Illinois. Northern Border Pipeline Co. has employed five contractors to lay the 42-in-diam, 1435-psig line, which is scheduled for fall 1982 completion. Nine construction spreads comprise the
This report documents our study of active legged systems that balance actively and move dynamically. The purpose of this research is to build a foundation of knowledge that can lead both to the construction of useful legged vehicles and to a better understanding of how animal locomotion works. In this report we provide an update on progress during the past year. Here are the topics covered in this report: (1) Is cockroach locomotion dynamic? To address this question we created three models of cockroaches, each abstracted at a different level. We provided each model with a control system and computer simulation. One set of results suggests that 'Groucho Running,' a type of dynamic walking, seems feasible at cockroach scale. (2) How do bipeds shift weight between the legs? We built a simple planar biped robot specifically to explore this question. It shifts its weight from one curved foot to the other, using a toe-off and toe-on strategy, in conjunction with dynamic tipping. (3) 3D biped gymnastics: The 3D biped robot has done front somersaults in the laboratory. The robot changes its leg length in flight to control rotation rate. This in turn provides a mechanism for controlling the landing attitude of the robot once airborne. (4) Passively stabilized layout somersault: We have found that the passive structure of a gymnast, the configuration of masses and compliances, can stabilize inherently unstable maneuvers. This means that body biomechanics could play a larger role in controlling behavior than is generally thought. We used a physical 'doll' model and computer simulation to illustrate the point. (5) Twisting: Some gymnastic maneuvers require twisting. We are studying how to couple the biomechanics of the system to its control to produce efficient, stable twisting maneuvers.
Raibert, Marc; Playter, Robert; Ringrose, Robert; Bailey, Dave; Leeser, Karl
\\u000a Research in the area of legged robotic systems has spanned almost the entire history of modern robotics. IFToMM has played\\u000a a crucial role in this history by providing a channel of communication between East and West during the cold war period, and\\u000a via its Technical Committee on Robotics in more recent years. In this chapter we have attempted an overview
The basic mechanics of human locomotion are associated with vaulting over stiff legs in walking and rebounding on compliant legs in running. However, while rebounding legs well explain the stance dynamics of running, stiff legs cannot reproduce that of walking. With a simple bipedal spring–mass model, we show that not stiff but compliant legs are essential to obtain the basic walking mechanics; incorporating the double support as an essential part of the walking motion, the model reproduces the characteristic stance dynamics that result in the observed small vertical oscillation of the body and the observed out-of-phase changes in forward kinetic and gravitational potential energies. Exploring the parameter space of this model, we further show that it not only combines the basic dynamics of walking and running in one mechanical system, but also reveals these gaits to be just two out of the many solutions to legged locomotion offered by compliant leg behaviour and accessed by energy or speed.
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.
Introduction A number of issues concerning stress ulcer prophylaxis remain unresolved despite numerous randomized, controlled trials and several meta-analyses. The role of stress ulcer prophylaxis, particularly in trauma patients, is further complicated by the lack of trials utilizing clinically important bleeding as an endpoint. Given the lack of consensus regarding stress ulcer prophylaxis in trauma patients, prescribing practices at Level I trauma centers in the United States were assessed. Materials and methods A survey was developed that contained questions related to institutional prescribing and evaluation of stress ulcer prophylaxis. The survey was intended to delineate these practices at the 188 Level I trauma centers (at the time of the present survey) in the United States. Results One hundred and nineteen surveys were returned, yielding a response rate of 63%. Eighty-six percent stated that medications for stress ulcer prophylaxis are used in a vast majority of trauma patients admitted to the intensive care unit. Sixty-five percent stated that there is one preferred medication. For these institutions, histamine-2-blockers were the most popular at 71%. Thirty-nine percent stated that greater than 50% of patients remain on stress ulcer prophylaxis following discharge from the intensive care unit. Conclusion The lack of consensus with regards to appropriate stress ulcer prophylaxis is apparent in this survey of Level I trauma centers. For those institutions with a preferred agent, histamine-2-blockers were most common.
Barletta, Jeffrey F; Erstad, Brian L; Fortune, John B
Reinforcement learning is very effective for robot learning. Because it does not need priori knowledge and has higher capability of reactive and adaptive behaviors. In our previous works, we proposed new reinforcement learning algorithm: “Q-learning with Dynamic Structuring of Exploration Space Based on Genetic Algorithm (QDSEGA)”. It is designed for complicated systems with large action-state space like a robot with many redundant degrees of freedom. And we applied it to 50 link manipulator and effective behavior is acquired. However optimality and fault tolerance of the proposed algorithm were not considered and to demonstrate effectiveness of the proposed algorithm other applications are necessary. Acquiring of locomotion patterns by a multi-legged robot is a very interesting problem. As it has many redundant degrees of freedom, application of usual reinforcement learning is difficult and an optimal locomotion has not been acquired using previous reinforcement learning algorithm. And the redundancy of the robot is effective to the fault tolerance and various locomotion patterns can be acquired for adapting the faults of the legs. In this paper, we applied QDSEGA to acquiring of locomotion pattern by the multi-legged robot and considered the optimality and fault tolerance. Effective behavior has been obtained by using our proposed algorithm.
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.
Gao, Xiang; Schwarzschild, Michael A.; O'Reilly, Eilis J.; Wang, Hao; Ascherio, Alberto
Foot ulceration remains the leading diabetic complication requiring hospitalization (1). Treatment of the diabetic foot ulcer is often a complex process that involves a multidisciplinary approach. Despite best\\u000a efforts, failure to heal a diabetic foot ulcer can lead to amputation (2). As the incidence of diabetes in the general population is expected to rise, the prevalence of ulcerations and amputations
Cadexomer iodine (Iodosorb) is a hydrophilic starch powder containing iodine, which is a suitable dressing for granulating wounds such as venous ulcers. A total of 61 outpatients with chronic venous ulcers participated in a randomised optional crossover trial using cadexomer iodine or a standard dressing for their ulcers. The trial lasted for 24 weeks or until the ulcer had healed.
M C Ormiston; M T Seymour; G E Venn; R I Cohen; J A Fox
Most models of legged locomotion have concentrated on properties of either the mechanical or the neural system. Here a combined neuro-mechanical model of stepping in a single leg is presented, as the first step in the process of modeling and building a fast and dynamically stable quadruped. It is based on general principles of legged animals with special reference to vertebrates. The mechanical leg was first studied separately in order to take advantage of its inherent mechanical properties and avoid over-control during stepping generation. As a part of the design strategy it uses elastic actuators to increase shock tolerance and energy efficiency. The neural controller consists of a neural phase generator (NPG), a system of fast feedback pathways, and a single control neuron representing descending drive from higher centers in the brain. Sensory information directly influences the movements through the fast feedback pathways, but also entrains the NPG. The NPG has its own description of the state of the leg, which then enables it to set the feedback pathways so that only actions appropriate for the particular stage of the step cycle are undertaken. This preprogramming benefits from the NPG's ability to filter out any inconsistencies or gaps in the afferent input. In this way the model unites the use of central pattern generators and peripheral feedback systems for the generation of stepping movements. The neuro-mechanical system produced stable stepping patterns over a large velocity range and was adaptable to different body weights and landing from varying heights. PMID:9791936
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 highly significant excess of cancers was observed overall but the excess was due entirely to cancers of the digestive system. In women there was no excess or deficit of cancers outside the digestive system. In men there was a small deficit of cancers of the respiratory system. An overall 11-fold excess colorectal cancer risk was found in the series compared with that in a relevant general population after patient-years at risk had been corrected for surgical resection and patients with colorectal cancer at their first referral had been corrected for surgical resection and patients with colorectal cancer at their first referral had been excluded. When these data were expressed in an actuarial form the cumulative probability of developing colorectal cancer in the series was 8% (3.5-13%) at 25 years, after the diagnosis of ulcerative colitis had been established. The relative risk of developing colorectal cancer was highest in those patients developing colitis before the age of 30 years, and the relative risk fell as the age at diagnosis of their colitis increased. The pattern of risk of colorectal cancer over time suggests that there is an association between cancer and colitis in susceptible individuals and that the level of risk is related to age at onset of colitis.
