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Differential diagnosis of leg ulcers.
Pannier, F; Rabe, E
Leg and foot ulcers are symptoms of very different diseases. The aim of this paper is to demonstrate the differential diagnosis of leg ulcers. The majority of leg ulcers occur in the lower leg or foot. In non-venous ulcers the localization in the foot area is more frequent. The most frequent underlying disease is chronic venous disease. In 354 leg ulcers, Koerber found 75.25% venous leg ulcers, 3.66% arterial leg ulcers, 14.66% ulcers of mixed venous and arterial origin and 13.5% vasculitic ulcers. In the Swedish population of Skaraborg, Nelzen found a venous origin in 54% of the ulcer patients. Each leg ulcer needs a clinical and anamnestic evaluation. Duplex ultrasound is the basic diagnostic tool to exclude vascular anomalies especially chronic venous and arterial occlusive disease. Skin biopsies help to find a correct diagnosis in unclear or non-healing cases. In conclusion, chronic venous disease is the most frequent cause of leg ulcerations. Because 25% of the population have varicose veins or other chronic venous disease the coincidence of pathological venous findings and ulceration is very frequent even in non-venous ulcerations. Leg ulcers without the symptoms of chronic venous disease should be considered as non-venous. PMID:23482536
[Martorell Hypertensive Ischaemic Leg Ulcer.
Nobbe, S; Hafner, J
Martorell hypertensive ischaemic leg ulcer (HYTILU) represents an important differential diagnosis of painful leg ulcerations. Stenotic subcutaneous arteriolosclerosis in patients with long-standing arterial hypertension finally leads to skin infarction. The typical histological changes are very similar in Martorell HYTILU and calciphylaxis. This raises the hypothesis that the two entities may have a common pathogenesis. Martorell HYTILU presents as an extremely painful ulcer that is regularly located at the laterodorsal lower leg or at the Achilles tendon. Because of its inflammatory and violaceous wound edges and its tendency to progression, clinicians unaware of the diagnosis Martorell HYTILU might misdiagnose pyoderma gangrenosum or necrotising cutaneous vasculitis start an immunosuppressive treatment and avoid surgical diagnostic and therapeutic procedures. Instead, necrosectomy and split skin grafting are the treatment of choice for Martorell HYTILU. PMID:25333521
Topical Haemotherapy for Leg Ulcers
B. Triquet; P. Ruffieux; C. Mainetti; D. Salomon; J.-H. Saurat
Several growth factors, present in the plasma or delivered by blood cells, are involved in wound healing. We have treated 15 chronic atonic leg ulcers by topical application of autologous heparinized blood under a hydrocolloidal dressing. This 'topical haemotherapy' (THT) was applied every other day. After the first THT, 30% of the fibrinonecrotic material had already been removed. After a
Venous Leg Ulcerations: A Treatment Update
Ronda S. Farah; Mark D. P. Davis
Opinion statement Selecting the appropriate treatment for venous leg ulcerations is essential for optimal wound healing and patient quality\\u000a of life. Compression therapy remains the mainstay of treatment for these wounds. Compression methods should be carefully selected\\u000a and tailored for compatibility with patients' daily life. Pain management should not be neglected. When response to compression\\u000a therapy is limited, adjuvant therapy such
[Differential diagnosis and work up of chronic leg ulcers].
Spoljar, Sanja
Many factors contribute to the pathogenesis of leg ulcers. The main causes are chronic venous insufficiency, peripheral arterial occlusive disease (PAOD) and diabetes. Some leg ulcers are caused by combinations of these well-known etiologic factors. The most common cause of PAOD is arteriosclerosis. In diabetic patients, distal symmetric neuropathy and peripheral vascular disease are probably the most important etiologic factors in the development of leg ulcers. Less frequent causes of chronic leg ulcers are hematologic diseases, autoimmune diseases, genetic defects, infections, primary skin disease, cutaneous malignant diseases, use of some medications and therapeutic procedures, and numerous exogenous factors. Diagnosis of leg ulcer is made upon medical history, clinical picture, palpation of arteries, functional testing and serologic testing. Device-based diagnostic testing should be performed for additional clarification. Also, lesion biopsy should be taken for histopathology, direct immunofluorescence, bacteriology and mycology. The knowledge of differential diagnosis is essential for ensuring treatment success in a patient with leg ulcer. PMID:25326987
Treatment of the leg ulcers by skin grafting.
Jank?nas, Vytautas; Rimdeika, Rytis; Pilipaityte, Loreta
The ulcers, located below the knees and remaining for 6 weeks and more, are called trophic leg ulcers. The leg ulcers of different etiology disable 0.8-1% of total Earth population. It was found that blood vessel problems in legs account for more than 80% of ulcers; even 65% from these are caused by venous diseases. In Lithuania about 8000 patients suffer from venous trophic ulcers. Regardless of modern methods the treatment of leg ulcers remains an extremely expensive process. The treatment cost of trophic ulcers is the highest of all surgical wounds and also requires a lot of personal investments. In order to assess the efficiency of autodermoplastics in the treatment of large venous ulcers in legs a prospective study was carried out of 111 patients who were treated in the Department of Plastic Surgery and Burns of Kaunas University of Medicine Hospital from January 2001 to January 2004. The data was analyzed exceptionally of the operated 54 patients with venous origin ulcers open for more 6 months or exceeding 50 cm2. The above-mentioned patients were prepared for surgery by dressing the wounds with hydrocolloid Granuflex bandages and were operated by transplanting a 0.2-0.3 mm thick skin graft. The results were estimated by the surgeon during the dressings after the operation. The graft was taken in 35 (64.81%) cases; in 19 (35.19%) cases the graft was partially not taken and there were no cases when it was not taken at all. We came to the conclusions that skin graft transplantation is efficient in treatment of trophic venous leg ulcers larger than 50 cm2 and cures the trophic leg ulcers of vein origin completely in 2-3 weeks for 64.81% patients. PMID:15170411
Klinefelter's syndrome presenting with leg ulcers.
De Morentin, Helena Martinez; Dodiuk-Gad, Roni P; Brenner, Sarah
A 54-year-old man of Persian origin presented to our department with a 1-year history of ulcers on the right leg that had been unresponsive to numerous topical treatments, accompanied by lymphedema of the right leg. Medical history included hypergonadotropic hypogonadism, which had not been further investigated. He was treated for 20 years with testosterone IM once monthly, which he stopped a year before the current hospitalization for unclear reasons. The patient reported no congenital lymphedema. Physical examination revealed two deep skin ulcers (Figure 1) on the right leg measuring 10 cm in diameter with raised irregular inflammatory borders and a boggy, necrotic base discharging a purulent hemorrhagic exudate. Bilateral leg pitting edema and right lymphangitis with lymphadenitis were noted. He had low head hair implantment, sparse hair on the body and head, hyperpigmentation on both legs, onychodystrophia of the toenails (mainly the large toe and less prominent on the other toes), which was atrophic lichen-planus-like in appearance and needed no trimming (Figure 2), normal hand nails, oral thrush, and angular cheilitis. Other physical findings were gynecomastia, pectus excavatum, small and firm testicles, long extremities, asymmetrical goiter, systolic murmur 2/6 in left sternal border, and slow and inappropriate behavior. The patient's temperature on admission was 39 degrees C. Blood cultures were negative for bacterial growth. Results of laboratory investigations included hemoglobin (11.2 g/dL), hematocrit (26.8%), normal mean corpuscular volume and mean corpuscular hemoglobin volume, and red blood cell distribution width (16%). Blood smear showed spherocytes, slight hypochromia, anisocytosis, macrocytosis, and microcytosis. Blood chemistry values were taken for iron (4 micro g/dL [normal range 40-150 micro g/dL]), transferrin (193 mg/dL [normal range 220-400 mg/dL]), ferritin (1128 ng/mL [normal range 14-160 ng/mL]), transferrin saturation (1.5% [normal range 20%-55%]), serum folate (within normal limits), and vitamin B12 (within normal limits). Direct Coombs' test equaled positive 2 + IgG. All these values indicated anemia of chronic diseases combined with hemolytic anemia. Further blood work-up tested antinuclear antibody (positive <1:80 homogeneous pattern), rheumatoid factors (143 IU/mL [positive >8.5 IU/mL]), C-reactive protein (286 mg/L [normal range 0-5 mg/L]), anticardiolipin IgM antibody (9.0 monophosphoryl lipid U/mL [normal range 0-7.00 MPL U/mL]) and antithrombin III activity (135% [normal range 74%-114%]). Results of other blood tests were within normal limits or negative, including lupus anticoagulant, beta2 glycoprotein, anticardiolipin IgG Ab, anti-ss DNA Ab, C3, C4, anti-RO, anti-LA, anti-SC-70, anti-SM Ab, P-ANCA, C-ANCA, TSH, FT4, anti-T microsomal, antithyroglobulin, protein C activity, protein S free, cryoglobulins, serum immunoelectrophoresis, VDRL, hepatitis C antibodies, hepatitis B antigen, and human immunodeficiency virus. Endocrinological work-up examined luteinizing hormone (22.9 mIU/mL [normal range for adult men 0.8-6 mIU/mL]), follicle stimulating hormone (49.7 mIU/mL [normal range for adult men 1-11 mIU/mL]), testosterone (0.24 ng/mL [normal range for adult men 2.5-8.0 ng/mL]), bioavailable testosterone (0.02 ng/mL [normal range for adult men >0.6 ng/mL]), and percent bioavailable test (8.1% [normal value >20%]). These results indicate hypergonadotropic hypogonadism. Plasminogen activator inhibitor 1 was 6 U (normal value 5-20 U/mL). Karyotyping performed by G-banding technique revealed a 47 XXY karyotype, which is diagnostic of Klinefelter's syndrome. Doppler ultrasound of the leg ulcers disclosed partial thrombus in the distal right femoral vein. X-rays and bone scan displayed osteomyelitis along the right tibia. Histological examination of a 4-mm punch biopsy from the ulcer border revealed hyperkeratosis, acanthosis, hypergranulosis, and mixed inflammatory infiltrate containing eosinophils compatible with chronic ulcer. Multiple vessels were seen, compatible with a h
Ulcer pain in patients with venous leg ulcers related to antibiotic treatment and compression therapy.
Akesson, Nina; Oien, Rut Frank; Forssell, Henrik; Fagerström, Cecilia
The aim of this study was to compare venous leg ulcer patients with and without ulcer pain to see whether ulcer pain affected the use of antibiotic treatment and compression therapy throughout healing. A total of 431 patients with venous leg ulcers were included during the study period. Every patient was registered in a national quality registry for patients with hard-to-heal leg, foot, and pressure ulcers. A high incidence of ulcer pain (57%) was found when the patients entered the study. Patients with ulcer pain had been treated more extensively with antibiotics both before and during the study period. Throughout healing there was a significant reduction of antibiotic use among patients in the 'no pain' group, from 44% to 23% (P=0.008). There was no significant difference between the two groups concerning compression therapy (85% vs. 88%), but 12% of patients in the 'pain' group did not get their prescribed compression compared with 6% of patients in the 'no pain' group. The groups did not differ significantly in terms of ulcer duration, ulcer size or healing time. This study shows a high incidence of ulcer pain, confirming that pain has a great impact on patients with venous leg ulcers. Results further suggest that the presence of ulcer pain increases the prescription of antibiotics but does not affect the use of compression therapy. Several advantages were found from using a national quality registry. The registry is a valuable clinical tool showing the importance of accurate diagnosis and effective treatment. PMID:25191864
Squamous cell carcinoma developed on chronic venous leg ulcer.
Sîrbi, Adelina Gabriela; Florea, Marius; P?tra?cu, Virgil; Rotaru, Maria; Mogo?, Dan Gabriel; Georgescu, Claudia Valentina; M?rg?ritescu, Nicolae Drago?
Chronic venous leg ulcers (VLU), especially long-lasting non-healing ulcers, are among the risk factors for squamous cell carcinoma (SCC). Malignant transformation of a VLU is a rare finding and the relative risk of carcinomatous transformation is quite low (about 5.8). SCC arising in the context of a VLU has a particularly aggressive behavior. A 76-year-old male patient with no relevant medical familial history, with chronic venous insufficiency CEAP C6 for 10 years [recurrent leg ulcers with favorable outcome (healing) after specific local and systemic treatment], showing for about three years one ulcerated lesion located on the anterior upper third of the right calf non-responsive to specific treatment, which subsequently increased their size and merged. Biopsy sample was taken. Histopathology showed epidermal acanthosis, papillomatosis, intense parakeratosis, pseudoepitheliomatous hyperplasia, dysplasia and moderately differentiated squamous cell carcinoma with areas of acantholysis. Immunohistochemistry (Ki67, EMA, cytokeratin 34?E12 and p63) was performed and all types of immunostaining were moderately to intense positive. Above-knee leg amputation and specific oncologic treatment were proposed as possible curative solutions but the patient refused. Ten months after diagnosis and discharge form the Department of Dermatology, the patient died. Patients with chronic venous leg ulcers and clinically suspicious lesions should be evaluated for malignant transformation of the venous lesion. When diagnosed, malignancy complicating a chronic venous leg ulcer requires a resolute treatment as it may be fatal. PMID:25826522
Venous leg ulcer management: single use negative pressure wound therapy.
Dowsett, Caroline; Grothier, Lorraine; Henderson, Valerie; Leak, Kathy; Milne, Jeanette; Davis, Lynn; Bielby, Alistair; Timmons, John
A number of leg ulcer specialist/tissue viability specialists from across the UK were invited to evaluate PICO (Smith and Nephew, Hull) as a treatment for venous leg ulcers also in conjunction with a variety of compression bandages and garments. Patients across 5 sites had PICO applied in conjunction with compression therapy. This group of treating clinicians were then asked to give feedback on the outcome of the patients on whom they had used the new device. All feedback was recorded at a meeting and this was used to create a guideline for use. PMID:24156166
Compression and venous surgery for venous leg ulcers.
Mosti, Giovanni
This article reviews published data on the effects of surgery and compression in the treatment of venous ulcers and the best options for compression therapy. Randomized controlled studies reveal that surgery and compression have similar effectiveness in healing ulcers but surgery is more effective in preventing recurrence. Most leg ulcers have a venous pathophysiology and occur because of venous ambulatory hypertension caused by venous reflux and impairment of the venous pumping function. Proposed surgical interventions range from crossectomy and stripping to perforator vein interruption and endovascular procedures (laser, radiofrequency). More conservative procedures (foam sclerotherapy, conservative hemodynamic treatment) have also been proposed. PMID:22732375
Percutaneous foam sclerotherapy for venous leg ulcers.
Bush, R; Bush, P
The technique of foam sclerotherapy directed at the distal most vessels, draining the ulcer bed was first described in 2010, with excellent penetration into the underlying venous network possible with this technique. Thirty-five patients have now been treated with this technique as the initial treatment at Midwest Vein Laser, USA. There have been no complications with this technique and rapid healing occurred within 4-8 weeks after the initial treatment in 90% of the patients, and all ulcers were healed at 4 months. Here we present the representative case of a 67-year-old man treated with a modified technique that used a percutaneous approach via reticular or spider veins at the margin of the ulcer bed. PMID:24142137
Insufficient Tetanus Vaccination Status in Patients with Chronic Leg Ulcers
A. Körber; N. Graue; J. Rietkötter; E. Kreuzfelder; S. Grabbe; J. Dissemond
Background: Tetanus disease is caused by Clostridium tetani and is one of the most common infectious diseases worldwide. Despite international recommendations for patients with a chronic leg ulcer, there has been a distinctive lack of protection provided by vaccination for these patients in the past decades. Methods: Within the context of our prospective clinical investigation we consecutively determined the concentrations
Wound Teleconsultation in Patients with Chronic Leg Ulcers
Wolfgang Salmhofer; Rainer Hofmann-Wellenhof; Gerald Gabler; Karin Rieger-Engelbogen; Dieter Gunegger; Barbara Binder; Thomas Kern; Helmut Kerl; H. Peter Soyer
Background: The treatment of chronic leg ulcers requires frequent assessments of local wound status and adjustment of therapy. The availability of reasonably priced photographic equipment and quick electronic transfer of high-quality digital images should make it possible that the assessment of wound status can be made by remote experts. Objective: This study examines the feasibility of using teledermatology for wound
Onychomycosis in patients with chronic leg ulcer and toenail abnormalities*
Cabete, Joana; Galhardas, Célia; Apetato, Margarida; Lestre, Sara
Nails have a limited number of reactive patterns to disease. Accordingly, toenail changes of different etiologies may mimic onychomycosis. OBJECTIVE To determine the prevalence of toenail onychomycosis among patients with leg ulcer and toenail abnormalities attending a dermatology clinic. METHODS A cross-sectional study was conducted through the analysis of clinical records and results of mycological examination. RESULTS A total of 81 patients were included, with a median age of 76.0 years. Most ulcers were of venous etiology, followed by those of mixed and arterial pathogenesis. The mycological evaluation confirmed the diagnosis of onychomycosis in 27.2% of the patients. The etiologic agent was a dermatophyte in 59.1% of isolates in nail samples, while Trichophyton interdigitale was the most frequent fungal species (40.9%). CONCLUSIONS Most toenail abnormalities in patients with chronic leg ulcer were not onychomycosis. This study highlights the importance of systematic mycological examination in these patients, in order to avoid overtreatment with systemic antifungals, unnecessary costs and side effects. PMID:25672317
Onychomycosis in patients with chronic leg ulcer and toenail abnormalities.
Cabete, Joana; Galhardas, Célia; Apetato, Margarida; Lestre, Sara
Nails have a limited number of reactive patterns to disease. Accordingly, toenail changes of different etiologies may mimic onychomycosis. OBJECTIVE To determine the prevalence of toenail onychomycosis among patients with leg ulcer and toenail abnormalities attending a dermatology clinic. METHODS A cross-sectional study was conducted through the analysis of clinical records and results of mycological examination. RESULTS A total of 81 patients were included, with a median age of 76.0 years. Most ulcers were of venous etiology, followed by those of mixed and arterial pathogenesis. The mycological evaluation confirmed the diagnosis of onychomycosis in 27.2% of the patients. The etiologic agent was a dermatophyte in 59.1% of isolates in nail samples, while Trichophyton interdigitale was the most frequent fungal species (40.9%). CONCLUSIONS Most toenail abnormalities in patients with chronic leg ulcer were not onychomycosis. This study highlights the importance of systematic mycological examination in these patients, in order to avoid overtreatment with systemic antifungals, unnecessary costs and side effects. PMID:25672317
Venous leg ulcers: Impact and dysfunction of the venous system.
Gordon, Phyllis; Widener, Jeanne M; Heffline, Melody
Management of chronic venous leg ulcers (VLU) can be frustrating for both patient and practitioner. It is a significant source of disability and cost of care. Before the practitioner enters the management phase of VLU care, it is helpful to understand the impact of VLUs. Additionally, it is essential to understand the structure and function of the venous system and manifestations indicative of a dysfunction of the system. This article focuses on the epidemiology, structure, and function of the venous system as well as clinical manifestations and prevention. PMID:26025148
[Efficacy of dermoplasty and the dermal equivalent in treatment of vast leg ulcers of mixed genesis].
Andreev, D Iu; Abramova, N V; Blinova, M I; Pinaev, G P
The most frequent causes of leg ulcers (90-95%) are chronic venous insufficiency (45-60%), obliterating atherosclerosis of the lower extremity arteries (10-20%), diabetes mellitus (15-25%) and their combinations (10-15%). The leg ulcers, specified as pyoderma gangrenosum, are the rare and severe pathology, which is very often misdiagnosed. The case history of a 58-year old female patient with vast leg ulcers of the both shanks is analyzed. The leg ulcers were caused by pyoderma gangrenosum and chronic venous insufficiency due to the varicose disease. Complete epithelization of both ulcers was achieved by means of dermoplasty combined using the dermal equivalent against the background of system immunosuppressive therapy. PMID:23808240
Which dressings reduce inflammation and improve venous leg ulcer healing.
Raffetto, Joseph D
Chronic venous leg ulcers (VLU) affect around 1% of the adult population in the Western world. The impact of VLU is both social and economic, with significant expenditures on active venous ulcers to provide medical treatment and eventual healing. At the core of VLU is venous hypertension which affects the venous macrocirculation. The changes incurred in venous hemodynamics leads to microcirculatory changes affecting the postcapillary venule and surrounding tissues. Inflammation by leukocytes affecting the venous endothelium, promotes a complex cascade and activation of adhesion molecules expression, chemokines and cytokines released, altered growth factor responses, and activation of protease (e.g. tPA) and proteinase (e.g. MMPs) activity that causes dysregulation and compromise of tissue integrity with eventual dermal damage and ulcer development. A critical component to treating VLU is correcting the abnormal venous hemodynamics and compression therapy. Unfortunately, VLU recurrence ranges between 30-70%, and other modalities in therapy along with compression are required. The goal for adjuvant products is to restore the balance from an inflammatory chronic wound to that of a reparative wound that will promote provisional matrix and epithelialization. There are many products on the market that can be used as adjuvant to compression therapy, but it must be recognized that there is a paucity of clinical trials that have evaluated the clinical effectiveness of specific products with clearly defined end points, and most importantly a healed VLU with a low recurrence rate. This review will discuss the fundamentals of VLU inflammation, and evaluate the available literature that may have benefit in reducing inflammation and lead to effective VLU healing. PMID:24843103
The analgesic effect of electrostimulation (WoundEL(®) ) in the treatment of leg ulcers.
Leloup, Pauline; Toussaint, Pascal; Lembelembe, Jean-Paul; Célérier, Philippe; Maillard, Hervé
This study aims to demonstrate the analgesic efficacy of electrostimulation (ES), a recognised treatment for leg ulcers. Patients treated by ES for leg ulcers between 2011 and 2013 were included in the study. The pain score obtained with the numerical rating scale (NRS) was reported before the start of the ES (D0), after 3?days (D3) and 1?week following treatment initialisation. The analgesic treatments (AT) were reported at each assessment. Seventy-three patients were included (mean age 75·19?years): 31 venous leg ulcers, 21 mixed venous leg ulcers, 2 arterial ulcers, 17 hypertensive ischaemic ulcers, 1 Hydrea®-induced ulcer and an amputation stump ulcer. The NRS at D0 was on average 5·3 (median?=?6) while it was 2·2 at D7 (median?=?2), that is P?0·001. The results were also significant between D0 and D3 (P?0·001). A decrease in the number of AT used was observed between D0 (2·0 AT per patient on average) and D7 (1·7 AT on average) (P?0·001). We also observed a decrease in the consumption of grade 3 analgesics on D0 and D7 (P?=?0·03). This study demonstrates the rapid analgesic efficacy of ES in leg ulcers, with a clear impact on the NRS score and especially on the decrease in analgesic consumption. PMID:24618089
Ehlers-Danlos Syndrome Type VIII: A Rare Cause of Leg Ulcers in Young Patients
Lucas, Antoine; Piérard, Gérald E.; Hermanns-Lę, Trinh; De Paepe, Anne; Dupuy, Alain
Ehlers-Danlos syndrome type VIII (EDS-VIII) is a very rare autosomal dominant disease characterized by early-onset periodontitis associated with features of Ehlers-Danlos syndrome. We report a 32-year-old man whose chronic leg ulcer led to the diagnosis of EDS-VIII. He had severe periodontitis with complete loss of permanent teeth and skin fragility with thin skin, atrophic scars, and brownish atrophic pretibial plaques. Leg ulcer is not a prominent feature of EDS-VIII. We suggest adding EDS-VIII to the list of rare diseases accounting for chronic leg ulcers, if this case report prompts others to report leg ulcers associated with EDS-VIII. PMID:24198978
Novel Wound Healing Powder Formulation for the Treatment of Venous Leg Ulcers
Ghatnekar, Angela V.; Elstrom, Tuan; Ghatnekar, Gautam S.; Kelechi, Teresa
Chronic venous disorders are common in the Western world. The current treatment of venous leg ulcers is unsatisfactory despite the availability of well-documented standards of care. Patients today are interested in alternative approaches to modern medicine. We have developed a wound-healing powder containing natural ingredients with absorptive, aromatic, antiseptic, and anti-inflammatory synergistic properties. This report describes 3 cases that were successfully treated with the powder, demonstrating the potential of herbal remedies in the clinical treatment of venous leg ulcers. PMID:24527167
Vasculopathy, inflammation, and blood flow in leg ulcers of patients with sickle cell anemia
Minniti, Caterina P.; Delaney, Kara-Marie H.; Gorbach, Alexander M.; Xu, Dihua; Lee, Chyi-Chia Richard; Malik, Nitin; Koroulakis, Antony; Antalek, Matthew; Maivelett, Jordan; Peters-Lawrence, Marlene; Novelli, Enrico M.; Lanzkron, Sophie M.; Axelrod, Karen C.; Kato, Gregory J.
Chronic leg ulcers are frequent and debilitating complications of sickle cell anemia. Inadequate blood supply has been postulated to be an important factor in their occurrence and delayed healing. Little is known about their microcirculatory and histopathological changes. We evaluated the microcirculation of lower extremity ulcers with laser speckle contrast imaging and infrared thermography and obtained clinical and laboratory characteristics in 18 adults with sickle cell anemia and chronic leg ulcers. Skin biopsies were obtained in four subjects. Subjects had markers of severe disease, anemia, high degree of hemolysis, inflammation, and thrombophilia. The highest blood flow was present in the ulcer bed, progressively less in the immediate periwound area, and an unaffected control skin area in the same extremity. Microscopic examination showed evidence of venostasis, inflammation, and vasculopathy. Blood vessels were increased in number, had activated endothelium and evidence of thrombosis/recanalization. High blood flow may be due to chronic inflammation, cutaneous vasodilatation, venostasis, and in situ thrombosis. These changes in skin microcirculation are similar to chronic venous ulcers in the non-sickle cell disease (SCD) population, thus suggesting that leg ulcers may be another end-organ complication with endothelial dysfunction that appears in patients with SCD at a younger age and with higher frequency than in the general population. PMID:23963836
Randomized clinical trial of three-layer tubular bandaging system for venous leg ulcers.
Weller, Carolina D; Evans, Sue M; Staples, Margaret P; Aldons, Pat; McNeil, John J
The safety and efficacy of three-layer (3L) tubular bandaging as a treatment for venous ulcer healing has not been evaluated despite its use in many clinical settings to treat people with venous leg ulcers. We evaluated the safety and efficacy of 3L tubular bandage compared with short-stretch compression bandage to heal venous ulcers in a multicenter, open-label, parallel-group, randomized controlled trial. We randomized 45 patients with venous leg ulcers of up to 20?cm(2) area and an ankle brachial pressure index of >0.8 from hospital outpatient wound clinics in Victoria and Queensland, Australia. We measured time to healing and percentage reduction of wound size from baseline to week 12. Secondary outcomes were proportion of ulcers healed, self-reported compliance of compression bandage, and health-related quality of life, costs, recurrence rates, and adverse events. A total of 27 ulcers healed, the proportion of healed ulcers was higher for the 3L group (17/23 [74%] vs. 10/22 [46%]) (p?=?0.05). Reported bandage tolerance at all treatment visits was 21 (91%) in 3L group vs. 17 (73%) (p?=?0.10). There was no difference between the groups in adverse events. Costs were substantially less in 3L group. PMID:23061541
An overview of technologies related to care for venous leg ulcers
Meghan Sarah Hegarty; Edward Grant; Lawrence Reid Jr.
Venous leg ulcers remain a major problem in the United States, with spending reaching more than $1 billion annually. Current treatment options for this condition center around the use of compression therapy delivered by bandages, medical-grade stockings, or pneumatic compression devices. While these forms of therapy can produce dramatic improvements, cost and patient compliance remain an issue. In parallel with
Mycobacterium Chelonae: Nonhealing Leg Ulcers Treated Successfully With an Oral Antibiotic
Shawn Terry; Nigel H. Timothy; John J. Zurlo; Ernest K. Manders
Leg ulcers plague mankind with prolonged suffer- ing and disability. The differential diagnosis is broad, and major causes include circulatory disor- ders, neuropathies, and infectious diseases. In the absence of a circulatory disturbance or neuropathy, and when conventional aerobic and anaerobic cul- tures are negative, the diagnosis of a mycobacterial infection should be considered. We report on an uncommon but
Hard-to-heal venous-lymphatic leg ulcers: a special case.
Silva, José António; Filipe, Rosário; Esteves Cardoso, Manuel; Andriessen, Anneke
In the treatment of this 56-year-old male, the aim was to attend to his multiple pathologies, reducing his venous-lymphatic oedema on both legs, closing the extended ulcers and improving his quality of life. The patient received treatment in a community-based wound healing clinic. After various local therapies were not successful, the wounds were cleansed with saline and covered with a biocellulose dressing (BWD) and polyhexanide (PHMB), after which a short-stretch bandage system was applied. Compression was then switched to a tubular compression system. At day 0, both lower legs had significant oedema and circumferential venous-lymphatic ulcers, and the left leg showed signs of inflammation. However, at day 8, inflammation, oedema and ulcer area had reduced. After 2 months, the ulcers were almost closed and the oedema had reduced to a level where the tubular compression system could be applied. Treatment using BWD and compression and good adherence to this regimen led to ulcer closure. This improved the patients' quality of life significantly. PMID:22874827
Venous leg ulcers: Summary of new clinical practice guidelines published August 2014 in the Journal of Vascular Surgery.
Widener, Jeanne M
The Society for Vascular Surgery(®) (SVS) and the American Venous Forum (AVF) published guidelines for the management of venous leg ulcers in August 2014. The goal of this article (Part 2) is to summarize the guidelines that address diagnosis and treatment recommendations published jointly by the SVS and AVF that may affect the nursing practice of vascular nurses. Specific sections include wound evaluation, therapies used on the wound bed itself, compression, and operative or endovascular management. Part 1, published elsewhere in this issue, addressed the epidemiology and financial impact of ulcers, venous anatomy, pathophysiology of venous leg ulcer development, clinical manifestations, and prevention of venous leg ulcers. These 2 parts together provide a comprehensive summary of the joint SVS and AVF guidelines for care of venous leg ulcers. PMID:26025149
Prevalence of skin problems and leg ulceration in a sample of young injecting drug users
Background Drug users suffer harm from the injecting process, and clinical services are reporting increasing numbers presenting with skin-related problems such as abscesses and leg ulcers. Skin breakdown can lead to long-term health problems and increased service costs and is often the first indication of serious systemic ill health. The extent of skin problems in injecting drug users has not previously been quantified empirically, and there is a dearth of robust topical literature. Where skin problems have been reported, this is often without clear definition and generic terms such as 'soft tissue infection' are used which lack specificity. The aim of this study was to identify the range and extent of skin problems including leg ulceration in a sample of injecting drug users. Definitions of skin problems were developed and applied to descriptions from drug users to improve rigour. Methods Data were collected in needle exchanges and methadone clinics across Glasgow, Scotland, from both current and former drug injectors using face-to-face interviews. Results Two hundred participants were recruited, of which 74% (n?=?148) were males and 26% (n?=?52) were females. The age range was 21–44 years (mean 35 years). Just under two thirds (64%, n?=?127) were currently injecting or had injected within the last 6 months, and 36% (n?=?73) had previously injected and had not injected for more than 6 months. Sixty per cent (n?=?120) of the sample had experienced a skin problem, and the majority reported more than one problem. Most common were abscesses, lumps, track marks and leg ulcers. Fifteen per cent (n?=?30) of all participants reported having had a leg ulcer. Conclusions This is an original empirical study which demonstrated unique findings of a high prevalence of skin disease (60%) and surprisingly high rates of leg ulceration (15%). Skin disease in injecting drug users is clearly widespread. Leg ulceration in particular is a chronic recurring condition that is costly to treat and has long-term implications for drug users and services caring for current or former injectors long after illicit drug use has ceased. PMID:25119472
A Repeat Validated Population Questionnaire of a Defined Swedish Population Verifies Reduction in Leg Ulcer Prevalence Over Time.
Forssgren, Alexandra; Nelzén, Olle
This study was performed to measure if the introduced interventions in leg ulcer care in a selected Swedish county yield a detectable reduction in leg ulcer prevalence in the population. A validated postal questionnaire sent to 10,000 (9,868) randomly selected 30-89 year olds in the Skaraborg county (255,042 inhabitants). All positive responders were telephone interviewed and verified ulcer patients were clinically examined including assessment of arterial/venous circulation with hand-held Doppler and, where indicated, duplex ultrasound scanning. All results were compared with numbers from 1990 (initial study). The response rate was 82% (8,070/9,868), 200 active ulcers and 290 previous ulcers. The calculated prevalence was 0.75% for 30-89 years and 1.05% for 50-89 years (2.1% in 1990). The leg ulcer prevalence was reduced by 32% (0.52% compared to 0.77% in 1990), and the relative risk was reduced by 50% (95%, CI 0.36-0.69). The study shows a true reduction in leg ulcer prevalence detectable in the population supporting a successful care of leg ulcer patients. PMID:25655638
Overview of guidelines for the prevention and treatment of venous leg ulcers: a US perspective
White-Chu, E Foy; Conner-Kerr, Teresa A
Comprehensive care of chronic venous insufficiency and associated ulcers requires a multipronged and interprofessional approach to care. A comprehensive treatment approach includes exercise, nutritional assessment, compression therapy, vascular reconstruction, and advanced treatment modalities. National guidelines, meta-analyses, and original research studies provide evidence for the inclusion of these approaches in the patient plan of care. The purpose of this paper is to review present guidelines for prevention and treatment of venous leg ulcers as followed in the US. The paper further explores evidence-based yet pragmatic tools for the interprofessional team to use in the management of this complex disorder. PMID:24596466
The Use of Biatain Ag in Hard-to-Heal Venous Leg Ulcers: Meta-Analysis of Randomised Controlled Trials
Leaper, David; Münter, Christian; Meaume, Sylvie; Scalise, Alessandro; Mompó, Nacho Blanes; Jakobsen, Birte Petersen; Gottrup, Finn
Background Venous leg ulcers are common, troublesome, and their failure to heal is often related to a heavy bio-burden. Ionized silver has both anti-inflammatory and antimicrobial properties. The ulcer healing properties of the silver releasing foam dressing Biatain Ag has been examined in 4 randomized controlled trials (RCTs). Aim To evaluate ulcer healing through a meta-analytic approach after treatment with either Biatain Ag or a non-active dressing. Patients and Methods 685 subjects with pure or mixed hard-to-heal venous leg ulcers were included in the meta-analysis. Results Biatain Ag showed a significant treatment effect (p<0.0001), responder rate (p<0.001), and healing rate (p?=?0.002). Conclusion The meta-analysis of the 4 RCTs provided statistical significant evidence to support the use of Biatain Ag dressing in treatment of hard-to-heal venous leg ulcers. PMID:23843984
Elevated Levels of Coagulation Factor VIII in Patients With Venous Leg Ulcers.
Criado, Paulo Ricardo; Alavi, Afsaneh; Kirsner, Robert S
Chronic venous disease affects millions of people around the world. Venous valvular incompetencies and venous reflux, often a result of outflow obstruction are important contributors to venous disease. The prevalence of thrombophilia is increased in patients with chronic venous insufficiency (CVI). The recognition of underlying thrombophilia particularly in young patients opens new avenues in the management and prevention plan. We emphasize on the consideration of workup for coagulopathy, especially factor VIII deficiency in young patients with venous disease. We report 3 patients with chronic leg ulcers and high levels of FVIII:C activity in plasma and other associated thrombophilic factors. We highlight the need to get a workup done for thrombophilia in young patients with recurrent and chronic leg ulcers related to venous insufficiency or livedoid vasculopathy. Further studies with larger sample sizes are required to define the definite indications for the thrombophilia workups. PMID:24861090
New single-layer compression bandage system for chronic venous leg ulcers.
Lee, Gillian; Rajendran, Subbiyan; Anand, Subhash
A new single-layer bandage system for the treatment of venous leg ulcers has been designed and developed at the University of Bolton. This three-dimensional (3D) knitted spacer fabric structure has been designed by making use of mathematical modelling and Laplace's law. The sustained graduated compression of the developed 3D knitted spacer bandages were tested and characterized, and compared with that of commercially available compression bandages. It was observed that the developed 3D single-layer bandage meets the ideal criteria stipulated for compression therapy. The laboratory results were verified by carrying out a pilot user study incorporating volunteers from different age groups. This article examines the insight into the design and development of the new 3D knitted spacer bandage, along with briefly discussing the issues of compression therapy systems intended for the treatment of venous leg ulcers. PMID:19718001
Recruitment rates and reasons for community physicians' non-participation in an interdisciplinary intervention study on leg ulceration
Oliver R Herber; Wilfried Schnepp; Monika A Rieger
BACKGROUND: This article describes the challenges a research team experienced recruiting physicians within a randomised controlled trial about leg ulcer 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 leg ulcer patients' self-care agency. The aim of this article is to
Novel Wound Healing Powder Formulation for the Treatment of Venous Leg Ulcers
Angela V. Ghatnekar; Tuan Elstrom; Gautam S. Ghatnekar; Teresa Kelechi
Chronic venous disorders are common in the Western world. The current treatment of venous leg ulcers is unsatisfactory despite the availability of well-documented standards of care. Patients today are interested in alternative approaches to modern medicine. We have developed a wound-healing powder containing natural ingredients with absorptive, aromatic, antiseptic, and anti-inflammatory synergistic properties. This report describes 3 cases that were
Effectiveness of an acellular synthetic matrix in the treatment of hard-to-heal leg ulcers.
Harding, Keith; Aldons, Pat; Edwards, Helen; Stacey, Michael; Finlayson, Kathleen; Gibb, Michelle; Jenkins, Liz; Shooter, Gary; Lonkhuyzen, Derek Van; Lynam, Emily; Heinrichs, Eva-Lisa; Upton, Zee
Hard-to-heal leg ulcers are a major cause of morbidity in the elderly population. Despite improvements in wound care, some wounds will not heal and they present a significant challenge for patients and health care providers. A multi-centre cohort study was conducted to evaluate the effectiveness and safety of a synthetic, extracellular matrix protein as an adjunct to standard care in the treatment of hard-to-heal venous or mixed leg ulcers. Primary effectiveness criteria were (i) reduction in wound size evaluated by percentage change in wound area and (ii) healing assessed by number of patients healed by end of the 12?week study. Pain reduction was assessed as a secondary effectiveness criteria using VAS. A total of 45 patients completed the study and no difference was observed between cohorts for treatment frequency. Healing was achieved in 35·6% and wound size decreased in 93·3% of patients. Median wound area percentage reduction was 70·8%. Over 50% of patients reported pain on first visit and 87·0% of these reported no pain at the end of the study. Median time to first reporting of no pain was 14?days after treatment initiation. The authors consider the extracellular synthetic matrix protein an effective and safe adjunct to standard care in the treatment of hard-to-heal leg ulcers. PMID:23834253
The views of district nurses on their level of knowledge about the treatment of leg and foot ulcers
Ruth Haram; Elisabeth Ribu; Tone Rustřen
Objective: The aim was to survey the views of a sample of district nurses on their own level of knowledge about the treatment of leg and foot ulcers and what they considered to be the most important issues in wound treatment. Design: A descriptive design was used. Setting and subjects: The subjects were all the nurses who treated leg and
Leg ulcer nursing care in the community: a prospective cohort study of the symptom of pain
Background Chronic wounds are managed almost entirely by community nurses. Almost all individuals with leg ulcers report acute pain usually related to dressing change. Little is known about pain after healing. The purpose of this study was to explore the course of pain from baseline to time of healing of leg ulcers (venous or mixed etiology). In order to understand this phenomenon and develop implications for nursing practice, objectives included: 1) Measure incidence and prevalence of pain at baseline and healing; 2) Describe characteristics associated with leg ulcer pain at baseline; 3) Identify predictors of leg ulcer pain at healing. Methods Data were from one randomized controlled trial (2004-2008) of 424 individuals with leg ulcers in the community receiving evidence-informed nursing management. The primary outcome was pain at the time of healing. Predictive factors included demographic, circumstance of living, clinical and ulcer characteristics. Multivariable logistic regression identified the subset of predictors of pain at healing. Odds ratios (OR) and 95% confidence intervals (CI) are reported. Results Eighty-two percent of participants reported pain at baseline and 32% at healing. Five percent with no pain at baseline reported pain at healing. Thirty-seven percent reported moderate to severe pain at baseline and 11% at healing. Twenty percent of all those who healed reported pain interfered with work moderately to extremely at time of healing. Being female (OR=1.64, 95% CI 1.00, 2.68, p=0.05), use of short-stretch vs. four-layer bandages (OR=1.73, 95% CI 1.06, 2.82, p=0.03), lower SF-12 PCS (OR=0.97, 95% CI 0.94, 0.99, p=0.02) and MCS (OR=0.98, 95% CI 0.95-1.00, p=0.04) scores, use of non-steroidal anti-inflammatory drugs (OR=2.28, 95% CI 1.06, 4.88, p=0.03), and tender pain (OR=2.17, 95% CI 1.29, 3.66, p=<0.01) were associated with pain at time of healing. Conclusions Pain is an issue on admission for chronic wounds and at healing, yet 58% with moderate to severe pain on admission were not taking pain medication(s). Future studies should examine the role of pain at healing and at subsequent ulcer recurrence. Mobility and other factors that may contribute to pain at time of healing should also be assessed. Community nurses are encouraged to consider pain when planning care on admission and also after wound healing, when most patients are discharged from care. Trial registration ClinicalTrials.gov, NCT00202267 PMID:23388350
Chronic venous disease and venous leg ulcers: An evidence-based update.
