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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Geriatric dermatology is a specialty that is receiving particular attention. Among the other topics and diseases briefly covered here are dermatologic nursing home visits, decubitus ulcers, pruritus/xerosis, eczematous dermatitis, psychogenic dermatitides, infections of the skin, purpura, vascular compromise, chronic venous insufficiency, and bullous pemphigoid. Illnesses originating in other organ systems that are made manifest on the skin often complicate the diagnostic and therapeutic picture. Chronic diseases such as diabetes mellitus and HIV compound the problems in diagnosing and treating geriatric dermatologic diseases. Since the human population is living longer, chronic diseases will become more prevalent, as will diseases of the skin.
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PMID:Geriatric dermatology. 1451 Aug 83

Most healthcare providers recognize that management of lower extremity wounds presents a difficult challenge. These chronic wounds significantly impact the quality of life for individuals and have implications for costs and utilization of healthcare resources. Lower extremity wounds can be due to a myriad of different diseases, but the primary causes are chronic venous insufficiency, lower extremity arterial disease, and diabetes/neuropathy. Differential assessment is necessary prior to implementation of management strategies in order to address the etiology and pathogenesis factors that are related to each type of leg wound. This article presents an overview of the risk and predisposing factors for venous, arterial, and diabetic/neuropathic wounds. Additionally, it addresses issues of differential assessment including typical locations, common clinical characteristics, typical wound appearance, key management issues, considerations for alternative treatments, collaborative care, and patient/family education.
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PMID:Assessment and management of patients with venous, arterial, and diabetic/neuropathic lower extremity wounds. 1459 3

Selective serotonin reuptake inhibitors (SSRIs) are well-established medications for the treatment of mood disorders including major depression. These agents are also known to exhibit potent antiplatelet and endothelium protective effects effects. Additionally, SSRIs can exacerbate the development of inflammation, and modulate the interleukin and interferon production. All of the above suggest that SSRIs therapy could be considered as a potential strategy for the wound healing treatment. We summarized some body of the available data on the history of serotonin metabolism, mechanism of action of ketanserin, and hypothesize why SSRIs may be beneficial in the wound repair natural history. Different pathophysiological considerations are also reflected in this review. Finally, we suggest that the topical use of SSRIs may represent a promising avenue for future strategies affecting wound repair in high-risk patients, especially those with diabetes mellitus, venous insufficiency, obesity, and other vascular disorders.
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PMID:Treatment with selective serotonin reuptake inhibitors for enhancing wound healing. 1519 59

Over the last decade, the sural flap has been popularized as a suitable alternative to free-tissue transfer for soft-tissue coverage of the lower extremity. However, flap failure rates may be increased especially if patients have certain risk factors, such as age over 40 years, peripheral artery disease, venous insufficiency, diabetes mellitus, and others. This article describes a sural flap delay procedure to avoid flap necrosis in this potentially "high-risk" patient population.
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PMID:Sural flap delay procedure: a preliminary report. 1618 23

This article reviews theories linked to endogenous bioelectric currents and the role they may play in wound repair with further appraisal of in vitro and in vivo research related to the effects of clinically applicable electrical currents on protein synthesis, cell migration, and antibacterial outcomes. In addition, studies on the effects of electrical stimulation (ES) on skin grafts, donor sites, and musculocutaneous flaps in animals are evaluated, as well as assessments of numerous clinical reports that examined the effects of ES on angiogenesis, perfusion, PtcO2, and epithelialization. Finally, a plethora of clinical trials related to the responses of chronic lower extremity wounds to ES therapy are reviewed, with emphasis on wounds caused by venous insufficiency, diabetic neuropathy, and ischemia in patients with and without diabetes mellitus. A glossary that addresses ES terminology is also included.
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PMID:Electrical stimulation for wound healing: a review of evidence from in vitro studies, animal experiments, and clinical trials. 1586 Apr 50

Wound healing is a sequence of complex events, an imbalance of which can result in a failure of the wound to heal, with significant implications for patients and health care services alike. Although the exact mechanism that underlies these events is not fully understood, inflammatory processes and the innate immune system play a vital role, not only in normal wound healing but also in the pathophysiology of delayed wound healing. These defense mechanisms are affected by underlying disease states and medical conditions, for example, diabetes, venous insufficiency, and the inflammation associated with acute trauma. Importantly, however, these processes are also modulated in health by bacteria within the wound. This article examines the role of the mediators of inflammation involved in the wound-healing process and discusses the function of these mediators when normal healing fails. The reaction of the wound to bacterial contamination and the effect of bacteria on wound healing are also discussed.
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PMID:Inflammation and wound healing: the role of bacteria in the immuno-regulation of wound healing. 1586 16

