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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Telemedical wound care is one of the applications of teledermatology. We present our experience using telemedicine in the successful assessment and treatment of three patients with hard-to-heal ulcers. Three patients were seen at the PEMEX General Hospital in Veracruz, Mexico. The first patient was a 53-year-old man with hypertension, morbid obesity, chronic venous insufficiency, recurrent erysipelas, leg ulcers and lymphoedema. There was one ulcer on his left lower leg (20 x 10 cm) and one on his right leg (9 x 7 cm). The second patient was a 73-year-old woman with class III obesity and ulcers in her right leg, secondary to surgical debridement of bullous erysipelas. The third patient was a 51-year-old female with rheumatoid arthritis with one ulcer on each leg and chronic lymphostasis. Photographs with a digital camera were taken and sent weekly via email to a wound care specialist in Mexico City. The photographs allowed the expert to diagnose and evaluate the chronic wounds periodically. In the present cases, telemedicine allowed us to have a rapid evaluation, diagnosis and treatment. The images were of enough quality to be useful and small enough to be sent via regular email to the remote physician who immediately gave his feedback. The expert was confident to give therapeutic recommendations in this way, and we considered this method to be very cost-effective, saving the patient and the health care system, especially in transportation.
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PMID:Telemedicine in wound care. 1880 29

Leg ulcers may result in serious morbidity in patients with connective tissue diseases and Raynaud's phenomenon (RP). We describe a 35-year-old woman with mixed connective tissue disease who suffered from leg ulcers refractory to iloprost. When the patient was treated with the selective endothelin A receptor antagonist sitaxsentan for pulmonary arterial hypertension, the ulcers improved within 4 weeks and resolved completely thereafter. In addition, severity of RP ameliorated markedly. Further evaluation of sitaxsentan in patients with connective tissue diseases suffering from ischemic skin ulcers is required.
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PMID:[Leg ulcer in mixed connective tissue disease. Resolution during sitaxsentan therapy]. 1915 32

This study evaluated the use of phototherapy in the healing of mixed leg ulcers in two diabetic patients (type 2) with arterial hypertension. The device had probe 1 (one 660 nm LED, 5 mW) applied in 3 ulcers and probe 2 (32 890 nm LEDs associated with 4 660 nm LEDs, 500 mW) in 6 ulcers. After asepsis, ulcers were treated with probes to 3 J/cm2, 30 sec per point, twice a week, followed by topical daily dressing with 1% silver sulphadiazine during 12 weeks. The following analyses of ulcers with software Image J showed that probe 2 presented mean healing rates of 0.6; 0.7 and 0.9, whereas probe 1 had 0.2; 0.4 and 0.6 at 30, 60 and 90 days, respectively. Phototherapy accelerated wound healing of leg ulcers in diabetic patients.
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PMID:Phototherapy (LEDs 660/890nm) in the treatment of leg ulcers in diabetic patients: case study. 1966 43

Varicose veins are a very frequent disorder with prevalence in our adult population between 14% for large varices and 59% for small teleangiectasias. Subjective symptoms may be very non-specific. The term "chronic venous insufficiency (CVI)" defines functional abnormalities of the venous system producing advanced symptoms like oedema, skin changes or leg ulcers. Both entities, varicose veins and CVI, may be summarized under the term "chronic venous disorders" which includes the full spectrum of morphological and functional abnormalities of the venous system. A classification system to describe chronic venous disorders regarding clinical appearance, etiology, anatomical distribution and pathophysiology has been proposed under the acronym of CEAP. The revised version of the CEAP classification contains also definitions of clinical signs and suggests three levels of apparative investigations adjusted to the clinical stage. Concerning the etiology of venous disorders controversial theories exist leading to different therapeutic concepts. As a matter of fact there is a vicious circle between structural changes in valves and venous wall and hemodynamic forces leading to reflux and venous hypertension. Different methods for treating varicose veins are available producing satisfactory early outcome in most cases, but followed by a high recurrence rate after years. Chronic venous insufficiency requires "chronic management". Compression therapy by bandages for initial treatment of severe stages and maintenance therapy using medical compression stockings is essential. In addition correction of venous refluxes by surgery or endovenous procedures including echo-guided foam sclerotherapy should be considered in every single case.
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PMID:Varicose veins and chronic venous insufficiency. 1999 50