Prior, P; Gyde, S N; Macartney, J C; Thompson, H; Waterhouse, J A; Allan, R N
Peripheral ulcerative keratitis (PUK) is a sight-threatening condition characterized by an epithelial defect, crescent-shaped stromal inflammation, and progressive stromal thinning. Peripheral ulcerative keratitis as a purely inflammatory entity is most commonly associated with collagen vascular diseases, including rheumatoid arthritis, polyarteritis nodosa, Wegener granulomatosis, systemic lupus erythematosus, and relapsing polychondritis. PUK can also be associated with infectious and inflammatory conditions such as hepatitis, syphilis, herpes simplex keratitis, fungal keratitis, Mooren ulcer, and marginal keratitis. We describe a case report of PUK associated with the inflammatory condition of sarcoidosis. PMID:23993305
The results of determination of various hereditary predisposition markers in peptic ulcer are given: in the population, in patients with duodenal ulcer and in their siblings (risk group). Of importance for revealing subjects with hereditary predisposition to duodenal ulcer are the clinico-genealogical analysis, determination of the blood group, especially in simultaneous determination of a "secretory status" ("status of non-secretion" of the ABH blood system agglutinogen in the saliva), increase in the mass of parietal cells and, to some extent, of the distinguishing features of dermatoglyphics (in combination with the above markers). Determination of taste sensitivity to phenylthiocarbamide is non-informative. PMID:2770215
BackgroundPressure ulcers continue to be a significant problem in hospitals, nursing homes and community care settings. Pressure ulcer incidence is widely accepted as an indicator for the quality of care. Negative attitudes towards pressure ulcer prevention may result in suboptimal preventive care. A reliable and valid instrument to assess attitudes towards pressure ulcer prevention is lacking.
D. Beeckman; T. Defloor; L. Demarré; A. Van Hecke; K. Vanderwee
Standard of care for venous legulcers (VLUs) consists of the application of compression bandages or stockings and of local moist wound care. While the majority of patients heal with the above mentioned treatments some ulcers become refractory to treatment causing significant disability and costs. The authors present the observation made on two patients with VLUs who had failed to respond to a comprehensive state of the art wound care approach for 11 and 3 years respectively. Both patients were treated with a poly-N-acetyl glucosamine-derived membrane (pGlcNAc) (Talymed, Marine Polymer Technologies, Danvers, Massachusetts, USA) in addition to compression bandaging. Both patients healed within 6 weeks of the first application of pG1cNAc. The authors present two cases of VLUs that had been considered non-healable that were successfully treated in a very short period of time with the application of a novel technology. PMID:22778460
Cutaneous lesions of the legs have been linked to Helicobacter species in a number of patients with X-linked agammaglobulinaemia (XLA), a primary immunodeficiency. We describe a 26-year-old patient with XLA, who was referred with an extensive skin ulcer that enlarged gradually over the course of 7 years. The ulcer resembled pyoderma gangrenosum (PG), and extended from below the knee to the ankle. The man (who has sex with men) was negative for human immunodeficiency virus. Helicobacter cinaedi was identified by 16S ribosomal (r)DNA PCR analysis from a biopsy of the lesion. This fastidious organism has been implicated previously in causing unexplained skin macules in one other patient with XLA. We suggest that early consideration of infection with Helicobacter species in immunocompromised patients who present with unexplained cutaneous lesions is important, as a prolonged antibiotic course can lead to clinical improvement. PMID:22439627
Dua, J; Elliot, E; Bright, P; Grigoriadou, S; Bull, R; Millar, M; Wijesuriya, N; Longhurst, H J
The aim of this study was to compare the validity of the leg-to-leg bioelectrical impedance analysis (BIA) method with that of anthropometry using hydrostatic weighing (HW) as the criterion test. A secondary objective was to cross-validate previously developed anthropometric regression equations as well as to develop a new regression equation formula based on the anthropometric data collected in this study. Three methods for assessing body composition (HW, BIA, and anthropometric) were applied to 60 women university athletes. The means and standard deviations of age, weight, height, and body mass index (BMI) of athletes were as follows: age, 20.70 +/- 1.43; weight, 56.19 +/- 7.83 kg; height, 163.33 +/- 6.11 cm; BMI, 21.01 +/- 2.63 kg x m(-2). Leg-to-leg BIA (11.82 +/- 2.39) has shown no statistical difference between percentage body fat determined by HW (11.63 +/- 2.42%) in highly active women (p > 0.05). This result suggests that the leg-to-leg BIA and HW methods were somewhat interchangeable in highly active women (R = 0.667; standard error of estimate [SEE] = 1.81). As a result of all cross-validation analyses, anthropometric and BIA plus anthropometric results have generally produced lower regression coefficients and higher SEEs for highly active women between the ages of 18 and 25 years. The regression coefficients (0.903, 0.926) and SEE (1.08, 0.96) for the new regression formulas developed from this study were better than the all the other formulas used in this study. PMID:16686564
The diagnosis of restless legs syndrome (RLS) relies upon diagnostic criteria which are based on history only, and dopaminergic treatment is not normally the first choice of treatment for all patients. It would be worthwhile to identify patients non-responsive to dopaminergic treatment beforehand, because they may suffer from a restless legs-like syndrome and may require alternative treatment. We included retrospectively 24 adult patients fulfilling the four essential criteria for restless legs and 12 age-matched healthy controls. They were investigated by ambulatory actigraphy from both legs over three nights, and patients started treatment with dopamine agonists after this diagnostic work-up. We examined 12 responders to dopaminergic treatment and 12 non-responders and studied the association between response to dopaminergic treatment and the periodic limb movement index (PLMI) as assessed with actigraphy. Demographic characteristics, excessive daytime sleepiness and fatigue at baseline were similar in all three groups. Baseline RLS severity was similar between responders and non-responders [International Restless Legs Severity Scale (IRLS): 25 ± 9 and 24 ± 8]. Group comparisons of PLMI before treatment initiation showed significant differences between the three groups. Post-hoc pairwise comparisons revealed that healthy controls had significantly lower PLMI (4.9 ± 4.5) than responders (29.3 ± 22.7) and non-responders (13.3 ± 11.2). Similarly, the PLMI in responders was lower than in non-responders. PLMI day-to-day variability did not differ between responders and non-responders and there was no correlation between treatment effect, as assessed by the decrease of the IRLS and baseline PLMI. Our retrospective study indicates that actigraphy to assess periodic limb movements may contribute to a better diagnosis of dopamine-responsive restless legs syndrome. PMID:23530689
Cippà, Maria A T; Baumann, Christian R; Siccoli, Massimiliano M; Bassetti, Claudio L; Poryazova, Rositsa; Werth, Esther
The objectives were (1) to estimate the genetic parameters and breeding values of hoof lesions, (2) to estimate the phenotypic effect of each feet and legs conformation traits on hoof lesions, and (3) to estimate genetic correlations between hoof lesions with feet and legs conformation traits. The presence or absence of specific hoof lesions was recorded for each hoof. Lesions were classified into infectious (digital and interdigital dermatitis, foot rot, and heel erosion), horn (sole and toe ulcer, sole hemorrhage, and white line disease), and other lesions (interdigital hyperplasia, fissures, thin soles, and corkscrew claw). A total of 34,905 hoof health records from 27,179 cows and 365 herds, collected by 18 different hoof-trimmers in Ontario, Alberta, and British Columbia, were analyzed using linear animal models. In addition, 5 feet and leg conformation traits (foot angle, heel depth, bone quality, rear leg side view, and rear leg rear view) and locomotion from primiparous cows were considered (n=11,419 and 6,966 cows, for conformation traits and locomotion, respectively). At least one lesion was found in nearly 40% of the hoof trimming records. The heritability estimates for hoof lesions ranged from 0.01 for front horn lesions to 0.09 for rear infectious lesions. Despite the low heritability estimates, we observed large variability in sire estimated breeding value (EBV) for resistance to hoof lesions. Positive genetic correlations were found between the occurrence of front and rear infectious lesions (0.77) and between front and rear horn lesions (0.61), but not between infectious and horn lesions (0.08). For most of the conformation traits, low scores were phenotypically associated with higher incidence of horn lesions, whereas we found no evidence of a phenotypic effect of feet and leg traits on infectious lesions. The heritability of the conformation traits ranged from 0.04 for rear leg rear view to 0.22 for bone quality, whereas that for locomotion was 0.03. The genetic correlations between hoof lesions and conformation traits were low to moderate, yet most of the estimates were associated with high standard errors. In conclusion, although hoof lesions are lowly heritable traits, sufficient genetic variation exists (as evidenced by large variability in sire EBV) for genetic improvement through direct selection in the long term. Standardization of hoof health data collection is encouraged. PMID:23415531