Kelechi, Teresa J; Johnson, Jan J; Yates, Stephanie
Chronic venous disease (CVD) is a complex chronic vascular condition with multifaceted primary and secondary etiologies leading to structural and functional changes in veins and valves and blood flow of the lower legs. As a consequence, a spectrum of clinical manifestations arise, ranging from symptoms of mild leg heaviness and achiness to debilitating pain, and signs of skin changes, such as eczema and hemosiderosis, to nonhealing, heavily draining venous leg ulcers (VLUs). Triggers such as trauma to the skin are responsible for a large majority of VLU recurrences. Diagnostic testing for venous reflux includes ultrasound imaging; unfortunately, there are no diagnostic tests to predict VLUs. The hallmark of treatment of both CVD and VLUs is compression. Leg elevation, exercise, and wound management with dressings and advanced healing technologies that provide an environment conducive to healing should focus on reducing pain, necrotic debris, drainage, and odor, as well as preventing infection. VLUs that become chronic without evidence of healing over a 4-week period respond best to multidisciplinary wound experts within a framework of patient-centered care. Nurses are in key positions to provide early recognition of the signs and symptoms as well as initiate prompt diagnostic and promote early treatment to offset the progression of the disease and improve quality of life. PMID:26025146
EMLA and Lidocaine Spray: A Comparison for Surgical Debridement in Venous Leg Ulcers
Cuomo, Roberto; D'Aniello, Carlo; Grimaldi, Luca; Nisi, Giuseppe; Botteri, Gaia; Zerini, Irene; Brandi, Cesare
Objective: In this study the author proposes to compare eutectic mixture of local anesthetics (EMLA) and an odontoiatric spray solution of 10% Lidocaine (Ecocain) for surgical debridement in venous leg ulcers. Approach: Fifty patients were recruited and randomly assigned into two groups (A, B). All of them have venous leg ulcer in the medial and/or lateral malleolar region. Group A: topical anesthetic EMLA with film occlusion. Group B: topical anesthesia with Ecocain. The author proceeded to surgical debridement after local anesthesia. A questionnaire and a visual analog scale (VAS) were administered to assess the amount of pain felt during the debridement and during the following 6?h. Results: The analysis of the VAS revealed no major significant differences statistically. The analysis of the questionnaires showed patients treated with Ecocain took more analgesic drugs. Analysis of the timing and quality of procedure showed that Ecocain reduced the timing of debridement and dressing change, improving the outpatient management and patient compliance. Innovations: For rapid debridement, the most appropriate is to use Ecocain. Conclusion: Methods of local anesthesia are multiple and must be identified according to the needs of the patient and the surgeon trying to get the best anesthesia with minimal use of time and resources. PMID:26029486
[Take of mesh grafts in chronic leg ulcer patients improves by vacuum-assisted closure device].
Dissemond, J; Körber, A; Grabbe, S
Vacuum-assisted closure (V.A.C.) is an established therapeutic option in the management of acute and chronic granulating wounds. In recent years, little data has been published concerning skin graft transplantation and postoperative V.A.C. therapy. We report a consecutive case series of 54 patients with chronic leg ulcer who received a total of 74 mesh grafts. A postoperative V.A.C. therapy was performed in 28 mesh grafts, and 46 mesh grafts were treated with standard gauze therapy. In the V.A.C. group, 92.9 % grafts showed complete healing. In the treatment group without postoperative V.A.C. therapy, 67.4 % of the mesh grafts had taken. Differential analysis revealed a correlation in patients over 70 years of age or in patients suffering from diabetes mellitus or dermato-lipo-sclerosis. Particularly patients with diabetes mellitus and of greater age exhibited improved take rates in the V.A.C. group. The results of our study demonstrate for the first time the significant benefit of V.A.C. therapy after mesh-graft-transplantation in chronic leg ulcer patients as evaluated in a clinical trial with a control group. PMID:16575672
[Clinical trial of Pulvo 47 Neomycin in the treatment of leg ulcer (author's transl)].
Privat, Y
Pulva 47 Neomycine was tested in 30 patients suffering from a leg ulcer, 11 of those were surinfected. Half the ulcers dated back over 6 months. The would preparation included a careful cleaning with a permanganate or dakin's solution. In most of the cases, the product was applied on a once a day basis during an average period of 30 days. In 12 patients, the severity of the infection needed an additional antibiotherapy administered orally. The results were expressed in relation to the activity on the infection and wound healing. In 28 patients, the signs of infection disappeared completely. The wound healing effect was very satisfying in 22 patients (19 of them had varicose or post-phlebitis ulcers). The value of the results is independent on the date of onset and on the area of the lesions. The tolerance was good; only 4 patients suffered from itching after the application of the compound. It is mainly through his wound healing effect that Pulvo 47 Neomycine represents a progress compared to other similar specialties. PMID:224488
Therapeutic effectiveness of a Mimosa tenuiflora cortex extract in venous leg ulceration treatment.
Rivera-Arce, Erika; Chávez-Soto, Marco Antonio; Herrera-Arellano, Armando; Arzate, Silvia; Agüero, Juan; Feria-Romero, Iris Angélica; Cruz-Guzmán, Angélica; Lozoya, Xavier
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 leg ulceration disease was explored. A randomized, double-blind, placebo-controlled clinical trial was conducted with ambulatory patients distributed into two groups, one receiving a hydrogel containing 5% of a crude extract standardized in its tannin concentration (1.8%), while the control group, was administered the same hydrogel but without addition of the extract. In both aseptic washings were performed initially followed by topical application of the corresponding hydrogel and dressing. Follow-up lasted 13 weeks and ulcer healing was determined through measurement of the lesion area by digital-photographic parameters. Therapeutic effectiveness occurred in all patients of the extract group; after the 8th treatment week, ulcer size was reduced by 92% as mean value in this group, whereas therapeutic effectiveness was observed only in one patient of the control group (chi(2), p=0.0001). No side effects were observed in any patient in either group. PMID:17088036
Influence of psychosocial factors on coping and living with a venous leg ulcer.
Peart, Joanna
This clinical focus and literature review describe the effect of psychosocial factors on coping and living with a venous leg ulcer (VLU). The associated stressors of living with a VLU include: pain, loss of self-esteem, and social isolation, with subsequent negative emotions that could potentially lead to anxiety and depression. The ability to cope with a VLU depends upon the individual, with some patients employing negative coping strategies such as denial, depending on the stage of the illness and level of acceptance reached ( Husband, 2001 ; Brown, 2014 ). Psychosocial interventions by health professionals have been shown to reduce the stress of living with a VLU, to improve a patient's coping ability, and subsequently enhance wound healing. This article highlights the importance of holistic assessment and joint treatment planning, to incorporate patients' psychosocial needs and individual coping methods in order to reduce the associated stress of living with a VLU. PMID:26052991
Expression of elastase and fibrin in venous leg ulcer biopsies: a pilot study of pentoxifylline versus placebo.
Mirshahi, S; Soria, J; Mirshahi, M; Soria, C; Lenoble, M; Vasmant, D; Cambazard, F; Claudy, A
The pathogenesis of venous leg ulcers is based on the leakage of fibrinogen leading to a pericapillary fibrin cuff and plugging of capillaries by white blood cells. On the basis of a previous work, we had assumed that the key event in the pathogenesis of venous leg ulcers is related to inflammation generated by activated white blood cells that accumulate under unrelieved blood pressure, because in ulcer biopsies we had detected the presence of tumor necrosis factor-alpha (TNF-alpha) in intracapillary monocytes, elastase in the polymorphonuclear leukocytes near the vessels, and a pericapillary undegraded fibrin cuff causing a diffusion barrier to oxygen. This concept was developed because TNF-alpha synthesized by activated monocytes is responsible for many deleterious effects. It has a potent mitogenic effect on fibroblasts, leading to new collagen deposition and angiogenesis, it induces an increase in collagenase production, it acts through upregulation of an intracellular adhesion molecule (ICAM-1), leading to leukocyte sequestration and consequently a release of toxic metabolites by the polymorphonuclear cells, an early step in chronic inflammation, it activates the coagulation pathway via a marked increase in monocyte-associated tissue factor (TF) procoagulant activity, and it inhibits fibrinolysis by promoting the release of PAI-1, contributing to undegraded fibrin deposition. Therefore, we were interested in evaluating, in patients with venous leg ulcers, the effect of pentoxifylline administered at 1,200 mg daily (versus placebo) for 2-months, as this drug induces a decrease in TNF-alpha synthesis and also blocks its activity. This pilot assay was performed in blind. Evolution of several parameters in ulcer biopsies are analyzed: TNF-alpha, intact fibrin, fibrin degradation products, ICAM-1, TF, and elastase. Pentoxifylline administration induced a decrease of local elastase and of fibrin deposit. These results support the hypothesis that accumulation of activated leukocytes is the key event in venous leg ulcers. PMID:8699846
Prevalence rate for inherited thrombophilia in patients with chronic and recurrent venous leg ulceration.
Wiszniewski, Adam; Bykowska, Ksenia; Bilski, Radoslaw; Ja?kowiak, Wojciech; Proniewski, Jacek
The aim of the study was to determine the prevalence rate for inherited thrombophilia (IT) in patients with chronic (CVU) and recurrent venous leg ulceration. We also investigated and evaluated the severity of the clinical pattern of CVU in patients with and without IT. We examined 110 patients with CVU (the study group) and 110 healthy subjects (the control group). We prepared a questionnaire to be completed by each study participant. Ultrasound Doppler color imaging or/and duplex ultrasonography was performed to evaluate the efficiency of the venous system. The ankle-brachial index was calculated to determine the efficiency of the arterial system. We examined both groups for the presence of IT. IT was diagnosed in 30% of study group and in 1.8% of control group. Our diagnoses of deep vein thrombosis (DVT) were based on medical interviews, physical examinations, and an ultrasonography of the venous system and concerned 64 study group patients (58.2%), 35 of whom (31.8%) experienced recurrent DVT. Proximal and/or distal DVT was determined in an interview and/or by an ultrasonography performed for all patients with CVU and IT. In 94% of these patients, DVT was recurrent, and in 88% of patients with CVU and IT, we observed recurrent DVT and CVU. It recurred more often and persisted longer when compared to patients with CVU and no IT, despite similar management. No differences were observed in ulcer size, localization, or pain level related to ulceration between patients with CVU and IT and those with CVU and no IT. PMID:22092793
The journey to chronic pain: a grounded theory of older adults' experiences of pain associated with leg ulceration.
Taverner, Tarnia; Closs, S José; Briggs, Michelle
This study aimed to develop a grounded theory to describe and explain the experience of pain and its impact, as reported by the individuals who had pain associated with chronic leg ulceration. The Strauss and Corbin grounded theory approach was used. In-depth interviews were undertaken with 11 people aged ? 65 years from Leeds in the north of England. All participants were cared for by home care nurses and had painful leg ulceration. The emergent grounded theory centered on a core category of "The journey to chronic pain." The theory suggested a trajectory consisting of three phases that the patient experiences, where the end result is a chronic pain syndrome. In phase 1, leg ulcer pain has predominantly acute nociceptive properties, and if this is not managed effectively, or ulcers do not heal, persistent pain may develop with both nociceptive and neuropathic properties (i.e., phase 2). If phase 2 pain is not managed effectively, patients may then develop refractory long-term pain (phase 3). Those who progress to phase 3 tend to experience negative consequences such as insomnia, depression, and suicidal ideation. Only when health care professionals understand and acknowledge the persistent and long-term nature of the pain in this patient group can the pain be managed effectively. PMID:23402894
A Comparison of the Efficacy and Cost of Different Venous Leg Ulcer Dressings: A Retrospective Cohort Study
Hussain, Syed M. Asim
Objective. To compare the efficacy and cost-effectiveness of simple nonadherent dressings with other more expensive dressing types in the treatment of venous leg ulcers. Study Design. Retrospective cohort study. Location. The leg ulcer clinic at the University Hospital of South Manchester. Subjects and Methods. The healing rates of twelve leg ulcer patients treated with simple nonadherent dressings (e.g., NA Ultra) were compared with an equal number of patients treated with modern dressings to determine differences in healing rates and cost. Main Outcome Measures. Rate of healing as determined by reduction in ulcer area over a specified period of time and total cost of dressing per patient. Results. Simple nonadherent dressings had a mean healing rate of 0.353?cm2/week (standard deviation ± 0.319) compared with a mean of 0.415?cm2/week (standard deviation ± 0.383) for more expensive dressings. This resulted in a one-tailed p value of 0.251 and a two-tailed p value of 0.508. Multiple regression analysis gave a significance F of 0.8134. Conclusion. The results indicate that the difference in healing rate between simple and modern dressings is not statistically significant. Therefore, the cost of dressing type should be an important factor influencing dressing selection. PMID:25954532
Management of leg ulcers in patients with chronic venous insufficiency: the experience of a Dermatology Clinic in Bucharest, Romania.
Salavastru, C M; Nedelcu, L E; Tiplica, G-S
Venous ulcers are the most severe skin manifestation of chronic venous insufficiency. Treatment is complex and it is performed according to the stage of the disease. It includes changes of lifestyle, compressive therapy, phlebotropic medication, topical therapy of the ulcer, antibiotic therapy (topical and systemic), sclerotherapy, and surgical treatment. Patients with venous leg ulcers that attend the Second Dermatology Clinic of Colentina Clinical Hospital, are treated both as inpatients and as outpatients. They benefit from topical treatment and bandaging performed by specialized medical personnel in separate treatment room with strictly monitored conditions of asepsis and antisepsis. A follow-up study of these patients was made from January 1, 2009 to December 31, 2011. The average age of patients was 65.9 years (± 14.2), most of them being in the eight decade of life (31.9%). In almost half of the cases (44.2%), the patients spent more than 1 week in the hospital. Bacteriological investigations from the ulcers were performed in 55.1% of patients and the most frequent infectious agents were found to be Staphylococcus aureus (26.3%) and Enterobacter spp. (17.2%). Treatment of leg ulcer patients proves to be a long and complex one, a systematic and organized approach being needed in order to obtain healing of the wound. PMID:22950557
Non-healing leg ulcers in a patient with dystrophic calcification and crest syndrome: a challenging clinical case.
Al-Najjar, Mahmoud; Jackson, Mark J
The management of non-healing leg ulcers 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 leg ulcers 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
An adolescent with sickle cell anaemia experiencing disease-related complications: priapism and leg ulcer – a management challenge
Vasconcelos, Alexandra; Prior, Ana Rita; Ferrăo, Anabela; Morais, Anabela
Sickle-cell anaemia (SCA) is a multi-system disease, associated with episodes of acute illness and progressive organ damage. Disease severity shows substantial variation and it is often a burden for adolescents. Complications such as leg ulcer and priapism have a significant impact on quality of life. There are still no definitive treatment guidelines available. Considering the embarrassing nature of priapism and the dire consequences for erectile dysfunction, it is important to inform patients, parents and providers about the relationship of SCA to prolonged painful erections. This article will review the pathophysiology and treatment options of SCA focusing the complications of leg ulcers, priapism, cholelithiasis and retinopathy. The case study of a 14-year-old boy is used to present a management challenge of multiple SCA-related complications. PMID:22605005
Decreased Hematocrit-To-Viscosity Ratio and Increased Lactate Dehydrogenase Level in Patients with Sickle Cell Anemia and Recurrent Leg Ulcers
Connes, Philippe; Lamarre, Yann; Hardy-Dessources, Marie-Dominique; Lemonne, Nathalie; Waltz, Xavier; Mougenel, Daničle; Mukisi-Mukaza, Martin; Lalanne-Mistrih, Marie-Laure; Tarer, Vanessa; Tressičres, Benoit; Etienne-Julan, Maryse; Romana, Marc
Leg ulcer is a disabling complication in patients with sickle cell anemia (SCA) but the exact pathophysiological mechanisms are unknown. The aim of this study was to identify the hematological and hemorheological alterations associated with recurrent leg ulcers. Sixty-two SCA patients who never experienced leg ulcers (ULC-) and 13 SCA patients with a positive history of recurrent leg ulcers (ULC+) - but with no leg ulcers at the time of the study – were recruited. All patients were in steady state condition. Blood was sampled to perform hematological, biochemical (hemolytic markers) and hemorheological analyses (blood viscosity, red blood cell deformability and aggregation properties). The hematocrit-to-viscosity ratio (HVR), which reflects the red blood cell oxygen transport efficiency, was calculated for each subject. Patients from the ULC+ group were older than patients from the ULC- group. Anemia (red blood cell count, hematocrit and hemoglobin levels) was more pronounced in the ULC+ group. Lactate dehydrogenase level was higher in the ULC+ group than in the ULC- group. Neither blood viscosity, nor RBC aggregation properties differed between the two groups. HVR was lower and RBC deformability tended to be reduced in the ULC+ group. Our study confirmed increased hemolytic rate and anemia in SCA patients with leg ulcers recurrence. Furthermore, our data suggest that although systemic blood viscosity is not a major factor involved in the pathophysiology of this complication, decreased red blood cell oxygen transport efficiency (i.e., low hematocrit/viscosity ratio) may play a role. PMID:24223994
Transplantation of autologous keratinocyte suspension in fibrin matrix to chronic venous leg ulcers: improved long-term healing after removal of the fibrin carrier
ANKE HARTMANN; JENNIFER QUIST; HENNING HAMM; E. B. Brocker; PETER FRIEDL
BACKGROUND: The transplantation of keratinocytes suspended in fibrin carrier represents a candidate regimen for chronic ulcer treatment in an outpatient setting. We evaluated the integration and survival of autologous individualized keratinocytes applied within fibrin matrix onto chronic venous leg ulcers in vivo. Parallel in vitro culture was used to validate keratinocyte survival and apoptosis in fibrin compared to collagen matrix
Use of weekly, low dose, high frequency ultrasound for hard to heal venous leg ulcers: the VenUS III randomised controlled trial
Objective To assess the clinical effectiveness of weekly delivery of low dose, high frequency therapeutic ultrasound in conjunction with standard care for hard to heal venous leg ulcers. Design Multicentre, pragmatic, two arm randomised controlled trial. Setting Community and district nurse led services, community leg ulcer clinics, and hospital outpatient leg ulcer clinics in 12 urban and rural settings (11 in the United Kingdom and one in the Republic of Ireland). Participants 337 patients with at least one venous leg ulcer of >6 months' duration or >5 cm2 area and an ankle brachial pressure index of ?0.8. Interventions Weekly administration of low dose, high frequency ultrasound therapy (0.5 W/cm2, 1 MHz, pulsed pattern of 1:4) for up to 12 weeks plus standard care compared with standard care alone. Main outcome measures Primary outcome was time to healing of the largest eligible leg ulcer. Secondary outcomes were proportion of patients healed by 12 months, percentage and absolute change in ulcer size, proportion of time participants were ulcer-free, health related quality of life, and adverse events. Results The two groups showed no significant difference in the time to healing of the reference leg ulcer (log rank test, P=0.61). After adjustment for baseline ulcer area, baseline ulcer duration, use of compression bandaging, and study centre, there was still no evidence of a difference in time to healing (hazard ratio 0.99 (95% confidence interval 0.70 to 1.40), P=0.97). The median time to healing of the reference leg ulcer was inestimable. There was no significant difference between groups in the proportion of participants with all ulcers healed by 12 months (72/168 in ultrasound group v 78/169 in standard care group, P=0.39 for Fisher's exact test) nor in the change in ulcer size at four weeks by treatment group (model estimate 0.05 (95% CI –0.09 to 0.19)). There was no difference in time to complete healing of all ulcers (log rank test, P=0.61), with median time to healing of 328 days (95% CI 235 to inestimable) with standard care and 365 days (224 days to inestimable) with ultrasound. There was no evidence of a difference in rates of recurrence of healed ulcers (17/31 with ultrasound v 14/31 with standard care, P=0.68 for Fisher's exact test). There was no difference between the two groups in health related quality of life, both for the physical component score (model estimate 0.69 (–1.79 to 3.08)) and the mental component score (model estimate –0.93 (–3.30 to 1.44)), but there were significantly more adverse events in the ultrasound group (model estimate 0.30 (0.01 to 0.60)). There was a significant relation between time to ulcer healing and baseline ulcer area (hazard ratio 0.64 (0.55 to 0.75)) and baseline ulcer duration (hazard ratio 0.59 (0.50 to 0.71)), with larger and older ulcers taking longer to heal. In addition, those centres with high recruitment rates had the highest healing rates. Conclusions Low dose, high frequency ultrasound administered weekly for 12 weeks during dressing changes in addition to standard care did not increase ulcer healing rates, affect quality of life, or reduce ulcer recurrence. Trial registration ISRCTN21175670 and National Research Register N0484162339 PMID:21385806
Principles and technique of foam sclerotherapy and its specific use in the treatment of venous leg ulcers.
Simka, Marian
Invention of foam sclerotherapy has significantly changed the current phlebological practice. Compared with liquid sclerosants, obliterating foam is more efficient, especially for the closure of larger veins. This review discusses clinical aspects of foam sclerotherapy with a focus on its use for the treatment of venous leg ulceration, including the rationale for its use in the treatment of these chronic wounds, physicochemical mechanisms responsible for stability and disintegration of sclerosant foam, pathomechanism of neurologic adverse events seen after foam sclerotherapy, and techniques that can increase efficacy of this procedure and lower frequency of adverse events. PMID:21856975
... your stomach makes. What about other medicines? Several other medicines can be used to help treat ulcers. Two types of medicines (H2 blockers and proton pump inhibitors) reduce the amount of acid that ...
Cost-Effective Use of Silver Dressings for the Treatment of Hard-to-Heal Chronic Venous Leg Ulcers
Jemec, Gregor B. E.; Kerihuel, Jean Charles; Ousey, Karen; Lauemřller, Sanne Lise; Leaper, David John
Aim To estimate the cost-effectiveness of silver dressings using a health economic model based on time-to-wound-healing in hard-to-heal chronic venous leg ulcers (VLUs). Background Chronic venous ulceration affects 1–3% of the adult population and typically has a protracted course of healing, resulting in considerable costs to the healthcare system. The pathogenesis of VLUs includes excessive and prolonged inflammation which is often related to critical colonisation and early infection. The use of silver dressings to control this bioburden and improve wound healing rates remains controversial. Methods A decision tree was constructed to evaluate the cost-effectiveness of treatment with silver compared with non-silver dressings for four weeks in a primary care setting. The outcomes: 'Healed ulcer', 'Healing ulcer' or 'No improvement' were developed, reflecting the relative reduction in ulcer area from baseline to four weeks of treatment. A data set from a recent meta-analysis, based on four RCTs, was applied to the model. Results Treatment with silver dressings for an initial four weeks was found to give a total cost saving (Ł141.57) compared with treatment with non-silver dressings. In addition, patients treated with silver dressings had a faster wound closure compared with those who had been treated with non-silver dressings. Conclusion The use of silver dressings improves healing time and can lead to overall cost savings. These results can be used to guide healthcare decision makers in evaluating the economic aspects of treatment with silver dressings in hard-to-heal chronic VLUs. PMID:24945381
Strategies and approaches towards evidence-based practice in the management of chronic leg ulcers by nurses working in the community in Kronoberg County, Sweden and the East Riding & Hull, UK
Britt-Lousie Anderson
Aim: This paper reports one aspect of a study concerning management of chronic leg ulcers by nurses working in the community in Kronoberg County, Sweden (KC) and the East Riding & Hull, UK (ER). Our study focus was to describe reported evidence-based practice in leg ulcer care in two samples of nurses from two countries. The paper describes the overall
Chronic venous ulceration of leg associated with peripheral arterial disease: an underappreciated entity in developing country.
Nag, Falguni; De, Abhishek; Hazra, Avijit; Chatterjee, Gobinda; Ghosh, Arghyaprasun; Surana, Trupti V
Chronic venous ulcer can often be associated with asymptomatic peripheral arterial disease (PAD), which usually remains undiagnosed adding significantly to the morbidity of these patients. The Ankle-Brachial Pressure Index (ABPI) is suggested for PAD evaluation. Many PAD studies were conducted in western countries, but there is a scarcity of data on the prevalence of PAD in clinical venous ulcer patient in developing countries. We conducted a study in a tertiary care hospital of eastern part of India to find out the prevalence of PAD in venous ulcer patients, and also to find the sensitivity of ABPI as a diagnostic tool in these patients. We evaluated clinically diagnosed patients with venous ulcer using ABPI and Colour Doppler study for the presence of PAD. Possible associations such as age, sex, body mass index (BMI), smoking, hypertension and atherosclerosis were studied. All results were analysed using the software Statistica version 6. PAD was present in 23 (27·71%) patients. Older age, longer duration, smoking, high BMI and hypertension were found to be significantly associated with PAD. A very strong level of agreement was found between venous Doppler and ABPI. Assessment for the presence of PAD is important in all clinically diagnosed venous ulcer patients. ABPI being a simple, non-invasive outpatient department (OPD)-based procedure, can be routinely used in cases of venous ulcer to find out the hidden cases of PAD even in developing countries. PMID:23170845
Coagulation factor V gene mutation associated with activated protein C resistance leading to recurrent thrombosis, leg ulcers, and lymphedema: successful treatment with intermittent compression
Dominik Peus; Sherko v Schmiedeberg; Andreas Pier; Rüdiger E Scharf; Artur Wehmeier; Thomas Ruzicka; Jean Krutmann
Activated protein C resistance is the most frequent cause of venous thrombosis. We describe a patient with extensive ulcerations and severe lymphedema of the legs after recurrent thrombosis. Laboratory tests revealed a pathologic activated protein C resistance and a reduced functional protein S. The underlying genetic defect was identified as a heterozygous coagulation factor V mutation. A combined therapeutic approach
Success Rate of Split-Thickness Skin Grafting of Chronic Venous Leg Ulcers Depends on the Presence of Pseudomonas aeruginosa: A Retrospective Study
Trine Hřgsberg; Thomas Bjarnsholt; Jens Schiersing Thomsen; Klaus Kirketerp-Mřller; Markus M. Heimesaat
The last years of research have proposed that bacteria might be involved in and contribute to the lack of healing of chronic wounds. Especially it seems that Pseudomonas aeruginosa play a crucial role in the healing. At Copenhagen Wound Healing Centre it was for many years clinical suspected that once chronic venous leg ulcers were colonized (weeks or months preoperatively)
The clinical feasibility of natural medicine, venotonic therapy and horsechestnut seed extract in the treatment of venous leg ulceration: a descriptive survey
Matthew J Leach
Background: The primary treatment of choice for venous leg ulceration (VLU) is compression therapy, however serious clinical issues demand the development of new treatments. An extract believed to promote VLU healing is Horsechestnut Seed Extract (HCSE).Methods: The clinical feasibility of HCSE in VLU was explored in a two-stage design. The second stage presented here, was a descriptive survey exploring current
Testing the effectiveness of a self-efficacy based exercise intervention for adults with venous leg ulcers: protocol of a randomised controlled trial
Background Exercise and adequate self-management capacity may be important strategies in the management of venous leg ulcers. However, it remains unclear if exercise improves the healing rates of venous leg ulcers and if a self-management exercise program based on self-efficacy theory is well adhered to. Method/design This is a randomised controlled in adults with venous leg ulcers to determine the effectiveness of a self-efficacy based exercise intervention. Participants with venous leg ulcers are recruited from 3 clinical sites in Australia. After collection of baseline data, participants are randomised to either an intervention group or control group. The control group receive usual care, as recommended by evidence based guidelines. The intervention group receive an individualised program of calf muscle exercises and walking. The twelve week exercise program integrates multiple elements, including up to six telephone delivered behavioural coaching and goal setting sessions, supported by written materials, a pedometer and two follow-up booster calls if required. Participants are encouraged to seek social support among their friends, self-monitor their weekly steps and lower limb exercises. The control group are supported by a generic information sheet that the intervention group also receive encouraging lower limb exercises, a pedometer for self-management and phone calls at the same time points as the intervention group. The primary outcome is the healing rates of venous leg ulcers which are assessed at fortnightly clinic appointments. Secondary outcomes, assessed at baseline and 12 weeks: functional ability (range of ankle motion and Tinetti gait and balance score), quality of life and self-management scores. Discussion This study seeks to address a significant gap in current wound management practice by providing evidence for the effectiveness of a home-based exercise program for adults with venous leg ulcers. Theory-driven, evidence-based strategies that can improve an individual's exercise self-efficacy and self-management capacity could have a significant impact in improving the management of people with venous leg ulcers. Information gained from this study will provide much needed information on management of this chronic disease to promote health and independence in this population. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12612000475842. PMID:25277416
Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of Săo Paulo State, Brazil*
Wachholz, Patrick Alexander; Masuda, Paula Yoshiko; Nascimento, Dejair Caitano; Taira, Cecilia Midori Higashi; Cleto, Norma Gondim
BACKGROUND Chronic leg ulcer may have an impact on patients' quality of life. OBJECTIVES This study aimed to identify the impact of leg ulcers on patient's quality of life using the Dermatology Life Quality Index and to define the main factors correlated with this perception. METHOD Cross-sectional, non-probabilistic sampling study. We included patients with chronic leg ulcers being treated for at least 3 months. A sociodemographic and clinical survey was conducted to assess the profile of the ulcers. We administered a screening for depressive symptoms and the Dermatology Life Quality Index. We performed a descriptive statistical analysis, chi-square test and Mann-Whitney test for categorical data, Pearson for numeric variables, and multiple regression for categorical data. RESULTS Forty-one patients were assessed. Their mean age was 61.78 years. Venous ulcers (48.8%) were the most prevalent. Seventy-three percent of the sample perceived no impact/low impact on quality of life in the past week, and 26.8% perceived moderate/high impact. A multiple regression analysis identified the causes of lesion, pain related to the ulcers, time of onset, and severity of the depressive symptoms as the variables that had an influence on quality of life. CONCLUSIONS The majority of the sample perceived low or no impact of the condition on the quality of the life. The variables etiology of the lesion (p<0.001), pain related to the ulcers (p=0.001), time of onset (p=0.006), and severity of the depressive symptoms (p<0.001) had an influence on the quality of life, suggesting the need for further studies with more robust designs to confirm the causal relationship between these characteristics and quality of life. PMID:24626651
Silver treatments and silver-impregnated dressings for the healing of leg wounds and ulcers: a systematic review and meta-analysis.
Carter, Marissa J; Tingley-Kelley, Kimberly; Warriner, Robert A
Previous systematic reviews of silver-impregnated dressings have been contradictory regarding the healing of leg wounds/ulcers. Our systematic review was restricted to randomized controlled trials. Cochrane Library, Scopus, and MEDLINE databases were searched using the term "silver" in combination with "wound" or "ulcer" (and plural versions) without date/language restriction. Study quality was assessed and meta-analysis conducted for complete wound healing, wound size reduction, and healing rates. Overall study quality was fair with most studies having some bias. Evidence for wound healing using individual studies was poor. Meta-analyses found strong evidence for wound healing based on wound size reduction but no evidence based on complete wound-healing or healing rates. Although our results provide some evidence that silver-impregnated dressings improve the short-term healing of wounds and ulcers, long-term effects remain unclear. Clinical trial data with longer follow-up times are needed to address these issues. PMID:20471135
Treatment of chronic diabetic lower leg ulcers with activated protein C: a randomised placebo-controlled, double-blind pilot clinical trial.
Whitmont, Kaley; McKelvey, Kelly J; Fulcher, Gregory; Reid, Ian; March, Lyn; Xue, Meilang; Cooper, Alan; Jackson, Christopher J
Lower leg ulcers are a serious and long-term complication in patients with diabetes and pose a major health concern because of the increasing number of patients diagnosed with diabetes each year. This study sought to evaluate the clinical benefit of topical activated protein C (APC) on chronic lower leg ulcers in patients with diabetes. Twelve patients were randomly assigned to receive either APC (N = 6) or physiological saline (placebo; N = 6) in a randomised, placebo-controlled, double-blind pilot clinical trial. Treatment was administered topically, twice weekly for 6 weeks with final follow-up at 20 weeks. Wound area was significantly reduced to 34·8 ± 16·4% of week 0 levels at 20 weeks in APC-treated wounds (p = 0·01). At 20 weeks, three APC-treated wounds had completely healed, compared to one saline-treated wound. Full-thickness wound edge skin biopsies showed reduced inflammatory cell infiltration and increased vascular proliferation following APC treatment. Patient stress scores were also significantly reduced following APC treatment (p < 0·05), demonstrating improved patient quality of life as assessed by the Cardiff Wound Impact Questionnaire. This pilot trial suggests that APC is a safe topical agent for healing chronic lower leg ulcers in patients with diabetes and provides supporting evidence for a larger clinical trial. PMID:23848141
Compression and venous ulcers.
Stücker, M; Link, K; Reich-Schupke, S; Altmeyer, P; Doerler, M
Compression therapy is considered to be the most important conservative treatment of venous leg ulcers. Until a few years ago, compression bandages were regarded as first-line therapy of venous leg ulcers. However, to date medical compression stockings are the first choice of treatment. With respect to compression therapy of venous leg ulcers the following statements are widely accepted: 1. Compression improves the healing of ulcers when compared with no compression; 2. Multicomponent compression systems are more effective than single-component compression systems; 3. High compression is more effective than lower compression; 4. Medical compression stockings are more effective than compression with short stretch bandages. Healed venous leg ulcers show a high relapse rate without ongoing treatment. The use of medical stockings significantly reduces the amount of recurrent ulcers. Furthermore, the relapse rate of venous leg ulcers can be significantly reduced by a combination of compression therapy and surgery of varicose veins compared with compression therapy alone. PMID:23482538
Effectiveness and tissue compatibility of a 12-week treatment of chronic venous leg ulcers with an octenidine based antiseptic--a randomized, double-blind controlled study.
Vanscheidt, Wolfgang; Harding, Keith; Téot, Luc; Siebert, Jörg
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 leg ulcers. 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
Leg ulcer and osteomyelitis due to methicillin-susceptible Staphylococcus aureus infection after fracture repair treatment: a case highlighting the potential role of prostaglandin E? vasodilator.
Bentivegna, Erminia; Citarrella, Emanuele; Vivaldi, Roberto; De Luca, Dario; Maira, Giovanna Grazia; Casuccio, Alessandra; Di Carlo, Paola
Prostaglandins appear to reduce biofilm formation and chronicization of infections, and stimulate a rapid and effective clearance of infecting micro-organisms. We report a case of recovery from methicillin-susceptible Staphylococcus aureus (MSSA) osteomyelitis after multidisciplinary management with antibiotics, anti-thrombotics and prostaglandin E1 (PGE1) vasodilator, in a patient with tibial plateau fracture repaired with internal fixation devices. A 47-year-old HIV-negative male with chronic ulcer on the proximal third of the left leg was admitted to the Orthopaedic Unit of the Orestano Clinic in Palermo, Italy, for suspected osteomyelitis. A biopsy of the skin ulcer and blood cultures were performed and resulted positive for MSSA. Labelled leukocyte scintigraphy confirmed osteomyelitis. No clinical improvement was observed after combined antibiotic treatment with rifampicin plus trimethoprim-sulfamethoxazole. The patient underwent a 4-day therapeutic cycle: PGE1 (alprostadil 60 mg/day IV) combined with nadroparin calcium plus gentamicin, followed by treatment with aminaftone plus sulodexide plus levofloxacin. At discharge, the patient's painful symptoms had completely resolved and the ulcer had cicatrized; recovery from osteomyelitis was confirmed by scintigraphy. This treatment protocol including PGE1 may result in a significant improvement in quality of life and functional status of patients with a reduction in direct and indirect costs and economic benefit for the National Health Service. PMID:25819055
A Real World, Observational Registry of Chronic Wounds and Ulcers
Diabetic Foot; Varicose Ulcer; Pressure Ulcer; Surgical Wound Dehiscence; Vasculitis; Skin Ulcer; Leg Ulcer; Wounds and Injuries; Pyoderma; Peripheral Arterial Disease; Diabetic Neuropathies; Lymphedema; Venous Insufficiency; Diabetes Complications; Amputation Stump
Evaluation of the bacterial diversity among and within individual venous leg ulcers using bacterial tag-encoded FLX and Titanium amplicon pyrosequencing and metagenomic approaches
Background Approximately 1 out of every 100 individuals has some form of venous insufficiency, which can lead to chronic venous disease and Venous Leg Ulcer (VLU). There are known underlying pathologies which contribute to the chronic nature of VLU including biofilm phenotype infections. Results Using pyrosequencing based approaches we evaluated VLU to characterize their microbial ecology. Results show that VLU 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. PMID:19860898
Clinical evaluation of the efficacy and safety of a medical device in various forms containing Triticum vulgare for the treatment of venous leg ulcers – a randomized pilot study
Romanelli, Marco; Macchia, Michela; Panduri, Salvatore; Paggi, Battistino; Saponati, Giorgio; Dini, Valentina
This study was carried out to assess the efficacy and tolerability of the topical application of an aqueous extract of Triticum vulgare (TV) in different vehicles (cream, impregnated gauzes, foam, hydrogel, and dressing gel) for the treatment of venous lower leg ulcers. Fifty patients were randomized to receive one of the five investigational vehicles. Treatment was performed up to complete healing or to a maximum of 29 days. The wound size reduction from baseline was the primary efficacy variable, which was measured by means of a noninvasive laser scanner instrument for wound assessment. In all groups, apart from the foam group, a similar trend toward the reduction of the surface area was observed. The cream showed the greatest effect on the mean reduction of the lesion size. At last visit, six ulcers were healed: two in the cream group, three in the gauze group, and one in the dressing gel group. In the patients treated with the cream, the gauzes, the hydrogel, and the dressing gel, the reduction of lesion size was 40%–50%; the reduction was smaller in the foam group. No impact in terms of age on the healing process was found. The Total Symptoms Score decreased in all groups during the study; a greater efficacy in terms of signs/symptoms was observed in the patients treated with the gauzes. In the dressing gel group, one patient had an infection of the wound after 3 weeks of treatment and 2 of colonization, leading to a systemic antibiotic treatment. The events were judged as nonrelated to the device used. On the basis of the results, it could be argued that the medical device may be useful in the treatment of chronic venous ulcers. PMID:26060395
T. Watanabe; T. Murakami; H. Okochi; K. Kikuchi; M. Furue
A 54-year-old man presented with multiple annular plaques since infancy. During the intake of nifedipine and nitroglycerin over a period of 6 years, reddish, eruptive and ulcerative changes were seen in the pre-existing skin lesions on the penis, scrotum and legs. In addition to a typical cornoid lamella, histological examination revealed a band-like infiltration beneath the epidermis, liquefaction degeneration of
Low-frequency ultrasound for patients with lower leg ulcers due to chronic venous insufficiency: a report of two cases.