Chronic venous insufficiency starts by promoting the case of events. This results in pathologic venous and tissue changes consequential to chronic venous insufficiency. In this article, chronic venous insufficiency is defined as an abnormal function of the venous system due to venous valvular incompetence with or without associated venous outflow obstruction, which may involve the superficial venous system, deep venous system, or both. Long-term venous hypertension may present by a variety of clinical manifestations in terms of the severity and duration of venous circulation damage. Venous leg ulcer occurs in distal part of the shin, mostly around medial malleolus. The base of the ulcer is often covered by a yellowish fibrin layer. The surrounding skin is hyperpigmented, usually irritated by ulcer secretion, and inflamed. Arterial leg ulcer is caused by arterial insufficiency. It is round-shaped with dry basis and involves deeper structures, up to tendons. The skin is dry, atrophic, cool, pale, smooth, and hairless. Therapy of ulcers is demanding and consists of numerous general measures, topical and/or systemic therapy. Topical therapy consists of cleansing, mechanical debridement, disinfection and stimulation of granulations and epithelialization with prevention of secondary infection. Therapy with currently available bio-occlusive wound dressings is most effective. These dressings are hydrocolloids, hydropolymers, transparent films, alginate, and ionic silver. Vascular protectors, venetonics and antiaggregation medications can be used in systemic therapy.
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PMID:[What should we know about venous and arterial ulcers?]. 2003 35

In 1945, Martorell described ischaemic leg ulcers in patients with hypertension. He suggested that the ischaemic necrosis was secondary to a hypertensive arteriolar disease and referred to them as 'hypertensive ischaemic ulcers'. In recent years, the specific entity of these ulcers has been questioned. Others claim they have a much higher incidence, but presume the diagnosis is frequently missed. Almost 900 cases of Martorell's ulcers have been reported in literature since the first description. A systematic review and comprehensive search of literature (evidence-based) was needed to characterize this type of ulcer. Based on aetiology and histopathology, it seems to be justified to maintain the name 'arteriolosclerotic ulcer of Martorell'. We conclude that the arteriolosclerotic ulcer of Martorell is a specific entity with its own clinical and histological diagnostic keys, wound management and preventive measures. We introduce a set of criteria that may be used to facilitate diagnosing arteriolosclerotic ulcer of Martorell as well as a flowchart that includes diagnosis, treatment and prevention of this particular type of vascular leg ulcer.
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PMID:Arteriolosclerotic ulcer of Martorell. 2011 82

The aim of this study was to evaluate the epidemiological data and the main comorbidities of patients with erysipelas admitted to a tertiary hospital. All patients admitted due to erysipelas during the period from 1999 to 2008 were included in a prospective and cross-sectional study. The Fisher exact test and logistic regression were used for statistical analysis. A total of 428 individuals were hospitalized with 41 rehospitalizations; 51.17% of the patients were women, the mean age was 58.6 years. The main comorbidities were hypertension (51.6%), diabetes mellitus (41.6%), chronic venous insufficiency (36.2%), other cardiovascular diseases (33.2%) including angina, peripheral arterial insufficiency, acute myocardial infarction, and strokes, obesity (12.1%), chronic renal failure (6.8%), neoplasms (4.9%), cirrhosis (4.9%), chronic lymphedema (4.2%), and leg ulcers (2.6%). Erysipelas is a seasonal disease that affects adults and the elderly people, has a repetitive nature, and is associated with comorbidities.
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PMID:Epidemiological data and comorbidities of 428 patients hospitalized with erysipelas. 2014 45