Chapinal, N; Koeck, A; Sewalem, A; Kelton, D F; Mason, S; Cramer, G; Miglior, F
The purpose of the present study was to test the hypothesis that leg blood flow responses during leg cycle ergometry are reduced with age in healthy non-estrogen-replaced women. Thirteen younger (20-27 yr) and thirteen older (61-71 yr) normotensive, non-endurance-trained women performed both graded and constant-load bouts of leg cycling at the same absolute exercise intensities. Leg blood flow (femoral vein thermodilution), mean arterial pressure (MAP; radial artery), mean femoral venous pressure, cardiac output (acetylene rebreathing), and blood O2 contents were measured. Leg blood flow responses at light workloads (20-40 W) were similar in younger and older women. However, at moderate workloads (50-60 W), leg blood flow responses were significantly attenuated in older women. MAP was 20-25 mmHg higher (P < 0.01) in the older women across all work intensities, and calculated leg vascular conductance (leg blood flow/estimated leg perfusion pressure) was lower (P < 0.05). Exercise-induced increases in leg arteriovenous O2 difference and O2 extraction were identical between groups (P > 0.6). Leg O2 uptake was tightly correlated with leg blood flow across all workloads in both subject groups (r2 = 0.80). These results suggest the ability of healthy older women to undergo limb vasodilation in response to submaximal exercise is impaired and that the legs are a potentially important contributor to the augmented systemic vascular resistance seen during dynamic exercise in older women. PMID:12882993
Proctor, David N; Koch, Dennis W; Newcomer, Sean C; Le, Khoi U; Leuenberger, Urs A
An 18-year-old female presented with a severe ulcerative lesion on her right ear of 6 weeks duration. Her right ear was edematous and erythematous with a large, painless ulcerative lesion covering a third of the pinna and satellite papular lesions on the posterior. She was diagnosed with chiclero's ulcer. A skin smear stained with Diff-quik showed abundant Leishmania parasites. Chiclero's ulcer is a rare clinical presentation and is typically severe and difficult to treat. Physicians in Ecuador recommend administering prolonged intramuscular Glucantime. Side effects are common and can be severe resulting in low patient compliance. Because of preferences of the patient and the large volume needed for her weight, we recommended topical treatment with a lotion of Glucantime mixed half and half with white Merthiolate. After applying this lotion to the lesion 3 to 4 times a day for 6 weeks, the lesion healed. PMID:23926136
...Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE FOR RATING DISABILITIES Disability Ratings The Digestive System Â§ 4.110 Ulcers. Experience has shown that the term âpeptic ulcerâ is not sufficiently specific for...
...Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE FOR RATING DISABILITIES Disability Ratings The Digestive System Â§ 4.110 Ulcers. Experience has shown that the term âpeptic ulcerâ is not sufficiently specific for...
...Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE FOR RATING DISABILITIES Disability Ratings The Digestive System Â§ 4.110 Ulcers. Experience has shown that the term âpeptic ulcerâ is not sufficiently specific for...
An 18-year-old female presented with a severe ulcerative lesion on her right ear of 6 weeks duration. Her right ear was edematous and erythematous with a large, painless ulcerative lesion covering a third of the pinna and satellite papular lesions on the posterior. She was diagnosed with chiclero's ulcer. A skin smear stained with Diff-quik showed abundant Leishmania parasites. Chiclero's ulcer is a rare clinical presentation and is typically severe and difficult to treat. Physicians in Ecuador recommend administering prolonged intramuscular Glucantime. Side effects are common and can be severe resulting in low patient compliance. Because of preferences of the patient and the large volume needed for her weight, we recommended topical treatment with a lotion of Glucantime mixed half and half with white Merthiolate. After applying this lotion to the lesion 3 to 4 times a day for 6 weeks, the lesion healed.
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.
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
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.
The Centers for Medicare & Medicaid Services' regulations regarding nonpayment for hospital-acquired conditions such as pressure ulcers have prompted a marked increase in focus on preventive care. Our hospital also used this change in payment policy as an opportunity to strengthen our pressure ulcer prevention practices. We used an 8-spoke prevention wheel to develop and implement practice changes that reduced pressure ulcer incidence from 7.3% to 1.3% in 3 years. Because it is about the journey, we will describe the mechanisms we designed and implemented, and identify strategies that worked or did not work as we promulgated a quality improvement process for pressure ulcer prevention in our large urban hospital center. PMID:21860330
Delmore, Barbara; Lebovits, Sarah; Baldock, Philip; Suggs, Barbara; Ayello, Elizabeth A
Hitherto we examined twice intractable recurrent gastric ulcer from the viewpoint of pancreatic function. Pancreatic function test (similar to the previous one) performed on the patients with so-called \\
M. Abe; S. Oshita; T. Nose; S. Yamaoka; S. Omata; Y. Watanabe
The prevalence and incidence of pressure ulcers are increasingly used to assess the quality of care delivered by health systems and facilities and the effectiveness of the pressure ulcer prevention initiatives in place. Available results about pressure ulcer prevalence and incidence in German hospitals are contradictory. The comparison of 3 multicentre nationwide studies is proposed to provide a more accurate estimation of the pressure ulcer frequency. Pressure ulcer prevalence was compared by data provided by the Charité with data of the software-based data collection packet "Kinexus". Additionally, data on pressure ulcer incidence of Kinexus were compared with the results of the incidence data of the "Generalindikator Dekubitusprophylaxe" of the German Society of Quality Assurance (BQS, now AQUA Institute). Data from 2007 and 2008 and patients 75 years and older were considered. For the calculation of the outcome "pressure ulcer" recommendations of the EPUAP and the NPUAP were followed. As category I (non-bleaching erythema) pressure ulcers are difficult to diagnose, all proportions were calculated including and excluding category I. All 3 samples were comparable regarding the mean age of 81 years. Pressure ulcer prevalence categories I-IV (II-IV) of the Kinexus study was 11.8% (6.1%) and of the Charité study it was 11.0% (5.5%). Regarding pressure ulcer incidence, the rate that was calculated by the BQS categories I-IV (II-IV) was 1.3% (0.8%), in comparison to the incidence rate of Kinexus which was 6.7% (3.9%). There were no statistically significant differences between the 2 prevalence measurements but the odds-ratio of the Kinexus incidence in comparison to the BQS incidence was more than 4 times higher (p<0.001). Results of the Kinexus study are more comparable to incidence figures of international studies on pressure ulcer incidence. The results of this secondary data analysis indicate that published incidence figures by the BQS (now AQUA Institute) might be underestimated. Since this measurement is expensive and burdensome, this mandatory procedure is questionable. PMID:22322334
Objective: Sulfide, a product of sulfate-reducing bacteria, has been proposed to play an etiologic role in ulcerative colitis. Ulcerative colitis feces have increased numbers and activity of sulfate-reducing bacteria, but only modestly increased sulfide. However, fecal sulfide exists largely in the volatile, highly toxic H2S form that moves rapidly from feces to surrounding gas. Our aim was to quantify the
Jimmy Levine; Carol J. Ellis; Julie K. Furne; John Springfield; Michael D. Levitt
Summary Appetite secretion was produced by “sham feeding” in a group of 35 normal healthy individuals and in a group of 34 patients\\u000a with peptic ulcer of the duodenum.\\u000a \\u000a During the first twenty minutes, after the mere chewing of an orange, the mean acidity of the group of ulcer patients was\\u000a significantly higher than that of the group of normal persons.
Pressure ulcer is an age-old problem imposing a huge cost to our health care system. Detecting and keeping record of the patient's posture on bed, help care givers reposition patient more efficiently and reduce the risk of developing pressure ulcer. In this paper, a commercial pressure mapping system is used to create a time-stamped, whole-body pressure map of the patient.