Maher, Sara F; Halverson, Jessica; Misiewicz, Rob; Reckling, Trisha; Smart, Ojas; Benton, Carol; Schoenherr, Dawn
Low-frequency ultrasound may facilitate debridement and healing of chronic wounds, including lower leg wounds in patients with chronic venous insufficiency (CVI). To evaluate the use of a low-frequency ultrasound (LFU) device with a curette, two patients with CVI and chronic wounds were treated for a period of 2 to 3 weeks. A 63-year-old woman with rheumatoid arthritis and two wounds, one on the right lower leg (250 cmł) and one wound on the left medial leg (0.80 cmł), present for 12 months; and a 77-year-old man with cardiopulmonary issues with seven wounds, three on the left medial calf (1.2 cmł, 11.40 cmł, and 0.72 cmł), one on the left anterior calf (0.30 cmł), two on the right posterior calf (0.90 cmł, 0.30 cmł), and one on the right anterior calf (0.14 cmł), present for 3 months consented to participate in the study. Both patients received low-intensity (50-70 ?m), low-frequency (35 kHz) ultrasound at an intensity of 50% through a saline mist in addition to antimicrobial dressing with silver, a multilayer compression bandage system applied at every visit, and pain medication as needed. Both patients received treatments every 1 to 3 weeks that were not timed. Treatment continued until no additional slough or other necrotic tissue could be removed from the wound bed; the female patient received two treatment sessions and the male received three. Average wound volume did not change significantly from the first to last treatment session (t(8)-1.2, P = 0.26). Five wounds (56%) with initial measurements of 0.8 cmł, 0.72 cmł, 0.3 cmł, 0.3 cmł, and 0.14 cmł reduced in volume by 100%. Mean wound characteristic scores changed significantly (P <0.05) for amount of fibrin, periwound skin, drainage amount, and color. In addition, the number of wounds filled with slough decreased from 89% at the first session to 22% at the final treatment session. The results of this study suggest LFU may have been beneficial for these patients with CVI. Additional studies using larger sample sizes are needed to evaluate the effect of this treatment on a variety of chronic wounds and to compare its effectiveness to other debridement methods. PMID:24515985
A randomised comparative trial on the use of a hydrogel with tepescohuite extract (Mimosa tenuiflora cortex extract-2G) in the treatment of venous leg ulcers.
Lammoglia-Ordiales, Lorena; Vega-Memije, Maria Elisa; Herrera-Arellano, Armando; Rivera-Arce, Erika; Agüero, Juan; Vargas-Martinez, Felipe; Contreras-Ruiz, José
Tepescohuite is an extract obtained from the bark of the Mimosa tenuiflora tree and is used as an empirical treatment in wounds for its healing and antiseptic properties. Venous leg ulcers (VLUs) are a common health care problem in most countries with a high rate of morbidity. The standard of care is moist interactive healing and compression; however, the ideal topical treatment is yet to be established. This study is designed to evaluate the effectiveness and safety of M. tenuiflora cortex extract (MTC-2G) in the treatment of VLUs in an Interdisciplinary Wound and Ostomy Care Center (IWOCC). A randomised, placebo-controlled, double blind clinical trial was conducted to compare the use of a hydrogel containing MTC-2G with the hydrogel alone in VLUs. The study included all patients with venous ulcers referred to the IWOCC. Laboratory tests and tissue biopsies were performed at the beginning and at the end of the study. The patients were instructed to daily cleansing followed by topical application of the hydrogel and compression. Forty-one patients were included, 22 patients received the MTC-2G and 19 patients received the hydrogel only. Of the 41 patients, 32 completed the study, 18 in the experimental arm and 14 in the control group, 19 were women and 13 men. The mean age of the subjects was 60 years. The mean time from presentation was 38 months. The mean surface reduction was 6·29 cm(2) [confidence interval (IC) 95%: 3·28-9·29] (P = 0·0001) in the MTC-2G group and 5·85 cm(2) (95% CI: 3·58-8·12) (P = 0·001) in the hydrogel group. There was no significant difference between the groups (P = 0·815). No changes in the laboratory parameters were noted. In the histology, there were not any differences between groups either. A hydrogel containing MTC-2G was not superior to a hydrogel alone in the treatment of VLUs. PMID:22128789
Inflammatory bowel disease - ulcerative colitis; IBD - ulcerative colitis ... Burger D, Travis S. Conventional medical management of inflammatory bowel disease. Gastroenterology ... . Kornbluth A, Sachar DB, et al. ...
Leg ulcer as a manifestation of eosinophilic vasculitis in a patient with hepatitis C virus infection, medicated with pegylated interferon/ribavirin.
Resende, Cristina; Pereira, Teresa; Ventura, Filipa; Brito, Celeste
Cryoglobulinaemic vasculitis is a complication of hepatitis C virus (HCV) infection, responding to treatment with pegylated interferon (peg-IFN)/ribavirin (RIB), but vasculitis may first appear after treatment with peg-IFN/RIB. A 35-year-old man with HCV infection presented to our department with a 2-month history of a 3.3×3?cm ulcer localised on the right shin, with a regular border, on a violaceous base. Histopathological examination revealed a leucocytoclastic vasculitis, rich in eosinophils. The patient had been treated with peg-IFN/RIB 10?months prior and treatment was discontinued after 2?months because of the appearance of arthralgias and neuropathy. Laboratory investigations revealed positive cryoglobulins, elevation of rheumatoid factor and reduction of C4 after treatment with peg-IFN/RIB. Dressings with a hydrocellular foam were placed and after 2?months the ulcer resolved. We presented this case because of the rarity of development of a cryoglobulinaemic vasculitis in a patient with HCV infection, previously treated with peg-IFN/RIB. PMID:26065548
A randomized, controlled, double-blind prospective trial with a Lipido-Colloid Technology-Nano-OligoSaccharide Factor wound dressing in the local management of venous leg ulcers.
Meaume, Sylvie; Truchetet, François; Cambazard, Frédéric; Lok, Catherine; Debure, Clélia; Dalac, Sophie; Lazareth, Isabelle; Sigal, Michčle-Léa; Sauvadet, Anne; Bohbot, Serge; Dompmartin, Anne
Venous leg ulcers (VLUs) are the most prevalent chronic wounds in western countries with a heavy socioeconomic impact. Compression therapy is the etiologic treatment of VLU but until now no wound dressing has been shown to be more effective than another. The aim of this study was to assess the efficacy of a new dressing in the management of VLU. Adult patients presenting a noninfected VLU and receiving effective compression therapy were enrolled in this randomized, controlled, double-blind trial. The VLUs were assessed every 2 weeks for 8 weeks. The primary study outcome was the relative Wound Area Reduction (WAR, in %), and the secondary objectives were absolute WAR, healing rate, and percentage of wounds with >40% surface area reduction. One hundred eighty-seven patients were randomly allocated to treatment groups. Median WAR was 58.3% in the Lipido-Colloid Technology-Nano-OligoSaccharide Factor (TLC-NOSF) dressing group (test group) and 31.6% in the TLC dressing group (control group) (difference: -26.7%; 95% confidence interval: -38.3 to -15.1%; p = 0.002). All other efficacy outcomes were also significant in favor of the TLC-NOSF dressing group. Clinical outcomes for patients treated with the new dressing are superior to those patients treated with the TLC dressing (without NOSF compound), suggesting a strong promotion of the VLU healing process. PMID:22681551
Ulcerative colitis (UC) is a disease that causes inflammation and sores, called ulcers, in the lining of the rectum and colon. It is one of a group of diseases called inflammatory bowel disease. UC can happen at ...
Mosti, G
Wound dressings: ulcer dressings should create and maintain a moist environment on the ulcer surface. It has been shown that in an ulcer with a hard crust and desiccated bed, the healing process is significantly slowed and sometimes completely blocked so favouring infection, inflammation and pain. In contrast a moist environment promotes autolytic debridement, angiogenesis and the more rapid formation of granulation tissue, favours keratinocytes migration and accelerates healing of wounds. Apart from these common characteristics, wound dressings are completely different in other aspects and must be used according to the ulcer stage. In necrotic ulcers, autolytic debridement by means of hydrogel and hydrocolloids or with enzymatic paste is preferred. In case of largely exuding wounds alginate or hydrofibre are indicated. When bleeding occurs alginate is indicated due to its haemostatic power. Where ulcers are covered by granulation tissue, polyurethane foams are preferred. When infection coexists antiseptics are necessary: dressing containing silver or iodine with large antibacterial spectrum have proved to be very effective. In the epithelization stage polyurethane films or membranes, thin hydrocolloids or collagen based dressings are very useful to favour advancement of the healing wound edge. Despite these considerations, a Cochrane review failed to find advantages for any dressing type compared with low-adherent dressings applied beneath compression. Surgical debridement and grafting of wounds, negative wound pressure treatment: surgical and hydrosurgical debridement are indicated in large, necrotic and infected wounds as these treatments are able to get rid of necrotic, infected tissue very quickly in a single surgical session, thereby significantly accelerating wound bed preparation and healing time. Negative wound pressure treatment creating a negative pressure on ulcer bed is able to favour granulation tissue and shorten healing time. In case of hard-to-heal leg ulcers such as large, deep, infected and long-lasting venous ulcers, sharp debridement and skin grafting may favour and shorten ulcer healing. PMID:23482540
Restless legs syndrome (RLS) causes a powerful urge to move your legs. Your legs become uncomfortable when you are lying down or sitting. Some ... asleep. In most cases, there is no known cause for RLS. In other cases, RLS is caused by a ...
Cutaneous Ulcer as Leading Symptom of Systemic Cytomegalovirus Infection
Guo, Richard F.; Gebreab, Frew H.; Tang, Emily Hsiang-Ho; Piao, Zhe; Lee, Steve S.; Perez, Mario L.
Cytomegalovirus (CMV) infection rarely manifests with skin ulcerations. We describe a case report of a 64-year-old woman with chronic immunosuppression for treatment of mixed connective tissue disease, presenting with new onset leg ulcerations after a recent change in immunosuppressive regimen. She subsequently developed fulminant hepatitis, encephalopathy, and pancytopenia and was found to have severe systemic CMV viremia. Skin ulcer biopsy was positive by immunohistochemical staining for CMV infected endothelial cells. Both systemic disease and skin ulcer rapidly improved after stopping immunosuppression and administering intravenous ganciclovir. New onset skin ulcers in an immunosuppressed individual, especially with recent changes in immunosuppressive regimen, should raise the suspicion of reactivation of CMV. PMID:25785212
[A cutaneous ulcer induced by fungi of the genus Fusarium].
Negroni, R; Martino, O; Robles, A M; Orduna, T; Arechavala, A; Brusca, S; Helou, S
A case of cutaneous hyalohyphomycosis, due to Fusarium oxysporum, in a 40 years old man is presented. The patient came from Paraguay where he worked in a tropical rural area. His disease had begun 2 months before his admission as a skin ulcer located in the left leg. Clinical characteristics, diagnosis methods, differential diagnosis with other ulcers of the legs in tropical areas as well as therapeutic measures are discussed in this presentation. PMID:9265228
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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).
[Skin ulcers in a returning traveler].
Ebiner, Jérome; Gaide, Olivier; Pedrazzini, Baptiste
We present the case of a 71 year old man returning from a back-packer trip in exotic countries. He presented several non-healing legs ulcers for three months. After many investigations, the bacterial culture gave us the answer. PMID:25946756
Dutch Venous Ulcer guideline update.
Maessen-Visch, M Birgitte; de Roos, Kees-Peter
The revised guideline of 2013 is an update of the 2005 guideline "venous leg ulcer". In this special project four separate guidelines (venous leg ulcer, varicose veins, compression therapy and deep venous disorders) were revised and developed simultaneously. A meeting was held including representatives of any organisation involved in venous disease management including patient organizations and health insurance companies. Eighteen clinical questions where defined, and a new strategy was used to accelerate the process. This resulted in two new and two revised guidelines within one year. The guideline committee advises use of the C of the CEAP classification as well as the Venous Clinical Severity Score (VCSS) and a Quality of life (QoL) score in the assessment of clinical signs. These can provide insight into the burden of disease and the effects of treatment as experienced by the patient. A duplex ultrasound should be performed in every patient to establish the underlying aetiology and to evaluate the need for treatment (which is discussed in a separate guideline). The use of the TIME model for describing venous ulcers is recommended. There is no evidence for antiseptic or antibiotic wound care products except for a Cochrane review in which some evidence is presented for cadexomer iodine. Signs of infection are the main reason for the use of oral antibiotics. When the ulcer fails to heal the use of oral aspirin and pentoxifylline can be considered as an adjunct. For the individual patient, the following aspects should be considered: the appearance of the ulcer (amount of exudate) according to the TIME model, the influence of wound care products on moisturising the wound, frequency of changing compression bandages, pain and allergies. The cost of the dressings should also be considered. Education and training of patients t improves compliance with compression therapy but does not influence wound healing rates. PMID:24843102
NSDL National Science Digital Library
Uwe Gille (None; )
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.
Schellong, S M; Wollina, U; Unger, L; Machetanz, J; Stelzner, C
Leg swelling is an extremely frequent symptom with a broad variety of largely differing causes. The most important mechanisms behind the symptom include venous and lymphatic pathology, volume overload, increased capillary permeability, and lowered oncotic pressure. Therefore, the most frequent diseases associated with leg swelling are deep vein thrombosis and chronic venous insufficiency, primary or secondary lymphedema, cardiac failure, hypoproteinemia due to liver or renal failure, idiopathic cyclic edema, and drug-induced edema. Lipedema as a misnomer represents an important differential diagnosis. History and physical examination, when based on a sound knowledge of the diseases of interest, enable a conclusive diagnosis in most cases. Additional test are required in only a minority of patients. The present review discusses pathophysiology and clinical features of the most prevalent types of leg swelling. Finally, a brief guide to differential diagnosis is given. PMID:24264570
NSDL National Science Digital Library
Patient Education Institute
This patient education program discusses ulcerative colitis and explains the anatomy of the digestive system, causes, symptoms, diagnosis, and treatment options for this disease. This resource is a MedlinePlus Interactive Health Tutorial from the National Library of Medicine, designed and developed by the Patient Education Institute. NOTE: This tutorial requires a special Flash plug-in, version 4 or above. If you do not have Flash, you will be prompted to obtain a free download of the software before you start the tutorial. You will also need an Acrobat Reader, available as a free download, in order to view the Reference Summary.
CAT scan - leg; Computed axial tomography scan - leg; Computed tomography scan - leg; CT scan - leg ... 2008:chap 2. Shaw AS, Dixon AK. Multidetector computed tomography. In: Adam A, Dixon AK, eds. Grainger & Allison's ...
MENU Return to Web version Leg Problems See complete list of charts. Follow this chart for more information about pain and swelling in ... warmth in your calf? Yes You may have DEEP VENOUS THROMBOSIS, a clot in ... 7. Do you have twisted dark blue or purple veins near the surface of ...
Factors related to venous ulceration: a cross-sectional study.
Vlajinac, Hristina; Marinkovic, Jelena; Maksimovic, Milos; Radak, Djordje
The aim of the study was to determine the factors related to venous ulceration. Patients with venous ulceration (278 patients) were compared with 1401 patients in other categories of clinical classification of venous disease (clinical, etiologic, anatomic, and pathophysiological [CEAP]). Demographic, anthropometric, and clinical data were collected. Univariate and multivariate logistic regression analyses were used. According to multivariate analyses, risk factors for venous ulceration were age, male sex, personal history of superficial and deep venous thrombosis, diabetes, high blood pressure, skeletal or joint disease in the legs and emphysema or chronic obstructive pulmonary disease, higher body mass index and physical inactivity, parental history of ankle ulcer as well as reflux in deep and perforator veins, deep obstruction, and combination of reflux and obstruction. It seems reasonable to pay special attention to patients in whom the postulated risk factors for venous ulceration are present. PMID:24165114
Ulcerative colitis - discharge
Inflammatory bowel disease - ulcerative colitis - discharge; Ulcerative proctitis - discharge; Colitis - discharge ... Baumgart DC and Sandborn WJ. Inflammatory bowel disease: clinical aspects and ... Clark M, Colombel JF, Feagan BC, Fedorak RN, ...
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 ...
Bridgman, S A; Bennet, G C; Evans, G A; Stirling, J
The combined experience of the Royal Hospital for Sick Children, Glasgow and the Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry in lengthening 52 lower limb segments with the Orthofix device is reviewed. Forty-eight segments were lengthened by callotasis, 24 in patients with achondroplasia. Attempted lengthening with chondrodiatasis was performed in 4 patients with leg length discrepancy. With callotasis, planned lengthening was achieved in 43/48 (90%) of segments. There was a small number of significant complications. Angulation or buckling of the new bone was the commonest major complication, and was seen in 10% of segments. Pin tract infection was the predominant minor complication. Premature union was noted commonly in the femurs of achondroplastics, but could usually be overcome with manipulation under anaesthesia. We confirm that callotasis achieves its objectives with fewer complications and operations than the commonly used Wagner method which it should supersede. By contrast, we had major complications in all cases with chondrodiatasis and have abandoned this method. PMID:8478826
Retrograde mechanochemical ablation of the small saphenous vein for the treatment of a venous ulcer.
Moore, Hayley M; Lane, Tristan Ra; Franklin, Ian J; Davies, Alun H
We present the first case of retrograde ablation of the small saphenous vein to treat active venous ulceration. A 73-year-old gentleman with complicated varicose veins of the left leg and a non-healing venous ulcer despite previous successful endovenous treatment to his left great saphenous vein underwent mechanochemical ablation of his small saphenous vein with the ClariVein® system, under local anaesthetic, using a retrograde cannulation technique. Post-operatively the patient had improved symptomatically and the ulcer size had reduced. This report highlights that patients with small saphenous vein incompetence and active ulceration can be treated successfully with retrograde mechanochemical ablation. PMID:24347131
Recurrence of chronic venous ulcers on the basis of clinical, etiologic, anatomic, and pathophysiologic criteria and air plethysmography
Huey B. McDaniel; William A. Marston; Mark A. Farber; Robert R. Mendes; Lewis V. Owens; Mary L. Young; Patty F. Daniel; Blair A. Keagy
Introduction: Leg ulcers associated with chronic venous insufficiency (CVI) frequently recur after healing. The risk of recurrence has not been well defined for patients in different anatomic and hemodynamic groups. We reviewed the risk of ulcer recurrence on the basis of clinical, etiologic, anatomic, and pathophysiologic criteria and hemodynamic characteristics of the affected limb as assessed with air plethysmography (APG).
Evaluation of foot ulcers in diabetic patients.
Quddus, M A; Uddin, M J
This is a prospective observational study of 50 cases of diabetic foot ulcer conducted from June 2010 to May 2011 in the Department of Surgery of Shaheed Ziaur Rahman Medical College Hospital and the Diabetic Hospital, Bogra. This study revealed that diabetic foot ulcers are not uncommon complication in our country. The purpose of the study was to undergo a thorough evaluation of diabetic foot ulcers for better management as well as better outcome of patients. The maximum age group of this study was 41-50 years; mean±SD age was 55±15 years and male to female ratio was 1.4:1. This study showed that diabetic foot ulcers were more common in low-socio-economic group, among smokers, among poor glycemic controlled group and long duration of diabetics. In this series, 92% patients had peripheral neuropathy, 22% had foot deformity and 70% patients had vascular insufficiency in the foot and legs. In this series, 68% patients presented early diabetic complication i.e. 44% patients belonged to grade '0' and 24% patients belonged to Grade 1, which were suitable for safety of the limb or reducing major amputation if treated properly. PMID:23982544
An integrated approach in the treatment of varicose ulcer.
Patil, Deepa; Jahagirdhar, Sangeeta H; Toshikhane, Hemant D
Venous ulcers (stasis ulcers, varicose ulcers) are the wounds occurring due to inappropriate functioning of venous valves, usually of the legs. It is one of the most serious chronic venous insufficiency complications. The overall incidence rate is 0.76% in men and 1.42% in women. When a venous valve gets damaged, it prevents the backflow of blood, which causes pressure in the veins that leads to hypertension and, in turn, venous ulcers. These are mostly along the medial distal leg, which is often very painful, can bleed, and get infected. Treating varicose ulcers is a difficult task to the physician and a nightmare to the suffering patients, though a good number of the treatment principles are mentioned and practiced in allied sciences. In Ayurveda, this condition is considered as du??a vra?a. It can be managed with the specific s'odhana therapy. So, the same treatment protocol was used to treat the case discussed here, i.e. with Nitya virecana and by Basti karma. The wound was successfully treated and, therefore, is discussed in detail. PMID:24501445
Richard Hepburn
Equine gastric ulceration syndrome (EGUS) was first described in 1986 and is common in all types of horses. The clinical signs are variable and often vague but EGUS can be easily diagnosed following thorough history taking and physical examination, and confirmed using gastroscopy. Ulcers can be effectively treated and prevented by introducing changes in management practices and instituting drug therapy.
Vasculitic Peripheral Ulcerative Keratitis
Elisabeth M Messmer; C. Stephen Foster
The onset of peripheral ulcerative keratitis in the course of a connective tissue disorder, such as rheumatoid arthritis, relapsing polychondritis, or systemic lupus erythematosus, may reflect the presence of potentially lethal systemic vasculitis. Moreover, peripheral ulcerative keratitis may be the first sign of systemic necrotizing vasculitis in patients with Wegener's granulomatosis, polyarteritis nodosa, microscopic polyangiitis, or Churg-Strauss syndrome. Although the
... page from the NHLBI on Twitter. What Is Restless Legs Syndrome? Restless legs syndrome (RLS) is a disorder that causes a strong ... treatments. Rate This Content: NEXT >> November 1, 2010 Restless Legs Syndrome Clinical Trials Clinical trials are research studies that ...
Ulcer necrotic legs as first manifestation of protein S deficiency
V. Vicente; I. Alberca; M. D. Tabernero; A. López Borrasca
Protein S is a vitamin K-dependent plasma protein which increases the rate of inactivation of factor Va by activated protein C. Recently, several families with members affected by a hereditary deficiency of this protein asociated with thrombosis have been reported [1-3]. Generally, the first thrombotic event in these patients appears towards the end of the second decade of life. In
Reddy, Madhuri; Keast, David; Fowler, Evonne; Sibbald, R Gary
Integrating pain management into a treatment paradigm for pressure ulcers can lead to improved outcomes. An approach to wound bed preparation that addresses the cause and patient-centered concerns--as well as local wound care factors of moisture balance, debridement, and bacterial balance--can be integrated with the Krasner model of chronic wound pain. The risk factors for pressure ulcers are well known, but pain may be an important contributor to immobility and the development of pressure ulcers. Pain is also an important signal of wound-related infections. Strategies must be developed to control the cyclic acute pain of dressing changes and the noncyclic acute pain of wound debridement. Spinal cord injured and elderly, cognitively impaired patients with pressure ulcers present special challenges in pain management. PMID:12856291
M. N. Satyanarayana
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
Ulcer healing time and antibiotic treatment before and after the introduction of the Registry of Ulcer Treatment: an improvement project in a national quality registry in Sweden
Öien, Rut F; Forssell, Henrik W
Objectives To investigate changes in ulcer healing time and antibiotic treatment in Sweden following the introduction of the Registry of Ulcer Treatment (RUT), a national quality registry, in 2009. Design A statistical analysis of RUT data concerning the healing time and antibiotic treatment for patients with hard-to-heal ulcers in Sweden between 2009 and 2012. Setting RUT is a national web-based quality registry used to capture areas of improvement in ulcer care and to structure wound management by registering patients with hard-to-heal leg, foot and pressure ulcers. Registration includes variables such as gender, age, diagnosis, healing time, antibiotic treatment, and ulcer duration and size. Population Every patient with a hard-to-heal ulcer registered with RUT between 2009 and 2012 (n=1417) was included. Main outcome measures Statistical analyses were performed using Stata V.12.1. Healing time was assessed with the Kaplan-Meier analysis and adjustment was made for ulcer size. A log-rank test was used for equality of survivor functions. Results According to the adjusted registry in December 2012, patients' median age was 80?years (mean 77.5?years, range 11–103?years). The median healing time for all ulcers, adjusted for ulcer size, was 146?days (21?weeks) in 2009 and 63?days (9?weeks) in 2012 (p=0.001). Considering all years between 2009 and 2012, antibiotic treatment for patients with hard-to-heal ulcers was reduced from 71% before registration to 29% after registration of ulcer healing (p=0.001). Conclusions Healing time and antibiotic treatment decreased significantly during 3?years after launch of RUT. PMID:23959752
Cushing's ulcer: Further reflections
Kemp, William J.; Bashir, Asif; Dababneh, Haitham; Cohen-Gadol, Aaron A.
Background: Brain tumors, traumatic head injury, and other intracranial processes including infections, can cause increased intracranial pressure and lead to overstimulation of the vagus nerve. As a result, increased secretion of gastric acid may occur which leads to gastro-duodenal ulcer formation known as Cushing's ulcer. Methods: A review of original records of Dr. Harvey Cushing's patients suffering from gastro-duodenal ulcers was performed followed by a discussion of the available literature. We also reviewed the clinical records of the patients never reported by Cushing to gain his perspective in describing this phenomenon. Dr. Cushing was intrigued to investigate gastro-duodenal ulcers as he lost patients to acute gastrointestinal perforations following successful brain tumor operations. It is indeed ironic that Harvey Cushing developed a gastro-duodenal ulcer in his later years with failing health. Results: Clinically shown by Cushing's Yale Registry, a tumor or lesion can disrupt this circuitry, leading to gastroduodenal ulceration. Cushing said that it was "reasonable to believe that the perforations following posterior fossa cerebellar operations were produced in like fashion by an irritative disturbance either of fiber tracts or vagal centers in the brain stem." Conclusion: Harvey Cushing's pioneering work depicted in his Yale registry serves as a milestone for continuing research that can further discern this pathway. PMID:25972936
NGF, a useful tool in the treatment of chronic vasculitic ulcers in rheumatoid arthritis.
Tuveri, M; Generini, S; Matucci-Cerinic, M; Aloe, L
Vasculitic necrosis and ulceration of the skin are frequent complications of connective tissue diseases and are very difficult to heal. We treated chronic vasculitic leg ulcers in rheumatoid arthritis and systemic sclerosis by topical application of nerve growth factor (NGF). In all patients with rheumatoid arthritis, NGF led to rapid healing, whereas less striking results were obtained in patients with systemic sclerosis. The efficacy of NGF could be due to its promoting activity on keratinocytes proliferation and vascular neoangiogenesis. We suggest that topical application of NGF could represent a powerful pharmacological tool for the treatment of vasculitic ulcers. PMID:11095266
Edlich, Richard F; Winters, Kathryne L; Woodard, Charles R; Buschbacher, Ralph M; Long, William B; Gebhart, Jocelynn H; Ma, Eva K
The purpose of this collective review is to outline the predisposing factors in the development of pressure ulcers and to identify a pressure ulcer prevention program. The most frequent sites for pressure ulcers are areas of skin overlying bony prominences. There are four critical factors contributing to the development of pressure ulcers: pressure, shearing forces, friction, and moisture. Pressure is now viewed as the single most important etiologic factor in pressure ulcer formation. Prolonged immobilization, sensory deficit, circulatory disturbances, and poor nutrition have been identified as important risk factors in the development of pressure ulcer formation. Among the clinical assessment scales available, only two, the Braden Scale and Norton Scale, have been tested extensively for reliability and/or validity. The most commonly used risk assessment tools for pressure ulcer formation are computerized pressure monitoring and measurement of laser Doppler skin blood flow. Pressure ulcers can predispose the patient to a variety of complications that include bacteremia, osteomyelitis, squamous cell carcinoma, and sinus tracts. The three components of pressure ulcer prevention that must be considered in any patient include management of incontinence, nutritional support, and pressure relief. The pressure relief program must be individualized for non-weight-bearing individuals as well as those that can bear weight. For those that can not bear weight and passively stand, the RENAISSANCE Mattress Replacement System is recommended for the immobile patient who lies supine on the bed, the stretcher, or operating room table. This alternating pressure system is unique because it has three separate cells that are not interconnected. It is specifically designed so that deflation of each individual cell will reach a ZERO PRESSURE during each alternating pressure cycle. The superiority of this system has been documented by comprehensive clinical studies in which this system has been compared to the standard hospital bed as well as to two other commercially available pressure relief mattresses. The most recent advance in pressure ulcer prevention is the development of the ALTERN8* seating system. This seating system provides regular periods of pressure relief and stimulation of blood flow to skin areas while users are seated. By offering the combination of pressure relief therapy and an increase in blood flow, the ALTERN8* reportedly creates an optimum pressure ulcer healing environment. Foam is the most commonly used material for pressure reduction and pressure ulcer prevention and treatment for the mobile individual. For those immobilized individuals who can achieve a passive standing position, a powered wheelchair that allows the individual to achieve a passive standing position is recommended. The beneficial effects of passive standing have been documented by comprehensive scientific studies. These benefits include reduction of seating pressure, decreased bone demineralization, increased blander pressure, enhanced orthostatic circulatory regulation, reduction in muscular tone, decrease in upper extremity muscle stress, and enhanced functional status in general. In the absence of these dynamic alternating pressure seating systems and mattresses, there are enormous medicolegal implications to the healthcare facility. Because there is not sufficient staff to provide pressure relief to rotate the patient every 2 hours in a hospital setting, with the exception of the intensive care unit, the immobile patient is prone to develop pressure ulcers. The cost of caring for these preventable pressure ulcers may now be as high as 60,000 dollars per patient. The occupational physical strain sustained by nursing personnel in rotating their patients has led to occupational back pain in nurses, a major source of morbidity in the healthcare environment. PMID:15447627
Acute motor sensory polyneuropathy (AMSAN) complicating active ulcerative colitis with a patchy distribution.
Zezos, Petros; Mpoumponaris, Alexandros; Koutsopetras, Petros; Vounotrypidis, Periklis; Molyvas, Epaminondas; Vadikolias, Konstantinos; Moschos, Ioannis; Kouklakis, Georgios
We report a case of acute motor and sensory neuropathy during a flare of ulcerative colitis. A 28-year-old male presented with a flare of distal ulcerative colitis despite treatment with mesalamine enemas and suppositories simultaneously with rapidly deteriorating weakness and needle sensation in both legs. Neurological assessment showed axonal sensorimotor polyneuropathy affecting mainly the lower limbs and to a lesser extent the upper limbs. Colonoscopy revealed moderately to severe active ulcerative colitis with a patchy distribution involving the rectum and the right colon. Vitamin and folic acid levels were normal. Virological, immunological and other laboratory tests were negative except for positive anti-ganglioside antibodies (anti-GM1). Ulcerative colitis and polyneuropathy improved when patient was treated with immunosuppressive therapy (corticosteroids, immunoglobulin and azathioprine). Peripheral polyneuropathy is a rare extraintestinal manifestation of ulcerative colitis and it is probably associated with an autoimmune pathogenetic mechanism. PMID:17715640
Diabetic foot ulcerations: an overview.
Daniels, T R
The development of a diabetic neuropathic ulcer is a multifactorial process with an emphasis on mechanical abnormalities. In the absence of vascular compromise, up to 90 percent of neuropathic ulcers will heal with proper ulcer debridement, treatment of infection and relief of weight from the ulcerated area. A thorough understanding of the etiology of a neuropathic ulcer is an essential component in the appropriate management of these patients. Treatment of the diabetic neuropathic ulcer is a multidisciplinary clinical problem and each member of the team has a unique role to play. PMID:9866607
Young, J R
Systemic causes of leg edema include idiopathic cyclic edema, heart failure, cirrhosis, nephrosis and other hypoproteinemic states. Lymphedema may be primary, or secondary to neoplasm, lymphangitis, retroperitoneal fibrosis and, rarely (in the U.S.), filariasis. Thrombophlebitis and chronic venous insufficiency are not uncommon causes. Finally, infection, ischemia, lipedema, vascular anomalies, tumors and trauma can be responsible for the swollen leg. PMID:188330
Restless legs syndrome (RLS) is a nervous system problem that causes you to feel an unstoppable urge to get ... There is no specific test for restless legs syndrome. Your health ... do a physical exam. You may have blood tests and other exams ...
Ahmed, W; Qureshi, H; Alam, S E; Zuberi, S J
Of 138 endoscopically or surgically confirmed cases of gastric ulcer, 102 (74%) were males and 36 (26%) females. Both sexes were affected most commonly in the 6th decade of life. Pain, vomiting and gastrointestinal bleeding were the major presenting symptoms, with a median duration of 6 months. Cigarette smoking was the most common (44%) addiction and 10% were on analgesics or nonsteroidal anti-inflammatory drugs (NSAID). Family history of ulcer was uncommon (2%) and no predilection for any blood group was noted. Among males 53% were skilled workers while 94% of females were housewives. Forty five percent patients were migrants from India and the rest belonged to different provinces of Pakistan. Presentation and behaviour of different sites of gastric ulcers though varied but the results were not significant. Healing rates with H2 receptor antagonists were 33% at 4 weeks and 78% at 8 weeks. PMID:1433804
Venous ulcers of the lower limb: Where do we stand?
Chatterjee, Sasanka S
Venous ulcers are the most common ulcers of the lower limb. It has a high morbidity and results in economic strain both at a personal and at a state level. Chronic venous hypertension either due to primary or secondary venous disease with perforator paucity, destruction or incompetence resulting in reflux is the underlying pathology, but inflammatory reactions mediated through leucocytes, platelet adhesion, formation of pericapillary fibrin cuff, growth factors and macromolecules trapped in tissue result in tissue hypoxia, cell death and ulceration. Duplex scan with colour flow is the most useful investigation for venous disease supplying information about patency, reflux, effects of proximal and distal compression, Valsalva maneuver and effects of muscle contraction. Most venous disease can be managed conservatively by leg elevation and compression bandaging. Drugs of proven benefit in venous disease are pentoxifylline and aspirin, but they work best in conjunction with compression therapy. Once ulceration is chronic or the patient does not respond to or cannot maintain conservative regime, surgical intervention treating the underlying venous hypertension and cover for the ulcer is necessary. The different modalities like sclerotherapy, ligation and stripping of superficial varicose veins, endoscopic subfascial perforator ligation, endovenous laser or radiofrequency ablation have similar long-term results, although short-term recovery is best with radiofrequency and foam sclerotherapy. For deep venous reflux, surgical modalities include repair of incompetent venous valves or transplant or transposition of a competent vein segment with normal valves to replace a post-thrombotic destroyed portion of the deep vein. PMID:23162226
... days. Before leaving the hospital, you will begin learning how to: Use a wheelchair or a walker Stretch your muscles to make them stronger Strengthen your arms and legs Begin walking with a walking aid and parallel bars Start ...
NSDL National Science Digital Library
This specimen of the horseshoe crab Mesolimulus displays the impression of three segmented arms. Although capable of walking on these legs, modern horseshoe crabs use them mainly for burrowing for prey (clams and worms).
[Conservative therapy of peptic ulcer].
Clémençon, G H
Ulcer disease is the product of different pathogenetic mechanisms which destroy the balance between protection and aggregation in the human organism. Investigation of such errors of physiologic balance in the human organism is in full swing, and has provided the theoretical elements for appropriate therapy. Therapy for ulcer disease must take into consideration the patient's personality as well as the surrounding conditions. Though duodenal and gastric ulcer show many different characteristics, therapy does not greatly differ. Food and antacids neutralize hydrochloric acid already produced and bind bile acids and other substances which have been regurgitated from the duodenum into the stomach. Furthermore, very potent inhibitors of acid secretion are available, such as the H2-receptor-antagonist cimetidine, and pirenzepine. Antacids, inhibitors of acid secretion and placebo may lead to disappearance of symptoms, but it should be borne in mind that abut one third of patients with an ulcer recurrence remain asymptomatic. Pain and other symptoms of active ulcer disease usually disappear as early as a few days after initiating therapy. On average the healing ratio of ulcers is higher with pharmacologically active substances than with placebo. In the present state of knowledge, endoscopic follow-up of ulcer disease is to be recommended not only because active ulcer disease and ulcer recurrences may be asymptomatic, but, above all, because of the risk of malignancy in gastric ulcer. PMID:6106967
Persistent nicorandil induced oral ulceration
Healy, C M; Smyth, Y; Flint, S R
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. PMID:15201264
Macular lymphocytic arteritis: first clinical presentation with ulcers.
Llamas-Velasco, M; García-Martín, P; Sánchez-Pérez, J; Sotomayor, E; Fraga, J; García-Diez, A
Macular lymphocytic arteritis describes a recently reported entity, clinically characterized by asymptomatic hyperpigmented macules on the lower limbs, without association of systemic diseases. Histopathologically it is characterized by a lymphocytic arteritis with a hyalinized fibrin ring. We report a new case presenting with ulceration, a finding not previously described. A 25-year-old Hispanic woman was evaluated for a 1-year history of a gradually progressive, asymptomatic eruption that begins at level of both knees and progressively affects both legs and feet. She also referred recently appeared ulcers on inner right ankle without previous traumatism. Physical examination revealed multiple fairly well-defined light brown and faint pink patches with petechiae on as well as retiform crusts and livedoid lesions on inner right ankle. Both types of lesions were biopsied showing lymphocytic arteritis with fibrinoid necrosis and thrombus. There were no relevant laboratory alterations. The clinical peculiarity of our case is the clinical image of the lesions mimicking a pigmented purpuric dermatosis and the presence of a non-traumatic ulcer which could be explained because chronic lymphocytic damage may cause ischemic damage. Ulceration in our case supports consideration of macular arteritis as a latent form of cutaneous polyarteritis nodosa. PMID:23384039
Metastable legged-robot locomotion
Byl, Katie
A variety of impressive approaches to legged locomotion exist; however, the science of legged robotics is still far from demonstrating a solution which performs with a level of flexibility, reliability and careful foot ...
... Certain medications may also cause your legs to swell: Antidepressants, including MAO inhibitors (such as phenelzine and ... ask questions like the following: What body parts swell? Your ankles, feet, legs? Above the knee or ...
NASA Astrophysics Data System (ADS)
Li, Chen; Umbanhowar, Paul; Komsuoglu, Haldun; Koditschek, Daniel; Goldman, Daniel
To understand how and why animals modulate foot kinematics to achieve effective locomotion on granular media, we study the speed of a six-legged robot with c-shaped legs, SandBot, moving on granular media for varying volume fraction, ?, limb frequency, f, and gait timing parametersfootnotetextLi et. al, PNAS, 106, 3029, 2009. Speed is determined by step length which in turn depends on limb penetration. At low f and high ? penetration is small, step length is large, and SandBot advances with a rotary walking gait in which c-legs rotate about their centers by slipping relative to stationary grains. In the opposite extreme, grains cannot support the robot; its underside always contacts the ground and it advances slowly via thrust generated as the c-legs translate through the grains. For varied gait parameters, high speeds are only observed in a small area of parameter space. A yield stress based model predicts the speed and reveals that performance is maximized when gait parameters minimize limb acceleration and interference, and limbs utilize the solidification properties of the media.