This review presents a hypothetical model of the development of a venous leg ulcer. The primary pathology is venous hypertension that leads to increased capillary permeability, resulting in extravasation of erythrocytes. Macrophages produce proinflammatory cytokines, which enhance the expression of adhesion molecules in the endothelium of postcapillary venules and increase the recruitment of leukocytes to the pericapillary interstitium. Extravasated T lymphocytes stimulated by cytokines, which are produced by activated macrophages, differentiate toward the Th1 phenotype. In the case of excessive extracapillary passage of erythrocytes or impaired transport of ferric ions by macrophages, the accumulation of iron in the dermis can occur. In tissues with a high concentration of iron, T lymphocytes proliferate instead of undergoing apoptosis. This is possible due to the internalization of the INF-gR2 chain of the interferon-g receptor, the downregulation of inducible nitric oxide synthase expression in macrophages and the inactivation of the active site of caspases. Stimulated by interferon-g skin keratinocytes produce chemokines: CXCL9, CXCL10 and CXCL11, which attract T lymphocytes. Finally, positive feedback loops develop resulting in the migration of T lymphocytes toward the epidermis and in high local concentrations of interferon-g and keratinocyte-derived chemokines. T lymphocytes invading epidermis produce interferon-g and Fas ligand. High concentrations of interferon-g result in the overexpression of Fas by keratinocytes. Matrix metalloproteinases shed Fas ligand from T lymphocytes. The combined effect of Fas ligand and interferon-g on Fas-overexpressing keratinocytes results in their abundant apoptosis and dermo-epidermal detachment, which is clinically manifested as blister-like lesions that progress to chronic ulcerations.
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PMID:Cellular and molecular mechanisms of venous leg ulcers development--the "puzzle" theory. 2022 26

Mood disturbances are characteristic and dominant feature of Mood disorders. Bipolar Affective Disorder (BAD) is a mood disorder which occurs equally in both sexes. BAD may occur in co morbidity with other mental diseases and disorders such as: Anorexia Nervosa, Bulimia Nervosa, Attention Deficit, Panic Disorder and Social Phobia. However, medical disorders (one or more) can also coexist with BAD. Metabolic syndrome is a combination of metabolic disorders that increase the risk of developing cardiovascular disease. A 61-year old female patient has been receiving continuous and systematic psychiatric treatment for Bipolar Affective Disorder for the last 39 years. The first episode was a depressive one and it occurred after a child delivery. Seventeen years ago the patient developed diabetes (diabetes type II), and twelve years ago arterial hypertension was diagnosed. High cholesterol and triglyceride levels as well as weight gain were objective findings. During the last nine years she has been treated for lower leg ulcer. Since metabolic syndrome includes abdominal obesity, hypertension, diabetes mellitus, increased cholesterol and serum triglyceride levels, the aforesaid patient can be diagnosed with Metabolic Syndrome. When treating Bipolar Affective Disorder, the antipsychotic drug choice should be careful and aware of its side-effects in order to avoid the development or aggravation of metabolic syndrome.
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PMID:Metabolic syndrome - the consequence of lifelong treatment of bipolar affective disorder. 2056 89

Lymphoedema is a chronic, incurable, debilitating condition, usually affecting a limb and causes discomfort, pain, heaviness, limited motion, unsatisfactory appearance and impacts on quality of life. However, there is a paucity of prevalence data on this condition. This study aimed to determine the prevalence of lymphoedema among persons attending wound management and vascular clinics in an acute tertiary referral hospital. Four hundred and eighteen patients meeting the inclusion criteria were assessed. A prevalence rate of 2.63% (n = 11) was recorded. Thirty-six percent (n = 4) had history of cellulitis and broken skin, 64% (n = 7) had history of broken skin and 36% (n = 4) had undergone treatment for venous leg ulcers. The most common co-morbidities were hypertension 55% (n = 6), deep vein thrombosis (DVT) 27% (n = 3), hypercholesterolemia 36% (n = 4) and type 2 diabetes 27% (n = 3). Quality of life scores identified that physical functioning was the domain most affected among this group. This study has identified the need to raise awareness of this condition among clinicians working in the area of wound management.
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PMID:Prevalence of lymphoedema and quality of life among patients attending a hospital-based wound management and vascular clinic. 2191 Aug 29


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