R. Yousefi; S. Ostadabbas; M. Faezipour; M. Farshbaf; M. Nourani; L. Tamil; M. Pompeo
Summary 1. Negroes constituted 12.7 per cent of all the peptic ulcer patients admitted to the Cook County Hospital during the period\\u000a of one year, while slightly higher or lower percentages are found in other hospitals admitting both White and Negro patients.\\u000a \\u000a 2. Environmentally conditioned psychic factors play an equally important role in the genesis of peptic ulcer in White and
Inflammation of the gastric and duodenal mucosa is the end result of an imbalance between mucosal defensive and aggressive\\u000a factors. The degree of inflammation and imbalance between defensive and aggressive factors can then result in varying degrees\\u000a of gastritis and\\/or frank mucosal ulceration. Gastritis and ulcers of the duodenum or stomach can be classified either as\\u000a primary or secondary. The
The purpose of this article is to provide education to the RN regarding pressure ulcer prevention and best practice interventions. This investigation focuses on the definition of a pressure ulcer, risk factors for pressure ulcers, and the benefits and importance of using unlicensed assistive personnel to help prevent pressure ulcers. A comprehensive literature review was completed using the Texas Woman's University Library, the Texas Christian University Library, and the World Wide Web. The search engine used was Google. The databases included were CINAHL, Academic Search Complete, Cochrane Library, MEDLINE, and ProQuest Nursing & Allied Health Source. The literature was current, defined as from the last 10 years, and the primary language searched was English. Full-text articles from these databases were included as well as print publications from the university collections. The key search terms from the literature review included (a) pressure ulcer, (b) prevention, (c) unlicensed assistive personnel, (d) nursing assistant, (e) theory of nursing knowledge, (f) incidence, (g) prevalence, (h) Braden scale, (i) moisture, and (j) repositioning. Best practice guidelines were reviewed via the Joanna Briggs database, National Guideline Clearinghouse, Cochrane Library, the Centers for Medicare & Medicaid Services, and the National Institutes of Health. Literature was synthesized to define evidence-based practices that would justify the use of unlicensed assistive personnel for the prevention and care of pressure ulcers. PMID:20827067
Walker Sewill, Danielle K; Van Sell, Sharon; Kindred, Chris
There have been remarkable recent advances in knowledge about duodenal ulcer, a disease which may be spontaneously disappearing. Multiple physiologic defects have been found including increased numbers of parietal cells and their increased sensitivity to gastrin, excessive gastrin release after food intake, decreased inhibition of gastrin release by low antral pH, more rapid gastric emptying, and, possibly, impaired duodenal mucosal resistance to acid. Antacid and diet therapies have been subjected to scientific scrutiny and their respective roles in the therapy of the duodenal ulcer are now better defined. New drugs have been developed which strongly inhibit gastric acid secretion in man--the recently marketed histamine H2-receptor antagonist, cimetidine, as well as chemically modified prostaglandins. Clinical trials have shown cimetidine to be effective in healing duodenal ulcers and free of significant side effects with short-term usage. Its role in the prevention of ulcer recurrence is presently being evaluated. A new operation for duodenal ulcer has been introduced which shows great promise following pilot studies and some randomized trials. Only the parietal cell containing portion of the stomach is denervated. Basal and stimulated gastric acid secretion are markedly inhibited while gastric motility is unimpaired. This operation thus eliminates the need for a drainage procedure or distal antral resection and decreases the incidence and severity of undesirable side effects associated with earlier operations for duodenal ulcer. PMID:645191
The authors report the results of a retrospective study of the treatment of chronic defects of soft tissues and bones of the leg and foot with free muscle and musclecutaneous flaps. The study deals with the results of the use of the microsurgical techniques during the period of 11 years at the Department of Plastic Surgery of the 3rd Medical School in Prague. Discussed are the advantages and disadvantages of this technique as one the of possible therapeutic methods inclusive of the results obtained at the above mentioned department. PMID:9018862
Pros, Z; Tvrdek, M; Kletenský, J; Nejedlý, A; Svoboda, S
The authors report an unusual case of Rocky Mountain spotted fever that presented as an asymptomatic petechial eruption on the lower legs. Rocky Mountain spotted fever is rare in New England and, as such, is typically not on the differential diagnosis when presented with such patients. What began as an asymptomatic eruption progressed to more classic signs of the disease, including a positive Rocky Mountain spotted fever titer. The patient was successfully treated with doxycydine and within a short period of time, was completely back at baseline. PMID:24062875
The authors report an unusual case of Rocky Mountain spotted fever that presented as an asymptomatic petechial eruption on the lower legs. Rocky Mountain spotted fever is rare in New England and, as such, is typically not on the differential diagnosis when presented with such patients. What began as an asymptomatic eruption progressed to more classic signs of the disease, including a positive Rocky Mountain spotted fever titer. The patient was successfully treated with doxycydine and within a short period of time, was completely back at baseline.
The dynamic response of tension-leg platforms subjected to wave loading was investigated using a deterministic dynamic analysis. The model employed in this study is based on coupled nonlinear stiffness coefficients and closed form inertia and drag forcing functions derived using Morison's equation. The forcing functions include relative motion behavior between the fluid particles and the structure. These forcing functions are integrated manually thereby avoiding the need for expensive numerical integration. A set of coupled nonlinear differential equations was integrated sequentially in the time domain using the Newmark beta-method. A computer program was developed to simulate the time history response of the platform motion.
This paper presents a hybrid adaptive fuzzy control of bio-robotic leg. A mathematical dynamic model of bio-robotic leg having three links i.e. thigh, shank and foot is considered here. The Lagrange-Euler formulation is used to obtain the dynamic equations of motion for calculating torques at various joints. Since the dynamics of leg is a highly complex and nonlinear system, hybrid
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))
The authors refer their experience in Urgent Ulcerative Colitis. They define the various clinical maniferstations and then specify the necessary elements for a corrent nosological arrangement. About diagnosis, their confirm the inconvenience of clinical examination like as colonscopy or an opaque clysma, giving their choice to other parameters, like as clinical, hematic (PCR), microscopic and cultural of the faeces, radiological (direct abdomen radiography; abdomino-pelvic echography; abdomino-pelvic TC, better if spiral), endoscopic (rectoscopy with minimal insufflation). They explain their guideline about medical therapy, the strategy adopted in relation to its duration, the protocol of evaluation during the administration period and the predictive sighs of its possible failure. After having precised the surgical indications, they stop a little about the timing of a surgical interventation, underlining its primary importance. In the range of a surgical strategy. They give their choice to the total colectomy with associated ioleostomy for its less incidence of complications and mortality versus proctocolectomy, reserving this last one to that cases with irreprensible rectal hemorragy, with preservation of the anal canal for a possible delayed ileo-anal anastomosis. They also think, at last, that after an Urgent Total Colectomy, the immediate ileo-rectum anastomosis could have an high risk of dehiscence of the anastomosis itself and so it must be reserved only to that selected cases which offer local and general guarantees of solidity of the anastomosis and it must be preferably done joinly whit a loop ileostomy at the bottom of the anastomosis itself. PMID:15139711
Miniello, S; Nacchiero, M; Testini, M; Tomasicchio, N; Cristallo, G; Lissidini, G; Bonomo, G M
A physician's approach to patients with ulcerative colitis (UC) who are refractory to standard first-line therapies must be thoughtful and systematic and include the individual's physical and emotional state as the physician examines the various dietary, medical, and surgical options currently available. It is of foremost importance to confirm that the refractory patient's symptoms are not simply due to dietary indiscretion, concomitant bowel infection (especially with Clostridium difficile), an incorrect diagnosis (eg, colitis due to infection, NSAIDs, ischemia, diverticulitis, or Crohn's disease), or even a concomitant diagnosis (eg, celiac sprue, pancreatic insufficiency, functional bowel disorder, laxative or sorbitol intake). The ability to quickly assess the status of the colonic mucosa with flexible sigmoidoscopy aids in the ability to distinguish patients with refractory inflammation from those with other diagnoses. The initiation and optimization of the long-term purine analogues azathioprine (AZA) or 6-mercaptopurine (6-MP) remain the backbone of medical therapy for patients with refractory UC. For those unresponsive to corticosteroids, quicker induction of remission may necessitate infliximab, cyclosporine, or tacrolimus. Successful induction and maintenance with AZA, 6-MP, and/or infliximab should be followed by long-term therapy with these agents. Cessation of therapy often leads to relapse. Novel therapies under investigation hold the promise of offering more options for both the induction and maintenance of remission in refractory UC patients. Discussions of surgical intervention should not be put off as a last resort but rather included in the overall treatment plan offered to the patient. PMID:16901387