NASA Astrophysics Data System (ADS)
Li, Chen; Umbanhowar, Paul; Komsuoglu, Haldun; Koditschek, Daniel; Goldman, Daniel
To understand how and why animals modulate foot kinematics to achieve effective locomotion on granular media, we study the speed of a six-legged robot with c-shaped legs, SandBot, moving on granular media for varying volume fraction, ?, limb frequency, f, and gait timing parameters.footnotetextLi et. al, PNAS, 106, 3029, 2009 Speed is determined by step length which in turn depends on limb penetration. At low f and high ? penetration is small, step length is large, and SandBot advances with a rotary walking gait in which c-legs rotate about their centers by slipping relative to stationary grains. In the opposite extreme, grains cannot support the robot; its underside always contacts the ground and it advances slowly via thrust generated as the c-legs translate through the grains. For varied gait parameters, high speeds are only observed in a small area of parameter space. A yield stress based model predicts the speed and reveals that performance is maximized when gait parameters minimize limb acceleration and interference, and limbs utilize the solidification properties of the media.
Timir Datta; Pamela Abshire; John A. Turner
We describe a substrate for a Legged Chip, a CMOS integrated circuit with built in actuation mechanisms for motion. We have designed and fabricated a custom integrated circuit using a commercial 0.5?m CMOS technology which implements walking gait control. The circuit specifications and physical implementation have been designed to take into consideration the addition of thermal actuators through low- temperature
Leg lengthening and shortening
BONE LENGTHENING This series of treatments involves several surgeries, a long recovery period, and a number of risks. However, it can add up to 6 inches of length to a leg. The child will be under general anesthesia. This means the child is asleep ...
Playing soccer with legged robots
Manuela Velosot; William Uthert; M. Fijita; Minoru Asadas; H. Kitano
Sony has provided a remarkable platform for research and development in robotic agents, namely fully autonomous legged robots. In this paper, we describe our work using Sony's legged robots to participate at the RoboCup'98 legged robot demonstration and competition. Robotic soccer represents a very challenging environment for research into systems with multiple robots that need to achieve concrete objectives, particularly
Leg size and muscle functions associated with leg compliance
NASA Technical Reports Server (NTRS)
Convertino, Victor A.; Doerr, Donald F.; Flores, Jose F.; Hoffler, G. Wyckliffe; Buchanan, Paul
The relationship between the leg compliance and factors related to the size of leg muscle and to physical fitness was investigated in ten healthy subjects. Vascular compliance of the leg, as determined by a mercury strain gauge, was found to be not significantly correlated with any variables associated with physical fitness per se (e.g., peak O2 uptake, calf strength, age, body weight, or body composition. On the other hand, leg compliance correlated with the calf cross-sectional area (CSA) and the calculated calf volume, with the CSA of calf muscle being the most dominant contributing factor (while fat and bone were poor predicators). It is suggested that leg compliance can be lowered by increasing calf muscle mass, thus providing structural support to limit the expansion of leg veins.
Pressure ulcer good practice published.
Patients admitted to hospital or a nursing home should have a pressure ulcer risk assessment within six hours of admission, the National Institute for Health and Care Excellence has said. PMID:26080953
Colonic motility in ulcerative colitis
Antonelli, Elisabetta; Villanacci, Vincenzo; Baldoni, Monia; Dore, Maria Pina
Background Inflammatory conditions affecting the gut may cause motility disturbances, and ulcerative colitis – one of the main disorders among the inflammatory bowel diseases – may display abnormal colonic motility. Aim To review the abnormalities of the large bowel in ulcerative colitis, by considering the motility, laboratory (in vitro) and pathological studies dealing with this topic. Methods A comprehensive online search of Medline and the Science Citation Index was carried out. Results Patients with ulcerative colitis frequently display colonic motor abnormalities, including lack of contractility, an increase of propulsive contractile waves, an excessive production of nitric oxide, vasoactive intestinal polypeptide nerves, interleukin 1 beta, neurotensin, tachykinins levels and the weaker action of substance P, likely related to a neuromuscular dysfunction due to the inflammatory process. Conclusions A better understanding of the pathophysiological grounds of altered colonic motility in ulcerative colitis may lead to a more in-depth knowledge of the accompanying symptoms and to better and more targeted therapeutic approaches. PMID:25452840
Laparoscopic Surgery for Ulcerative Colitis
Stocchi, Luca
Laparoscopic techniques have become increasingly used in the treatment of ulcerative colitis: in experienced hands, they are safe and feasible. Recovery advantages have not been consistently demonstrated and functional results have been comparable to open surgery. Other possible benefits and costs issues have also been inconsistent. Further investigation on the role of laparoscopic surgery for ulcerative colitis with larger populations and longer follow-up with a focus on recovery parameters, quality of life, and costs are needed. PMID:22131895
Quality of life in patients with venous stasis ulcers and others with advanced venous insufficiency.
Tracz, Edyta; Zamojska, Ewa; Modrzejewski, Andrzej; Zaborski, Daniel; Grzesiak, Wilhelm
The quality of life (QoL) in patients with advanced venous insufficiency (including venous stasis ulcers, skin discoloration, stasis eczema, and lipodermatosclerosis) assessed using the Clinical Etiological Anatomical Pathophysiological (CEAP) and Venous Clinical Severity Score (VCSS) classifications is presented. Also, disease features such as: intensity of pain, edema and inflammatory response that exerted the most profound effect on different domains of QoL are reported. The global QoL in patients with lower leg venous ulcerations was relatively similar to that observed in other patients with chronic venous insufficiency. The presence of venous ulcerations was associated with lower QoL in a Physical domain. Significant correlations were found between pain intensity and the values of Physical, Physiological, Level of Independence and Environmental domains, between edema intensity and Social domain as well as between the intensity of inflammatory response and Physical and Spiritual domains. PMID:25658932
LEGS data acquisition facility
LeVine, M.J.
The data acquisition facility for the LEGS medium energy photonuclear beam line is composed of an auxiliary crate controller (ACC) acting as a front-end processor, loosely coupled to a time-sharing host computer based on a UNIX-like environment. The ACC services all real-time demands in the CAMAC crate: it responds to LAMs generated by data acquisition modules, to keyboard commands, and it refreshes the graphics display at frequent intervals. The host processor is needed only for printing histograms and recording event buffers on magnetic tape. The host also provides the environment for software development. The CAMAC crate is interfaced by a VERSAbus CAMAC branch driver.
Control of a Bow Leg Hopping Robot
Ben Brown; Garth Zeglin
The bow leg hopper is a new design for a locomoting system with a resilient, flexible leg. It features a passive stance phase and natural pitch stability. It is controlled with actuators that configure the leg angle and stored leg energy during flight. During stance, the actuators are me- chanically decoupled from the leg and the stored energy is released.
Droste, Dirk W; Diederich, Nico
About 7% of the population are affected by the restless legs syndrome (RLS). The most invalidating subjective complaints are dysesthesia / pain / an urge to move the legs (46%), an alteration of sleep (38%), and difficulties in performing activities of daily life (7%). The onset of the disease is variable, ranging from childhood (often unrecognised) to old age. The clinical course is generally chronic with phases of spontaneous remission. The cause of RLS is probably mainly genetic with a dysfunction of iron and dopamine metabolism accentuated by peripheral factors (neuropathy, radiculopathy, and temperature). There are secondary forms of RLS, such as iron deficiency (under debate), side effects of drugs (that can be stopped), renal insufficiency, radiculopathy, and neuropathy. RLS can come up during pregnancy, in particular in the last trimenon. Treatment of aggravating factors and sleep hygiene are general measures. Drug treatment of the RLS comprises levodopa, dopaminergic drugs, opioids, and antiepileptic drugs; however, drug treatment is only necessary in about a third of the affected. PMID:17953080
Inclined leg jack-up platform with flexible leg guides
Goldman, J.; Bennett, R.M.
This patent describes an offshore platform assembly. It comprises a floatable hull having wells extending vertically therethrough; a plurality of inclined supporting legs secured to the hull and movable between a first, retracted position and a second, hull supporting position; flexible guide means for absorbing bending moments and forces acting on a leg chord of a corresponding leg which moves through a flexible guide means during elevation of the hull, each of the guide means being positioned in a corresponding well of the hull; means for elevating the hull with respect to the supporting legs; and wherein each of the flexible guide means is movable to a limited degree along a horizontal plane to absorb bending moments and forces acting on a corresponding leg while the hull is being elevated to an operating level.
Differentiating nocturnal leg cramps and restless legs syndrome.
Rana, Abdul Qayyum; Khan, Fatima; Mosabbir, Abdullah; Ondo, William
Leg pain and discomfort are common complaints in any primary physician's clinic. Two common causes of pain or discomfort in legs are nocturnal leg cramps (NLC) and restless leg syndrome (RLS). NLC present as painful and sudden contractions mostly in part of the calf. Diagnosis of NLC is mainly clinical and sometimes involves investigations to rule out other mimics. RLS is a condition characterized by the discomfort or urge to move the lower limbs, which occurs at rest or in the evening/night. The similarity of RLS and leg cramps poses the issue of errors in diagnosing and differentiating the two. In this paper we review the pathopysiology of each entity and their diagnosis as well as treatment. The two conditions are then compared to appreciate the differences and similarities. Finally, suggestions are recommended for complete assessment. PMID:24931546
Options for Treating Restless Legs Syndrome
... Consumer Summary – Aug. 30, 2013 Options for Treating Restless Legs Syndrome Formats View PDF (PDF) 759 kB Download Audio ( ... or physician assistant. Understanding Your Condition What is restless legs syndrome? Restless legs syndrome (RLS) is a disorder of ...
Karroum, E; Konofal, E; Arnulf, I
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
Ulcerative Lichen Planus in Childhood
Padmini, Chiyadu; Bai, K. Yellamma; Chaitanya, Vinil; Reddy, M. Shilpa
Lichen planus (LP) is a chronic inflammatory mucocutaneous condition which is relatively common in adults but rarely affects children. The present study is a report on an unusual case of ulcerative oral LP involving the dorsum of tongue in a 12-year-old boy. Patient complained of painful oral lesion on the tongue which was burning in nature and obstructing talking and eating spicy foods. On intraoral examination, a white ulcerative lesion on the dorsum of tongue was observed. Diagnosis was made based on clinical examination and histopathological features. We instituted local treatment and patient responded well to the treatment. Although rarely reported in childhood, lichen planus should be considered in a differential diagnosis of hyperkeratotic, reticular, and ulcerative lesions of the oral mucosa in children. PMID:24455324
Kayexalate-induced colonic ulcer.
Albeldawi, Mazen; Gaur, Varun; Weber, Luke
A 61-year-old male presents to the emergency room with complaints of fatigue, dizziness and bright red blood per rectum (BRBPR) for 2 days. Past medical history was significant for gastroesophageal reflux disease, non-steroidal anti-inflammatory drug (NSAID) induced ulcer, and end-stage renal disease (GFR < 30) status post 2 failed renal grafts. Pertinent medications include pantoprazole and sodium polystyrene sulfonate in sorbitol (Kayexalate 30 g/d orally). On esophagogastroduodenoscopy (EGD) there was a single shallow, flat, non-bleeding gastric ulcer (3 mm) in the pre-pyloric region of the stomach with no stigmata of bleeding. A colonoscopy was performed showing evidence of colitis and localized ulcerations in the cecum which were biopsied. Histopathology revealed basophilic, nonpolarizable, rhomboid-like crystals without evidence of necrosis. PMID:24759345
Benign gastric ulceration in pernicious anemia
J. Reid; T. V. Taylor; S. Holt; R. C. Heading
Summary Benign gastric ulceration occurred in a patient with pernicious anemia in association with aspirin therapy. Previous reports of benign gastric ulceration in patients with achlorhydria are reviewed, and the potential role of aspirin in the pathogenesis of benign ulceration in the absence of acid is discussed.
Aspirin, gastrointestinal bleeding, and peptic ulcer
M. Levrat; R. Lambert
Summary 1. We have observed 52 cases of digestive attacks provoked by aspirin; 13 were cases of nonhemorrhagic peptic ulcer with 1 perforated ulcer; 39 were cases of gastrointestinal hemorrhage.2. Among the hemorrhages, radiological proof of the peptic ulcer was obtained in 15 cases, and X-ray evidence was noted in 21 cases (isolated hemorrhages). In the 3 cases of the latter
Acute Pancreatitis Due to a Duodenal Ulcer
Pyeon, Sung Ik; Kim, Yong Tae; Lee, Ban Seok; Lee, Sang Ho; Lee, Jae Nam; Cheong, Jae Hoon; Oh, Kong Jin
Duodenal ulcers and acute pancreatitis are two of the most commonly encountered gastrointestinal diseases among the general population. However, duodenal ulcer-induced pancreatitis is very rarely reported worldwide. This report elaborates on a distinct medical treatment that contributes to partial or complete treatment of acute pancreatitis induced by a duodenal ulcer scar. PMID:25505728
Leg discomfort: beyond the joints.
Berger, Douglas
Although simple characterization of discomfort as cramps, heaviness, shooting pains, and so forth can be misleading, history and examination are key to accurate diagnosis. Absence of both dorsalis pedis and posterior tibial pulses strongly suggests peripheral arterial disease (PAD), and the presence of either pulse makes PAD less likely. Hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) are a common cause of lower extremity myalgias. Restless legs syndrome causes nocturnal discomfort but must be distinguished from confounding"mimics." Neurologic causes of leg symptoms include lumbar spinal stenosis, radiculopathy, distal symmetric polyneuropathy, and entrapment neuropathy. Many common causes of leg discomfort can be managed conservatively. PMID:24758955
Oesophageal ulcer caused by warfarin.
Loft, D. E.; Stubington, S.; Clark, C.; Rees, W. D.
Oesophageal injury is a well recognized complication of certain oral medications but warfarin has not been implicated previously. We present a case of an oesophageal ulcer occurring in a patient with mitral regurgitation taking warfarin, and demonstrate a delayed oesophageal tablet transit time. PMID:2594605
Design of robotic quadruped legs
McKenzie, Jacob Elijah
Prized for their performance on prepared surfaces, wheeled vehicles are often limited in mobility by rough and unstructured terrain. Conversely, systems that rely on legs have shown promising rough terrain performance but ...
Stoffregen, Thomas A.; Chen, Fu-Chen; Varlet, Manuel; Alcantara, Cristina; Bardy, Benoît G.
Sea travel mandates changes in the control of the body. The process by which we adapt bodily control to life at sea is known as getting one's sea legs. We conducted the first experimental study of bodily control as maritime novices adapted to motion of a ship at sea. We evaluated postural activity (stance width, stance angle, and the kinematics of body sway) before and during a sea voyage. In addition, we evaluated the role of the visible horizon in the control of body sway. Finally, we related data on postural activity to two subjective experiences that are associated with sea travel; seasickness, and mal de debarquement. Our results revealed rapid changes in postural activity among novices at sea. Before the beginning of the voyage, the temporal dynamics of body sway differed among participants as a function of their (subsequent) severity of seasickness. Body sway measured at sea differed among participants as a function of their (subsequent) experience of mal de debarquement. We discuss implications of these results for general theories of the perception and control of bodily orientation, for the etiology of motion sickness, and for general phenomena of perceptual-motor adaptation and learning. PMID:23840560
Helicobacter pylori and peptic ulcer disease.
Feldman, M; Peterson, W L
Medical therapy for duodenal or gastric ulcer disease has traditionally involved gastric acid antisecretory therapy for 4 to 8 weeks to promote initial healing and indefinitely to prevent recurrences of ulcer. The discovery of Helicobacter pylori in most patients with peptic ulcer disease has led to a change in this approach. Therapy designed to eradicate H pylori may facilitate ulcer healing with acid antisecretory agents and, more important, may greatly reduce the incidence of ulcer recurrence, obviating the need for maintenance antisecretory therapy. Regimens designed to eradicate H pylori are difficult to comply with, however, and are associated with adverse effects in some patients. In this article we review the diagnosis and treatment of H pylori infection in patients with peptic ulcer disease and make recommendations regarding the use of conventional ulcer therapies and therapies designed to eradicate H pylori. PMID:8279151
Prevention and management of diabetic foot ulcers.
Turns, Martin
As part of an annual foot review, trained and competent personnel should examine patients' feet to detect risk factors for ulceration. Foot examination with shoes and stockings removed should include: palpation of foot pulses; testing foot sensations using 10g monofilament or vibration; inspection for significant callus or deformed nails; inspection for any structural deformity; asking about any previous ulceration; checking for signs of ulceration; asking about any pain; and inspecting footwear. Following assessment, a foot risk classification score should be given. The person with diabetes should then be informed of their risk score, with education offered regarding future foot-care management. Diabetic foot complications include ulceration, Charcot foot, painful neuropathy, gangrene and amputation. Risk factors for ulceration include non-palpable pulses, insensate foot, significant callus, deformed nails, history of previous ulcer or amputation, tissue damage or signs of ulceration, foot pain and unsuitable footwear. PMID:25757381
Leg recirculation in horizontal plane locomotion
A. Wickramasuriya; J. Schmitt
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
Mileti?, Vladimir; Relja, Maja
Being of the most frequent causes of insomnia, which in the end leads to chronic fatigue, inadequate performance of daily activities, and serious disruption of quality of living, restless legs syndrome (RLS) is nowadays not only a serious medical problem but a socio-economical one as well. Prevalence of the disorder in general population is estimated at 5 to 15%. Family history is positive in over 50% of idiopathic RLS patients which points to genetic basis of the disorder. The characteristics of the secondary or acquired form of RLS are symptoms that start later in life as well as a rapid progression of the disease. On the other hand, idiopathic RLS more often starts at a younger age and the prognoses are better. Over twenty disorders and conditions are brought in connection with secondary RLS. Although the cause of primary RLS is still unknown, there is a strong connection between central metabolism of iron as well as dopamine levels and RLS manifestation. A differential diagnosis of RLS includes a wide specter of motor and sensory disorders. Diagnosis is based on clinical features and the history of disease. To correctly diagnose idiopathic RLS one must first eliminate secondary causes of RLS and then also exclude any disorders with clinical features that mimic those of RLS. It has been estimated that some 20 to 25% of patients need pharmacological therapy. Best initial therapy is the application of nonergot dopamine agonists. Anticonvulsants, benzodiazepines and opioides can be given to patients who are refractory to dopaminergic therapy, those suffering from RLS with emphasized painful sensory component and those with RLS connected with insomnia. PMID:22397285
Cancer complicating chronic ulcerative and scarifying mucocutaneous disorders
Kaplan, R.P. (Univ. of California, Los Angeles (USA))
Skin affected by a burn cancer is scarred, ulcerated, and often appears as erythema ab igne clinically in adjacent skin. The latent period in burn scar malignancy is much longer for SCC than BCC. Malignant melanoma and various sarcomas are reported to arise in burn scars, too. The other extreme on the temperature scale can less often result in enough permanent acral damage that poor wound healing may eventually result in cancer, usually SCC. About 1% of patients with chronic osteomyelitis develop cancer, usually SCC in sinus tracts. As with tumors arising in burn scars and chronic leg ulcers of varied etiology, black patients are disproportionately overrepresented in osteomyelitic malignancy. In nearly all of the patients with radiation-induced skin cancer, concomitant radiodermatitis is present. As with burn scar and osteomyelitic cancer, x-ray related cancer has a long latent period. Similar to burn scar cancer, SCC predominates in osteomyelitis and occurs on the extremities. BCC, when it arises, is more common on the face and neck in burn- and radiation-induced tumors. Multiple tumors are frequent as is recurrence in x-ray malignancy. Mortality is high: one out of three to four patients with burn scar, osteomyelitic, and radiation cancer die of dermatosis-related malignancy. Recently, radioactivity-contaminated gold rings have been implicated in causing SCC. Carcinoma tends to occur in irradiated benign dermatoses whereas sarcomas tend to complicate irradiated malignancies. Stasis ulceration and anogenital fistulae may rarely lead to cancer, SCC in the former and adenocarcinoma in the latter. SCC can rarely develop in four related conditions (acne conglobata, dissecting perifolliculitis of the scalp, hidradenitis suppurativa, and pilonidal sinus) after a lengthy latent period; prognosis is poor with a high metastatic rate. 147 references.
Management of ulcers in lymphoedematous limbs
Karnasula, Vishnu M.
Lymphoedema is a progressive condition that can have a marked physical and psychological impact on affected patients and significantly reduce the quality of life. The ulcers on chronic lymphoedema patient, which often also makes it impossible for them to work. If left untreated, tends to progress or worsen. Ulcers in lymphoedema patients, therefore, represent not only a medical but also a psychological problem. The treatment is often regarded as being worse than it actually is. In our study of more than 25 years shows around 10% cases are due to chronic lymphodema. Ulcers of chronic lymphoedema are classified into four stages according to their presentation. Their management depends upon their stage of presentation. Patients with chronic lymphoedema and ulceration require a different approach to treatment. The specific issues associated with managing the patient with lymphoedematous ulceration include, limb shape distortion i.e., elephantiasis, care of the skin creases and folds, and swelling of the toes and fore foot. Stage I ulcers will heal with conservative treatment without any surgical intervention. Stage II ulcers needs debridement of the wound and split-thickness skin grafting. The most difficult to treat are the stage III and IV ulcers, due to associated skin changes and reduced vascularity. These cases need debulking along with excision of the ulcer. In order to prevent recurrence of the ulcer in all the four stages needs prolonged follow-up and limb care. PMID:23162225
Endoscopic management of peptic ulcer disease.
Laws, H L; McKernan, J B
OBJECTIVE: This article reviews the authors' experience with endoscopic management of duodenal ulcer and ulcers occurring after a previous drainage procedure. SUMMARY BACKGROUND DATA: Patients with complications of duodenal ulcer and ulcers occurring after a previous drainage procedure still require surgical management. Virtually all operations for duodenal ulcer include some form of vagotomy. American surgeons in academic centers prefer highly selective vagotomy in suitable candidates. Video-directed laparoscopic and thoracoscopic operations have been done for all complications of duodenal ulcer except for acute hemorrhage. METHODS: The authors have performed laparoscopic operation on eight patients with intractable chronic duodenal ulcer, seven patients with gastroesophageal reflux disease combined with duodenal ulcer, one patient with chronic duodenal ulcer and gastric outlet obstruction, and one patient with acute perforation. Operations performed included omentopexy, anterior seromyotomy plus post truncal vagotomy, and highly selective vagotomy. Seven patients had a simultaneous Nissen fundoplication; and the patient with obstruction underwent concomitant pyloroplasty and vagotomy. Six patients with intestinal ulcers occurring after a previous drainage procedure were treated with thoracoscopic vagotomy. Techniques used are shown. RESULTS: There has been one recurrent ulcer in the laparoscopic group after anterior seromyotomy plus posterior truncal vagotomy. The patient treated by omentopexy for duodenal perforation recovered gastrointestinal function promptly with no further difficulty, but eventually died of primary medical disease. Patients undergoing thoracoscopic vagotomy have all become asymptomatic. Postoperative hospital stay after highly selective vagotomy, anterior seromyotomy plus posterior truncal vagotomy, or thoracoscopic vagotomy was 1-5 days. CONCLUSIONS: Laparoscopic management of duodenal ulcers is feasible. Larger numbers of patients with longer follow-up are essential. Ulcers occurring after a drainage procedure deserve thoracoscopic vagotomy. PMID:8489318
[Digital ulcers in systemic scleroderma].
Belz, D; Hunzelmann, N; Moinzadeh, P
Digital ulcers (DU's) are one of the main symptoms of systemic scleroderma and occur in approximately 60% of all scleroderma patients. Due to possible complications such as infections, gangrene or amputation, they require regular medical attention and a good wound treatment by doctors and nursing staff. A definition of DU's has not yet been established. In 2009 the European League Against Rheumatism (EULAR) published guidelines for the treatment of DU's. An improvement of the healing of active ulcers has been described with Iloprost. Bosentan significantly reduced the frequency of occurrence of new DU's. In some small studies PDE-5 inhibitors appear helpful. Further studies with other therapeutic approaches will follow in the next few years. PMID:25336296
Cancer morbidity in ulcerative colitis
P Prior; S N Gyde; J C Macartney; H Thompson; J A Waterhouse; R N Allan
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
Broberger, Ove; Perlmann, Peter
Sera from 30 children, suffering from ulcerative colitis, were examined for the presence of antibodies capable of reacting with antigens of normal human tissue. It was possible to demonstrate that most of the sera contained a precipitating and hemagglutinating factor, reacting with a constituent of human colonic tissue. This constituent was obtained, within 1 hour after death, from colonic tissue of newborn babies who had died without feeding. It could also be prepared from fetal tissue. The antigen can be extracted with phenol-water at 65°C. and seems to be a polysaccharide. The precipitating factor in the sera of the patients behaves electrophoretically as a ?-globulin. Phenol-water extracts from liver and from kidney also reacted positively with the sera from certain patients. There are indications which suggest that the antigen obtained from these tissues is identical with that from colon. Sera from 38 healthy children did not give any reactions with the extracts used. In additional controls, the sera of 32 children with various diseases, all of suspected autoimmune origin, were also tested. A few of these reacted positively with the phenol-water extracts from the organs mentioned above. Most likely, the antigen reacting in these cases is different from that reacting with the antibodies in the sera from patients with ulcerative colitis. The possible role of the antibodies in the pathogenesis of ulcerative colitis and the mechanism of their formation are discussed. PMID:13804543
The effects of sulodexide on both clinical and molecular parameters in patients with mixed arterial and venous ulcers of lower limbs
Serra, Raffaele; Gallelli, Luca; Conti, Angela; De Caridi, Giovanni; Massara, Mafalda; Spinelli, Francesco; Buffone, Gianluca; Caliň, Francesco Giuseppe; Amato, Bruno; Ceglia, Simona; Spaziano, Giuseppe; Scaramuzzino, Luca; Ferrarese, Alessia Giovanna; Grande, Raffaele; de Franciscis, Stefano
Background Mixed venous and arterial ulcers account for approximately 15%–30% of all venous leg ulcerations. Several studies have shown that matrix metalloproteinases (MMPs) and neutrophil gelatinase-associated lipocalin (NGAL) play a central role in the pathophysiology of venous and arterial diseases. Some studies have shown the efficacy of glycosaminoglycans, such as sulodexide (SDX), in treating patients with leg ulcers. The aim of this study was to evaluate clinical effects of SDX and its correlation with MMPs and NGAL expression in patients with mixed arterial and venous leg ulcers. Methods Patients eligible for this study were of both sexes, older than 20 years, and with a clinical and instrumental diagnosis of mixed ulcer. Results Fifty-three patients of both sexes were enrolled and divided into two groups by means of randomization tables. Group A (treated group) comprised 18 females and ten males (median age: 68.7 years) treated with standard treatment (compression therapy and surgery) + SDX (600 lipoprotein lipase-releasing units/day intramuscularly) for 15 days followed by SDX 250 lipase-releasing units every 12 hours day orally for 6 months as adjunctive treatment. Group B (control group) comprised 17 females and eight males (median age: 64.2 years) treated with standard treatment only (compression therapy and surgery). The type of surgery was chosen according to anatomical level of vein incompetence: superficial venous open surgery and/or subfascial endoscopic perforating surgery. In all enrolled patients, blood samples were collected in order to evaluate the plasma levels of MMPs and NGAL through enzyme-linked immunosorbent assay. These results were compared to another control group (Group C) of healthy individuals. Moreover, biopsies of ulcers were taken to evaluate the tissue expression of MMPs and NGAL through Western blot analysis. Our results revealed that SDX treatment is able to reduce both plasma levels and tissue expression of MMPs improving the clinical conditions in patients with mixed ulcers. Conclusion Inhibition of MMPs could represent a possible therapeutic intervention to limit the progression of leg ulceration. In particular, our findings demonstrate the efficacy of SDX in patients with mixed arterial and venous chronic ulcers of the lower limbs. PMID:24872682
Promethus Hot Leg Piping Concept
AM Girbik; PA Dilorenzo
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.
Non-contact optical imaging of healing and non-healing diabetic foot ulcers
NASA Astrophysics Data System (ADS)
Godavarty, A.; Khandavilli, Y.; Jung, Y.-J.; Rao, P. N. S.
Diabetic foot ulcer is the most devastating complication of diabetes that is still un-recognized. The treatment costs of these ulcers are very high to eventually save the leg/foot from amputation. To date, clinicians employ visual inspection of the wound site during its standard 4-week of healing process via monitoring of surface granulation. There is a need to develop on-site, low-cost imaging tools that can monitor the wound healing process periodically during the standard 4-week treatment process. A novel ultra-portable near-infrared optical scanner (NIROS) has been developed at the Optical Imaging Laboratory that can perform non-contact 2D area imaging of the wound site. Non-contact optical imaging studies were carried on diabetic subjects with foot ulcers (at Somesh Diabetic Foot Clinic, India) that were of healing and non-healing nature. A 710 nm LED source and a compact NIR sensitive camera were employed during non-contact imaging of the diabetic foot in order to obtain the near-infrared absorption images. From these preliminary studies it was observed that the non-healing wounds had a greater absorption contrast with respect to the normal site, unlike in the healing wounds. Demonstrating the ability of NIROS to differentiate healing vs. non-healing wounds in diabetic subjects can potentially impact early intervention in the treatment of diabetic foot ulcers.
Lipschütz Genital Ulceration Associated with Mumps
Johan Chanal; Agnčs Carlotti; Hélčne Laude; Nadčge Wallet-Faber; Marie-Françoise Avril; Nicolas Dupin
Lipschütz ulcers are characterised by a first flare of non-sexually related acute genital ulcers (AGU) occurring in adolescent girls. Epstein-Barr primary infection is the most frequently reported aetiology but other infectious agents are probably implicated. We report the first case of mumps associated with an AGU in a 21-year-old girl. She presented a bilateral parotitis with genital ulcers, and serology
Vitamin U therapy of peptic ulcer.
Vitamin U, administered as raw cabbage juice to 100 patients with peptic ulcer, was apparently effective in promoting the rapid healing of uncomplicated peptic ulcers. The evidence of therapeutic benefit was (1) the rapid relief of the symptom, pain, without the use of any set plan of symptomatic treatment, and (2) ulcer crater healing time (determined roentgenographically) considerably shorter than in groups of cases, reported in the literature, in which "standard" types of diet and drug therapy were employed. PMID:13009468
[Differential diagnosis of leg edema].
Fries, R
Both generalized and localized edema needs to be submitted to a differential diagnostic investigation. In the case of edema affecting the lower extremities, in particular the Stemmer sign which is the inability to tent the skin at the dorsum of the toes is a useful distinguishing aid. If there is acute unilateral swelling of a leg, other processes with diffuse space-consuming processes need to be distinguished from deep venous thrombosis and secondary lymphedema. Chronic bilateral leg edema is usually due to a venous flowoff obstruction (stasis edema). Less commonly, lipedema or a primary lymphedema may be responsible for the swelling. PMID:15222499
High Cost of Stage IV Pressure Ulcers
Brem, Harold; Maggi, Jason; Nierman, David; Rolnitzky, Linda; Bell, David; Rennert, Robert; Golinko, Michael; Yan, Alan; Lyder, Courtney; Vladeck, Bruce
Objective To calculate and analyze the cost of treatment for stage IV pressure ulcers. Methods A retrospective chart analysis of patients with stage IV pressure ulcers was conducted. Hospital records and treatment outcomes of these patients were followed for a maximum of 29 months and analyzed. Costs directly related to the treatment of pressure ulcers and their associated complications were calculated. Results Nineteen patients with stage IV pressure ulcers (11 hospital-acquired and 8 community-acquired) were identified and their charts reviewed. The average hospital treatment cost associated with stage IV pressure ulcers and related complications was $129,248 for hospital-acquired ulcers during one admission, and $124,327 for community-acquired ulcers over an average of 4 admissions. Conclusions The costs incurred from stage IV pressure ulcers are much greater than previously estimated. Halting the progression of early stage pressure ulcers has the potential to eradicate enormous pain and suffering, save thousands of lives, and reduce healthcare expenditures by millions of dollars. PMID:20887840
Gastric emptying abnormal in duodenal ulcer
Holt, S.; Heading, R.C.; Taylor, T.V.; Forrest, J.A.; Tothill, P.
To investigate the possibility that an abnormality of gastric emptying exists in duodenal ulcer and to determine if such an abnormality persists after ulcer healing, scintigraphic gastric emptying measurements were undertaken in 16 duodenal ulcer patients before, during, and after therapy with cimetidine; in 12 patients with pernicious anemia, and in 12 control subjects. No difference was detected in the rate or pattern of gastric emptying in duodenal ulcer patients before and after ulcer healing with cimetidine compared with controls, but emptying of the solid component of the test meal was more rapid during treatment with the drug. Comparison of emptying patterns obtained in duodenal ulcer subjects during and after cimetidine treatment with those obtained in pernicious anemia patients and controls revealed a similar relationship that was characterized by a tendency for reduction in the normal differentiation between the emptying of solid and liquid from the stomach. The similarity in emptying patterns in these groups of subjects suggests that gastric emptying of solids may be influenced by changes in the volume of gastric secretion. The failure to detect an abnormality of gastric emptying in duodenal ulcer subjects before and after ulcer healing calls into question the widespread belief that abnormally rapid gastric emptying is a feature with pathogenetic significance in duodenal ulcer disease.
Refractory duodenal ulcers (nonhealing duodenal ulcers with standard doses of antisecretory medication)
Martin J. Collen; Valerie J. Stanczak; Cecelia A. Ciarleglio
To evaluate possible differences between patients with refractory duodenal ulcers and those with duodenal ulcers that respond to standard doses of antisecretory medications, we determined basal acid outputs by nasogastric suction and daily smoking histories in 75 patients with endoscopically documented active duodenal ulcers. Patients were treated for at least eight weeks with standard doses of antisecretory medications and endoscopic
Application of platelet-rich plasma accelerates the wound healing process in acute and chronic ulcers through rapid migration and upregulation of cyclin A and CDK4 in HaCaT cells.
Kim, Sung-Ae; Ryu, Han-Won; Lee, Kyu-Suk; Cho, Jae-We
Application of autologous platelet-rich plasma (PRP) has been used for chronic wound healing. The aim of this study was to evaluate the effect of PRP on the wound healing processes of both acute and chronic ulcers and the underlying molecular mechanisms involved. We treated 16 patients affected by various acute and chronic ulcers with PRP. We performed molecular studies of cell proliferation, migration assays, immunoblotting and chloramphenicol acetyltransferase (CAT) assays in PRP-treated HaCaT keratinocyte cells. PRP treatment induced increased rates of cell proliferation and cell migration of HaCaT cells. In addition, the expression of cyclin A and cyclin dependent kinase (CDK) 4 proteins was markedly increased with a low concentration (0.5%) of PRP treatment in HaCaT cells. In 11 patients with chronic ulcers, including stasis ulcers, diabetic ulcers, venous leg ulcers, livedoid vasculitis, claw foot and traumatic ulcers, 9 patients showed 90-100% epithelization after 15.18 days. In 5 patients with acute ulcers, such as dehiscence, open wound and burn wound, 80-100% epithelization was achieved between 4 to 20 days. Topical application of PRP to acute and chronic skin ulcers significantly accelerated the epithelization process, likely through upregulation of the cell cycle regulatory proteins cyclin A and CDK4. PMID:23242428
Help-Seeking for Pre-Ulcer and Ulcer Conditions of Mycobacterium ulcerans Disease (Buruli Ulcer) in Ghana
Ackumey, Mercy M.; Gyapong, Margaret; Pappoe, Matilda; Weiss, Mitchell G.
This study examined sociocultural features of help-seeking for Buruli ulcer–affected persons with pre-ulcers and ulcers in a disease-endemic area in Ghana. A sample of 181 respondents were purposively selected. Fisher's exact test was used to compare help-seeking variables for pre-ulcers and ulcers. Qualitative phenomenologic analysis of narratives clarified the meaning and content of selected quantitative help-seeking variables. For pre-ulcers, herbal dressings were used to expose necrotic tissues and subsequently applied as dressings for ulcers. Analgesics and left-over antibiotics were used to ease pain and reduce inflammation. Choices for outside-help were influenced by the perceived effectiveness of the treatment, the closeness of the provider to residences, and family and friends. Health education is required to emphasize the risk of self-medication with antibiotics and the importance of medical treatment for pre-ulcers, and to caution against the use of herbs to expose necrotic tissues, which could lead to co-infections. PMID:22144453
Rotational joint for prosthetic leg
NASA Technical Reports Server (NTRS)
Jones, W. C.; Owens, L. J.
Device is installed in standard 30 millimeter tubing used for lower leg prosthetics. Unit allows proper rotation (about 3 degrees) of foot relative to the hip, during normal walking or running. Limited rotational movement with restoring force results in a more natural gait.
NSDL National Science Digital Library
S. Bedell
In this lesson, students are given a variety of materials and are asked to design a heat loss experiment that will result in a reasonable explanation of why whales do not have legs. Students will learn that natural selection favors a body design that is energy efficient.
NSDL National Science Digital Library
Molly Weinburgh
The three "legs" on which science instruction rests are the content of science, process of science, and the nature of science. Each leg performs its own function and need not be competitive with the others. This article uses the metaphor of a three-legged stool to remind teachers that good science instruction must have a balance that is both stable and engaging.
OCEAN DRILLING PROGRAM LEG 179 SCIENTIFIC PROSPECTUS HAMMER DRILLING and NERO Dr. Jack Casey Chief.S.A. Tom Pettigrew Chief Engineer, Leg 179 Ocean Drilling Program Texas A&M University Research Park 1000 Discovery Drive College Station, Texas 77845-9547 U.S.A. Dr. D. Jay Miller Staff Scientist, Leg 179 Ocean
OCEAN DRILLING PROGRAM LEG 100 REPORT NORTHEASTERN GULF OF MEXICO Philip D Rabinowitz Co-Chief Scientist, Leg 100 Ocean Drilling Program Texas A&M University College Station, TX 77843 William J. Merrell Co-Chief Scientist, Leg 100 Ocean Drilling Program Texas A&M University College Station, TX 77843
Water strider robots with microfabricated hydrophobic legs
Kenji Suzuki; Hideaki Takanobu; Kota Noya; Hiroyuki Koike; Hirofumi Miura
This paper discusses biomimetic water strider robots that have microfabricated hydrophobic legs. Various kinds of supporting legs with hydrophobic microstructures on their surfaces were developed using MEMS (micro electromechanical systems) techniques. The lift and pull-off forces of these supporting legs were analyzed theoretically and then measured. The experimental results were in good agreement with the calculations. Two different mechanisms for
Navigation Planning for Legged Robots Thesis Proposal
improvement for legged locomotion, including actuator and mechanism design, balance control and robustnessNavigation Planning for Legged Robots Thesis Proposal Joel Chestnutt The Robotics Institute Hirukawa November 15, 2006 Abstract As legged robots gain the abilities to walk and balance on more than
How Is Restless Legs Syndrome Treated?
... page from the NHLBI on Twitter. How Is Restless Legs Syndrome Treated? Restless legs syndrome (RLS) has no cure. If a condition or ... effects. Rate This Content: NEXT >> November 1, 2010 Restless Legs Syndrome Clinical Trials Clinical trials are research studies that ...
Colonoscopic evaluation in ulcerative colitis
Paine, Elizabeth R.