Ulcerated necrobiosis lipoidica is one of the differential diagnoses in leg ulcers. 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 leg ulcer that did not respond to good ulcer care and compression bandaging. Skin biopsies revealed necrobiosis lipoidica. The patient was recently discovered to have diabetes mellitus that was treated orally by ascarose. Phlebosurgery and mesh grafting were performed, and the patient was given pentoxyfiline, dapsone, and clofazimine, but none of these treatments was successful. Therefore, topical PUVA therapy was introduced that resulted in partial remission and stabilizing of the residual pathology. Based on these experiences, the use of surgical methods alone is questionable.
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PMID:Ulcerated necrobiosis lipoidica: a combined treatment approach with dermatosurgery and PUVA. 1586 53

Chronic venous insufficiency (CVI) with the resultant clinical sequelae significantly reduces quality of life. Most elderly patients with CVI are treated nonoperatively owing to concerns of increased operative risk and therefore suffer more advanced disease. Radiofrequency ablation (RFA) has emerged as a minimally invasive procedure to treat patients with superficial venous insufficiency (SVI) due to great saphenous vein (GSV) incompetence. The purpose of this study was to review our experience using RFA of the GSV to treat CVI due to superficial disease in elderly patients compared to younger patients in terms of procedure-related morbidity and severity of disease at time of treatment. RFA treatment of the GSV was performed in 490 extremities of 421 patients with SVI between March 2001 and December 2002. Indications, medical history, and outcome (operative complications and hospital stay) were compared between 2 groups: Group I:41 extremities of 35 patients, 70 years if age or older (mean 75 +/-4); and Group II:449 limbs of 386 patients younger than 70 years (mean 47 +/-11). The incidence of skin pigmentation and healed/nonhealed ulcers (CEAP 4-6) was significantly higher in the elderly than in the younger group (41% vs 16%, p <0.05). Hypertension, diabetes, and previous myocardial infarction were 2.8, 5.4, and 6.7 times more prevalent in the elderly (p <0.05), respectively. There were no major postoperative complications in either group; 97% of all patients were discharged on the day of operation and there was no difference between the 2 groups in overnight hospital stay. There is a treatment bias against operative management in elderly patients with SVI, as evidenced by their more advanced disease at the time of definitive treatment than their younger cohort. However, operative morbidity is no different compared to the younger subset. RFA is a safe and effective procedure for older patients; therefore, the threshold for operative management of older patients should be lowered.
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PMID:Chronic venous insufficiency due to great saphenous vein incompetence treated with radiofrequency ablation: an effective and safe procedure in the elderly. 1607 43

Insufficient blood flow through end-resistance arteries leads to symptoms associated with peripheral vascular disease. This may be caused in part by poor macrocirculatory inflow or impaired microcirculatory function. Dysfunction of the microcirculation occurs in a similar fashion in multiple tissue beds long before the onset of atherosclerotic symptoms. Impaired microcirculatory vasodilatation has been shown to occur in certain disease states including peripheral vascular disease, diabetes mellitus, hypercholesterolemia, hypertension, chronic renal failure, abdominal aortic aneurysmal disease, and venous insufficiency, as well as in menopause, advanced age, and obesity. Microcirculatory structure and function can be evaluated with transcutaneous oxygen, pulp skin flow, iontophoresis, and capillaroscopy. We discuss the importance of the microcirculation, investigative methods for evaluating its function, and clinical applications and review the literature of the microcirculation in these different states.
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PMID:Evaluation of the microcirculation in vascular disease. 1617 12

The survey included 3807 records (vouchers for therapeutic and orthopedic requisites) from five pharmacies of the basic type within six months. Health requisites were prescribed and issued to 1337 patients in a total number of 14,431 items, which represents 290 different kinds (codes) of health requisites. The most frequently prescribed items included: dressing materials, aids for incontinence, and requisites for diabetic patients. Health requisites prescribed in vouchers are dispensed to patients of all age categories, most of them being older than 50 years of age. The diagnoses, for which the health requisites are prescribed, are typical of the individual age categories: to 30 years of age they are primarily respiratory and allergic problems and accidents, after 30 years of age it is venous insufficiency, and after 50 years of age various types of incontinence prevail. The diagnosis of diabetes mellitus is found in all age categories. It follows from the trend of ageing of the population that dispensation of health requirements in pharmacies will be increased.
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PMID:[Prescription of health requisites to patients]. 1650 10


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