This paper illustrates the problem of active locomotion in the gastrointestinal tract for endoscopic capsules. Authors analyze the problem of locomotion in unstructured, flexible and tubular environments and explain the reasons leading to the selection of a legged system. They present a theoretical simulation of legged capsule locomotion, which is used to define the optimal parameters for capsule design and gait selection. Finally, a legged capsule--about 3 cm3 in volume--is presented; it consists of 4 back legs whose actuation is achieved thanks to a miniaturized DC brushless motor. In vitro tests demonstrate good performance in terms of achievable speed (92 mm/min). PMID:17946504
Menciassi, Arianna; Stefanini, Cesare; Orlandi, Giovanni; Quirini, Marco; Dario, Paolo
Identifying the major determinant of leg stiffness during hopping would be helpful in the development of more effective training methods. Despite the fact that overall leg stiffness depends on a combination of the joint stiffness, it is unclear how the major determinants of leg stiffness are influenced by hopping frequency. The purpose of this study was to identify the major determinant of leg stiffness over a wide range of hopping frequencies. Fourteen well-trained male athletes performed in a place hopping on two legs, at three frequencies (1.5, 2.2 and 3.0 Hz). We determined leg and joint stiffness of the hip, knee and ankle from kinetic and kinematic data. Multiple linear regression analysis revealed that knee stiffness could explain more of the variance of leg stiffness than could ankle or hip stiffness at 1.5 Hz hopping. Further, only ankle stiffness was significantly correlated with leg stiffness at both 2.2 and 3.0 Hz, and the standardized regression coefficient of ankle stiffness was higher than that of knee and hip stiffness. The results of the present study suggest that the major determinant of leg stiffness during hopping switches from knee stiffness to ankle stiffness when the hopping frequency is increased. PMID:21318314
The factors that determine the recurrence rate of chronic gastric ulcer were studied in 105 patients. It was found that complete healing of the ulcer significantly reduced the recurrence rate and subsequent need for hospital admission because of ulcer symptoms when this group was compared with those who left hospital with their ulcers unhealed. Those admitted with large ulcers also had a higher recurrence rate. The age and sex of the patient, ingestion of analgesics and cigarette smoking did not influence recurrence. The initial healing rate of the ulcer also had no effect on the subsequent course of the patient.
Piper, D W; Greig, M; Coupland, G A; Hobbin, E; Shinners, J
Restless legs syndrome (RLS) is a common sleep-related disorder principally characterised by leg paresthesia associated with\\u000a an irresistible urge to move. A majority of RLS patients experience periodic leg movements during sleep (PLMS) and wakefulness.\\u000a Pharmacological evidence suggests that RLS-PLMS may be caused by a central nervous system dopaminergic (DA) dysfunction. The\\u000a aim of the present study was to evaluate
Martin Michaud; Jean-Paul Soucy; Allal Chabli; Gilles Lavigne; Jacques Montplaisir
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
SUMMARY Continuous measurements of anterior-posterior leg position recorded from stick insects walking on a wheel were tested for relationships among spatial and temporal parameters of leg coordination. This analysis revealed that the protraction of middle and rear legs is guided by the ipsilateral front and middle legs respectively. Protraction endpoint for each rear leg shows a significant positive correlation with
Treatment of diabetic foot ulceration is very challenging, costly and often needs to be of long duration. This leads to substantial economic burden. Population-based research suggests that a meaningful reduction of the incidence of amputations caused by diabetes mellitus has already been achieved since the St. Vincent resolution in 1989. Still, it cannot be inferred from these studies that the current preventive efforts are (cost-)effective because reduction of amputation incidence can also be the result of improvements in ulcer treatment. Nevertheless, education of people with diabetes is widely advocated and implemented in standard practice. Despite the fact that preventive interventions are often combined in daily practice, there is little scientific evidence demonstrating the effect of those efforts. In systematically reviewing the evidence, there is insufficient evidence that limited patient education alone is effective in achieving clinically relevant reductions in ulcer and amputation incidence. To date, high quality evidence that more complex interventions including patient education can prevent diabetic foot ulceration is not available either. This, however, should be interpreted as lack of evidence rather than evidence of no effect. Future directions for research and practice may be to concentrate preventive effort on those patients who appear to be at highest risk of foot ulceration after careful screening and selection. PMID:22271733
Background Radiomicrosphere therapy (RT) utilizing yttrium-90 (90Y) microspheres has been shown to be an effective regional treatment for primary and secondary hepatic malignancies. We sought to determine a large academic institution's experience regarding the extent and frequency of gastrointestinal complications. Methods Between 2004 and 2007, 27 patients underwent RT for primary or secondary hepatic malignancies. Charts were subsequently reviewed to determine the incidence and severity of GI ulceration. Results Three patients presented with gastrointestinal bleeding and underwent upper endoscopy. Review of the pretreatment angiograms showed normal vascular anatomy in one patient, sclerosed hepatic vasculature in a patient who had undergone prior chemoembolization in a second, and an aberrant left hepatic artery in a third. None had undergone prophylactic gastroduodenal artery embolization. Endoscopic findings included erythema, mucosal erosions, and large gastric ulcers. Microspheres were visible on endoscopic biopsy. In two patients, gastric ulcers were persistent at the time of repeat endoscopy 1–4 months later despite proton pump inhibitor therapy. One elderly patient who refused surgical intervention died from recurrent hemorrhage. Conclusion Gastrointestinal ulceration is a known yet rarely reported complication of 90Y microsphere embolization with potentially life-threatening consequences. Once diagnosed, refractory ulcers should be considered for aggressive surgical management.
South, Christopher D; Meyer, Marty M; Meis, Gregory; Kim, Edward Y; Thomas, Fred B; Rikabi, Ali A; Khabiri, Hooman; Bloomston, Mark
Congenital entropion is a rare eyelid anomaly that can cause chronic corneal erosions or ulceration. The diagnosis may be easily overlooked by both the pediatrician and the ophthalmologist, particularly when the lids are tightly closed in the crying child. We present three cases of congenital entropion associated with corneal ulceration. Each patient underwent a complete ophthalmologic examination. Examination under anesthesia, including corneal scrapings for culture and photography, was performed before surgical repair of the entropion. There were two cases of lower lid entropion and one case of upper lid entropion. In all three cases symptoms were present since birth, and the diagnosis was overlooked by the treating pediatrician. Corneal ulceration ultimately developed in all three cases. Cultures revealed Staphylococcus aureus in one case, and coagulase negative Staphylococcus in another case. Cultures were negative in one case. In all three patients the ulcers healed rapidly after surgical entropion repair. Congenital upper or lower lid entropion is an uncommon condition that does not spontaneously improve and is an important cause of corneal ulceration in infants. Recognition of this condition is often difficult, and early surgical intervention to repair the lid deformity may help to avoid permanent corneal scarring and visual loss. PMID:8985631
Luchs, J I; Laibson, P R; Stefanyszyn, M A; Rapuano, C J; Cohen, E J; Schnall, B M; Raber, I M
The restless legs syndrome (RLS) characteristically presents with an irresistible urge to move that is most often accompanied by creeping sensations deep in the limbs. Occasionally the upper limbs can also be affected. RLS symptoms occur at rest and are typically more intense at night and at bedtime. Some patients complain about involuntary leg movements, so-called periodic limb movements (PLM),
K Stiasny; T. C Wetter; C Trenkwalder; W. H Oertel
Research on legged locomotion has encountered its limits in human-made actuation technology. Building a structure and an actuation system capable of performing like a biological muscle for the dynamic locomotion of a mid- to large-sized machine is prohibitive. Novel technologies are being explored with the aim of improving actuator performance. This paper describes the development of a robotic leg for
E. Garcia; J. C. Arevalo; F. Sanchez; J. F. Sarria; P. Gonzalez-de-Santos
Restless Legs Syndrome (RLS) is a sensori-motor disorder characterized by unpleasant, abnormal feelings in the legs and occasionally arms which occur at rest and when initiating sleep. The sufferer experiences an uncontrollable urge to move in order to re...