Colonoscopic evaluation is an important tool in the evaluation of ulcerative colitis (UC). UC is divided by disease extent into proctitis, proctosigmoiditis, left-sided colitis, and pan-colitis. In addition, a cecal or peri-appendiceal patch and backwash ileitis are associated with UC. The extent and behavior of UC has been characterized further using various indices and scoring systems; among these systems is the Mayo Score, which is widely used in current clinical trials for new medications. As these medical therapies for UC have developed, achieving mucosal healing with medications has become an important therapeutic objective. PMID:24879406
Operative Debridement of Pressure Ulcers
Jessica Schiffman; Michael S. Golinko; Alan Yan; Anna Flattau; Marjana Tomic-Canic; Harold Brem
Background Infection in severe pressure ulcers can lead to sepsis with a 6-month mortality as high as 68%.\\u000a \\u000a \\u000a \\u000a Methods Operative records of 142 consecutive operative debridements on 60 patients in a dedicated wound healing inpatient unit were\\u000a reviewed, from the Wound Electronic Medical Record, for identification of key steps in debridement technique, mortality, unexpected\\u000a returns, and time to discharge following debridement.\\u000a \\u000a \\u000a \\u000a Results The
Arterial thrombosis in ulcerative colitis: Case report
Dimitrios A. Mikroulis; George D. Antypas; Spyridon D. Fournogerakis; Paul N. Antoniadis; Anastasios M. Rigas
Arterial thrombosis is a rare complication of ulcerative colitis with many difficulties in its treatment. The pathogenesis of thrombosis is not well known and many factors are implicated such as elevated fibrinogen, increased platelet count, and decreased antithrombin III levels. We report a case of a 43-year-old man with ulcerative colitis and sudden and refractory thrombosis of the brachial and
Ulcerative colitis flare with splenic ven thrombosis
Bozkurt, Huseyin Sancar; Kara, Banu; Citil, Serdal
Patients with ulcerative colitis (UC) have an increased risk of thromboembolic events. Here, we present a 28-year-old man with active ulcerative pancolitis presenting via splenic vein thrombosis and left renal superior infarct that was not associated with a surgical procedure.
Vesicular, ulcerative, and necrotic dermatitis of reptiles.
Maas, Adolf K
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
Current and emerging biologics for ulcerative colitis.
Park, Sung Chul; Jeen, Yoon Tae
Conventional medical treatment for ulcerative colitis can have limited efficacy or severe adverse reactions requiring additional treatment or colectomy. Hence, different biological agents that target specific immunological pathways are be-ing investigated for treating ulcerative colitis. Anti-tumor necrosis factor (TNF) agents were the first biologics to be used for treating inflammatory bowel disease. For example, infliximab and adalimumab, which are anti-TNF agents, are be-ing used for treating ulcerative colitis. Recently, golimumab, another anti-TNF agent, and vedolizumab, an anti-adhesion therapy, have been approved for ulcerative colitis by the U.S. Food and Drug Administration. In addition, new medications such as tofacitinib, a Janus kinase inhibitor, and etrolizumab, another anti-adhesion therapy, are emerging as therapeutic agents. Therefore, there is a need for further studies to select appropriate patient groups for these biologics and to improve the outcomes of ulcerative colitis treatment through appropriate medical usage. PMID:25547087
Current and Emerging Biologics for Ulcerative Colitis
Park, Sung Chul; Jeen, Yoon Tae
Conventional medical treatment for ulcerative colitis can have limited efficacy or severe adverse reactions requiring additional treatment or colectomy. Hence, different biological agents that target specific immunological pathways are being investigated for treating ulcerative colitis. Anti-tumor necrosis factor (TNF) agents were the first biologics to be used for treating inflammatory bowel disease. For example, infliximab and adalimumab, which are anti-TNF agents, are being used for treating ulcerative colitis. Recently, golimumab, another anti-TNF agent, and vedolizumab, an anti-adhesion therapy, have been approved for ulcerative colitis by the U.S. Food and Drug Administration. In addition, new medications such as tofacitinib, a Janus kinase inhibitor, and etrolizumab, another anti-adhesion therapy, are emerging as therapeutic agents. Therefore, there is a need for further studies to select appropriate patient groups for these biologics and to improve the outcomes of ulcerative colitis treatment through appropriate medical usage. PMID:25547087
[Relationship between disaster stress and peptic ulcers].
Kanno, Takeshi; Iijima, Katsunori; Koike, Tomoyuki; Shimosegawa, Tooru
There had been several reports about the increasing of peptic ulcers under a large-scale disaster or a war. But in human, it was still unclear that a severe psychological stress itself cause peptic ulcer independently of two major causes (Helicobacter pylori infection and nonsteroidal anti-inflammatory drugs). After Great East Japan earthquake in March 11th, 2011, one of the five most powerful earthquakes in the world since modern record keeping began in 1900, we also noticed remarkable increasing of patients with peptic ulcer in wide stricken area. Reports after this gigantic earthquake gave us two new important viewpoints. Disaster (psychological) stress possibly induce peptic ulcer independently of two major causes. And, people living in refugee shelter immediately after a disaster are strong risk group of peptic ulcer bleeding as well as an intake of anti-thrombotic agents. PMID:26165082
Factors precipitating acute ulcerative colitis.
Puri, A S; Chaubal, C C; Midha, Vandana
Ulcerative colitis is characterized by mucosal inflammation of a variable length of the colon starting from the rectum. The precise etiopathogenesis is unknown but it occurs in genetically susceptible individuals who manifest an abnormal immunological response against gut commensal bacteria. The disease course is-characterized by multiple spontaneous relapses and remissions. Two pathogens namely CMV and C. difficile have been associated with disease exacerbation in specific clinical situations. Whereas C. difficile may produce worsening of the disease in those exposed to broad spectrum antibiotics, CMV reactivation is seen only in patients with moderate to severe steroid refractory disease. The importance of these two super-infections can be gauged by the fact that both the ACG and the ECCO recommend testing for these two pathogens in appropriate clinical situations. The applicability of these guidelines in the Indian scenario has yet to be determined in view of the bacterial and parasitic infections endemic in tropical countries. The guidelines for diagnosis and management of these two super-infections in the presence of ulcerative colitis are discussed in this review. PMID:25735121
Large B-cell lymphoma of the leg in a patient with multiple malignant tumours.
Eros, Nora; Karolyi, Zsuzsanna; Kovács, Anikó; Matolcsy, András; Barna, Tibor; Kelényi, Gábor
A patient who had primary gastric B-cell non-Hodgkin's lymphoma, invasive ductal breast cancer and a basocellular carcinoma of the forehead in her medical history was studied. Three years after polychemotherapy and irradiation of the breast cancer, a rapidly enlarging, ulcerated violaceous tumour developed on the patient's left leg. The tumour was identified by the histopathological, immunohistochemical and immunoglobulin gene rearrangement analyses as a cutaneous large B-cell lymphoma. No signs of extracutaneous involvement were detectable. Despite surgical excision, interferon-alpha2b treatment and chlorambucil + prednisone chemotherapy, a relapse occurred in the previously affected site, whereafter the patient received radiotherapy. She was lost to follow-up, and died approximately 14 months after the surgical intervention without autopsy. We discuss the clinical and histologic features and outcome of the large B-cell lymphoma of the leg, its coincidence with other diseases, and the uncommon occurrence of primary multiple malignant tumours. PMID:14609103
Restless legs syndrome in the elderly.
O'Keeffe, S. T.; Noel, J.; Lavan, J. N.
The prevalence and significance of restless legs syndrome was assessed in 307 patients presenting to an acute-care geriatric medical service. Fifteen patients (5%) had restless legs syndrome; 13 (87%) of these patients had insomnia and 10 (67%) reported troublesome or frequent leg symptoms. Of 147 patients with current insomnia, iron deficiency (serum ferritin < 18 ng/ml) was present in 4/13 (31%) patients with restless legs and 8/134 (6%) patients without restless legs (P < 0.025). Improvement in symptoms of restless legs was noted with iron repletion. These findings suggest that restless legs syndrome is relatively common in the elderly and causes significant discomfort and sleep disturbance. Iron deficiency is a common and treatable cause. PMID:8255834
Rabbit gastric ulcer models: comparison and evaluation of acetic acid-induced ulcer and mucosectomy-induced ulcer
Maeng, Jin Hee; Lee, Eunhye
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
Analysis of lymphatic drainage in various forms of leg edema using two compartment lymphoscintigraphy.
Bräutigam, P; Földi, E; Schaiper, I; Krause, T; Vanscheidt, W; Moser, E
The anatomical and functional status of the epifascial and subfascial lymphatic compartments was analyzed using two compartment lymphoscintigraphy in five groups of patients (total 55) with various forms of edema of the lower extremities. Digital whole body scintigraphy enabled semiquantitative estimation of radiotracer transport with comparison of lymphatic drainage between those individuals without (normal) and those with leg edema by calculating the uptake of the radiopharmaceutical transported to regional lymph nodes. A visual assessment of the lymphatic drainage pathways of the legs was also performed. In patients with cyclic idiopathic edema, an accelerated rate of lymphatic transport was detected (high lymph volume overload or dynamic insufficiency). In those with venous (phlebo) edemas, high volume lymphatic overload (dynamic insufficiency) of the epifascial compartment was scintigraphically detected by increased tracer uptake in regional nodes. In patients with deep femoral venous occlusion (post-thrombotic syndrome). subfascial lymphatic transport was uniformly markedly reduced (safety valve lymphatic insufficiency). On the other hand, in the epifascial compartment, lymph transport was accelerated. In those patients with recurrent or extensive skin ulceration, lymph transport was reduced. Patients with lipedema (obesity) scintigraphically showed no alteration in lymphatic transport. This study demonstrates that lymphatic drainage is notably affected (except in obesity termed lipedema) in various edemas of the leg. Lymphatic drainage varied depending on the specific compartment and the pathophysiologic mechanism accounting for the edema. Two compartment lymphoscintigraphy is a valuable diagnostic tool for accurate assessment of leg edema of known and unknown origin. PMID:9664268
Guts & Glory H. pylori: Cause of Peptic Ulcer
Ashley Johnson; Bryan Kratz; Lorraine Scanlon; Alina Spivak
Summary Due to the 1983 discovery of H. pylori bacteria as the leading cause of peptic ulcers, the understanding of the disease dramatically changed. We now know that stress and spicy foods are not the leading causes of peptic ulcers. Symptoms including acute abdominal pain, vomiting of blood, and weight loss are characteristic of peptic ulcers. Ulcers form because of
Biological therapy for ulcerative colitis.
Arora, Zubin; Shen, Bo
Ulcerative colitis (UC) is a major form of inflammatory bowel disease (IBD) worldwide. Better understanding of the pathogenesis of UC has led to the development of novel therapeutic agents that target specific mediators of the inflammatory cascade. A number of biological agents have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of UC and several more are currently in various phases of drug development. The commonly used agents include TNF? antagonists (e.g. infliximab, adalimumab, and golimumab) and anti-integrin agents (vedolizumab). These biological agents have profoundly influenced the management of UC patients, especially those with refractory disease. This paper reviews the currently available knowledge and evidence for the use of various biological agents in the treatment of UC. PMID:25344680
Positioning Therapy for Ulcerative Colitis.
Grinspan, Ari; Kornbluth, Asher
Ulcerative colitis (UC) is a chronic inflammatory condition of the colon, characterized by diffuse mucosal inflammation, bloody diarrhea, and urgency. The mainstay of treatment has been mesalamine agents, steroids, thiopurines, and anti-tumor necrosis factor alpha (TNF-?) antibodies. Over the past several years, new therapies have emerged which have provided clinicians new treatment options as well as new challenges in deciding which treatment is best for their patient at given points in their disease course. These agents include budesonide-Multi-Matrix System (MMX), adalimumab, golimumab, and vedolizumab. In addition, randomized controlled trials have investigated a combination therapy of infliximab and azathioprine and a controlled trial of infliximab versus cyclosporine for intravenous steroid refractory UC. This review will focus on where these agents may be optimally positioned in treatment algorithms for UC. PMID:26143627
Characterization of running with compliant curved legs.
Jun, Jae-Yun; Clark, Jonathan E
Running with compliant curved legs involves the progression of the center of pressure, the changes of both the leg's stiffness and effective rest length, and the shift of the location of the maximum stress point along the leg. These phenomena are product of the geometric and material properties of these legs, and the rolling motion produced during stance. We examine these aspects with several reduced-order dynamical models to relate the leg's design parameters (such as normalized foot radius, leg's effective stiffness, location of the maximum stress point and leg shape) to running performance (such as robustness and efficiency). By using these models, we show that running with compliant curved legs can be more efficient, robust with fast recovery behavior from perturbations than running with compliant straight legs. Moreover, the running performance can be further improved by tuning these design parameters in the context of running with rolling. The results shown in this work may serve as potential guidance for future compliant curved leg designs that may further improve the running performance. PMID:26151098
Risk of plantar ulceration in diabetic patients with single-leg amputation
R. V. Kanade; R. W. M. van Deursen; Patricia Price; Keith Harding
BackgroundThere is a disconcerting rate of bilateral limb loss in patients with diabetes. Therefore, this study aimed to explore plantar loading of the surviving foot following unilateral trans-tibial amputation within a wider context of daily walking activity to investigate the precise risk to the surviving limb.
Acid inhibition and peptic ulcer bleeding.
Štimac, D; Franji?, N; Krznari?, Ž
Peptic ulcer bleeding is one of the most common emergency situations in medicine. Combined pharmacological and endoscopic therapy together with emerging interventional radiological procedures are successfully treating peptic ulcer disease, reserving surgical procedures for only a small portion of patients unresponsive to 'conventional' therapy. Technological advancement has seen a great improvement in the field of endoscopic treatment in the form of various methods of hemostasis. However, pharmacological therapy with proton pump inhibitors still plays the central role in the peptic ulcer bleeding treatment algorithm. PMID:22095017
Peripheral ulcerative keratitis in association with sarcoidosis.
Harthan, Jennifer S; Reeder, Renée E
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
Inner / Outer Leg Symmetry Of the Cornell Ranger
Ruina, Andy L.
of the walking `cycle' of the Ranger is as follows First, say, the inner leg is the pivot or stance leg, while the outer leg is swung forward, by the hip-motor and a push-off mechanism on the outer leg (actuated by the foot motor on the outer leg). After the foot on the outer leg lands, it is now the stance leg
[Squamous cell carcinoma in neuropathic plantar ulcers in leprosy: another example of Marjolin's ulcer].
Schoeman, B J
Seven cases of squamous cell carcinoma (SCC) arising in chronic neuropathic plantar ulcers of leprosy are described. These patients (average age 59 years) presented over a 5-year period. The mean duration of neuropathic ulceration until diagnosis of SCC was 24.5 years. Six patients required limb amputations and 3 underwent lymphadenectomy for involved nodes. One patient died of disseminated disease. The history of the eponym "Marjolin's ulcer' is traced and a case put forward for recognition of malignant change in neuropathic ulcers as yet another example of Marjolin's ulcer. A plea is made for an increased awareness of the possibility of malignant transformation in chronic neuropathic ulcers in order to effect an early diagnosis of a potentially aggressive cancer. This is the first report of its kind in South Africa. Similar cases, however, have been reported from other parts of the world where leprosy is endemic. PMID:8966648
A fundamental mechanism of legged locomotion with hip torque and leg damping.
Shen, Z H; Seipel, J E
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
Small bowel ulcerative lesions are common in elderly NSAIDs users with peptic ulcer bleeding
Tsibouris, Panagiotis; Kalantzis, Chissostomos; Apostolopoulos, Periklis; Zalonis, Antonios; Isaacs, Peter Edward Thomas; Hendrickse, Mark; Alexandrakis, Georgios
AIM: To determine the frequency of small bowel ulcerative lesions in patients with peptic ulcer and define the significance of those lesions. METHODS: In our prospective study, 60 consecutive elderly patients with upper gastrointestinal bleeding from a peptic ulceration (cases) and 60 matched patients with a non-bleeding peptic ulcer (controls) underwent small bowel capsule endoscopy, after a negative colonoscopy (compulsory in our institution). Controls were evaluated for non-bleeding indications. Known or suspected chronic inflammatory conditions and medication that could harm the gut were excluded. During capsule endoscopy, small bowel ulcerative lesions were counted thoroughly and classified according to Graham classification. Other small bowel lesions were also recorded. Peptic ulcer bleeding was controlled endoscopically, when adequate, proton pump inhibitors were started in both cases and controls, and Helicobacter pylori eradicated whenever present. Both cases and controls were followed up for a year. In case of bleeding recurrence upper gastrointestinal endoscopy was repeated and whenever it remained unexplained it was followed by repeat colonoscopy and capsule endoscopy. RESULTS: Forty (67%) cases and 18 (30%) controls presented small bowel erosions (P = 0.0001), while 22 (37%) cases and 4 (8%) controls presented small bowel ulcers (P < 0.0001). Among non-steroidal anti-inflammatory drug (NSAID) consumers, 39 (95%) cases and 17 (33%) controls presented small bowel erosions (P < 0.0001), while 22 (55%) cases and 4 (10%) controls presented small bowel ulcers (P < 0.0001). Small bowel ulcerative lesions were infrequent among patients not consuming NSAIDs. Mean entry hemoglobin was 9.3 (SD = 1.4) g/dL in cases with small bowel ulcerative lesions and 10.5 (SD = 1.3) g/dL in those without (P = 0.002). Cases with small bowel ulcers necessitate more units of packed red blood cells. During their hospitalization, 6 (27%) cases with small bowel ulcers presented bleeding recurrence most possibly attributed to small bowel ulcers, nevertheless 30-d mortality was zero. Presence of chronic obstructive lung disease and diabetes was related with unexplained recurrence of hemorrhage in logistic regression analysis, while absence of small bowel ulcers was protective (relative risk 0.13, P = 0.05). CONCLUSION: Among NSAID consumers, more bleeders than non-bleeders with peptic ulcers present small bowel ulcers; lesions related to more severe bleeding and unexplained episodes of bleeding recurrence. PMID:25512771
Leukemia cutis presenting as a scrotal ulcer.
Zax, R H; Kulp-Shorten, C L; Callen, J P
A patient with acute nonlymphocytic leukemia developed a painful scrotal ulcer thought initially to be caused by infection. The lesion failed to heal with oral antibiotic therapy and local wound care. Histopathologic examination of a biopsy specimen revealed an infiltrate of leukemic cells. This cutaneous lesion heralded the relapse of acute myelogenous leukemia. A review of the literature indicates that acute nonlymphocytic leukemia rarely presents as an ulcer or on the genitalia, thus emphasizing the uniqueness of this case regarding morphology, and site of presentation. To our knowledge, this is the first case of leukemia cutis presenting as a scrotal ulcer. Therefore leukemia cutis should be added to the differential diagnosis of chronic genital ulcers. Also, because a variety of skin lesions may signify the relapse of leukemia, any skin lesion in a patient with leukemia should be examined by biopsy. PMID:2754075
Sunitinib induced pyoderma gangrenosum-like ulcerations
Pyoderma gangrenosum is a non-infectious neutrophilic skin disease commonly associated with underlying systemic diseases. Histopathological and laboratory diagnostics are unspecific in the majority of the cases and the diagnosis is made in accordance with the clinical picture. Here, we report the case of a 69-year old man with progredient pyoderma gangrenosum-like ulcerations under treatment with sunitinib due to hepatocellular carcinoma. A conventional ulcer therapy did not lead to a regression of the lesions. Solely cessation of sunitinib therapy resulted in an improvement of the ulcerations. Sunitinib is a multikinase inhibitor that targets the PDGF-? - and -?-, VEGF-1-3-, KIT-, FLT3-, CSF-1- and RET-receptor, thereby impairing tumour proliferation, pathological angiogenesis and metastasation. Here, we demonstrate that pyoderma gangrenosum-like ulcers may represent a serious side effect of sunitinib-based anti-cancer treatment. PMID:22027642
Buruli Ulcer Surveillance, Benin, 2003–2005
Johnson, Roch Christian; Chauty, Annick; Dossou, Ange Dodji; Aguiar, Julia; Salmon, Olivier; Portaels, Françoise; Asiedu, Kingsley
We reviewed Buruli ulcer (BU) surveillance in Benin, using the World Health Organization BU02 form. We report results of reliable routine data collected on 2,598 new and recurrent cases from 2003 through 2005. PMID:18252113
Helicobacter pylori and Ulcers: A Paradigm Revised
NSDL National Science Digital Library
PhD Nancy A. Lynch (University of Iowa College of Medicine)
FASEB Breakthroughs in Bioscience article. The story of the serendipitous discovery of the link between Helicobacter pylori and stomach ulcers. This story includes how this finding was applied to epidemiology, cancer research, and drug development.
Cutaneous leishmaniasis "chiclero's ulcer" in subtropical Ecuador.
Calvopińa, Manuel; Martinez, Leonardo; Hashiguchi, Yoshihisa
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
Cutaneous Leishmaniasis "Chiclero's Ulcer" in Subtropical Ecuador
Calvopińa, Manuel; Martinez, Leonardo; Hashiguchi, Yoshihisa
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
[Mycobacterium chelonae and solitary rectal ulcer].
Rodríguez, J C; Reyes, D M; Royo, G; Andrada, E; Sillero, C
Solitary rectal ulcer is of varied etiology and the appearance of this syndrome due to Mycobacterium chelonae is exceptional. We present a case of a solitary rectal ulcer associated with Mycobacterium chelonae subspecies chelonae in an immunocompetent individual. This microorganism is involved in cutaneous, ocular, pulmonary and soft tissue infections. Treatment of infections has traditionally been surgical, although various antibiotic treatments have been used depending on the sensitivity of the microorganism, the severity of the infection and the surgical possibilities. PMID:11149222
Fingertip and palmar patterns in duodenal ulcer.
Habibullah, C M; Mujahid Ali, M; Shivaprakash, M; Iqbal, M A; Ishaq, M
Dermatoglyphic studies were carried out on 90 adult males suffering from duodenal ulcer. Fingertip and palmar patterns were analysed to see if there was an association between duodenal ulcer and any of the dermatoglyphic traits. The patterns which were significantly different are: (1) increased frequency of whorls; (2) reduced frequency of loops on fingertips, and (3) increased frequency of patterns in the thenar I and IV interdigital area. PMID:7152533
Surgical and reconstructive management of pressure ulcers
Valentina Lefemine; Stuart Enoch; Dean Edward Boyce
Despite significant advances in therapeutic options, pressure ulcers continue to pose a challenge to physicians and surgeons\\u000a and frequently require multidisciplinary input. In addition, they place huge financial burdens on health care providers. Generally\\u000a classified as grades I to IV depending on the extent and severity of the ulcer, grades I and II are usually amenable to conservative\\u000a management. Grades
Bending of floating flexible legs
NASA Astrophysics Data System (ADS)
Park, Kun Joong; Kim, Ho-Young
When long thin flexible solid objects, such as the legs of water striders, disposable spoons and human hairs, are pressed against a liquid surface, they bend due to interfacial and hydrostatic forces. To understand the phenomenon, we study the bending of a sheet touching the liquid surface at an angle while clamped at the other end, to find its deflection and the load that the sheet can support before sinking. The theoretically predicted shapes of the sheet and the meniscus match well with experiments. Our theory shows that flexible sheets can support more load than rigid ones before sinking when the sheets are highly hydrophobic.
Integrating studies of mechanics, neural control and isolated muscle function are possible using arthropod legs. To evaluate leg performance, we measured the ground reaction forces generated by individual legs of the six- legged cockroach Blaberus discoidalis (3.1 g), during an emergency behavior, righting or over-turning. We used a photoelastic method to measure the forces generated by individual legs simultaneously. A
Compliant leg behaviour explains basic dynamics of walking and running
Hartmut Geyer; Andre Seyfarth; Reinhard Blickhan
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
Diabetic foot ulcers--a comprehensive review.
Leung, P C
As the incidence of diabetes mellitus is increasing globally, complications related to this endocrine disorder are also mounting. Because of the large number of patients, foot ulcers developing in the feet of diabetics have become a public health problem. The predisposing factors include abnormal plantar pressure points, foot deformities, and minor trauma. Vulnerable feet usually already have vascular insufficiency and peripheral neuropathy. The complex nature of these ulcers deserves special care. The most useful prognostic feature for healing remains the ulcer depth, ulcers heal poorly if they clearly involve underlying tendons, ligament or joints and, particularly, when gangrenous tissue is seen. Local treatment of the ulcer consists of repeated debridement and dressing. No 'miraculous' outcome is expected, even with innovative agents like skin cover synthetics, growth factors and stem cells. Simple surgery like split skin grafting or minor toe amputations may be necessary. Sophisticated surgery like flap coverages are indicated for younger patients. The merits of an intact lower limb with an abnormal foot have to be weighed against amputation and prosthesis in the overall planning of limb salvage or sacrifice. If limb salvage is the decision, additional means like oxygen therapy, and other alternative medicines, might have benefits. The off-loading of footwear should always be a major consideration as a prevention of ulcer formation. PMID:17849958
Treatment and prognosis in peptic ulcer bleeding.
Laursen, Stig Borbjerg
Peptic ulcer bleeding is a frequent cause of admission. Despite several advances in treatment the 30-day mortality seems unchanged at a level around 11%. Use of risk scoring systems is shown to be advantageous in the primary assessment of patients presenting with symptoms of peptic ulcer bleeding. Studies performed outside Denmark have demonstrated that use of risk scoring systems facilitates identification of low-risk patients suitable for outpatient management. Nevertheless, these systems have not been implemented for routine use in Denmark. This is mainly explained by concerns about the external validity due to considerable inter-country variation in patients' characteristics. In recent years, transcatheter arterial embolization (TAE) has become increasingly used for achievement of haemostasis in patients with peptic ulcer bleeding not responding to endoscopic therapy. As rebleeding is associated with poor outcome TAE could, in theory, also be beneficial as a supplementary treatment in patients with ulcer bleeding responding to endoscopic therapy. This has not been examined previously. Several studies have concluded that peptic ulcer bleeding is associated with excess long-term mortality. These findings are, however, questioned as the studies were based on life-table analysis, unmatched control groups, or did not perform adequate adjustment for comorbidity. Treatment with blood transfusion is, among patients undergoing cardiac bypass surgery, shown to increase the long-term mortality. Despite frequent use of blood transfusion in treatment of peptic ulcer bleeding a possible adverse effect of on long-term survival has not been examined in these patients. PMID:24495895
History of Helicobacter pylori, duodenal ulcer, gastric ulcer and gastric cancer.
Graham, David Y
Helicobacter pylori (H. pylori) infection underlies gastric ulcer disease, gastric cancer and duodenal ulcer disease. The disease expression reflects the pattern and extent of gastritis/gastric atrophy (i.e., duodenal ulcer with non-atrophic and gastric ulcer and gastric cancer with atrophic gastritis). Gastric and duodenal ulcers and gastric cancer have been known for thousands of years. Ulcers are generally non-fatal and until the 20th century were difficult to diagnose. However, the presence and pattern of gastritis in past civilizations can be deduced based on the diseases present. It has been suggested that gastric ulcer and duodenal ulcer both arose or became more frequent in Europe in the 19th century. Here, we show that gastric cancer and gastric ulcer were present throughout the 17th to 19th centuries consistent with atrophic gastritis being the predominant pattern, as it proved to be when it could be examined directly in the late 19th century. The environment before the 20th century favored acquisition of H. pylori infection and atrophic gastritis (e.g., poor sanitation and standards of living, seasonal diets poor in fresh fruits and vegetables, especially in winter, vitamin deficiencies, and frequent febrile infections in childhood). The latter part of the 19th century saw improvements in standards of living, sanitation, and diets with a corresponding decrease in rate of development of atrophic gastritis allowing duodenal ulcers to become more prominent. In the early 20th century physician's believed they could diagnose ulcers clinically and that the diagnosis required hospitalization for "surgical disease" or for "Sippy" diets. We show that while H. pylori remained common and virulent in Europe and the United States, environmental changes resulted in changes of the pattern of gastritis producing a change in the manifestations of H. pylori infections and subsequently to a rapid decline in transmission and a rapid decline in all H. pylori-related diseases. PMID:24833849
Ninja Legs: Amphibious One Degree of Freedom Robotic Legs Bir Bikram Dey, Sandeep Manjanna and Gregory Dudek
Ninja Legs: Amphibious One Degree of Freedom Robotic Legs Bir Bikram Dey, Sandeep Manjanna as "Ninja legs") that enable amphibious operation, both walking and swimming, for use on a class of hexapod in this paper. We refer to these amphibious legs as Ninja legs as the design resembles a spinning ninja star
A programme to reduce acquired pressure ulcers in care homes.
Thompson, Trish Morris; Marks-Maran, Di
Prevention of pressure ulcers is a major health concern, especially for older people. Much of the literature related to prevention of pressure ulcers focuses on hospital-acquired pressure ulcers. There is less literature related to prevention of pressure ulcers in care homes. This article presents a review of the literature related to prevention of pressure ulcers in care homes and an ambitious project undertaken by one care home provider to raise awareness of pressure ulcers, provide training in prevention and monitor and evaluate pressure ulcers in over 200 care home across the UK. Known as MI SKIN, the project involves ongoing training to all levels of care staff, a robust system of monitoring pressure ulcers and a mechanism to investigate and learn from any incident of pressure ulcer using root cause analysis. PMID:26110989
Golimumab in unresponsive ulcerative colitis.
Lippert, Elisabeth; Müller, Martina; Ott, Claudia
Ulcerative colitis (UC) is a chronic inflammation mainly affecting the colon mucosa. It predominantly occurs in younger patients. Until recently, the main goals in the treatment of UC were to temper the symptoms, such as diarrhea, pain, and weight loss, by using mesalazine and steroids. With newer medications, such as immunomodulators (thiopurines) and the biologics providing blockade of tumor necrosis factor (TNF), the goals of the therapy in UC have changed to long-term remission and mucosal healing. The first available anti-TNF therapy in UC included infusion therapy with infliximab every few weeks. In 2012, subcutaneously administered adalimumab gained approval for the treatment of UC in Germany. In patients with a mild disease, therapy with mesalazine, orally or topically, can be sufficient. In patients with moderate to severe disease, therapy with azathioprine or anti-TNF is often required to reach disease control; however, this is only efficient in about two-thirds of patients. Some patients either show no response or a lost response while on treatment. So, further medical options are warranted in the treatment of UC. With golimumab, a new approach in the treatment of mild to moderate UC recently became available in Germany and is a promising new option in the therapy regimen for patients with UC. PMID:24904202
Golimumab in unresponsive ulcerative colitis
Lippert, Elisabeth; Müller, Martina; Ott, Claudia
Ulcerative colitis (UC) is a chronic inflammation mainly affecting the colon mucosa. It predominantly occurs in younger patients. Until recently, the main goals in the treatment of UC were to temper the symptoms, such as diarrhea, pain, and weight loss, by using mesalazine and steroids. With newer medications, such as immunomodulators (thiopurines) and the biologics providing blockade of tumor necrosis factor (TNF), the goals of the therapy in UC have changed to long-term remission and mucosal healing. The first available anti-TNF therapy in UC included infusion therapy with infliximab every few weeks. In 2012, subcutaneously administered adalimumab gained approval for the treatment of UC in Germany. In patients with a mild disease, therapy with mesalazine, orally or topically, can be sufficient. In patients with moderate to severe disease, therapy with azathioprine or anti-TNF is often required to reach disease control; however, this is only efficient in about two-thirds of patients. Some patients either show no response or a lost response while on treatment. So, further medical options are warranted in the treatment of UC. With golimumab, a new approach in the treatment of mild to moderate UC recently became available in Germany and is a promising new option in the therapy regimen for patients with UC. PMID:24904202
Bonded center leg for TEXT iron yoke
R. L. Deblois; T. S. Latham; D. J. McFarlin; D. H. Polk; D. F. Brower; G. L. Cardwell; P. Wildi
The paper presents the bond test program which was realized to select the adhesives and coating process for the laminations of the center leg of the TEXT (Texas EXperimental Tokamak) iron yoke and the test program conducted to select the urethane casing used as the nose-bearing material for the TF coils. Plans for the fabrication of the bonded center leg
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of the Ocean Drilling Program in consultation with the Planning Committee and the Pollution PreventionOCEAN DRILLING PROGRAM LEG 162 SCIENTIFIC PROSPECTUS NORTH ATLANTIC ARCTIC GATEWAYS II Dr. Maureen Scientist, Leg 162 Ocean Drilling Program Texas A&M University Research Park 1000 Discovery Drive College
of the Ocean Drilling Program in consultation with the Planning Committee and the Pollution PreventionOCEAN DRILLING PROGRAM LEG 166 SCIENTIFIC PROSPECTUS THE BAHAMAS TRANSECT Dr. Gregor Eberli Co.S.A. Dr. Mitchell Malone Staff Scientist, Leg 166 Ocean Drilling Program Texas A&M University Research
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LEG 142 PRELIMINARY REPORT OCEAN DRILLING PROGRAM ENGINEERING PRELIMINARY REPORT NO. 3 EAST PACIFIC RISE 1992 #12;OCEAN DRILLING PROGRAM LEG 142 PRELIMINARY REPORT East Pacific Rise Dr. Rodey Batiza Co 96822 Mr. Michael A. Storms Operations Superintendent/ Assistant Manager of Engineering and Drilling
Reconfigurable Planar Three-Legged Parallel Manipulators
Hayes, John
Reconfigurable Planar Three-Legged Parallel Manipulators M. John D. Hayes Department of Mechanical of reconfigurable planar three legged plat- forms is introduced. Kinematic mapping techniques are applied to solve Introduction There has been great interest in reconfigurable mechanisms in recent years (see Yim et al., March
Swing leg retraction helps biped walking stability
M. Wisse; C. G. Atkeson; D. K. Kloimwieder
In human walking, the swing leg moves backward just prior to ground contact, i.e. the relative angle between the thighs is decreasing. We hypothesized that this swing leg retraction may have a positive effect on gait stability, because similar effects have been reported in passive dynamic walking models, in running models, and in robot juggling. For this study, we use
. #12;Leg 133 Prospectus Page 3 ABSTRACT Five physiographic regions define offshore northeastern Australia: the platforms of the Great Barrier Reef and the Queensland and Marionplateaus, and the basins of the evolution of these carbonate platforms and adjacent basins. Leg 133 will sample Oligocene to Holocene
Gait Planning Research for Biped Robot with Heterogeneous Legs
Jun Xiao; Xing Song; Jie Su; Xinhe Xu
\\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
Fournier's gangrene complicating ulcerative pancolitis.
Katsanos, Konstantinos H; Ignatiadou, Eleftheria; Sarandi, Maria; Godevenos, Dimitrios; Asproudis, Ioannis; Fatouros, Michael; Tsianos, Epameinondas V
Fournier gangrene is a very rare and a rapidly progressing, polymicrobial necrotizing faciitis or myonecrosis of the perineal, perianal and genital regions, with a high mortality rate. Infection is associated with superficial traum, urological and colorectal diseases and operations. The most commonly found bacteria are Escherichia coli followed by Bacteroides and streptococcal species. Diabetes mellitus, alcoholism, and immunosuppression are perpetuating co-factors. Fournier's gangrene complicating inflammatory bowel disease has been reported in three patients so far, two with Crohn's disease. A 78-year-old man diagnosed with ulcerative pancolitis was referred for fever, and painful perianal and scrotal swelling after perianal surgery for a horseshoe-type perianal abscess. Since bowel disease diagnosis, patient was on mesalazine and achieved long-term remission. Perianal abscess occurred suddenly one week before perianal surgery without any evidence of pre-existing fistula or other abnormalities. Physical examination showed extensive edema and crepitus of perineum and genitalia and patient had symptoms of significant toxicity. The diagnosis of Fournier's gangrene was made and patient underwent emergency surgery with extensive surgical debridement of the scrotal and perianal area and Hartman procedure with a diverting colostomy. In addition, patient started on therapy with mesalazine 3gr, methylprednisolone 16 mg, parenteral nutrition and broad spectrum of antibiotics. Two days after the first operation the patient needed a second operation for perianal debridement. On the fourth day, blood cultures showed E. coli. Patient had an uneventful recovery and was discharged after 34 days of hospitalization. On follow up, disease review is scheduled and colostomy closure is planned. PMID:21122507
Hydroxyurea and colonic ulcers: a case report
Background Hydroxyurea at a relatively low dose is frequently prescribed to induce hemoglobin F production in patients with sickle cell and ?-thalassemia diseases because of its good efficacy and safety profiles. However, a potentially fatal gastrointestinal ulceration was recently found and herein reported. Case presentation A thirty-seven-year-old man with transfusion dependent hemoglobin E/?-thalassemia disease was treated with hydroxyurea to induce hemoglobin F production since 2007 without incident. From 2008 to April 2010, episodes of hematochezia, mucous diarrhea and epigastric pain intermittently manifested. Four colonoscopies done during the period repeatedly showed ulcerative lesions from the terminal ileum to the ascending colon with a non-specific histo-pathologic finding. Subsequently, ulcerative lesions also developed at the pharynx, histo-pathologic findings of which were not different from those in the colon. These ulcerative lesions resolved within a month after discontinuing hydroxyurea in April 2010 and have not recurred since. Conclusion The findings suggested role of hydroxyurea in the pathogenesis of these ulcers, and that it must be immediately discontinued to prevent further damage to the digestive mucosa. PMID:25082414
Reducing avoidable pressure ulcers in the community.
Parnham, Alison; Pankhurst, Sarah; Dabell, Wendy
The elimination of avoidable pressure ulcers remains a challenge in healthcare provision, represents an increasing financial burden on resources and continues to affect patients' quality of life. Many pressure ulcers are deemed to be avoidable and there are several factors that can influence this, including the development of a care delivery system and a service delivery strategy that incorporate a comprehensive structure, a meticulous process and measurable outcomes. Nottingham CityCare developed a strategy to reduce avoidable pressure ulcers. The implementation of the strategy in an inner city community setting is discussed. The importance of eliminating pressure ulcers is explored, and the barriers to care delivery are reviewed, demonstrating how a new culture in clinical practice can ensure the elimination of avoidable pressure ulcers. The challenges within the implementation process are reflected on and the implementation of the SSKIN (Surface, Skin inspection, Keep your patient moving, Incontinence and moisture, Nutrition and hydration) phenomenon is reviewed in relation to care delivery, record-keeping and evaluation. PMID:25711596
Salivary enzymes in peptic ulcer disease
Motamedi, Mojdeh; Mansour-Ghanaei, Fariborz; Sariri, Reyhaneh; Vesal, Mahmoud
Aim Peptic ulcer, the common disease of the upper gastro-intestinal tract, occurs in about 5–10% of the world's population. Therefore, diagnosis of trace disease progression with a noninvasive method is of prime importance in the field of healthcare research. The aim of this study was to evaluate the validity of salivary enzymes as noninvasive biomarkers for peptic ulcer. Materials and methods In practice, 34 peptic ulcer patients and 30 healthy subjects donated their un-stimulated saliva samples after 8 h of fasting. The activity of some selected enzymes was measured using appropriate enzymatic assay methods. Results The results indicated an overall alternation in enzymatic activity of saliva in patients suffering from peptic ulcer. Biological activity of a-amylase, peroxidase and lactate dehydrogenase, showed significantly higher values in almost all patients as compared to control subjects. Conclusions Based on the results of salivary enzyme activity, it was concluded that besides the influence of their peptic ulcer on enzyme activity of saliva, the considerably higher activity of a-amylase could also be related to the major role of the enzyme on physiological oxidative stress. PMID:25737890
Does a crouched leg posture enhance running stability and robustness?
Blum, Yvonne; Birn-Jeffery, Aleksandra; Daley, Monica A; Seyfarth, Andre
Humans and birds both walk and run bipedally on compliant legs. However, differences in leg architecture may result in species-specific leg control strategies as indicated by the observed gait patterns. In this work, control strategies for stable running are derived based on a conceptual model and compared with experimental data on running humans and pheasants (Phasianus colchicus). From a model perspective, running with compliant legs can be represented by the planar spring mass model and stabilized by applying swing leg control. Here, linear adaptations of the three leg parameters, leg angle, leg length and leg stiffness during late swing phase are assumed. Experimentally observed kinematic control parameters (leg rotation and leg length change) of human and avian running are compared, and interpreted within the context of this model, with specific focus on stability and robustness characteristics. The results suggest differences in stability characteristics and applied control strategies of human and avian running, which may relate to differences in leg posture (straight leg posture in humans, and crouched leg posture in birds). It has been suggested that crouched leg postures may improve stability. However, as the system of control strategies is overdetermined, our model findings suggest that a crouched leg posture does not necessarily enhance running stability. The model also predicts different leg stiffness adaptation rates for human and avian running, and suggests that a crouched avian leg posture, which is capable of both leg shortening and lengthening, allows for stable running without adjusting leg stiffness. In contrast, in straight-legged human running, the preparation of the ground contact seems to be more critical, requiring leg stiffness adjustment to remain stable. Finally, analysis of a simple robustness measure, the normalized maximum drop, suggests that the crouched leg posture may provide greater robustness to changes in terrain height. PMID:21569779
Research on gait planning of artificial leg based on central pattern generator
Jun Xiao; Jie Su; Yu Cheng; Fei Wang; Xinhe Xu
Biped robot with heterogeneous legs (BRHL) is a novel robot model, which consists of an artificial leg and an intelligent bionic leg. The artificial leg is used to simulate the amputeepsilas healthy leg and the bionic leg works as the intelligent artificial limb. To describe the present gait of the healthy leg and make intelligent bionic leg follow the walking
Thyroid Storm Precipitated by Duodenal Ulcer Perforation
Natsuda, Shoko; Nakashima, Yomi; Horie, Ichiro; Kawakami, Atsushi
Thyroid storm is a rare and life-threatening complication of thyrotoxicosis that requires prompt treatment. Thyroid storm is also known to be associated with precipitating events. The simultaneous treatment of thyroid storm and its precipitant, when they are recognized, in a patient is recommended; otherwise such disorders, including thyroid storm, can exacerbate each other. Here we report the case of a thyroid storm patient (a 55-year-old Japanese male) complicated with a perforated duodenal ulcer. The patient was successfully treated with intensive treatment for thyroid storm and a prompt operation. Although it is believed that peptic ulcer rarely coexists with hyperthyroidism, among patients with thyroid storm, perforation of a peptic ulcer has been reported as one of the causes of fatal outcome. We determined that surgical intervention was required in this patient, reported despite ongoing severe thyrotoxicosis, and reported herein a successful outcome. PMID:25838951
Postoperative management of ulcerative colitis and crohn's disease
Rajesh N. Keswani; Russell D. Cohen
Approximately 10% to 30% of patients with ulcerative colitis and up to 70% of patients with Crohn's disease will undergo surgery\\u000a at some point during their lifetime. Although patients with ulcerative colitis are considered \\
Pressure Ulcers Among Nursing Home Residents: United States, 2004
... Brief Number 14, February 2009 Pressure Ulcers Among Nursing Home Residents: United States, 2004 On this Page ... quality of care More than 1 in 10 nursing home residents had a pressure ulcer. Of the ...
An index to measure the healing potential of ischaemic ulcers using Thallium 201
Prediction of healing of ulcers in ischaemic limbs can preclude unnecessary treatment for ulcers that cannot heal. Non-invasive methods are of marked value as the ischaemic limb is susceptible to further ulceration from local skin penetration. Relative hyperemia of the ulcer was measured by scintillation count over the ulcer and at points 2.5 cm from the edge of the ulcer.
Management of patients with ulcer bleeding.
Laine, Loren; Jensen, Dennis M
This guideline presents recommendations for the step-wise management of patients with overt upper gastrointestinal bleeding. Hemodynamic status is first assessed, and resuscitation initiated as needed. Patients are risk-stratified based on features such as hemodynamic status, comorbidities, age, and laboratory tests. Pre-endoscopic erythromycin is considered to increase diagnostic yield at first endoscopy. Pre-endoscopic proton pump inhibitor (PPI) may be considered to decrease the need for endoscopic therapy but does not improve clinical outcomes. Upper endoscopy is generally performed within 24h. The endoscopic features of ulcers direct further management. Patients with active bleeding or non-bleeding visible vessels receive endoscopic therapy (e.g., bipolar electrocoagulation, heater probe, sclerosant, clips) and those with an adherent clot may receive endoscopic therapy; these patients then receive intravenous PPI with a bolus followed by continuous infusion. Patients with flat spots or clean-based ulcers do not require endoscopic therapy or intensive PPI therapy. Recurrent bleeding after endoscopic therapy is treated with a second endoscopic treatment; if bleeding persists or recurs, treatment with surgery or interventional radiology is undertaken. Prevention of recurrent bleeding is based on the etiology of the bleeding ulcer. H. pylori is eradicated and after cure is documented anti-ulcer therapy is generally not given. Nonsteroidal anti-inflammatory drugs (NSAIDs) are stopped; if they must be resumed low-dose COX-2-selective NSAID plus PPI is used. Patients with established cardiovascular disease who require aspirin should start PPI and generally re-institute aspirin soon after bleeding ceases (within 7 days and ideally 1-3 days). Patients with idiopathic ulcers receive long-term anti-ulcer therapy. PMID:22310222
Genome-wide association identifies multiple ulcerative colitis susceptibility loci
Agnčs Gardet; Leif Törkvist; Philippe Goyette; Jonah Essers; Kent D Taylor; Benjamin M Neale; Rick T H Ong; Caroline Lagacé; Chun Li; Todd Green; Christine R Stevens; Claudine Beauchamp; Phillip R Fleshner; Marie Carlson; Mauro D'Amato; Jonas Halfvarson; Martin L Hibberd; Mikael Lördal; Leonid Padyukov; Angelo Andriulli; Elisabetta Colombo; Anna Latiano; Orazio Palmieri; Edmond-Jean Bernard; Colette Deslandres; Daan W Hommes; Dirk J de Jong; Pieter C Stokkers; Rinse K Weersma; Yashoda Sharma; Mark S Silverberg; Judy H Cho; Jing Wu; Kathryn Roeder; Steven R Brant; L Phillip Schumm; Richard H Duerr; Marla C Dubinsky; Nicole L Glazer; Talin Haritunians; Andy Ippoliti; Gil Y Melmed; David S Siscovick; Eric A Vasiliauskas; Stephan R Targan; Vito Annese; Cisca Wijmenga; Sven Pettersson; Jerome I Rotter; Ramnik J Xavier; Mark J Daly; Dermot P B McGovern; John D Rioux; Mark Seielstad
Ulcerative colitis is a chronic, relapsing inflammatory condition of the gastrointestinal tract with a complex genetic and environmental etiology. In an effort to identify genetic variation underlying ulcerative colitis risk, we present two distinct genome-wide association studies of ulcerative colitis and their joint analysis with a previously published scan, comprising, in aggregate, 2,693 individuals with ulcerative colitis and 6,791 control
The Mycotic Ulcer Treatment Trial
Prajna, N. Venkatesh; Krishnan, Tiruvengada; Mascarenhas, Jeena; Rajaraman, Revathi; Prajna, Lalitha; Srinivasan, Muthiah; Raghavan, Anita; Oldenburg, Catherine E.; Ray, Kathryn J.; Zegans, Michael E.; McLeod, Stephen D.; Porco, Travis C.; Acharya, Nisha R.; Lietman, Thomas M.
Objective To compare topical natamycin vs voriconazole in the treatment of filamentous fungal keratitis. Methods This phase 3, double-masked, multicenter trial was designed to randomize 368 patients to voriconazole (1%) or natamycin (5%), applied topically every hour while awake until reepithelialization, then 4 times daily for at least 3 weeks. Eligibility included smear-positive filamentous fungal ulcer and visual acuity of 20/40 to 20/400. Main Outcome Measures The primary outcome was best spectacle-corrected visual acuity at 3 months; secondary outcomes included corneal perforation and/or therapeutic penetrating keratoplasty. Results A total of 940 patients were screened and 323 were enrolled. Causative organisms included Fusarium (128 patients [40%]), Aspergillus (54 patients [17%]), and other filamentous fungi (141 patients [43%]). Natamycin-treated cases had significantly better 3-month best spectacle-corrected visual acuity than voriconazole-treated cases (regression coefficient=?0.18 logMAR; 95% CI, ?0.30 to ?0.05; P=.006). Natamycin-treated cases were less likely to have perforation or require therapeutic penetrating keratoplasty (odds ratio=0.42; 95% CI, 0.22 to 0.80; P=.009). Fusarium cases fared better with natamycin than with voriconazole (regression coefficient=?0.41 logMAR; 95% CI, ?0.61 to ?0.20; P<.001; odds ratio for perforation=0.06; 95% CI, 0.01 to 0.28; P<.001), while non-Fusarium cases fared similarly (regression coefficient=?0.02 logMAR; 95% CI, ?0.17 to 0.13; P=.81; odds ratio for perforation=1.08; 95% CI, 0.48 to 2.43; P=.86). Conclusions Natamycin treatment was associated with significantly better clinical and microbiological outcomes than voriconazole treatment for smear-positive filamentous fungal keratitis, with much of the difference attributable to improved results in Fusarium cases. Application to Clinical Practice Voriconazole should not be used as monotherapy in filamentous keratitis. Trial Registration clinicaltrials.gov Identifier: NCT00996736 PMID:23710492
Biological therapy for ulcerative colitis: an update.
Seo, Geom Seog; Chae, Soo-Cheon
Of the diverse biological agents used for patients with ulcerative colitis, the anti-tumor necrosis factor-? agents infliximab and adalimumab have been used in large-scale clinical trials and are currently widely used in the treatment of inflammatory bowel disease patients. Recent studies have indicated that golimumab, oral tofacitinib and vedolizumab reportedly achieved good clinical response and remission rates in ulcerative colitis patients. Thus, we believe that the detailed investigation of various studies on clinical trials may provide important information for the selection of appropriate biological agents, and therefore, we have extensively reviewed such trials in the present study. PMID:25309060
Biological therapy for ulcerative colitis: An update
Seo, Geom Seog; Chae, Soo-Cheon
Of the diverse biological agents used for patients with ulcerative colitis, the anti-tumor necrosis factor-? agents infliximab and adalimumab have been used in large-scale clinical trials and are currently widely used in the treatment of inflammatory bowel disease patients. Recent studies have indicated that golimumab, oral tofacitinib and vedolizumab reportedly achieved good clinical response and remission rates in ulcerative colitis patients. Thus, we believe that the detailed investigation of various studies on clinical trials may provide important information for the selection of appropriate biological agents, and therefore, we have extensively reviewed such trials in the present study. PMID:25309060
Hybrid treatment of penetrating aortic ulcer*
Lara, Juan Antonio Herrero; Martins-Romęo, Daniela de Araújo; Escudero, Carlos Caparrós; Vázquez, Rosa María Lepe; Falcón, María del Carmen Prieto; Batista, Vinicius Bianchi
Penetrating atherosclerotic aortic ulcer is a rare entity with poor prognosis in the setting of acute aortic syndrome. In the literature, cases like the present one, located in the aortic arch, starting with chest pain and evolving with dysphonia, are even rarer. The present report emphasizes the role played by computed tomography in the diagnosis of penetrating atherosclerotic ulcer as well as in the differentiation of this condition from other acute aortic syndromes. Additionally, the authors describe a new therapeutic approach represented by a hybrid endovascular surgical procedure for treatment of the disease. PMID:26185346
Plantar decubitus ulcers in rats and rabbits.
Honma, M; Kast, A
A high incidence of plantar decubitus ulcers, 35% in males and 22 or 45% in females, respectively, occurred in rats of two carcinogenicity studies independent of the bedding used, hard or soft wood chips. Among rabbits kept in chrome-plated wire cages, about 2-year-old female breeders suffered from the plantar ulcers, but not their male partners of the same age group. The causes of the foot disease appear to be manifold, however, in our cases the lesions could be prevented in both species by housing on a cage floor made from flattened stainless wire. PMID:2792208
Biomechanical implications of mild leg length inequality.
McCaw, S T; Bates, B T
The effect of mild leg length inequality (lower extremity length difference less than 3 cm) on posture and gait has been the source of much controversy. Many opinions have been expressed both for and against the need for intervention to reduce the magnitude of the discrepancy. This paper emphasizes the need for accurate and reliable assessment of leg length differences using a clinically functional radiographic technique, and reviews the biomechanical implications of leg length inequality as related to the development of stress fractures, low back pain and osteoarthritis. PMID:1913023
Haemophilus ducreyi Associated with Skin Ulcers among Children, Solomon Islands
Chi, Kai-Hua; Vahi, Ventis; Pillay, Allan; Sokana, Oliver; Pavluck, Alex; Mabey, David C.; Chen, Cheng Y.; Solomon, Anthony W.
During a survey of yaws prevalence in the Solomon Islands, we collected samples from skin ulcers of 41 children. Using PCR, we identified Haemophilus ducreyi infection in 13 (32%) children. PCR-positive and PCR-negative ulcers were phenotypically indistinguishable. Emergence of H. ducreyi as a cause of nongenital ulcers may affect the World Health Organization's yaws eradication program. PMID:25271477
Haemophilus ducreyi associated with skin ulcers among children, Solomon Islands.
Marks, Michael; Chi, Kai-Hua; Vahi, Ventis; Pillay, Allan; Sokana, Oliver; Pavluck, Alex; Mabey, David C; Chen, Cheng Y; Solomon, Anthony W
During a survey of yaws prevalence in the Solomon Islands, we collected samples from skin ulcers of 41 children. Using PCR, we identified Haemophilus ducreyi infection in 13 (32%) children. PCR-positive and PCR-negative ulcers were phenotypically indistinguishable. Emergence of H. ducreyi as a cause of nongenital ulcers may affect the World Health Organization's yaws eradication program. PMID:25271477
Exploratory clinical trial of combination wound therapy with a gelatin sheet and platelet-rich plasma in patients with chronic skin ulcers: study protocol
Morimoto, Naoki; Kakudo, Natsuko; Matsui, Makoto; Ogura, Tsunetaka; Hara, Tomoya; Suzuki, Kenji; Yamamoto, Masaya; Tabata, Yasuhiko; Kusumoto, Kenji
Introduction Chronic skin ulcers, such as diabetic ulcers, venous leg ulcers and pressure ulcers, are intractable and increasing in prevalence, representing a costly problem in healthcare. We developed a combination therapy with a gelatin sheet, capable of providing sustained release of platelet-rich plasma (PRP). The objective of this study is to investigate the safety and efficacy of autologous PRP covered with a hydrocolloid dressing and PRP covered with a gelatin sheet in the treatment of chronic skin ulcers. Methods and analysis Thirty patients with chronic skin ulcers who have not healed with conventional therapy for at least 1?month are being recruited. The patients will receive PRP after debridement, and the wounds will be covered with a hydrocolloid dressing or gelatin sheet. The efficacy will be evaluated according to the time from the beginning of PRP application to secondary healing or the day on which wound closure is achieved with a relatively simple surgical procedure, such as skin grafting or suturing. All patients will be followed up until 6?weeks after application to observe adverse events related to the application of PRP and the dressings. This study was designed to address and compare the safety and efficacy of PRP covered with a hydrocolloid dressing versus a gelatin sheet. If successful, this combination therapy may be an alternative to bioengineered skin substitutes containing living cells and lead to substantial progress in the management of chronic skin ulcers. Ethics and dissemination The study protocol was approved by the Institutional Review Board of Kansai Medical University (KMU Number 0649-1, 4 August 2014: V.1.0). The findings of this trial will be disseminated through peer-reviewed journals, and national and international scientific meetings as well as to the patients. Trial registration number UMIN000015689. PMID:25968005
Leg venous hemodynamics and leg volumes during a 42-day-6 ° head-down bedrest
NASA Astrophysics Data System (ADS)
Louisy, F.; Schroiff, P.; Guezennec, C.-Y.; Güell, A.
Seven healthy subjects were submitted to a 42-day head down bedrest, where leg venous compliance (venous distensibity index VDI) and leg volumes were assessed by mercury strain gauge plethysmography with venous occlusion and optoelectronic plethysmography, respectively. Plethysmographic and volometric measurements were made, before, during (at days 1, 4, 7, 14, 21, 26, 34 and 41), and after bedrest (days 1, 4, 7, 11 and 30 of the recovery period). Results showed a continuous decrease in leg volumes throughout bedrest, when VDI increased until day 26 of bedrest, and then decreased afterwards. The recovery period was characterized by a rapid return of VDI to prebedrest levels while leg volumes progressively normalised. These results showed that leg venous compliance changes are not always dependant upon skeletal muscle changes, and that factors other than size of muscle compartment are able to determine increases in leg venous compliance during long-term bedrest.
Goodisman, Michael
the net forces on both an L-leg and a reversed L-leg rotated through granular media with better accuracy1 A RESISTIVE FORCE MODEL FOR LEGGED LOCOMOTION ON GRANULAR MEDIA* CHEN LI, TINGNAN ZHANG on granular surfaces like sand and gravel. Understanding the mechanics of legged locomotion on granular media
Compliant leg behaviour explains basic dynamics of walking and running
Compliant leg behaviour explains basic dynamics of walking and running Hartmut Geyer1,*, Andre in walking and rebounding on compliant legs in running. However, while rebounding legs well explainmass model, we show that not stiff but compliant legs are essential to obtain the basic walking mechanics
Static Stability of Tension Leg Platforms
Xu, Ning
The static stability of a Tension Leg Platform (TLP) with an intact tendon system is principally provided by its tendons and hence quite different from those of a conventional ship or even a floating structure positioned by its mooring system...
James P Kennett Co-Chief Scientist, Leg 113 Graduate School of Oceanography University of Rhode Island, University of Rhode Island, Narraganett, Rhode Island 02882-1197) Suzanne 0'Connell, ODP Staff Scientist
, Universidad de Granada Campus Fuentenueva 18002 Granada Spain Dr. Rainer Zahn Co-Chief Scientist, Leg 161; E-mail: mcomas@ goliat.ugr.es) Rainer Zahn, Co-Chief Scientist (GEOMAR, Wischhofstraße 1-3, D-24148
Prosthetic Leg Design Biomedical Technology Exploration
Provancher, William
.00 Large Sponge = $2.00 Duct Tape = $7.00 (share with others?) #12;Assignment Draw prosthetic leg design & detail materials (Next Monday) Proposal (Next Wednesday) Document that engineers must write before
Pepsinogen C gene polymorphisms associated with gastric body ulcer.
Azuma, T; Teramae, N; Hayakumo, T; Yasuda, K; Nakajima, M; Kodama, T; Inokuchi, H; Hayashi, K; Taggart, R T; Kawai, K
This study was aimed to investigate the association of restriction fragment length polymorphisms (RFLPs) for pepsinogen genes with peptic ulcer disease. Eighty unrelated controls, 61 patients with gastric ulcer, and 57 patients with duodenal ulcer were studied. No genetic polymorphisms for pepsinogen A were detected by EcoRI digestion in Japanese subjects but a 100 base pairs insertion-deletion RFLP for the pepsinogen C gene was observed. The allele frequencies of the large (3.6 kilobase EcoRI fragment) and the small fragment (3.5 kilobase EcoRI fragment) were 80.6% and 19.4% respectively in controls, 55.4% and 44.6% in patients with gastric body ulcer, 79.4% and 20.6% in patients with gastric angular ulcer, 71.4% and 28.6% in patients with gastric antral ulcer, and 75.4% and 24.6% in patients with duodenal ulcer. The allele frequency of the small fragment was significantly higher in patients with gastric body ulcer than in controls and in patients with gastric angular or antral ulcer. The genotypes which possessed the small fragment were significantly more frequent in patients with gastric body ulcer (78.4%) than in controls (33.8%) and in patients with gastric angular or antral ulcer (37.5%). These results suggest that there is a significant association between the genetic polymorphism at the pepsinogen C gene locus and gastric body ulcer, and that the pepsinogen C RFLP is a useful marker of the genetic predisposition to this disorder. These results also indicate genetic heterogeneity of gastric ulcer disease, and suggest that the pepsinogen C RFLP may be a useful subclinical marker to explain the differences in genetic aetiologies of gastric body ulcer and gastric angular or antral ulcer. Images Figure 1 Figure 2 PMID:8098309
Pressure ulcers: effectiveness of risk-assessment tools. A randomised controlled trial (the ULCER trial)
Joan Webster; Kerrie Coleman; Alison Mudge; Louise Marquart; Glenn Gardner; Monica Stankiewicz; Julie Kirby; Catherine Vellacott; Margaret Horton-Breshears; Alice McClymont
ObjectiveTo evaluate the effectiveness of two pressure-ulcer screening tools against clinical judgement in preventing pressure ulcers.DesignA single blind randomised controlled trial.SettingA large metropolitan tertiary hospital.Participants1231 patients admitted to internal medicine or oncology wards. Patients were excluded if their hospital stay was expected to be 2 days or less.InterventionsParticipants allocated to either a Waterlow (n=410) or Ramstadius (n=411) screening tool group
Stege, H
The leg is a very important aesthetic unit along with the face, neck, décolleté and hands. In addition to individual and inherited factors, which define the appearance and shape of the legs, multiple changes may occur during life which are cosmetically disturbing and may influence individual attractiveness. These changes offer dermato-phlebologists a wide spectrum of possibilities to intervene. Sclerotherapy, laser procedures, surgical approaches such as liposuction, conventional and endovasal phlebosurgery and physical therapy can all be beneficial. PMID:15761695
Rotational joint assembly for the prosthetic leg
NASA Technical Reports Server (NTRS)
Owens, L. J.; Jones, W. C. (inventors)
A rotational joint assembly for a prosthetic leg has been devised, which enables an artificial foot to rotate slightly when a person is walking, running or turning. The prosthetic leg includes upper and lower tubular members with the rotational joint assembly interposed between them. The assembly includes a restrainer mechanism which consists of a pivotably mounted paddle element. This device applies limiting force to control the rotation of the foot and also restores torque to return the foot back to its initial position.
On the stability of legged locomotion
Zhuohua Shen
Spring-Loaded Inverted Pendulum(SLIP) is a canonical model legged locomotion, but it fails to predict dynamical stability of real world legged locomotion. Recently there are some actuated models with greater stability than SLIP developed and analyzed. But the reason behind the improved stability is still unknown. Here, we introduce a new model called Forced-Damped Spring-Loaded Inverted Pendulum(FD-SLIP) capable of achieving fully
Sustaining pressure ulcer prevention in practice.
McDonagh, Vanessa
This article describes a campaign to eliminate avoidable grade 2-4 pressure ulcers at University Hospitals Coventry and Warwickshire Trust. The 100 Days Free strategy used traditional educational approaches along with ward-based power training and social media to engage staff and update practice. Root cause analysis has been vital in providing feedback to staff and identifying training needs. PMID:23696992
Failure of colonoscopic surveillance in ulcerative colitis
D A Lynch; A J Lobo; G M Sobala; M F Dixon; A T Axon
A prospective surveillance programme for patients with longstanding (> = 8 years), extensive (> = splenic flexure) ulcerative colitis was undertaken between 1978 and 1990. It comprised annual colonoscopy with pancolonic biopsy. One hundred and sixty patients were entered into the programme and had 739 colonoscopies (4.6 colonoscopies per patient; 709 patient years follow up). Eight eight per cent of
Cytokines in the pathogenesis of ulcerative colitis.
Bamias, Giorgos; Kaltsa, Garyfallia; Ladas, Spiros D
Ulcerative colitis is a chronic inflammatory condition of the large intestine whose etiology remains largely unknown. Its pathogenesis involves the breakdown of intestinal mucosal homeostasis due to a genetically determined miscommunication between commensal flora and the gut associated immune system. Cytokines are central components of the inflammatory pathways that take place during the active and chronic phases of ulcerative colitis. Recent research has identified several novel cytokine systems that are upregulated at the mucosa of patients with ulcerative colitis and started to unveil their functional importance for disease pathogenesis. The significance of interleukin-13 (IL-13), TNF-like cytokine 1A (TL1A), IL-33, and their receptors in ulcerative colitis is strongly supported by converging expression and functional data. These molecular systems may define subgroups of patients with uniform immunological profiles. Within these subpopulations such novel cytokine systems may serve as markers of biological activity of the disease. More importantly, they may offer unique therapeutic opportunities through the development of drugs that specifically target and neutralize well-defined inflammatory pathways. PMID:21616044
Chemoprevention of colorectal cancer in ulcerative colitis
Victoria J. Croog; Thomas A. Ullman; Steven H. Itzkowitz
Background Patients with ulcerative colitis (UC) are at greater risk of developing colorectal cancer (CRC) than the general population. Both duration and extent of UC are important risk factors for CRC, as is the presence of primary sclerosing cholangitis, family history of CRC, and (in some studies) early age at diagnosis of UC. Efforts to reduce this risk have focused
Healing of chronic gastroduodenal ulcerations by antacids
STANISILAW J. KONTUREK; Tomasz Brzozowski; Danuta Drozdowicz; Artur Dembi?ski; Christian Nauert
Antacids show gastroprotective action against various irritants in experimental animals and enhance the healing of chronic gastroduodenal ulcers in humans but the mechanisms of these effects are unknown. The present study was designed to determine whether prostaglandin (PG) and epidermal growth factor (EGF), which also have protective and antiulcer properties, contribute to the action of antacids on rat's stomach. It
The gastric acid conundrum in peptic ulcer.
Dobrilla, G; Steele, A; Comberlato, M; Amplatz, S
According to the traditional view, gastric acid and pepsin are a sine qua non for ulcer development. Acid suppression, however, is far from being the only successful therapeutic approach, and similar healing rates are achieved by drugs with substantially different mechanism of action antacids, H2-antagonists, antimuscarinics, cytoprotective and site-protective agents-thus denoting a multifactorial pathogenesis. Even with the antisecretory compounds, the relationship between gastric acid and ulcer healing gives rise to perplexity: antacids prove effective at widely varying doses; pirenzipine and H2-blockers, which are clinically equieffective, differ considerably in antisecretory efficacy; H2-antagonist studies on early vs late postprandial dosing, yield contradictory clinical results; morning and bedtime single administration of H2-antagonists prove equiactive on ulcer healing, leading to a appraisal of the alleged importance of nocturnal acidity. Ulcer sealants such as colloidal bismuth and sucralfate prove as effective as H2-antagonists despite their total lack of antisecretory activity, thereby reapparently under-mining the primary pathogenetic role of acid. However, with the spectacular 100% healing rates achieved by the proton-pump blocker, omeprazole, the wheel has come full circle, and gastric acid appears to re-emerge as a primary element in pathogenesis. Specific therapy, based on the predominant pathogenetic factor involved, is likely to be a feasible proposition, but, at present, remains little more than a remote possibility. PMID:2131944
Stomach Ulcers and the Endurance Horse
David Marlin
The results of numerous surveys, conducted from the 1980s to present day suggest that gastric (stomach) ulcers are an ongoing and widespread problem for adult horses. Thoroughbreds in active race training were quickly identified as being a 'high risk' group, with the results of several published studies citing a prevalence of 80-90% within horses in training. Following on from these
When Is Surgery Indicated in Ulcerative Colitis?
Qin Ouyang; Yan Pan
Background: Surgery continues to play an important role in ulcerative colitis (UC) therapy, with the operation rate for severe UC (SUC) cases varying between 25 and 30% in western countries. The indication and timing for surgery are not clearly defined, and there are some differences between the West and the East. By analyzing present data from different levels, the evidence
Barrett's ulcer: cause of spontaneous oesophageal perforation.
Limburg, A J; Hesselink, E J; Kleibeuker, J H
We report two patients, who presented within six months with the classic clinical picture of 'spontaneous' oesophageal perforation, which was caused by a perforated Barrett's ulcer. These two cases underline the importance of postoperative endoscopy in ruling out intrinsic oesophageal disease as the cause of the rupture in every patient, who survives this life threatening condition. PMID:2707641
Allergy as a factor in surface ulcers, varicose veins, phlebitis and thrombosis
John A. Turnbull
Conclusions \\u000a \\u000a \\u000a \\u000a 1. \\u000a \\u000a The causes and symptoms of varicose veins, together with their sequelae, varicose ulcer, thrombosis and phlebitis, are reviewed.\\u000a \\u000a \\u000a \\u000a \\u000a 2. \\u000a \\u000a Attention is called to the fact that\\u000a \\u000a \\u000a \\u000a \\u000a \\u000a \\u000a \\u000a a) \\u000a \\u000a most of these conditions occur most frequently in the legs, but\\u000a \\u000a \\u000a \\u000a \\u000a b) \\u000a \\u000a thrombosis, in particular, while it has been observed in all parts of the body, is more frequent in the
Ulcer healing activity of Mumijo aqueous extract against acetic acid induced gastric ulcer in rats
Shahrokhi, Nader; Keshavarzi, Zakieh; Khaksari, Mohammad
Objective: Gastric ulcer is an important clinical problem, chiefly due to extensive use of some drugs. The aim was to assess the activity of Mumijo extract (which is used in traditional medicine) against acetic acid induced gastric ulcer in rats. Materials and Methods: The aqueous extract of Mumijo was prepared. Animals were randomly (n = 10) divided into four groups: Control, sham-operated group (received 0.2 ml of acetic acid to induce gastric ulcer), Mumijo (100 mg/kg/daily) were given for 4 days postacetic acid administration, and ranitidine group (20 mg/kg). The assessed parameters were pH and pepsin levels (by Anson method) of gastric contents and gastric histopathology. Ranitidine was used as reference anti-ulcer drug. Results: The extract (100 mg/kg/daily, p.o.) inhibited acid acetic-induced gastric ulceration by elevating its pH versus sham group (P < 0.01) and decreasing the pepsin levels compared to standard drug, ranitidine (P < 0.05). The histopathology data showed that the treatment with Mumijo extract had a significant protection against all mucosal damages. Conclusion: Mumijo extract has potent antiulcer activity. Its anti-ulcer property probably acts via a reduction in gastric acid secretion and pepsin levels. The obtained results support the use of this herbal material in folk medicine. PMID:25709338
Fasting and postprandial gastrointestinal motility in ulcer and non-ulcer dyspepsia.
Stanghellini, V; Ghidini, C; Maccarini, M R; Paparo, G F; Corinaldesi, R; Barbara, L
This study aimed to compare fasting and postprandial gastrointestinal motor patterns in patients with ulcer and non-ulcer dyspepsia. Forty five subjects were studied: 10 with uncomplicated gastric ulcer, eight with uncomplicated duodenal ulcer, 18 with chronic idiopathic dyspepsia, and nine healthy asymptomatic controls. Gastrointestinal fasting and postprandial motor patterns were recorded using a low compliance perfusion technique. The interdigestive antral cumulative motility index, computed for 30 minutes before the appearance of duodenal activity fronts, and the number of activity fronts with an antral component were significantly less in patients with ulcers and those with non-ulcer dyspepsia compared with asymptomatic controls. The patient groups also had a reduced antral motor response to a solid-liquid test meal compared with healthy controls. Intestinal motor abnormalities (bursts of non-propagated phasic pressure activity and discrete clustered contractions) were recorded in a minority of patients, all with associated irritable bowel symptoms. In conclusion, antral hypomotility is a frequent but nonspecific motor abnormality in dyspepsia; abnormal motor patterns of the small bowel are less frequent and seem to be confined to patients with concomitant irritable bowel syndrome. PMID:1541413
The role of nutrition for pressure ulcer management: national pressure ulcer advisory panel, European pressure ulcer advisory panel, and pan pacific pressure injury alliance white paper.
Posthauer, Mary Ellen; Banks, Merrilyn; Dorner, Becky; Schols, Jos M G A
Nutrition and hydration play an important role in preserving skin and tissue viability and in supporting tissue repair for pressure ulcer (PrU) healing. The majority of research investigating the relationship between nutrition and wounds focuses on PrUs. This white paper reviews the 2014 National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance Nutrition Guidelines and discusses nutrition strategies for PrU management. PMID:25775201
Become the PPUPET Master: Mastering Pressure Ulcer Risk Assessment With the Pediatric Pressure Ulcer Prediction and Evaluation Tool (PPUPET).
Sterken, David J; Mooney, JoAnn; Ropele, Diana; Kett, Alysha; Vander Laan, Karen J
Hospital acquired pressure ulcers (HAPU) are serious, debilitating, and preventable complications in all inpatient populations. Despite evidence of the development of pressure ulcers in the pediatric population, minimal research has been done. Based on observations gathered during quarterly HAPU audits, bedside nursing staff recognized trends in pressure ulcer locations that were not captured using current pressure ulcer risk assessment tools. Together, bedside nurses and nursing leadership created and conducted multiple research studies to investigate the validity and reliability of the Pediatric Pressure Ulcer Prediction and Evaluation Tool (PPUPET). PMID:25450444
Healing of venous ulcers using compression therapy: Predictions of a mathematical model.
Flegg, Jennifer A; Kasza, Jessica; Darby, Ian; Weller, Carolina D
Venous Leg Ulceration (VLU) is a chronic condition for which healthcare systems worldwide face rising treatment costs. VLU can be due to sustained venous hypertension which causes the veins to become cuffed with fibrin, inhibiting the supply of nutrients to the wound site. For patients that cannot tolerate compression therapy with an inelastic short stretch (SS) bandage, the mainstay treatment, an elastic three layered (3L) bandage is an alternative. In this paper, a mathematical model is developed to investigate whether the healing of venous ulcers under SS and 3L bandages occurs at different rates and to postulate the reason for any difference. The two treatments were applied to a simplified wound geometry, under the assumption that the rate limiting step of healing is the supply of oxygen to the wounded tissue. Clinical data of wound size over time under the two treatments from Weller et al. (2012) was used to fit key, unknown, model parameters using a least squares approach. Numerical results are presented for the oxygen distribution within the wound space, using the fitted parameter values. The 3L bandage allows more oxygen flow into the wound than the SS bandage and, hence, the 3L bandage results in faster healing, however the difference is more significant for wounds of larger initial size. The model can be used as a predictive tool in a clinical setting to estimate the time to heal for a wound of a given initial size, treated with either a SS or 3L bandage. PMID:25957521
Stable control of a simulated one-legged running robot with hip and leg compliance
Mojtaba Ahmadi; Martin Buehler
We present a control strategy for a simplified model of a one-legged running robot which features compliant elements in series with hip and leg actuators. For this model, proper spring selection and initial conditions result in "passive dynamic" operation close to the desired motion, without any actuation. However, this motion is not stable. Our controller is based on online calculations
A novel method to produce extensive gastric antral ulcer in rats: pharmacological factors involved in the etiology of antral ulceration.
Uchida, M; Takayama, M; Kato, Y; Tsuchiya, S; Horie, S; Watanabe, K
Gastric antral area is the most susceptible region to gastric ulceration in man. However, only limited information is available on animal models. In the present paper, we have developed an improved method for inducing gastric antral ulcers by the administration of 1.0 M HCl after refeeding for 1 h in rats. On day 4, the severe ulcer was found covering extensively the whole area of the antrum, and penetrated through the muscularis mucosae. The incidence of ulceration was 100% and the mean ulcer index was 37.1 +/- 16.6 mm2. In contrast, none of the erosive lesions were observed in the corpus area. Before 24 h, only slight hyperemia was observed in the antral region, suggesting that some submucosal mechanisms are involved in the ulceration processes other than the direct erosive action of HCl on the mucosal surface. Additional treatment with diethyldithiocarbamate (125 mg x kg(-1), s.c.), superoxide dismutase inhibitor, significantly aggravated this antral ulcer, and the ulcer index was 66.0 +/- 13.6 mm2. Allopurinol (50 mg x kg(-1), p.o.) significantly prevented ulcer formation induced by HCl plus DDC. GSH (150 mg x kg(-1), i.p.) also markedly prevented the ulceration. However, DMSO (0.5%, 5 mL x kg(-1), p.o.) was found not to affect ulcer formation. Famotidine (20 mg x kg(-1), p.o.) almost completely inhibited ulcer formation. From the above results, it was concluded that gastric antral ulcer can be induced by the simple treatment of 1.0 M HCl in refed rats, and the antrum has a different defensive mechanism from that in the corpus area. In addition. oxygen derived radicals, especially superoxide anion and endogenous acid secretion were found to be involved in the etiology of the aggravation of the gastric antral ulcer induced by DDC. PMID:10674922
Novel therapeutic approaches to gastric and duodenal ulcers: an update.
Dajani, E Z; Klamut, M J
Over the last 25 years, a remarkable revolution in the pathophysiology and treatment of gastric and duodenal ulcers has occurred. Effective therapies were developed not only to heal ulcers, but also to cure most patients. The two principal causes for gastric and duodenal ulcers are either infection with Helicobacter pylori or the use of non-steroidal anti-inflammatory drugs (NSAIDs). With H. pylori eradication, gastric and duodenal ulcers are rapidly becoming historical diseases. This communication reviews the salient pharmacology of the novel anti-ulcer drugs currently in development, with particular emphasis on the treatment of gastric and duodenal ulcers. Intense research is currently focused on the development of proton pump inhibitors primarily for the treatment and prevention of gastroesophageal reflux disease. The older proton pump inhibitors, omeprazole and lansoprazole, are effective in healing gastric and duodenal ulcers. Furthermore, both drugs are effective in eradicating H. pylori when given with various antibiotics. Pantoprazole, rabeprazole and esomeprazole are new proton pump inhibitors, which appear to have comparable therapeutic profiles with omeprazole and lansoprazole. Rebamipide is a new mucosal protective drug, which is effective in healing gastric ulcers. Polaprezinc and nocloprost are also mucosal protective drugs, which are in clinical development. However, none of these three cytoprotective drugs have been evaluated for their efficacy in eradicating H. pylori when given in combination with antibiotics. Likewise, no published literature exists on the use of these drugs for preventing NSAID-induced ulcers. With the rapid eradication of H. pylori currently happening in the developed world, the therapeutic challenge is now directed toward preventing NSAID-associated ulcer. Significant reduction of NSAID-induced ulcers is achieved by using continuous prophylactic anti-ulcer therapy (misoprostol or omeprazole) or by using NSAIDs possessing selective COX-2 inhibitory activity. However, outcome clinical studies are needed to compare the adjuvant anti-ulcer therapies given with COX-1 inhibitors versus the selective COX-2 inhibitors given alone. PMID:11060758
Leucocytoclastic vasculitis in severe ulcerative colitis.
Martin, Donald; Handler, Tristan; McDermott, Joseph
Ulcerative colitis may be associated with a number of extraintestinal skin manifestations including erythema nodosum and pyoderma gangrenosum. We describe an unusual case of a 26-year-old military pilot with ulcerative colitis and skin lesions diagnosed as leucocytoclastic vasculitis. The skin lesions occurred twice during the severe flare. The first occurrence was treated successfully with corticosteroids. When the lesions recurred several weeks later, concomitant with the ongoing flare, treatment with mesalamine and infliximab resolved the lesions. Ultimately, the patient required total colectomy for flare unresponsive to maximum medical therapy. The leucocytoclastic vasculitis did not recur after colectomy. We propose a potential immunopathophysiologic mechanism linking the 2 conditions based on recent biochemical and clinical research. PMID:21634306
Prognosis of carcinoma in ulcerative colitis.
Ritchie, J K; Hawley, P R; Lennard-Jones, J E
Between 1947 and 1980, 67 patients with carcinoma complicating ulcerative colitis were treated at St Mark's Hospital. The tumours in these patients were compared with those in 4817 patients without colitis seen over the same period. There was a higher proportion of inoperable and high grade tumours in the colitic group but the prognosis was found to be very similar in patients with and without colitis. PMID:7297924
Rectal ulcers induced by systemic lupus erythematosus.
Yau, Alan Hoi Lun; Chu, Karen; Yang, Hui Min; Ko, Hin Hin
A 28-year-old woman presented with diarrhoea, haematochezia, tenesmus and rectal pain for 2?months. She was diagnosed with systemic lupus erythematosus (SLE) 8?years ago and remained on prednisone, azathioprine and hydroxychloroquine. Blood work revealed a positive ANA (antinuclear antibody test), anti-dsDNA 749?IU/mL (0-300?IU/mL), C3 0.22?g/L (0.65-1.65?g/L) and C4 0.05?g/L (0.16-0.60?g/L). Stool studies were unremarkable. MRI of the pelvis showed a rectum with eccentric wall thickening. Flexible sigmoidoscopy showed severe proctitis with multiple deep ulcers and diffuse submucosal haemorrhage. Rectal biopsy revealed crypt architectural distortion and reactive fibrosis in the lamina propria. The patient was given mesalamine suppository for 2?weeks with minimal improvement. Repeat flexible sigmoidoscopy showed a coalesced 3×4?cm full-thickness rectal ulcer. Therefore, the patient was given intravenous methylprednisolone for 3?days, followed by intravenous cyclophosphamide for 2?weeks. Her symptoms resolved and repeat flexible sigmoidoscopy showed fibrotic healing of the rectal ulcers. PMID:25150239
Histiocytic sarcoma with fatal duodenal ulcers.