A random sample of 200 women, aged 18–64 years, living in a county in mid-Sweden, was sent a questionnaire that included questions about sleep habits, symptoms of sleepiness and neuropsychiatric complaints. Standardized diagnostic criteria determined by the International Restless Legs Syndrome Study Group were used to investigate the prevalence of restless legs syndrome (RLS). Possible associations between RLS and neuropsychiatric
Jan Ulfberg; Birgitta Nyström; Ned Carter; Christer Edling
Background: Restless legs syndrome (RLS) is a disorder characterized by disagreeable sensations in the legs that occur at rest and are relieved by movement. These symptoms, which are worse at night, may result in sleep onset or sleep maintenance insomnia. Most patients are found on polysomnography (PSG) to have periodic limb movements in sleep (PLMS). The disorder, idiopathic in most
Katsuhisa Banno; Kenneth Delaive; Randy Walld; Meir H Kryger
Restless legs syndrome (RLS) is a sensory-motor disorder characterized by discomfort of and urge to move the legs, primarily during rest or inactivity, partial or total relief with movement, with presence or worsening exclusively in the evening. It is a relatively common but frequently unrecognized disorder, with a prevalence ranging from 2.5 to 15% of the general population, increasing with
Treating spastic paretic stiff-legged gait, defined as reduced knee flexion in swing, holds a high priority in the rehabilitation of patients with upper motor neuron lesions. We propose a method to determine the relative contributions of hip, knee, and ankle inpairments to this disability. We analyzed the gait of ten patients with stiff-legged gait (SLG) due to a single stroke
Tension Leg Platform design is a challenging and popular area of research in the offshore oil industry. In order to compete in the International Student Offshore Design Competition (ISODC), a Tension Leg Platform (TLP) was designed. Out TLP design addresses five fundamental areas of technical competency (general arrangement and overall hull\\/system design, weight, buoyancy and stability, global loading, general strength
Two-legged and four-legged walking are the most versatile forms of land locomotion in the sense of maneuverability and the ability to traverse irregular terrain. Unfortunately, the problem of practical bipedal walking with dynamic balance has so far elude...
When humans and other mammals run, the body's complex system of muscle, tendon and ligament springs behaves like a single linear spring (‘leg spring’). A simple spring-mass model, consisting of a single linear leg spring and a mass equivalent to the animal's mass, has been shown to describe the mechanics of running remarkably well. Force platform measurements from running animals,
The ''cold leg'' in a PWR is defined as that portion of the primary coolant loop that lays between the coolant pump and the reactor vessel. One of the conditions which may lead to failure in a cold leg consists of repeated cycles of stress. These repeated stress cycles may cause the growth of any small defect in the weld
X-Ray Exam: Lower Leg (Tibia and Fibula) KidsHealth > Parents > Doctors & Hospitals > Medical Tests & Exams > X-Ray Exam: Lower Leg (Tibia and Fibula) Print A ... If You Have Questions What It Is An X-ray of the tibia and fibula is a safe ...
Describes an integrated system capable of walking over rugged terrain using a single leg suspended below a carriage that rolls along rails. To walk, the system uses a laser scanner to find a foothold, positions the leg above the foothold, contacts the terrain with the foot, and applies force enough to advance the carriage along the rails. Walking both forward
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
In locomotion, humans have to deal with changes in ground level like pavement or stairs. When they encounter uneven ground with changes in terrain height, they reduce their angle of attack and leg stiffness on a step. This strategy was found for the single step upward movement. However, are these adjustments the result of a general strategy? In our study we focused on leg adjustments while running up and down, implying permanent adaptation to a new track level. To investigate this, we measured ten healthy participants as they ran along a runway with 10 cm increased and 10 cm lowered steps. We found that ground reaction force, leg length, leg stiffness, and angle of attack were adjusted to the direction of the vertical disturbance (up or down) but also to its length. When running upwards, leg stiffness decreased by about 20.4% on the single step and by about 9.3% on the permanently elevated track step. In addition to that - when running downwards - leg stiffness decreased in preparation for the downward step by about 18.8%. We also observed that the angle of attack diminished on elevated contact from 61 degrees to 59 degrees, and increased on lowered contact from 61 degrees to 65 degrees. The adjustment of leg stiffness seemed to be actively achieved, whereas the angle of attack appeared to be passively adjusted, consistent with a running model that includes leg retraction in late swing phase. PMID:20591519
This paper presents preliminary bipedal running experiments with our Robotic Hexapod, RHex. The robot and the bipedal gait are under-actuated, using only one actuated degree of freedom per compliant leg. We doubled up the hind legs by attaching a duplicat...
The aim of this study was to investigate the role of the swing leg movement on running stability. A simple model was used describing a forward hopping motion. The model consisted of two sub-models, namely a spring-mass system for the stance phase and a functional control model for the swing phase (represented by a passive or actively driven pendulum). To verify the main simulation results, an experimental study on treadmill running was performed. The results of the model indicated that for certain running speeds and pendulum lengths, the behavior of the mechanical system was stable. The following characteristic dependencies between the model parameters were observed. (1) Pendulum length and hip muscle activity determined running height and therefore swing duration. (2) Horizontal velocity was inversely related to leg angle of attack. Increased speed corresponded to flatter leg angles at touch-down, which is in agreement with experimental studies and previous predictions of spring-mass running. It was shown that a biologically motivated control approach with oscillating leg movements is well capable of generating stable hopping movements. Due to its simplicity, however, the monopedal model failed to explain more detailed mechanisms like the swing-leg to stance-leg interaction or the functional role of the leg segmentation. This simple model is therefore considered as a functional mechanical template for legged locomotion, which could help to build more elaborate models in the future. PMID:16213046
Occupant lower leg injury prediction is a difficult procedure due to the complex interactions between the occupant and vehicle structure. This study presents a method to simulate the lower leg kinematics and injuries with MADYMO in the European New Car Assessment Programme (EuroNCAP) 40% offset deformable barrier (ODB) crash test. This study also addresses how to model the vehicle motion,
Yuanzhi Hu; Xi Liu; Clive E. Neal-Sturgess; Cheng Yue Jiang
This paper describes an omni-directional walking robot, which has six legs and can move in any direction. The mechanism consists of a parallel link mechanism connecting the two frames with three linear actuators. Legs are attached to each frame. The relative position and angle of the two frames are selected arbitrarily in accordance with the length of three actuators. The
Anisopteran leg functions change dramatically from the final larval stadium to the adult. Larvae use legs mainly for locomotion, walking, climbing, clinging, or burrowing. Adults use them for foraging and grasping mates, for perching, clinging to the vegetation, and for repelling rivals. In order to estimate the ontogenetic shift in the leg construction from the larva to the adult, this study quantitatively compared lengths of fore, mid, and hind legs and the relationships between three leg segments, femur, tibia, and tarsus, in larval and adult Anisoptera of the families Gomphidae, Aeshnidae, Cordulegastridae, Corduliidae, and Libellulidae, represented by two species each. We found that leg segment length ratio as well as ontogenetic shift in length ratios was different between families, but rather similar within the families. While little ontogenetic shift occurred in Aeshnidae, there were some modifications in Corduliidae and Libellulidae. The severest shift occurred in Gomphidae and Cordulegastridae, both having burrowing larvae. These two families form a cluster, which is in contrast to their taxonomic relationship within the Anisoptera. Cluster analysis implies that the function of larval legs is primarily responsible for grouping, whereas adult behavior or the taxonomic relationships do not explain the grouping. This result supports the previous hypothesis about the convergent functional shift of leg characters in the dragonfly ontogenesis. PMID:21036021
Leipelt, Klaus Guido; Suhling, Frank; Gorb, Stanislav N
The objective of this paper is to investigate towards active actuated natural walking humanoid robot legs. Conventional humanoid robots suffer from problems like artificial and unnatural motion, or low agility. To improve the performance of the humanoid robot, this paper introduces the idea which employs the active-actuated biped robot legs and the passive dynamic walkers with more naturally walking. The
Ren C. Luo; Chwan Hsen Chen; Yi Hao Pu; Jia Rong Chang
The article presents the data on the assessment of the degree of severity of ulcerative colitis and the selection of nutritional support with the account of the violations of the nutrition status with ulcerative colitis. PMID:23947173
Following a tick bite, rubor and severe itching encircles the affected area. Polymorphism, protracted existence of the nodule, periodically changing into pustules, and serous fluid discharge occur. Later, the nodule is transformed into an ulcer. The ulcer...