Akishima, Yuri; Akasaka, Yoshikiyo; Yih-Chang, Ger; Ito, Kinji; Ishikawa, Yukio; Lijun, Zhang; Kiguchi, Hideko; Lipscomb, Gary; Strong, Jack P; Ishii, Toshiharu
Histiocytic sarcoma is an uncommon neoplasm of mature histiocytes with very poor outcome. We report an autopsy case of a true histiocytic sarcoma with characteristic symptoms of so-called "malignant histiocytosis of the intestine". The liver and spleen were enlarged, with remarkable tumor cell infiltration in the hepatic sinusoids and splenic sinuses. Tumor cells aggregated to form sporadic nodular lesions in the liver, which often showed coagulative necrosis. Infarcted lesions also occurred at the splenic subcapsular area. In addition, tumor cell infiltration was noted in the sinuses of bone marrow and lymph node. Tumor cells often demonstrated moderate pleomorphism with multinucleated giant cells. They were positive for CD68 and negative for T- and B-cell lineage markers, megakaryocytic markers, and CD30. Various examinations were done to rule out infection-associated hemophagocytic syndrome, and the absence of infectious diseases was revealed. Thus, the diagnosis of histiocytic sarcoma was made. Apart from these lesions, multiple ulcerations, some with fatal perforation, were found in the esophagus and duodenum. They showed only non-specific inflammatory changes without tumor cell involvement. The ulcers probably derived from ischemic condition through an embolic process caused by tumor cell infiltration elsewhere in the blood vessels at the periphery of the ulcers. PMID:15310151
Effects of Antiulcer Agents on Healing of Mepirizole-induced Duodenal Ulcers in Rats
Y. Ishihara; S. Okabe
Healing processes of duodenal ulcers induced by mepirizole and effects of several drugs on the ulcer healing were studied in rats. Mepirizole-induced duodenal ulcers, except for the perforated ones within 3 days after ulceration, gradually diminished in size and depth by the 15th day. Several ulcers persisted for up to 40 days, but complete healing in all rats occurred by
Probabilistic Mechanical Reliability Prediction of Thermoelectric Legs
Jadaan, Osama M. [University of Wisconsin, Platteville; Wereszczak, Andrew A [ORNL
The probability of failure, Pf, for various square-arrayed thermoelectric device designs using bismuth telluride, lead telluride, or skutterudite thermoelectric materials were estimated. Only volume- or bulk-based Pf analysis was considered in this study. The effects of the choice of the thermoelectric material, the size of the leg array, the height of the thermoelectric legs, and the boundary conditions on the Pf of thermoelectric devices were investigated. Yielding of the solder contacts and mounting layer was taken into account. The modeling results showed that the use of longer legs, using skutterudites, allowing the thermoelectric device to freely deform while under a thermal gradient, and using smaller arrays promoted higher probabilities of survival.
Pressure ulceration and palliative care: prevention, treatment, policy and outcomes.
Stephen-Haynes, Jackie
Pressure ulcer development and management have particular significance in palliative and end-of-life care owing to the prevalence of mobility issues and the skin changes that can occur with ageing, chronic illness, and at the end of life. Hence, it is important for nurses working in palliative care to be vigilant for pressure ulcer development and to possess knowledge relating to the prevention and management of pressure ulceration. This article considers current UK policy regarding pressure ulcers, highlighting contradictions of relevance to patients requiring palliative care. It then provides a brief overview of pressure ulcer prevention, prescription, preservation, and palliation, highlighting areas of specific consideration to pressure ulcer care within palliative care. PMID:22306714
Cutaneous ulcerative lichen planus exhibiting pathergy, response to acitretin.
Henderson, Robert L; Williford, Phillip M; Molnar, Joseph A
While ulcerative lichen planus is a common diagnosis when involving the mucosa, it is uncommonly found on the cutaneous surface. Cutaneous ulcerative lichen planus is usually found on the palmar or plantar surfaces and has only rarely been described elsewhere. We describe a case of cutaneous ulcerative lichen planus involving the pretibia and exhibiting pathergy, which to our knowledge has not been previously reported. We also describe successful treatment with oral acitretin in conjunction with topical and intralesional corticosteroids. PMID:15098977
A quality improvement programme to reduce pressure ulcers.
Heywood, Nicola; Brown, Lisa; Arrowsmith, Michaela; Poppleston, Alexa
This article outlines an innovative way of preventing pressure ulcers in the acute hospital setting. A programme using Rapid Spread Methodology was undertaken to reduce hospital-acquired pressure ulcers over a short period of time. Results demonstrated a reduction to zero in the prevalence of hospital-acquired pressure ulcers and an 80% reduction in their incidence, in a six-month period. PMID:26174287
[Vascular diseases in lipedema of the legs. Special symptoms, common therapeutic results, viewpoint on vascular surgery].
Brunner, U
Lipedema of the legs is a symmetrical thickening of upper and lower leg and topically accentuated fat pads. The back of the foot is usually free of swelling. Pathogenetically it is a disturbance of the distribution pattern of subcutaneous fat tissue. Epidemiologically, the subjects affected are women, starting from puberty. Weight reduction programs do not influence the real deformations. If this abnormal fat tissue is infiltrated by angiological diseases, these manifest themselves in modified form. In particular, all the symptoms are more painful. In arterial ischemic syndromes that taut skin is susceptible to necrosis at atypical locations. For reconstruction of trunk arteries it is advisable to bypass larger bulges for better wound nealing. Venous strips should be peeled out away from fat pads and venous-bridges very carefully to protect the tissue. Acute and chronic phlebothrombosis lead to unusual and asymmetrical forms of swelling. The venous ulcer lies directly beneath a fat-muff in the gaiter region. Since they are hard to compress, free skin transplants should be considered early in the course of development. Surgery of varicose veins calls for most careful technique to ensure wound healing. From the lymphological viewpoint there are clinically and lymphographically mixed forms of lymphedema with lipedema. PMID:7134941
Optimal management of digital ulcers in systemic sclerosis
Abraham, Shawn; Steen, Virginia
Raynaud's phenomenon and digital ulcerations are two common clinical features seen in patients with systemic sclerosis. They are painful and lead to significant morbidity and altered hand function within this patient population. While currently there are no US Food and Drug Administration (FDA)-approved medications for the treatment of digital ulcerations in the United States, clinical trials have supported the use of pharmacologic and nonpharmacologic modalities in facilitating healing of existing digital ulcers and preventing formation of new ulcers. This article reviews the published data on these therapeutic options. PMID:26109864
The prevention of foot ulceration in diabetic patients.
Howard, Ileana M
Diabetic foot ulcerations are a costly and common public health challenge. Although several organizations have emphasized the need to increase awareness of this problem and called health care providers to action to decrease the incidence of ulceration and amputation, there is limited evidence regarding what interventions are best suited to accomplish this goal. This article reviews the pathogenesis, risk factors, and current interventions that have been studied for the prevention of foot ulceration. Preventive measures with evidence for decreasing incidence of ulceration include patient education, offloading abnormal pressures with foot orthotics, and thermal monitoring. PMID:19781501
[Gastroduodenal ulcers during the period of acute economical crisis].
Pomakov, P; Guéorgiéva, S; Stantchéva, J; Ténev, T; Rizov, A
The occurrence and development of acute ulcers in Sofia during the period of heavy economical recession--January trough February 1991--is analyzed. There is a clear cut increase in the total number and rate of acute duodenal ulcers from 2 to 14%. No gastric ulcer cases are recorded. The young age group--up to 40 years of age--is mainly affected (79% of cases). The incidence among the female population shows a noticeable rise. Difficult living, working and social conditions, associated with inadequate feeding regimen with diets, poor in meat and vitamins, are taken to be the underlying factors of acute ulcers development during the period in question. PMID:8320659
Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey
11. NORTH VIEW OF INNER FACING OF SOUTHEASTERN LEG OF SEA WALL. SOUTHERN END OF NORTHEASTERN LEG OF SEA WALL IN BACKGROUND. - Fort Delaware, Sea Wall, Pea Patch Island, Delaware City, New Castle County, DE
Genetic and expression analysis of enabled in Drosophila leg segmentation
Ramel, Marie-Christine
Drosophila leg segmentation is a process which is beginning to be understood. The Notch (N) signaling pathway has been identified as a key regulator of joint formation and segmental growth in Drosophila legs. In this context, four-jointed (fj...
Tandem wheel drop-legs for standard truck trailer
NASA Technical Reports Server (NTRS)
Cantwell, W.; Selstad, R.
Tandem wheel drop-leg device provides a semitrailer with fore and aft mobility that allows it to be moved without a prime mover. The modified drop-legs have trunnion dual wheels and an adjustable brace.
Triggers for Willis Ekbom Disease / Restless Legs Syndrome
... willis-ekbom.org Triggers for Willis-Ekbom Disease/ Restless Legs Syndrome The exact cause of Willis-Ekbom disease or WED, formerly known as restless legs syndrome (RLS), is unknown. We do know that WED/ ...
Get Your Legs Ready For Summer!
Leistikow, Bruce N.
Get Your Legs Ready For Summer! Free seminars: Treatments for spider veins The vascular program at UC Davis Health System is the most comprehensive in the Sacramento area for the treatment of varicose and spider veins. The UC Davis Vascular Center's vein program offers advanced cosmetic and therapeutic
Chronic Lower Leg Pain in Athletes
Brewer, Rachel Biber; Gregory, Andrew J. M.
Context: Chronic lower leg pain in athletes can be a frustrating problem for patients and a difficult diagnosis for clinicians. Myriad approaches have been suggested to evaluate these conditions. With the continued evolution of diagnostic studies, evidence-based guidance for a standard approach is unfortunately sparse. Evidence Acquisition: PubMed was searched from January 1980 to May 2011 to identify publications regarding chronic lower leg pain in athletes (excluding conditions related to the foot), including differential diagnosis, clinical presentation, physical examination, history, diagnostic workup, and treatment. Results: Leg pain in athletes can be caused by many conditions, with the most frequent being medial tibial stress syndrome; chronic exertional compartment syndrome, stress fracture, nerve entrapment, and popliteal artery entrapment syndrome are also considerations. Conservative management is the mainstay of care for the majority of causes of chronic lower leg pain; however, surgical intervention may be necessary. Conclusion: Chronic lower extremity pain in athletes includes a wide differential and can pose diagnostic dilemmas for clinicians. PMID:23016078
OCEAN DRILLING PROGRAM LEG 199 SCIENTIFIC PROSPECTUS PALEOGENE EQUATORIAL TRANSECT Dr. Mitchell Oceanography Centre School of Ocean and Earth Science European Way Southampton SO14 3ZH UK __________________ Dr. Jack Baldauf Deputy Director of Science Operations Ocean Drilling Program Texas A&M University
OCEAN DRILLING PROGRAM LEG 201 SCIENTIFIC PROSPECTUS CONTROLS ON MICROBIAL COMMUNITIES IN DEEPLY. Jack Baldauf Deputy Director of Science Operations Ocean Drilling Program Texas A&M University 1000 Manager and Staff Scientist Ocean Drilling Program Texas A&M University 1000 Discovery Drive College
OCEAN DRILLING PROGRAM LEG 184 SCIENTIFIC PROSPECTUS SOUTH CHINA SEA Dr. Warren L. Prell Co's Republic of China Dr. Peter Blum Staff Scientist Ocean Drilling Program Texas A&M University Research Park the written consent of the Director, Ocean Drilling Program, Texas A&M University Research Park, 1000
OCEAN DRILLING PROGRAM LEG 182 SCIENTIFIC PROSPECTUS GREAT AUSTRALIAN BIGHT Cenozoic Cool Ocean Drilling Program Texas A&M University Research Park 1000 Discovery Drive College Station, Texas purposes; however, republication of any portion requires the written consent of the Director, Ocean
OCEAN DRILLING PROGRAM LEG 195 SCIENTIFIC PROSPECTUS MARIANA CONVERGENT MARGIN/ WEST PHILIPPINE SEA Baldauf Deputy Director of Science Operations Ocean Drilling Program Texas A&M University 1000 Discovery and Staff Scientist Ocean Drilling Program Texas A&M University 1000 Discovery Drive College Station TX
OCEAN DRILLING PROGRAM LEG 190 SCIENTIFIC PROSPECTUS DEFORMATION AND FLUID FLOW PROCESSES Taira Co-Chief Scientist Ocean Research Institute University of Tokyo 1-15-1 Minamidai Nakano-ku Tokyo 164 Japan __________________ Dr. Jack Baldauf Deputy Director of Science Operations Ocean Drilling
OCEAN DRILLING PROGRAM LEG 177 SCIENTIFIC PROSPECTUS SOUTHERN OCEAN PALEOCEANOGRAPHY Dr. David 177 Ocean Drilling Program Texas A&M University Research Park 1000 Discovery Drive College Station of the Director, Ocean Drilling Program, Texas A&M University Research Park, 1000 Discovery Drive, College Station
OCEAN DRILLING PROGRAM LEG 172 SCIENTIFIC PROSPECTUS NW ATLANTIC SEDIMENT DRIFTS Dr. Lloyd D Ocean Drilling Program Texas A&M University Research Park 1000 Discovery Drive College Station, Texas portion requires the written consent of the Director, Ocean Drilling Program, Texas A&M University
OCEAN DRILLING PROGRAM LEG 188 SCIENTIFIC PROSPECTUS PRYDZ BAY-COOPERATION SEA, ANTARCTICA: GLACIAL Stanford University Stanford, CA 94305-2115 Dr. Carl Richter Staff Scientist Ocean Drilling Program Texas A portion requires the written consent of the Director, Ocean Drilling Program, Texas A&M University
OCEAN DRILLING PROGRAM LEG 200 SCIENTIFIC PROSPECTUS DRILLING AT THE H2O LONG-TERM SEAFLOOR Director of Science Operations Ocean Drilling Program Texas A&M University 1000 Discovery Drive College Ocean Drilling Program Texas A&M University 1000 Discovery Drive College Station TX 77845-9547 USA
OCEAN DRILLING PROGRAM LEG 187 SCIENTIFIC PROSPECTUS MANTLE RESERVOIRS AND MIGRATION ASSOCIATED WITH AUSTRALIAN-ANTARCTIC RIFTING Dr. David M. Christie Co-Chief Scientist College of Oceanic and Atmospheric 5007 Bergen, Norway Dr. Jay Miller Staff Scientist Ocean Drilling Program Texas A&M University 1000
July 2002 OCEAN DRILLING PROGRAM LEG 206 SCIENTIFIC PROSPECTUS AN IN SITU SECTION OF UPPER OCEANIC 93106-9630 USA Dr. Damon A.H. Teagle Co-Chief Scientist School of Ocean and Earth Science Southampton Ocean Drilling Program Texas A&M University 1000 Discovery Drive College Station TX 77845-9547 USA
of the Ocean Drilling Program in consultation with the Planning Committee and the Pollution PreventionOCEAN DRILLING PROGRAM LEG 161 SCIENTIFIC PROSPECTUS MEDITERRANEAN SEA II - THE WESTERN Ocean Drilling Program Texas A&M University Research Park 1000 Discovery Drive College Station, Texas
OCEAN DRILLING PROGRAM LEG 169 SCIENTIFIC PROSPECTUS SEDIMENTARY RIDGES II Dr. Yves Fouquet Dr the written consent of the Director, Ocean Drilling Program, Texas A&M University Research Park, 1000://www-odp.tamu.edu/publications. D I S C L A I M E R This publication was prepared by the Ocean Drilling Program, Texas A
OCEAN DRILLING PROGRAM LEG 135 SCIENTIFIC PROSPECTUS Lau Basin Dr. James Hawkins Co-Chief Scientist Road, Wormley Godalming, Surrey GU8 5UB United Kingdom Dr. James Allan StaffScientist,Legl35 Ocean of the Director, Ocean Drilling Program, Texas A&M University Research Park, 1000 Discovery Drive, College Station
OCEAN DRILLING PROGRAM LEG 191 SCIENTIFIC PROSPECTUS NORTHWEST PACIFIC SEISMIC OBSERVATORY Director of Science Operations Ocean Drilling Program Texas A&M University 1000 Discovery Drive College Scientist Ocean Drilling Program Texas A&M University 1000 Discovery Drive College Station TX 77845-9547 USA
OCEAN DRILLING PROGRAM LEG 202 SCIENTIFIC PROSPECTUS SOUTHEAST PACIFIC PALEOCEANOGRAPHIC TRANSECTS Dr. Alan C. Mix Co-Chief Scientist College of Oceanic and Atmospheric Sciences Oregon State University 104 Ocean Administration Building Corvallis OR 97331-5503 USA Dr. Ralf Tiedemann Co
OCEAN DRILLING PROGRAM LEG 196 SCIENTIFIC PROSPECTUS LOGGING WHILE DRILLING AND ADVANCED CORKS Deputy Director of Science Operations Ocean Drilling Program Texas A&M University 1000 Discovery Drive Scientist Ocean Drilling Program Texas A&M University 1000 Discovery Drive College Station TX 77845-9547 USA
OCEAN DRILLING PROGRAM LEG 197 SCIENTIFIC PROSPECTUS MOTION OF THE HAWAIIAN HOTSPOT: A PALEOMAGNETIC TEST Dr. Robert A. Duncan Co-Chief Scientist Oregon State University College of Oceanic and Atmospheric Sciences 104 Ocean Administration Building Corvallis OR 97331-5503 USA Dr. John A. Tarduno Co
OCEAN DRILLING PROGRAM LEG 183 SCIENTIFIC PROSPECTUS KERGUELEN PLATEAU-BROKEN RIDGE: A Large of Technology Cambridge, Massachusetts 02139 Dr. Paul Wallace Staff Scientist Ocean Drilling Program Texas A of any portion requires the written consent of the Director, Ocean Drilling Program, Texas A&M University
OCEAN DRILLING PROGRAM LEG 186 SCIENTIFIC PROSPECTUS WESTERN PACIFIC GEOPHYSICAL OBSERVATORIES Dr-Chief Scientist Ocean Research Institute The University of Tokyo 1-15-1 Minamidai Tokyo 164-8639, Japan Dr. Gary D. Acton Staff Scientist Ocean Drilling Program Texas A&M University Research Park 1000 Discovery Drive
OCEAN DRILLING PROGRAM LEG 205 SCIENTIFIC PROSPECTUS FLUID FLOW AND SUBDUCTION FLUXES ACROSS __________________ Dr. Jack Baldauf Deputy Director of Science Operations Ocean Drilling Program Texas A&M University Manager and Staff Scientist Ocean Drilling Program Texas A&M University 1000 Discovery Drive College
OCEAN DRILLING PROGRAM LEG 189 SCIENTIFIC PROSPECTUS THE TASMANIAN SEAWAY BETWEEN AUSTRALIA J. Malone Staff Scientist Ocean Drilling Program Texas A&M University 1000 Discovery Drive College the written consent of the Director, Ocean Drilling Program, Texas A&M University Research Park, 1000
OCEAN DRILLING PROGRAM LEG 194 SCIENTIFIC PROSPECTUS MARION PLATEAU Dr. Alexandra Isern Co-Chief Scientist Ocean Studies Board National Research Council 2101 Constitution Avenue, NW Washington, DC 20418 of Science Operations Ocean Drilling Program Texas A&M University 1000 Discovery Drive College Station, TX
, Leg 165 Graduate School of Oceanography Department of Geosciences University of Rhode Island University of Massachusetts Narragansett, Rhode Island 02828 Amherst, Massachusetts 01003 U.S.A. U.S.A. Dr of Rhode Island, Narragansett, Rhode Island 02882-1197, USA, E-mail: firstname.lastname@example.com) Mark
Three Uses for Springs in Legged Locomotion
R. Mcn. Alexander
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
OCEAN DRILLING PROGRAM LEG 104 SCIENTIFIC PROSPECTUS NORWEGIAN SEA Olav Eldholm Co-Chief Scientist Ocean Drilling Program Texas A & M University College Station, Texas 77843-3469 Pni±ip o Rabinowitz Director Ocean Drilling Program Robert B Kidd Manager of Science Operations Ocean Drilling Program Louis E
OCEAN DRILLING PROGRAM LEG 106 PRELIMINARY REPORT BARE ROCK DRILLING IN THE MID-ATLANTIC RIDGE RIFT 106 Ocean Drilling Program Texas A & M University College Station, TX 77843-3469 ±nuwiLZ" ector ODP Drilling Program, Texas A & M University, College Station, Texas 77843-3469. In some cases, orders
OCEAN DRILLING PROGRAM LEG 132 PRELIMINARY REPORT ENGINEERING II: WESTERN AND CENTRAL PACIFIC Mr. Michael A. Storms Supervisor of Development Engineering Ocean Drilling Program Texas A&M University and Drilling Operations ODP/TAMU Timothy J.G. Francis Deputy Director ODP/TAMU September 1990 #12;This informal
OCEAN DRILLING PROGRAM LEG 109 PRELIMINARY REPORT BARE ROCK DRILLING IN THE MID-ATLANTIC RIDGE RIFT 109 Ocean Drilling Program Texas A & M University College Station, TX 77843-3469 Philip D. Rabinowitz Director Ocean Drilling Program Robert B. Kidd Manager of Science Operations Ocean Drilling Program Louis E
Force and motion management in legged locomotion
Kenneth J. Waldron; Nordholt Nordholt
The control of a legged locomotion system over uneven terrain requires a new approach to coordination. The system has a high degree of static indeterminacy and, because of the stiffness of the structural and actuation systems, has stability problems if position-velocity control is used. The problem has many similarities to that of grasping and manipulating an object in a multi-fingered
Force and motion management in legged locomotion
Kenneth J. Waldron
The control of a legged locomotion system over uneven terrain requires a new approach to coordination. The system has a high degree of static indeterminacy and, because of the stiffness of the structural and actuation systems, has stability problems if position-velocity control is used. The problem has many similarities to that of grasping and manipulating an object in a multi-fingered
Brunswick, New Jersey) Arthur Moore (Marathon Oil Company, Littleton, Colorado) Henry Mullins (Syracuse Unversity, Syracuse, New York) Amanda Palmer (Ocean Drilling Program, Texas A&M University, College StationOCEAN DRILLING PROGRAM LEG 101 PRELIMINARY REPORT BAHAMAS James A. Austin, Jr. Co-Chief Scientist
Gait pattern estimation for intelligent bionic leg
Fei Wang; Shiguang Wen; Chengdong Wu
Intelligent bionic leg (IBL) can restitute walking function for above-knee amputees. To realize symmetrical stable walking, IBL must be able to perceive the movement intention of amputee so as to actuate its knee joint accordingly when walking on various terrains with different cadences and stride length. Gait pattern estimation schemes using thigh kinematic data based on two classical pattern recognition
. These sites will provide a latitudinal transect allowing integration of records of surface and deep-water Federal Republic of Germany Dr. Jack G. Baldauf Staff Scientist, Leg 108 Ocean Drilling Program Texas A & M University College Station, Texas 77843-3469 Philip W Rabin Direct Ocean Drilling Program
SLIP running with an articulated robotic leg
Marco Hutter; C. David Remy; Mark A. Höpflinger; Roland Siegwart
SLIP models are generally known as one of the best and simplest abstractions describing the spring-like leg behavior found in human and animal running, and have thus been subject to exhaustive investigation. To exploit these findings in real robots, we utilize an operational space controller that projects the behavior of the SLIP model onto the dynamics of an actual segmented
A Leg Exoskeleton Utilizing a Magnetorheological Actuator
Jinzhou Chen; Wei-hsin Liao
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
OCEAN DRILLING PROGRAM LEGS 143 AND 144 SCIENTIFIC PROSPECTUS NORTHWEST PACIFIC ATOLLS AND GUYOTS-Milano 20113, Italy Dr. John Firth Staff Scientist, Leg 143 Ocean Drilling Program Texas A&M University Scientist, Leg 144 Ocean Drilling Program Texas A&M University Research Park 1000 Discovery Drive College
The Significance of Leg Mass in Modeling Quadrupedal Running Gaits
James Schmiedeler; Robert Siston; Kenneth Waldron
In modeling running gaits of biological and robotic quadrupeds, leg mass is often neglected. Analysis of the system angular momentum in a biological model and a robot model indicates that including leg mass is significant in capturing the roll motion in trotting and pacing. Leg mass has a more significant effect on the pitch motion in bounding and is most
Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology
Richard P Allen; Daniel Picchietti; Wayne A Hening; Claudia Trenkwalder; Arthur S Walters; Jacques Montplaisi
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
The Bow Leg Hopping Robot Ben Brown and Garth Zeglin
Zeglin, Garth
with a highly resilient leg that resembles an archer's bow. During flight, a ``thrust'' actuator adds elastic energy to the leg, which is automatically released during stance to control hopping height. LateralThe Bow Leg Hopping Robot Ben Brown and Garth Zeglin The Robotics Institute Carnegie Mellon
Optimal motion planning of a one-legged hopping robot
Guang-Ping He; Zhi-Yong Geng
The optimal motion planning and stable jumping control for a new one-legged hopping robot are investigated. The new robot has one passive telescopic leg and two actuated arms, therefore an underactuated mechanical system of which the motion can only be controlled by the internal dynamic coupling. The features of the dynamic coupling between the passive leg and the actuated arms
The Bow Leg Hopping Robot Ben Brown and Garth Zeglin
Zeglin, Garth
with a highly resilient leg that resembles an archer's bow. During flight, a "thrust" actuator adds elastic energy to the leg, which is automatically released during stance to control hopping height. LateralThe Bow Leg Hopping Robot Ben Brown and Garth Zeglin The Robotics Institute Carnegie Mellon
Athletic Footwear, Leg Stiffness, and Running Kinematics
Bishop, Mark; Fiolkowski, Paul; Conrad, Bryan; Brunt, Denis; Horodyski, MaryBeth
Context: The leg acts as a linear spring during running and hopping and adapts to the stiffness of the surface, maintaining constant total stiffness of the leg-surface system. Introducing a substance (eg, footwear) may affect the stiffness of the leg in response to changes in surface stiffness. Objective: To determine if the type of athletic footwear affects the regulation of leg stiffness in dynamic activities. Design: Repeated-measures design. Setting: Motion analysis laboratory. Patients or Other Participants: Nine healthy adults (age = 28 ± 6.8 years, mass = 71.6 ± 12.9 kg) free from lower extremity injuries. Intervention(s): Subjects hopped at 2.2 Hz on a forceplate under 3 footwear conditions (barefoot, low-cost footwear, high-cost footwear). Subjects ran on a treadmill at 2 speeds (2.23 m/s, 3.58 m/s) under the same footwear conditions. Main Outcome Measure(s): Limb stiffness was calculated from forceplate data. Kinematic data (knee and ankle angles at initial contact and peak joint excursion after contact) were collected during running. We calculated 1-way repeated-measures (stiffness) and 2-way (speed by footwear) repeated-measures analyses of variance (running kinematics) to test the dependent variables. Results: A significant increase in leg stiffness from the barefoot to the "cushioned" shoe condition was noted during hopping. When running shod, runners landed in more dorsiflexion but had less ankle motion than when running barefoot. No differences were seen between the types of shoes. The primary kinematic difference was identified as running speed increased: runners landed in more knee flexion. At the ankle, barefoot runners increased ankle motion to a significantly greater extent than did shod runners as speed increased. Conclusions: Footwear influences the maintenance of stiffness in the lower extremity during hopping and joint excursion at the ankle in running. Differences in cushioning properties of the shoes tested did not appear to be significant. PMID:17273463
Water-soluble vitamin deficiencies in complicated peptic ulcer patients soon after ulcer onset in Japan.
Miyake, Kazumasa; Akimoto, Teppei; Kusakabe, Makoto; Sato, Wataru; Yamada, Akiyoshi; Yamawaki, Hiroshi; Kodaka, Yasuhiro; Shinpuku, Mayumi; Nagoya, Hiroyuki; Shindo, Tomotaka; Ueki, Nobue; Kusunoki, Masafumi; Kawagoe, Tetsuro; Futagami, Seiji; Tsukui, Taku; Sakamoto, Choitsu
We investigated over time whether contemporary Japanese patients with complicated peptic ulcers have any water-soluble vitamin deficiencies soon after the onset of the complicated peptic ulcers. In this prospective cohort study, fasting serum levels of water-soluble vitamins (vitamins B1, B2, B6, B12, C, and folic acid) and homocysteine were measured at 3 time points (at admission, hospital discharge, and 3 mo after hospital discharge). Among the 20 patients who were enrolled in the study, 10 consecutive patients who completed measurements at all 3 time points were analyzed. The proportion of patients in whom any of the serum water-soluble vitamins that we examined were deficient was as high as 80% at admission, and remained at 70% at discharge. The proportion of patients with vitamin B6 deficiency was significantly higher at admission and discharge (50% and 60%, respectively, p<0.05) than at 3 mo after discharge (10%). In conclusion, most patients with complicated peptic ulcers may have a deficiency of one or more water-soluble vitamins in the early phase of the disease after the onset of ulcer complications, even in a contemporary Japanese population. PMID:24477246
Severe Ulcerative Esophagitis Induced by Crizotinib Therapy
Craig, Jamie; Bajaj, Rajesh; Spurling, Timothy
Crizotinib is an oral tyrosine-kinase inhibitor that inhibits anaplastic lymphoma kinase (ALK) in gene-rearranged non-small cell lung cancer (NSCLC). In 2011, the Food and Drug Administration approved crizotinib for treatment of locally advanced or metastatic ALK-positive NSCLC. The crizotinib adverse events profile included esophageal disorders in 11% of patients treated during trial phases I, II, and III, but none of them had severe events. We describe the development of severe ulcerative esophagitis secondary to crizotinib therapy and the re-introduction of therapy at a lower dose without recurrence of esophageal symptoms.
Perforated marginal ulcers after laparoscopic gastric bypass
Edward L. Felix; John Kettelle; Elijah Mobley; Daniel Swartz
Background Perforated marginal ulcer (PMU) after laparoscopic Roux-en-Y gastric bypass (LRYGB) is a serious complication, but its incidence\\u000a and etiology have rarely been investigated. Therefore, a retrospective review of all patients undergoing LRYGB at the authors'\\u000a center was conducted to determine the incidence of PMU and whether any causative factors were present.\\u000a \\u000a \\u000a \\u000a Methods A prospectively kept database of all patients at the
Epithelial Cell Apoptosis in Recurrent Aphthous Ulcers.
Al-Samadi, A; Drozd, A; Salem, A; Hietanen, J; Häyrinen-Immonen, R; Konttinen, Y T
A recurrent aphthous ulcer (RAU) is a common inflammatory ulcerative lesion affecting oral mucosa. We studied the eventual apoptosis of epithelial cells from the point of view of ulcer and inflammation. RAU lesions and healthy mucosa samples were immunostained for caspase-3 and high-mobility group box 1 (HMGB1). DNA nicks were identified using TUNEL staining. We studied the effects of tumor necrosis factor ? (TNF?) and interferon ? (IFN?) on the toll-like receptor 2 and 4 (TLR2 and TLR4) expression of human oral SCC-25 keratinocytes. We also studied the effects of self-DNA, all-thiol-HMGB1, and disulfide-HMGB1 on epithelial cells, with or without IFN?. At the edge of RAU lesions, all epithelial cell layers were caspase-3(+), TUNEL(+), and HMGB-1(+) and had widened intercellular spaces. In contrast, healthy epithelial cells were negative for caspase-3 and TUNEL staining. HMGB1 was seen in only the basal cell layers, and the cells retained close cell-to-cell contacts. Self-DNA increased TNF-? mRNA (P = 0.02) in SCC-25 cells. Both TNF? and IFN? (P = 0.01) increased TLR2. Upon TNF? stimulation, SCC-25 cells lost their nuclear HMGB1 staining. HMGB1 did not increase IL-8, IL-6, or TNF-? mRNA in SCC-25 cells, which was unaffected by the presence of IFN?. We conclude that in healthy epithelium, the most superficial cells at the end of their life cycle are simply desquamated. In contrast, RAU is characterized by top-to-bottom apoptosis such that dead cells may slough off, leading to an ulcer. Because of a lack of scavenging anti-inflammatory macrophages, apoptotic cells probably undergo secondary necrosis releasing proinflammatory danger signals, which may contribute to the peripheral inflammatory halo. This is supported by self-DNA-induced TNF? synthesis. In contrast to TLR4- and TLR2-binding lipopolysaccharide used as a positive control, disulfide-HMGB1 did not stimulate proinflammatory cytokines. PMID:25861801
Mechanisms of Disease: pathogenesis of Crohn's disease and ulcerative colitis
R Balfour Sartor
Crohn's disease and ulcerative colitis are idiopathic, chronic, relapsing, inflammatory conditions that are immunologically mediated. Although their exact etiologies remain uncertain, results from research in animal models, human genetics, basic science and clinical trials have provided important new insights into the pathogenesis of chronic, immune-mediated, intestinal inflammation. These studies indicate that Crohn's disease and ulcerative colitis are heterogeneous diseases characterized
The trigeminal trophic syndrome: an unusual cause of nasal ulceration
Seetha U Monrad; Jeffrey E Terrell; David M Aronoff
Trigeminal trophic syndrome (TTS) is an unusual complication after peripheral or central damage to the trigeminal nerve, characterized by anesthesia, paresthesias, and ala nasi ulceration. We describe a patient with classic TTS after trigeminal rhizotomy who underwent several extensive evaluations for nasal ulceration and received prolonged immunosuppressive therapy for a presumed autoimmune disorder before the correct diagnosis was made. An
Current misunderstandings in the management of ulcerative colitis
Thomas Ochsenkühn; Geert DHaens
Past and ongoing therapeutic concepts for ulcerative colitis have only been moderately successful. A significant proportion of patients with ulcerative colitis will still have to undergo colectomy and overall half of the patients do not achieve sustained remission, leading to impairment of physical and mental health, social life, employment issues and sexual activity. Reluctance to treat patients early on with
Epstein-Barr virus associated oesophageal ulcers in AIDS.
Kitchen, V S; Helbert, M; Francis, N D; Logan, R P; Lewis, F A; Boylston, A W; Pinching, A J; Harris, J R
Epstein-Barr virus (EBV) associated ulceration has not previously been included in the differential diagnosis of oesophageal ulcers in AIDS. We report five cases of oesophageal ulceration in homosexual men with advanced human immunodeficiency virus infection in whom this was considered to be the most likely cause. DNA in situ hybridisation studies showed EBV in biopsy material from three of four patients with oesophageal ulcers and in none of three controls. Of other viruses studied, only human papillomavirus was present, and this was found in both patients and control subjects. These findings support the hypothesis that EBV is an aetiological factor in some cases of AIDS-associated oesophageal ulceration. Images p1224-a PMID:2174817
Anaerobic bacteria and herpes simplex virus in genital ulceration.
Masfari, A N; Kinghorn, G R; Hafiz, S; Barton, I G; Duerden, B I
Of 91 patients with genital ulceration, herpes simplex virus was isolated from 52 (57%) and Haemophilus ducreyi from 12 (13%); none had syphilis. The difference in incidence of other aerobes in patients and controls was not significant. Anaerobes, predominantly Bacteroides spp, were isolated from a large proportion (77%) of men and women patients with ulcers but from few control men. The most common anaerobic species were B asaccharolyticus and B ureolyticus, with fewer isolates of the melaninogenicus/oralis group. The bacterial flora of herpetic and non-herpetic ulcers were similar, but Candida albicans was isolated significantly more often from non-herpetic ulcers. Anaerobic bacteria may contribute to the pathogenesis of genital ulcers. PMID:2984108
Tracheobronchitis with dyspnea in a patient with ulcerative colitis.
Hiyoshi, Masaya; Kawai, Kazushige; Shibuya, Mihoko; Ozawa, Tsuyoshi; Kishikawa, Junko; Nirei, Takako; Tanaka, Toshiaki; Tanaka, Junichiro; Kiyomatsu, Tomomichi; Tada, Tomohiro; Kanazawa, Takamitsu; Kazama, Shinsuke; Shoda, Hirofumi; Sumitomo, Shuji; Kubo, Kanae; Yamaguchi, Hironori; Ishihara, Soichiro; Sunami, Eiji; Kitayama, Joji; Yamamoto, Kazuhiko; Watanabe, Toshiaki
We herein report the case of a 42-year-old man with a one-year history of ulcerative colitis who presented with exacerbated bloody diarrhea, a productive cough and increasing breathing difficulties. Colonoscopy revealed typical deep ulcers in the rectosigmoid colon and atypical multiple sucker-like ulcers in the transverse colon, and computed tomography of the chest demonstrated wall thickening of the trachea and bronchi. In addition, bronchoscopy showed ulcers in the trachea, and histopathology disclosed findings of necrosis and inflammation of the subepithelial tissue of the trachea. Based on these findings, the patient's respiratory symptoms were strongly suspected to be due to ulcerative colitis-related tracheobronchitis. Treatment with systemic corticosteroids subsequently resulted in a rapid clinical improvement. PMID:25832936
Ulcerative colitis: epidemiology, diagnosis, and management.
Feuerstein, Joseph D; Cheifetz, Adam S
Ulcerative colitis is a chronic idiopathic inflammatory bowel disease characterized by continuous mucosal inflammation that starts in the rectum and extends proximally. Typical presenting symptoms include bloody diarrhea, abdominal pain, urgency, and tenesmus. In some cases, extraintestinal manifestations may be present as well. In the right clinical setting, the diagnosis of ulcerative colitis is based primarily on endoscopy, which typically reveals evidence of continuous colonic inflammation, with confirmatory biopsy specimens having signs of chronic colitis. The goals of therapy are to induce and maintain remission, decrease the risk of complications, and improve quality of life. Treatment is determined on the basis of the severity of symptoms and is classically a step-up approach. 5-Aminosalycilates are the mainstay of treatment for mild to moderate disease. Patients with failed 5-aminosalycilate therapy or who present with more moderate to severe disease are typically treated with corticosteroids followed by transition to a steroid-sparing agent with a thiopurine, anti-tumor necrosis factor agent, or adhesion molecule inhibitor. Despite medical therapies, approximately 15% of patients still require proctocolectomy. In addition, given the potential risks of complications from the disease itself and the medications used to treat the disease, primary care physicians play a key role in optimizing the preventive care to reduce the risk of complications. PMID:25199861
Leg regeneration in the cockroach, Blattella germanica
Vernon French
The interactions occuring between graft and host leg epidermis at a congruent junction (non-rotated, homopleural combination of components cut perpendicular to the proximal-distal axis) were studied at the tibia level in the cockroach,Blattella germanica. Grafts were made between dark (Bl) and light (br) cuticle colour mutants.1)Precise boundaries could not usually be drawn between Bl and br tissue over areas of
Energy Efficient Legged Robotics at Sandia Labs
Buerger, Steve
Sandia is developing energy efficient actuation and drive train technologies to dramatically improve the charge life of legged robots. The work is supported by DARPA, and Sandia will demonstrate an energy efficient bipedal robot at the technology exposition section of the DARPA Robotics Challenge Finals in June, 2015. This video, the first in a series, describes early development and initial integration of the Sandia Transmission Efficient Prototype Promoting Research (STEPPR) robot.
Dynamic legged locomotion in robots and animals
NASA Astrophysics Data System (ADS)
Raibert, Marc; Playter, Robert; Ringrose, Robert; Bailey, Dave; Leeser, Karl
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.