The genesis of ulcers in restrained rats is discussed through an investigation of the relationship between the protective effects of nervous system effectual substances examined vis-a-vis ulcers in restrained rats and their elective or secondary pharmacol...
Progressive multifocal leukoencephalopathy (PML) is associated with JC polyomavirus (JCV) infection of central nervous system oligodendrocytes resulting in demyelinization and progressive focal neurologic deficits. Reactivation of dormant JCV occurs in the setting of immunosuppression, most commonly in patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) or hematological malignancies. PML has also been reported in solid organ transplant recipients. We report the case of a 61-year-old man after bilateral lung transplantation for chronic hypersensitivity pneumonitis who presented with leg weakness, cognitive decline, and expressive aphasia at 5 months post transplantation. Magnetic resonance imaging and brain biopsy were consistent with PML. Treatment attempt with cytarabine was unsuccessful, and immunomodulation resulted in recurrent grade A3 rejection. The difficulty of managing PML in lung transplant patients is highlighted by the lack of directed therapy and risk of graft rejection or failure with attempts at decreasing immunosuppression. PMID:23582024
Restless legs syndrome (RLS) disrupts sleep in a substantial proportion of the population and is associated with higher cross-sectional rates of affective illness and cardiovascular disease. While dopamine and iron availability in the brain modulate emergence of symptoms, and dopamine agonists and iron alleviate the sensory symptoms and motor signs of RLS, the biology of the disorder is incompletely understood. Genetic factors, as opposed to environmental ones, account for most of the disease variance. The at-risk allelic variants exist in non-coding regions of at least six genes rendering it a complex genetic disease. Nonetheless, these provide the first hypothesis independent clues that advance a better understanding of RLS pathophysiology. PMID:23896312
Restless Legs Syndrome (RLS) is a prevalent sleep-associated movement disorder greatly affecting patients’ quality of life (QoL). Several drugs can be used to control this condition although the first-line dopamine agents often cause adverse effects. Non-dopaminergic drugs such as oral gabapentin (GBP) have been more recently advocated. Despite ameliorating RLS symptoms, GBP’s pharmacokinetic limitations restrict its overall effectiveness. A novel specifically designed prodrug, gabapentin enacarbil (GE), has demonstrated successful RLS alleviation with a superior pharmacokinetic profile. This review aims to examine the efficacy and tolerability of both GBP and GE as pharmacotherapy for RLS. Despite some heterogeneity and limitations across research methodologies, GE appears to be a potential RLS therapy superior to GBP and other dopaminergic agents.
Jones, Ruth; Rickards, Hugh; Cavanna, Andrea Eugenio
"Critical" according to the Oxford dictionary means: a "turning point" where an acute change for better or worse may be anticipated. Thus, the meaning of the word "critical" complies with its use in relation to ischaemia. We don't really know, prospectively, what will happen to the critically ischaemic limb, whether it will improve or worsen. The answer to the question "How critical is critical leg ischaemia (CLI)?" must be: "We don't know!" The addition of ankle systolic pressure as an objective haemodynamic measurement has not made the definition of the Second European Consensus Group significantly better than the original Fontaine classification, grade III and IV. For clinical practice the Fontaine classification will be sufficient. For scientific purposes macro- and microcirculatory assessments and information about the patient's risk profile should be added. PMID:9676324
Series Elastic Actuators provide many benefits in force control of robots in unconstrained environments. These benefits include high force fidelity, extremely low impedance, low friction, and good force control bandwidth. Series Elastic Actuators employ a novel mechanical design architecture which goes against the common machine design principal of "stiffer is better." A compliant element is placed between the gear train and driven load to intentionally reduce the stiffness of the actuator. A position sensor measures the deflection, and the force output is accurately calculated using Hooke"s Law (F=Kx). A control loop then servos the actuator to the desired output force. The resulting actuator has inherent shock tolerance, high force fidelity and extremely low impedance. These characteristics are desirable in many applications including legged robots, exoskeletons for human performance amplification, robotic arms, haptic interfaces, and adaptive suspensions. We describe several variations of Series Elastic Actuators that have been developed using both electric and hydraulic components.
Leg 124 of the Ocean Drilling Program drilled five sites in the Sulu and Celebes Seas (Figure 1). The papers presented in this issue provide an overview of some of the preliminary results of the shipboard science. They represent a team effort, and all are co-authored by the entire scientific party. Our objectives were to determine the age and origin of these basins, and their stratigraphic histories, as indicators of the complex tectonic and paleoceanographic events that have affected the western Pacific region during the Cenozoic. Numerous competing hypotheses have been put forward to explain the array of marginal basins and island arcs in the western Pacific, and these basins are all potential recorders of the complex history of the western Pacific history.
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
14 patients with non-specific ulcers of the small intestine are discussed: 9 ulcers of the ileum; 3 of the section between the jejunum and the ileum; and 2 of the jejunum. The operations were performed on the basis of a clinical picture of the abdomen acutum, while the correct diagnosis was confirmed during the operation itself. This affirmed the well-known fact that diseases are almost always diagnosed after some complication: perforation, hemorrhage, or stenosis. Two of the patients died (14.3%). A resection was performed on the younger patients operated on within eight hours of the initial manifestation of the disease. The others survived the ulcer by the extraction of their edges. PMID:7269997
The purpose of our investigation was to study the effect of two somatostatin analogs (SMS 201-995 and 008) on duodenal ulcer disease induced by cysteamine in rats. Male Wistar rats were given cysteamine (28 mg/100 g body wt.) by rubber stomach tube three times in a single day. All animals of the test group were injected subcutaneously either with SMS 201-995 in different doses or with 008. On the 3rd day stomach, duodenum, and adrenal glands were macroscopically examined for lesions (duodenal ulceration, gastrointestinal bleeding, adrenal hemorrhage). Our results showed a dose-dependent effect of SMS 201-995 on the mortality, incidence, and intensity of cysteamine-induced duodenal lesions in rats. The incidence and the intensity of gastrointestinal bleeding and adrenal hemorrhage were also dose-dependently reduced by SMS 201-995. There was no definite effect of 008 on the mortality, incidence, or intensity of cysteamine-induced duodenal ulceration. PMID:2882057
Palitzsch, K D; Schuler, H; Schwedes, U; Usadel, K H
Gastric ulceration is a relatively uncommon but well-described complication of yttrium 90 (Y90) radioembolization therapy in the locoregional treatment of hepatic tumors. Meticulous attention to vascular anatomy, an assessment of antegrade hepatic arterial flow, and knowledge of the dynamic embolic effect of the chosen Y90 particulate at treatment are requirements to reduce the risk of nontarget embolization to gastrointestinal structures. Radiation-associated gastrointestinal ulceration is difficult to treat, and may be associated with gastrointestinal bleeding, bowel obstruction, and perforation. Surgical excision of the involved segment with bypass may be necessary. The increased use of coil embolization of at-risk vessels combined with administration of Y90 particulates with minimal embolic effect has reduced the incidence of radioembolization associated gastrointestinal ulceration.
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 used to detect stage-I pressure ulcers and deep tissue injury. Its high bandwidth makes it possible to load the skin under wide range of conditions. The instrument is portable, inexpensive, and intrinsically precise. Several experiments were conducted to validate the function of the device. Preliminary results show that the device could effectively measure the difference in the viscoelasticity between human skin of different sites, hence paving the way for the development of clinical protocols and trials. PMID:17946732
Wang, Qi; Kong, Linghua; Sprigle, Stephen; Hayward, Vincent
Pressure ulcer is an age-old problem imposing a huge cost to our health care system. Detecting and keeping record of the patient's posture on bed, help care givers reposition patient more efficiently and reduce the risk of developing pressure ulcer. In this paper, a commercial pressure mapping system is used to create a time-stamped, whole-body pressure map of the patient. An image-based processing algorithm is developed to keep an unobtrusive and informative record of patient's bed posture over time. The experimental results show that proposed algorithm can predict patient's bed posture with up to 97.7% average accuracy. This algorithm could ultimately be used with current support surface technologies to reduce the risk of ulcer development. PMID:22255993
Yousefi, R; Ostadabbas, S; Faezipour, M; Farshbaf, M; Nourani, M; Tamil, L; Pompeo, M
Ulcerative colitis is a chronic disease that specifically affects the mucosa of the rectum and colon. Although the etiology of this recurring inflammatory disorder remains essentially unknown, there have been significant advances in identifying the likely genetic and environmental factors that contribute to its pathogenesis. The clinical course of the disease typically manifests with remissions and exacerbations characterized by rectal bleeding and diarrhea. Since ulcerative colitis most commonly affects patients in their youth or early middle age, the disease can have serious long-term local and systemic consequences. There is no specific medical therapy that is curative. Although medical therapy can ameliorate the inflammatory process and control most symptomatic flares, it provides no definitive treatment for the disease. Proctocolectomy or total removal of the colon and rectum provides the only complete cure; however, innovative surgical alternatives have eliminated the need for a permanent ileostomy. The aim of this review is to provide a detailed account of the surgical management of ulcerative colitis.
Natural selection is responsible for the creation of robust and adaptive control systems. Nature's control systems are created only from primitive building blocks. Using insect neurophysiology as a guide, a neural architecture for leg coordination in a hexapod robot has been developed. Reflex chains and sensory feedback mechanisms from various insects and crustacea form the basis of a pattern generator for intra-leg coordination. The pattern generator contains neural oscillators which learn from sensory feedback to produce stepping patterns. Using sensory feedback as the source of learning information allows the pattern generator to adapt to changes in the leg dynamics due to internal or external causes. A coupling between six of the single leg pattern generators is used to produce the inter-leg coordination necessary to establish stable gaits.
Three facilities (CIEMAT, HMGU and HML) have used their in vivo counters to compare two leg phantoms. One was commercially produced with (241)Am activity artificially added to the bone inserts. The other, the United States Transuranium and Uranium Registries' (USTUR) leg phantom, was manufactured from (241)Am-contaminated bones resulting from an intake. The comparison of the two types of leg phantoms showed that the two phantoms are not similar in their activity distributions. An error in a bone activity estimate could be quite large if the commercial leg phantom is used to estimate what is contained in the USTUR leg phantom and, consequently, a real person. As the latter phantom was created as a result of a real contamination, it is deemed to be the more representative of what would actually happen if a person were internally contaminated with (241)Am. PMID:21799341
Kramer, Gary H; Hauck, Barry; Capello, Kevin; Rühm, Werner; El-Faramawy, Nabil; Broggio, David; Franck, Didier; Lopez, Maria Antonia; Navarro, Teresa; Navarro, Juan Francisco; Perez, Begoña; Tolmachev, Sergei
The roles of biological springs in vertebrate animals and their implementations in compliant legged robots offer significant advantages over the rigid legged ones in certain types of scenarios. A large number of robotics institutes have been attempting to work in conjunction with biologists and incorporated these principles into the design of biologically inspired robots. The motivation of this review is to investigate the most published compliant legged robots and categorize them according to the types of compliant elements adopted in their mechanical structures. Based on the typical robots investigated, the trade-off between each category is summarized. In addition, the most significant performances of these robots are compared quantitatively, and multiple available solutions for the future compliant legged robot design are suggested. Finally, the design challenges for compliant legged robots are analysed. This review will provide useful guidance for robotic designers in creating new designs by inheriting the virtues of those successful robots according to the specific tasks. PMID:23151609
Rembrandt's etching of a beggar with a wooden leg is notable because the two lower limbs of the presumed beggar are present and not deformed. Using the facilities of four specialised Dutch art institutes, we carried out a systematic investigation to find other etchings and engravings of subjects with artificial legs supporting non-amputated limbs, from the period 1500 to 1700 AD. We discovered 28 prints produced by at least 18 artists. Several offered clues to a disorder of a knee, the lower leg or the foot. All individuals were adult males, suggesting the probability of traumatic lesions. We conclude that in this period artificial legs were not only used in the case of absence of part of a lower limb, but also for other reasons, notably disorders of the knee, lower leg or foot. They may also have been used to attract compassion. PMID:19190068
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.
The authors compared leg stiffness (KVERT), muscle activation, and joint movement patterns between 11 men and 10 women during hopping. Physically active and healthy men and women performed continuous 2-legged hopping at their preferred rate and at 3.0 Hz. Compared with men, women demonstrated decreased KVERT; however, after the authors normalized for body mass, gender differences in KVERT were eliminated. In comparison with men, women also demonstrated increased quadriceps and soleus activity, as well as greater quadriceps-to-hamstrings coactivation ratios. There were no significant gender differences for joint movement patterns (p > .05). The relationship between the observed gender differences in muscle recruitment and the increased risk of anterior cruciate ligament injury in women requires further study.
Padua, Darin A.; Arnold, Brent L.; Carcia, Christopher R.; Granata, Kevin P.
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.
Summary Recently the term H2 receptor antagonist-resistant (H2RA-resistant) ulcer has been used increasingly commonly, instead of the conventional term of intractable ulcer, to designate\\u000a an ulcer which does not respond to treatment with an H2 receptor antagonist (H2RA). However, many authors report that an H2RA resistant ulcer can be cured by increasing the dosage of H2RA, or using another H2RA. In
Marjolin's ulcer is an aggressive form of squamous cell carcinoma that develops over time from chronic wounds and scars, including burns and chronic venous stasis ulcers. The incidence of malignant transformation is low, resulting in a delay in diagnosis and increased morbidity and mortality in these patients. We report a case of Marjolin's ulcer that was incidentally found after limb amputation for chronic venous stasis ulcer along with a comprehensive literature review on the etiology, diagnosis, and treatment of this disease. PMID:23972640
Eliassen, Anna; Vandy, Frank; McHugh, Jonathan; Henke, Peter K
Gastroduodenal ulceration is still poorly understood and changes in gene expression may provide new mechanistic insights. Previously, we demonstrated that angiogenic growth factors are potent ulcer healing agents, and the synthesis of bFGF, PDGF and VEGF is enhanced early in duodenal ulcer healing. The initial molecular event in duodenal ulceration seems to be the organ-specific early release of ET-1 in
Sandor Szabo; Xiaoming Deng; Tetyana Khomenko; Masashi Yoshida; Martin R Jadus; Zsuzsa Sandor; Zoltan Gombos; Hiroko Matsumoto
. 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
To examine stance during the measurement of balance ability, this study aimed to clarify the differences and relationships between balance ability in one-legged (dominant or nondominant leg) and two-legged stances in 25 typical male adults and 25 male soccer players. Balance ability was evaluated with four sway factors: sway velocity, anterior-posterior sway, lateral sway, and high-frequency sway factors. The one-legged stance was more unstable than the two-legged stance, the balance abilities related to two-legged and one-legged stances differed, and the balance abilities related to dominant-legged and nondominant-legged stances were similar. The one-legged stance, which was difficult to maintain stably, may be useful in the measurement of static balance ability in young people. PMID:20681329
... 2009-07-01 false Marco Polo Tension Leg Platform safety zone. 147.837...SAFETY ZONES Â§ 147.837 Marco Polo Tension Leg Platform safety zone. (a) Description. Marco Polo Tension Leg Platform, Green Canyon 608 (GC...
... 2013-07-01 false Marco Polo Tension Leg Platform safety zone. 147.837...SAFETY ZONES Â§ 147.837 Marco Polo Tension Leg Platform safety zone. (a) Description. Marco Polo Tension Leg Platform, Green Canyon 608 (GC...
... 2009-07-01 false Matterhorn Tension Leg Platform safety zone. 147.829...SAFETY ZONES Â§ 147.829 Matterhorn Tension Leg Platform safety zone. (a) Description. The Matterhorn Tension Leg Platform A (Matterhorn TLP),...