Optimal jumps for biarticular legged robots
Bokman Lim; Jan Babic; Frank C. Park
This paper investigates the extent to which biarticular actuation mechanisms-antagonistic actuation schemes with spring stiffness that extend over two joints, similar in function to biarticular muscles found in legged animals-improve the performance of jumping and other fast explosive robot movements. Robust gradient-based optimization algorithms that take into account the dynamic properties and various contact and actuator constraints of biarticular systems
Fecal calprotectin and ulcerative colitis endoscopic activity index as indicators of mucosal healing in ulcerative colitis.
Taghvaei, Tarang; Maleki, Iradj; Nagshvar, Farshad; Fakheri, Hafez; Hosseini, Vahid; Valizadeh, Seyed Mohammad; Neishaboori, Hassan
Ulcerative colitis (UC) is a chronic, idiopathic, inflammatory large bowel disease with recurrent variable periods of exacerbation. The aim of the current study is to evaluate the correlation of UCEIS with fecal calprotectin (FC) level to assess disease activity in UC patients in order to determine whether FC can prognosticate clinical outcome and disease activity of UC instead of colonoscopic evaluation. Our endoscopic investigations revealed the extension of UC as the following: proctitis (11.6%), procto-sigmoiditis (18.5%), left-sided colitis (15.8%), extensive colitis (11.7%), and normal endoscopy (42.4%). Conclusively, we suggest that FC can be used as a reliable tool to evaluate disease activity in ulcerative colitis patients. Moreover, our findings indicate a significant correlation between FC level and mucosal healing. PMID:25366383
Under Treated Necrotizing Fasciitis Masquerading as Ulcerated Edematous Mycobacterium ulcerans Infection (Buruli Ulcer)
Phanzu, Mavinga D.; Bafende, Aombe E.; Imposo, Bofunga B. D.; Meyers, Wayne M.; Portaels, Françoise
We report a case of under treated necrotizing fasciitis (NF) in a 65-year-old woman with diabetes misdiagnosed as Mycobacterium ulcerans infection. She came to the Institut Médical Evangélique (IME) with an extensive painful edematous ulcerated lesion on the dorsum of the right foot and ankle. The diagnosis of Buruli ulcer (BU) was based initially on clinical findings and place of residence (Songololo Territory, the largest known focus of BU in Bas-Congo province). Tissue specimens gave negative results for acid-fast bacilli (AFB), culture, and polymerase chain reaction (PCR) for M. ulcerans. Histopathologic analysis revealed marked necrosis of the lower dermis and subcutaneous tissue. No AFB was found. Later, scattered foci of intracellular gram-positive cocci typical of streptococci were seen. Clinicopathologic correlation of these findings strongly supported the diagnosis of NF. This patient shows the difficulties that may be encountered even in known endemic areas in recognizing BU cases purely on clinical findings. PMID:20207877
On the Biomimetic Design of Agile-Robot Legs
Garcia, Elena; Arevalo, Juan Carlos; Muńoz, Gustavo; Gonzalez-de-Santos, Pablo
The development of functional legged robots has encountered its limits in human-made actuation technology. This paper describes research on the biomimetic design of legs for agile quadrupeds. A biomimetic leg concept that extracts key principles from horse legs which are responsible for the agile and powerful locomotion of these animals is presented. The proposed biomimetic leg model defines the effective leg length, leg kinematics, limb mass distribution, actuator power, and elastic energy recovery as determinants of agile locomotion, and values for these five key elements are given. The transfer of the extracted principles to technological instantiations is analyzed in detail, considering the availability of current materials, structures and actuators. A real leg prototype has been developed following the biomimetic leg concept proposed. The actuation system is based on the hybrid use of series elasticity and magneto-rheological dampers which provides variable compliance for natural motion. From the experimental evaluation of this prototype, conclusions on the current technological barriers to achieve real functional legged robots to walk dynamically in agile locomotion are presented. PMID:22247667
Anti-ulcer activity of Ficus religiosa leaf ethanolic extract
Gregory, Marslin; Divya, B.; Mary, Revina Ann; Viji, M. M. Hipolith; Kalaichelvan, V. K.; Palanivel, V.
Objective To evaluate the anti-ulcer activity and acute toxicity of Ficus religiosa (F. religiosa) leaf ethanolic extract in animal models. Methods Anti-ulcer activity of F. religiosa ethanolic extract (250 and 500 mg/kg body weight) was studied on stress induced ulcer animal models. Ranitidine was used as standard. The anti-ulcer activity of F. religiosa was evaluated with the help of ulcer area and histopatholgical examination. Preliminary phyto-chemical screening and acute toxicity studies of F. religiosa also carried out. Results Results showed that the extract treatments prevented ulcer area and gastric secretion in a dose-dependent manner. Administration of 2?000 mg/kg extract did not show any acute toxicity in albino mice. Preliminary phytochemical analysis identified the presence of flavonoids in the ethanolic extract of F. religiosa. Conclusions The extract is non-toxic even at relatively high concentrations. The anti-ulcer activity is probably due to the presence of flavanoids. PMID:23836366
From Aphthous Ulcer to Full-Blown Crohn's Disease
Paul J. Rutgeerts
At onset, Crohn's disease (CD) is characterized by transmural inflammation with mucosal ulcerations. In its earliest phase the lesions are mainly aphthous ulcers. The ulcers then become larger, a nodular pattern develops and penetration of the deep ulcers leads to fistulas and collagen deposition to fibrotic strictures. The best model to study the earliest lesions in CD is the postoperative
Role of dietary polyphenols in the management of peptic ulcer
Farzaei, Mohammad Hosein; Abdollahi, Mohammad; Rahimi, Roja
Peptic ulcer disease is a multifactorial and complex disease involving gastric and duodenal ulcers. Despite medical advances, the management of peptic ulcer and its complications remains a challenge, with high morbidity and death rates for the disease. An accumulating body of evidence suggests that, among a broad reach of natural molecules, dietary polyphenols with multiple biological mechanisms of action play a pivotal part in the management of gastric and duodenal ulcers. The current review confirmed that dietary polyphenols possess protective and therapeutic potential in peptic ulcer mediated by: improving cytoprotection, re-epithelialization, neovascularization, and angiogenesis; up-regulating tissue growth factors and prostaglandins; down-regulating anti-angiogenic factors; enhancing endothelial nitric oxide synthase-derived NO; suppressing oxidative mucosal damage; amplifying antioxidant performance, antacid, and anti-secretory activity; increasing endogenous mucosal defensive agents; and blocking Helicobacter pylori colonization associated gastric morphological changes and gastroduodenal inflammation and ulceration. In addition, anti-inflammatory activity due to down-regulation of proin?ammatory cytokines and cellular and intercellular adhesion agents, suppressing leukocyte-endothelium interaction, inhibiting nuclear signaling pathways of inflammatory process, and modulating intracellular transduction and transcription pathways have key roles in the anti-ulcer action of dietary polyphenols. In conclusion, administration of a signi?cant amount of dietary polyphenols in the human diet or as part of dietary supplementation along with conventional treatment can result in perfect security and treatment of peptic ulcer. Further well-designed preclinical and clinical tests are recommended in order to recognize higher levels of evidence for the confirmation of bioefficacy and safety of dietary polyphenols in the management of peptic ulcer. PMID:26074689
Golimumab for the treatment of ulcerative colitis.
Löwenberg, Mark; de Boer, Nanne Kh; Hoentjen, Frank
The introduction of therapeutic antibodies against tumor necrosis factor (TNF) had a major impact on the treatment of ulcerative colitis (UC). Infliximab and adalimumab are powerful agents that are used for remission induction and maintenance therapy in UC and have an acceptable safety profile. However, a proportion of UC patients for whom therapy with anti-TNF agents is indicated fail or become intolerant to treatment with infliximab or adalimumab. Hence, there remains an unmet need for novel anti-TNF agents. Golimumab (Simponi®), a human anti-TNF antibody that is administered by monthly subcutaneous injections, is the most recently introduced TNF blocker for the treatment of UC. Here, we will discuss recent literature on clinical efficacy and safety of golimumab induction and maintenance treatment in patients with UC. Furthermore, we will discuss the positioning of golimumab for UC in current treatment algorithms. PMID:24648749
[Lysolecithin and stress ulcers in rats].
Clémençon, G; Fehr, H; Aebi, M
The effect of lysolecithin on gastric mucosa in rats has been investigated using a new operative model. Ten rats underwent sham-laparotomy. In 4 other groups, each of 10 animals, the rats underwent pyloro-jejunostomy and Roux-en-Y anastomosis. 9 of 10 rats operated upon in this way, and given a solution of lysolecithin to drink before administration of restraint stress, produced stress ulcers. However, only 3 of 10 animals given Ringer-solution produced minor mucosal defects. Lysolecithin not combined with stress had no noteworthy deleterious effect on gastric mucosa either in sham-operated rats or in those with our operation model. Thus, lysolecithin combined with stress in our model performed an important function in the pathogenesis of stress lesions. Lysolecithin is produced in considerable quantities during fat metabolism in the intestine, and may be regurgitated together with duodenal contents into the stomach. PMID:7190726
An unusual presentation of ulcerative colitis.
Kesav, Praveen; Khurana, Dheeraj
Ulcerative colitis (UC) may have diverse extraintestinal manifestations. Nutritional deficiencies, medications or immune-mediated epiphenomena are considered to be pathogenic mechanisms involved. We describe a case of a 56-year-old woman who presented with rapidly progressive tingling paraesthesias in both lower limbs followed by sensory ataxia, ascending spastic quadriparesis, urgency and urge incontinence of 3?months duration. She had an episode of bloody diarrhoea 1?month later for which a colonoscopy was carried out with colonic biopsy features revealing a diagnosis of UC. In view of lack of alternative aetiology, the posterolateral column disease in our patient was attributed to an extraintestinal manifestation of UC. She improved dramatically with a course of intravenous steroids followed by tapering dose of oral steroids and oral mesalamine for her UC. Although rare, UC should be considered in the differential diagnosis of posterolateral column disease of the spinal cord in the appropriate clinical scenario. PMID:25564640
Risk Factors for Buruli Ulcer, Benin
Debacker, Martine; Portaels, Françoise; Aguiar, Julia; Steunou, Christian; Zinsou, Claude; Meyers, Wayne
We identified risk factors for Buruli ulcer (BU) in Benin in an unmatched case-control study at the Centre Sanitaire et Nutritionnel Gbemoten in southern Benin. A total of 2,399 persons admitted from 1997 through 2003 and 1,444 unmatched patients with other conditions in 2002 were recruited. Adjusted odds ratios were determined for age, sex, place of residence, Mycobacterium bovis BCG vaccination at birth, type of water for domestic use, and occupation. Children <15 years of age and adults >49 years of age had a higher risk for BU. Use of unprotected water from swamps was associated with increased risk for BU; this association was strongest in adults >49 years of age. Sex was not a risk factor for BU. Our data showed that BU was mainly associated with age, place of residence, and water sources in all age groups. Risk for BU was higher in BCG-vaccinated patients >5 years of age. PMID:17073079
Ulcerative colitis and Crohn's disease tissue cytotoxins
McLaren, L.C.; Gitnick, G.
Bowel-wall tissue filtrates from patients with inflammatory bowel disease produce cytopathic effects in tissue culture. The cytopathic effects inducers have been reported to have the characteristics of a small RNA virus. Clostridium difficile toxin also produces cytopathic effects and has been found in the stools of patients with Crohn's disease and ulcerative colitis. The present study concerns the further characterization of the cytopathic inducers in tissues of inflammatory bowel disease patients. It was found that they are nonsedimentable at 148,000 g for 2 h and resistant to inactivation by UV light. They are proteins that are distinct from C. difficile toxin and are unique cytotoxins which are associated with the early cytopathic effects observed in Riff-free chick embryo and rabbit ileum cell cultures. These results suggest that the early cytopathic effects previously described are not produced by a virus. They do not explain the delayed cytopathic effects seen in rabbit ileum or WI-38 cells.
[Therapeutic effect of gastrozolum in stomach ulcers].
Sukhareva, G V; Tsaregorodtseva, T M; Trubitsina, I E; Serova, T I; Goncharenko, L S; Dolgova, N Iu; Zarudnaia, S I; Kuz'mina, O S; Lopatina, I N; Manannikov, I V; Melik-Ogandzhanian, N B
Gastrozolum is the proprietary name of a drug made in Saint Petersburg. Its international nonproprietary name is Omeprazole. The absorption rate is not related to food. Its pharmacotherapeutic action becomes apparent as an inhibitor of the proton pump leading to the inhibition of H+/K(+)-ATPase of the secretory membrane of parietal cells of the stomach mucous membrane and blocking of the concluding stage of hydrochloric acid secretion. The entire action leads to the decrease of the level of basal and induced secretion regardless of the nature of stimulus. As a result of this, symptoms of stomach ulcer decrease, and gastroduodenal ulcers heal faster. Penetrating into the stomach mucous membrane cells, the drug also has a cytoprotective action. The maximum blood concentration (0.6-1.5 mg/l) is found 2-3 hours after a single intake of 40 mg of the drug. It was determined that after the intake of 20 mg of Gastrozolum its action lasts for 24 hours and provides for the inhibition of both night and day secretion. The ricochet syndrome does not take place when the treatment is over. It was proved that Gastrozolum has a bactericidal action on Helicobacter pylori due to the sharp increase of stomach pH, which contributes to the realization of the effect of used components of the anti-helicobacter therapy. The experiment failed to establish any teratogenic or poisonous action on the embryos. The dosage form is a capsule containing 20 mg of Omeprazole in the form of pellets. PMID:14621606
Golimumab: clinical update on its use for ulcerative colitis.
Gilardi, D; Fiorino, G; Allocca, M; Bravatŕ, I; Danese, S
Monoclonal antibodies directed against tumor necrosis factor alpha (anti-TNF-? agents) have dramatically changed the therapeutical approach to inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis. A new anti-TNF drug, golimumab, has recently been approved for patients with moderate to severe ulcerative colitis. Its efficacy has been demonstrated by preclinical and clinical studies and the drug showed an efficacy and safety profile in line with the other anti-TNF agents, such as infliximab and adalimumab. This review gives an overview on golimumab in the treatment of moderate to severe ulcerative colitis. PMID:25876561
Using a national guideline to prevent and manage pressure ulcers.
Neilson, Julie; Avital, Liz; Willock, Jane; Broad, Nigel
Developing pressure ulcers is a painful and distressing event for patients, and one that can be prevented. The National Institute for Health and Care Excellence pressure ulcer guideline has recently been updated to cover the prevention and management of this condition. This article focuses on the recommendations that are relevant to nurses, covering areas such as risk assessment, skin assessment, repositioning, pressure-redistributing devices, dressings, patient and carer information, and training and education. It also identifies what senior nurses and nurse managers must do to ensure their staff can prevent and manage pressure ulcers effectively. PMID:24779761
Restless legs syndrome and hypertension in middle-aged women.
Batool-Anwar, Salma; Malhotra, Atul; Forman, John; Winkelman, John; Li, Yanping; Gao, Xiang
Limited research suggests a relationship between restless legs syndrome and hypertension. We, therefore, assessed the relationship between restless legs syndrome and hypertension among middle-aged women. This is a cross-sectional study including 65 544 women (aged 41-58 years) participating in Nurses' Health Study II. The participants with diabetes mellitus and arthritis were excluded, because these conditions can mimic restless legs syndrome. Restless legs syndrome was assessed by a self-administered questionnaire based on the International Restless Legs Study Group criteria. Information on diagnosis of hypertension and blood pressure values were collected via questionnaires. Multivariable logistic regression models were used to analyze the relation between restless legs syndrome and hypertension, with adjustment for age, race, body mass index, physical activity, menopausal status, smoking, use of analgesics, and intake of alcohol, caffeine, folate, and iron. Compared with women with no restless legs symptoms, the multiple adjusted odds of having hypertension were 1.20 times (95% CI: 1.10-1.30; P<0.0001) higher among women with restless legs symptoms. The adjusted odds ratios for women who reported restless legs symptoms 5 to 14 times per month and ?15 times per month were 1.06 (95% CI: 0.94-1.18) and 1.41 (95% CI: 1.24-1.61) respectively, compared with those without the symptoms (P trend: <0.0001). Greater frequency of restless legs symptoms was associated with higher concurrent systolic and diastolic blood pressures (P trend: <0.0001 for both). Women with restless legs syndrome have a higher prevalence of hypertension, and this prevalence increases with more frequent restless legs symptoms. PMID:21986505
Attitude control of a quadruped robot during two legs supporting
Takashi EMURA; Akin ARAKAWA
Concerns a study aimed at achieving lengthy support of a quadruped robot on two legs during walking. When the robot is supported on diagonally opposite legs it can stand without change of supporting legs using a model of a reaction-wheel type inverted pendulum. Therefore, some basic experiments of the reaction-wheel model were performed using vibration rate-gyros as attitude sensors. Since
Design, control, and energetics of an electrically actuated legged robot
Pedro Gregorio; Mojtaba Ahmadi; Martin Buehler
To study the design, control and energetics of autonomous dynamicallystable legged machines we have built a planar one-legged robot,the ARL Monopod. Its top running speed of 4:3km=hr (1:2m=s)makes it the fastest electrically actuated legged robot to date. Weadapted Raibert's control laws for the low power electric actuationnecessary for autonomous locomotion and performed a detailed energeticanalysis of our experiments. A comparison
D-ribose benefits restless legs syndrome.
Shecterle, Linda; Kasubick, Robert; St Cyr, John
Restless legs syndrome is a neurological disorder characterized by unpleasant sensations and pain, predominantly in the lower extremities while at rest, accompanied by an uncontrollable urge for movement for relief. We report on two affected male individuals, a father and son, ages 71 and 47, from a family in which three generations carry the diagnosis. To evaluate any potential benefit of D-ribose in this condition, each individual orally consumed 5-g doses of D-ribose daily at different trial stages. Each stage lasted 3 weeks with a 2-week washout period between stages. The initial stage involved a single 5 gm dose of D-ribose consumed at breakfast. Throughout the second stage, D-ribose was taken at breakfast and lunch. In the third stage, D-ribose was taken at all meals, breakfast, lunch, and dinner. Diaries by the subjects pertaining to their documentation and severity of restless legs syndrome symptoms was compiled. During the initial stage both men reported a general feeling of more energy and less fatigue, most notably after exercise, without any significant changes in their symptoms. With the increase in the daily dose of D-ribose, in the second stage, their leg twitching and the feeling to move during the day was reduced for 1 subject, and rarely present in the other. Both still experienced the unpleasant sensations during the night. However, during the final stage, a further increase in the daily dose of D-ribose eliminated their daily symptoms and the symptoms at night were of a lesser degree and had a later occurrence. Both men reported that D-ribose did not totally eliminate their discomfort, but the severity and onset of symptoms affecting their quality of life was substantially improved with D-ribose without any adverse reactions. PMID:19055337
Is leg compression beneficial for alpine skiers?
Background This study examined the effects of different levels of compression (0, 20 and 40 mmHg) produced by leg garments on selected psycho-physiological measures of performance while exposed to passive vibration (60 Hz, amplitude 4-6 mm) and performing 3-min of alpine skiing tuck position. Methods Prior to, during and following the experiment the electromygraphic (EMG) activity of different muscles, cardio-respiratory data, changes in total hemoglobin, tissue oxygenation and oscillatory movement of m. vastus lateralis, blood lactate and perceptual data of 12 highly trained alpine skiers were recorded. Maximal isometric knee extension and flexion strength, balance, and jumping performance were assessed before and after the experiment. Results The knee angle (?10°) and oscillatory movement (?20-25.5%) were lower with compression (P?0.05 in all cases). The EMG activities of the tibialis anterior (20.2-28.9%), gastrocnemius medialis (4.9-15.1%), rectus femoris (9.6-23.5%), and vastus medialis (13.1-13.7%) muscles were all elevated by compression (P?0.05 in all cases). Total hemoglobin was maintained during the 3-min period of simulated skiing with 20 or 40 mmHg compression, but the tissue saturation index was lower (P?0.05) than with no compression. No differences in respiratory parameters, heart rate or blood lactate concentration were observed with or maximal isometric knee extension and flexion strength, balance, and jumping performance following simulated skiing for 3 min in the downhill tuck position were the same as in the absence of compression. Conclusions These findings demonstrate that with leg compression, alpine skiers could maintain a deeper tuck position with less perceived exertion and greater deoxygenation of the vastus lateralis muscle, with no differences in whole-body oxygen consumption or blood lactate concentration. These changes occurred without compromising maximal leg strength, jumping performance or balance. Accordingly, our results indicate that the use of lower leg compression in the range of 20-40 mmHg may improve alpine skiing performance by allowing a deeper tuck position and lowering perceived exertion. PMID:24004479
Transcutaneous laser treatment of leg veins.
Meesters, Arne A; Pitassi, Luiza H U; Campos, Valeria; Wolkerstorfer, Albert; Dierickx, Christine C
Leg telangiectasias and reticular veins are a common complaint affecting more than 80% of the population to some extent. To date, the gold standard remains sclerotherapy for most patients. However, there may be some specific situations, where sclerotherapy is contraindicated such as needle phobia, allergy to certain sclerosing agents, and the presence of vessels smaller than the diameter of a 30-gauge needle (including telangiectatic matting). In these cases, transcutaneous laser therapy is a valuable alternative. Currently, different laser modalities have been proposed for the management of leg veins. The aim of this article is to present an overview of the basic principles of transcutaneous laser therapy of leg veins and to review the existing literature on this subject, including the most recent developments. The 532-nm potassium titanyl phosphate (KTP) laser, the 585-600-nm pulsed dye laser, the 755-nm alexandrite laser, various 800-983-nm diode lasers, and the 1,064-nm neodymium yttrium-aluminum-garnet (Nd:YAG) laser and various intense pulsed light sources have been investigated for this indication. The KTP and pulsed dye laser are an effective treatment option for small vessels (<1 mm). The side effect profile is usually favorable to that of longer wavelength modalities. For larger veins, the use of a longer wavelength is required. According to the scarce evidence available, the Nd:YAG laser produces better clinical results than the alexandrite and diode laser. Penetration depth is high, whereas absorption by melanin is low, making the Nd:YAG laser suitable for the treatment of larger and deeply located veins and for the treatment of patients with dark skin types. Clinical outcome of Nd:YAG laser therapy approximates that of sclerotherapy, although the latter is associated with less pain. New developments include (1) the use of a nonuniform pulse sequence or a dual-wavelength modality, inducing methemoglobin formation and enhancing the optical absorption properties of the target structure, (2) pulse stacking and multiple pass laser treatment, (3) combination of laser therapy with sclerotherapy or radiofrequency, and (4) indocyanin green enhanced laser therapy. Future studies will have to confirm the role of these developments in the treatment of leg veins. The literature still lacks double-blind controlled clinical trials comparing the different laser modalities with each other and with sclerotherapy. Such trials should be the focus of future research. PMID:24220848
[Diagnosis and differential diagnosis of swollen leg].
Ludwig, M; Vetter, H
Leg swelling is often of edematous nature. The most important differential diagnosis lies in the distinction between venous or lymphatic forms of edema. An increased vascular permeability and alterations in blood composition have also to be taken into account. A particular entity is the lipedema. Next to an accurate history, specific inspection and palpatory criteria permit to distinguish the various forms. Tests for venous function, laboratory and technologically investigative techniques increase diagnostic accuracy. Lymphedema can only be diagnosed by an exact clinical diagnosis. PMID:2678371
[Crooked and short legs. Historical retrospect].
Rüttimann, B; Böni, T
In the past rickets, poliomyelitis, and tuberculosis of the knee joint were the main causes for deformities and shortening of the children's legs. Orthotics played a major role in treatment and rehabilitation, and they were often used for life. In the nineteenth century orthopaedic surgeons developed procedures such as tenotomy, osteoclasis, osteotomy, excision of joints and arthrodesis, combined with conservative therapy or instead of it. In an incessant attempt to control wound suppuration--before Lister's antiseptic principle and aseptic practices were available--the "subcutaneous" approach was inaugurated for tendon and bone surgery. PMID:11091996
Asymptomatic petechial eruption on the lower legs.
Mendese, Gary; Grande, Donald
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
Colorectal juvenile polyposis in an adult with ulcerative colitis.
Elhjouji, A; Aitali, A; Rouibaa, F; Rharrassi, I; Zentar, A; Sair, K
Juvenile polyposis is a rare disorder. We report an unusual case of juvenile polyposis in a 22-yr-old woman with ulcerative colitis, apparently one of the first cases reported in the literature. PMID:21296636
Simultaneous Onset of Ulcerative Colitis and Disseminated Pyoderma Gangrenosum
Neesse, Albrecht; Michl, Patrick; Kunsch, Steffen; Ellenrieder, Volker; Gress, Thomas M.; Steinkamp, Martin
Pyoderma gangrenosum (PG) is an immune-mediated inflammatory skin condition representing one of the most distinct extraintestinal manifestations of inflammatory bowel disease (IBD). PG occurs independently from intestinal disease activity in about 1–2% of patients suffering from ulcerative colitis or Crohn's disease and is characterized by chronic deep skin ulcers whose exact pathogenesis is still unknown. So far, patients with ulcerative colitis have only been reported to develop PG during the course of IBD but not at the initial manifestation of bowel symptoms. This is the first report demonstrating the simultaneous onset of ulcerative colitis and severe multifocal PG. In addition, we provide first evidence that infliximab may have a particularly powerful effect in early disseminated PG compared to late-onset PG, advocating an early application of this drug. PMID:21487555
Effect of Concentrate Form on Gastric Ulcer Syndrome in Horses
Huth, Lindsey
Equine gastric ulcer syndrome (EGUS) is common amongst equine athletes of various disciplines and linked to decreased performance. Prevalence among racehorses has been reported to be over 90%, performance horses at 60%, and endurances horses...
Drug cutaneous side effect: focus on skin ulceration.
D'Epiro, S; Salvi, M; Luzi, A; Mattozzi, C; Luci, C; Macaluso, L; Marzocca, F; Salvo, V; Cantisani, C; Paolino, G; Calvieri, S; Richetta, A G
Skin ulcers are defined as tissue loss interesting the deeper layers of the dermis and hypodermis, with low tendency to spontaneous healing. They cause disability related to pain, risk of infection and amputation, chronic management, requiring working absence with notably economic burden. The major cause is often related to underlying vascular disease, infections, tumors, autoimmunity, trauma, even if literature occasionally reported several cases of drug inducing skin ulceration. Most of drugs involved are chemotherapy agents and more recently molecular target therapies. Evidences supporting these drugs as the major cause of skin ulcers include delay of onset after therapy initiation, improvement after withdrawal of the drug, recurrence after its reintroduction and, sometimes, simultaneous occurrence of other skin lesions that have previously been reported to be associated with these agents. Attention should be reserved to patients undergoing antineoplastic agents, especially if previously affected by predisposing comorbidities, considering such side effect as possible differential diagnosis for skin ulceration in neoplastic patients. PMID:25203350
Swing leg retraction helps biped walking stability M. Wisse*, C. G. Atkeson, D. K. Kloimwieder
Atkeson, Christopher G.
inverted pendulum model for the stance leg. The swing leg is assumed to accurately follow a time feel that the motion of the hand and ball is analogous to that of the swing leg and stance legSwing leg retraction helps biped walking stability M. Wisse*, C. G. Atkeson, D. K. Kloimwieder
First Hops of the 3D Bow Leg Garth Zeglin and H. Benjamin Brown, Jr.
Zeglin, Garth
bearing--and no forces or torques need to be supported by actuators during stance. The leg is controlled to the leg occurs during flight and the stance is passive. These principles address the typical losses of legged systems: negative work and leg sweep. Negative work occurs in articulated legs when an actuator
Prevalence of nonadherence with maintenance mesalamine in quiescent ulcerative colitis
Sunanda V. Kane; Russell D. Cohen; James E. Aikens; Stephen B. Hanauer
OBJECTIVE:There are scant data regarding outpatient adherence in quiescent ulcerative colitis aside from patients enrolled in controlled clinical trials. We conducted a prevalence study to determine the medication adherence rate of maintenance therapy and to identify possible risk factors for nonadherence.METHODS:Outpatients with clinically quiescent ulcerative colitis for >6 months on maintenance mesalamine (Asacol, Procter and Gamble, Cincinnati, OH) were eligible.
Randomised controlled trial of azathioprine withdrawal in ulcerative colitis
A. B. Hawthorne; R. F. Logan; C. J. Hawkey; P. N. Foster; A. T. Axon; E. T. Swarbrick; B. B. Scott; J. E. Lennard-Jones
OBJECTIVE--To determine whether azathioprine can prevent relapse in ulcerative colitis. DESIGN--One year placebo controlled double blind trial of withdrawal or continuation of azathioprine. SETTING--Outpatient clinics of five hospitals. SUBJECTS--79 patients with ulcerative colitis who had been taking azathioprine for six months or more. Patients in full remission for two months or more (67), and patients with chronic low grade or
Intravenous cyclosporin in ulcerative colitis: a five-year experience
Russell D Cohen; Robert Stein; Stephen B Hanauer
OBJECTIVE: Cyclosporin (CSA) is a promising alternative for patients with severe steroid-refractory ulcerative colitis (UC) previously facing only surgical options. Concerns over the long term efficacy and side effects resulted in this investigation of the University of Chicago's 5-yr CSA experience in these patients.METHODS: All steroid-refractory severe ulcerative colitis (UC) patients treated with IV CSA from 1991 to 1995 were
Bile duct carcinoma in patients with ulcerative colitis
Seid Hossein Mir-Madjlessi; Richard G. Farmer; Michael V. Sivak
Six cases of bile duct carcinoma were encountered among 1207 patients with ulcerative colitis, a prevalence rate of 0.5%. The relative risk of bile duct carcinoma in patients with ulcerative colitis was 31.3. Colitis was extensive in all six patients with a mean duration of 23.2 years before the diagnosis of carcinoma. The mean age at the diagnosis of carcinoma
Roles of NSAIDs and aspirin in bleeding peptic ulcers
Ryuichi Iwakiri; Kazuma Fujimoto
Upper gastrointestinal bleeding is one of the most common complications associated with peptic ulcer disease. In Japan, most\\u000a patients were infected by Helicobacter pylori and the infection was considered to be one of the major causes of bleeding ulcers. Exposure to non-steroidal anti-inflammatory\\u000a drugs (NSAIDs) and low dose aspirin are known to be other important risk factors of upper gastrointestinal
Aspirin and bleeding peptic ulcers in the elderly
G. Faulkner; P. Prichard; K. Somerville; M. J. Langman
A case-control study was performed to determine whether aspirin confers a similar risk of bleeding from gastric or duodenal ulcers in the elderly as non-aspirin, non-steroidal anti-inflammatory drugs. The intake of analgesics in 230 patients with bleeding ulcers aged 60 and over and in hospital and community controls matched for age and sex was examined. Those who had taken aspirin
Assessing infected ulcers: a step-by-step guide.
Chadwick, Paul; McCardle, Joanne; Malone, Matthew
While every attempt can be made to avoid the development of diabetic foot ulcers, it is inevitable that some patients will present with them. Once they develop, these ulcers are hard to heal, placing the patient at increased at risk of infection and, ultimately, amputation. It is vital, therefore, that health-care professionals are able to recognise the signs of increased bioburden and infection, so that prompt treatment can be given. PMID:26079163
[Treatment of perforated duodenal ulcer: the celioscopic approach].
Mutter, D; Evrard, S; Keller, P; Vix, M; Vartolomei, S; Marescaux, J
Ten patients underwent laparoscopic surgery for typical perforated peptic ulcer symptomatology. Two conversions to open surgery were due to technical problems related to delayed hospital admission. Nine patients underwent duodenal suture reinforced with fibrin glue, and one perforation was only glued. The postoperative course was uneventful without abdominal septic or abdominal wall complications in the eight patients treated by laparoscopy. Laparoscopic surgery may become the method of choice for the treatment of perforated peptic ulcer. PMID:8085758
Cryptogenic Multifocal Ulcerous Stenosing Enteritis: A Review of the Literature
Kohoutová, Darina; Bártová, Jolana; Tachecí, Ilja; Rejchrt, Stanislav; Repák, Rudolf; Kopá?ová, Marcela; Bureš, Jan
Cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) is an extremely rare illness characterised by chronic or relapsing subileus status resulting from multiple small intestinal fibrous strictures and multiple shallow ulcers of the small bowel. The etiology is unknown and pathogenesis is not fully understood. Therapy with systemic glucocorticosteroids is the treatment of choice. However, most patients develop corticosteroid dependence. Deep enteroscopy enables precise diagnostic work, possible endoscopic treatment of stenoses; may obviate the need for surgery and prevent excessive small bowel resections. PMID:24369459
Correlation of diversity of leg morphology in Gryllus bimaculatus (cricket) with divergence in dpp expression pattern during leg development.
Niwa, N; Inoue, Y; Nozawa, A; Saito, M; Misumi, Y; Ohuchi, H; Yoshioka, H; Noji, S
Insects can be grouped into mainly two categories, holometabolous and hemimetabolous, according to the extent of their morphological change during metamorphosis. The three thoracic legs, for example, are known to develop through two overtly different pathways: holometabolous insects make legs through their imaginal discs, while hemimetabolous legs develop from their leg buds. Thus, how the molecular mechanisms of leg development differ from each other is an intriguing question. In the holometabolous long-germ insect, these mechanisms have been extensively studied using Drosophila melanogaster. However, little is known about the mechanism in the hemimetabolous insect. Thus, we studied leg development of the hemimetabolous short-germ insect, Gryllus bimaculatus (cricket), focusing on expression patterns of the three key signaling molecules, hedgehog (hh), wingless (wg) and decapentaplegic (dpp), which are essential during leg development in Drosophila. In Gryllus embryos, expression of hh is restricted in the posterior half of each leg bud, while dpp and wg are expressed in the dorsal and ventral sides of its anteroposterior (A/P) boundary, respectively. Their expression patterns are essentially comparable with those of the three genes in Drosophila leg imaginal discs, suggesting the existence of the common mechanism for leg pattern formation. However, we found that expression pattern of dpp was significantly divergent among Gryllus, Schistocerca (grasshopper) and Drosophila embryos, while expression patterns of hh and wg are conserved. Furthermore, the divergence was found between the pro/mesothoracic and metathoracic Gryllus leg buds. These observations imply that the divergence in the dpp expression pattern may correlate with diversity of leg morphology. PMID:11003837
Neuropathic diabetic foot ulcers – evidence-to-practice
Ndip, Agbor; Ebah, Leonard; Mbako, Aloysius
Foot ulcers and their attendant complications are disquietingly high in people with diabetes, a majority of whom have underlying neuropathy. This review examines the evidence base underpinning the prevention and management of neuropathic diabetic foot ulcers in order to inform best clinical practice. Since it may be impractical to ask patients not to weight-bear at all, relief of pressure through the use of offloading casting devices remains the mainstay for management of neuropathic ulcers, whilst provision of appropriate footwear is essential in ulcer prevention. Simple non-surgical debridement and application of hydrogels are both effective in preparing the wound bed for healthy granulation and therefore enhancing healing. Initial empirical antibiotic therapy for infected ulcers should cover the most common bacterial flora. There is limited evidence supporting the use of adjunctive therapies such as hyperbaric oxygen and cytokines or growth factors. In selected cases, recombinant human platelet-derived growth factor has been shown to enhance healing; however, its widespread use cannot be advised due to the availability of more cost-effective approaches. While patient education may be beneficial, the evidence base remains thin and conflicting. In conclusion, best management of foot ulcers is achieved by what is taken out of the foot (pressure, callus, infection, and slough) rather than what is put on the foot (adjuvant treatment). PMID:22371655
Usefulness of anti-ulcer drugs for the prevention and treatment of peptic ulcers induced by low doses of aspirin
Nakashima, Sayaka; Ota, Shinichi; Arai, Shin; Yoshino, Kiyoko; Inao, Mie; Ishikawa, Keiko; Nakayama, Nobuaki; Imai, Yukinori; Nagoshi, Sumiko; Mochida, Satoshi
AIM: To investigate the usefulness of anti-ulcer drugs for the prevention and treatment of low-dose aspirin-induced peptic ulcer. METHODS: Upper gastrointestinal endoscopy was performed in 68 patients receiving daily low-dose aspirin (81 or 100 mg/day). The endoscopic findings were classified according to the Lanza score, and the scores were compared between groups categorized according to the concomitant use of anti-ulcer drugs and the types of drugs used. In another study, 31 hemorrhagic peptic ulcer patients who had been receiving low-dose aspirin were enrolled. The patients were randomly classified into the proton pump inhibitor (PPI)-treated group and the H2 receptor antagonist (H2RA)-treated group. The administration of low-dose aspirin was continued concomitantly, and endoscopic examinations were performed 8 wk later. RESULTS: The Lanza scores (mean ± SD) of the gastro-mucosal lesions were 1.0 ± 1.9 and 1.9 ± 2.3 in 8 and 16 patients receiving prevention therapy with a PPI and an H2RA, respectively. Both scores were significantly smaller than the scores in 34 patients who were not receiving prevention therapy (4.7 ± 1.0) and in 10 patients receiving cytoprotective anti-ulcer drugs (4.3 ± 1.6). In the prospective study, 18 and 13 patients received a PPI and an H2RA, respectively. Endoscopic examinations revealed that the tissue in the region of the gastro-mucosal lesions had reverted to normal in all patients in the PPI-treated group and in 12 patients (92%) in the H2RA-treated group; no significant differences were observed between the groups. CONCLUSION: H2RA therapy was effective for both the prevention and treatment of low-dose aspirin-induced peptic ulcer, similar to the effects of PPIs, while cytoprotective anti-ulcer drugs were ineffective in preventing ulceration. PMID:19222098
Management of acute, severe ulcerative colitis.
Sachar, David B
When a patient is hospitalized with acute, severe ulcerative colitis, the primary decision is whether or not to proceed directly to surgery. Absolute indications for an immediate colectomy include exsanguinating hemorrhage, perforation and cancer. If medical therapy is undertaken, however, the decision for urgent surgery or non-operative salvage therapy will still be required in 15-50% of the patients in which there is a failure to respond within 3-5 days to a standard regimen of i.v. steroids, antibiotics, decompressive maneuvers, fluid and electrolyte replacement and other supportive measures. The options for medical salvage therapy are usually cyclosporine or infliximab. There are theoretical and practical arguments on each side; the current GETAID and CONSTRUCT trials will probably provide support for either. The choice between colectomy or medical salvage therapy, however, must not be delayed under any circumstances. Before choosing salvage therapy, one must first be certain that there is the luxury of time, that there is a post-hospital strategy for the maintenance of remission and that the colon is worth saving. The priority is not so much saving colons as it is saving lives. PMID:22257473
Relationship between Ulcerative Colitis and Lung Injuries.
Tang, Zhi-Peng; Wu, Jia-Wei; Dai, Yan-Cheng; Zhang, Ya-Li; Bi, Rong-Rong
Objective To explore the relationship between ulcerative colitis (UC) and lung injuries by assessing their clinical manifestations and characteristics.Methods From July 2009 to April 2012, 91 UC patients presenting to Longhua Hospital who met the established inclusion and exclusion criteria were enrolled in this retrospective study. According to the scores of disease activity index, the patients were divided into the mild, moderate, and severe groups. Meanwhile, the records of pulmonary symptoms, chest X-ray image, and pulmonary function were reviewed.Results Sixty-eight (74.7%) patients had at least 1 pulmonary symptom, such as cough (38.5%), shortness of breath (27.5%), and expectoration (17.6%). And 77 (84.6%) had at least 1 ventilation abnormality. Vital capacity value was significantly lower in the severe group than that in the mild group (91.82%±10.38% vs. 98.92%±12.12%, P<0.05).Conclusions Lung injury is a common extraintestinal complication of UC. According to the theory in Traditional Chinese Medicine that the lung and large intestine are related, both the lungs and large intestine should be treated simultaneously.. PMID:26148994
Tacrolimus for the Treatment of Ulcerative Colitis.
Matsuoka, Katsuyoshi; Saito, Eiko; Fujii, Toshimitsu; Takenaka, Kento; Kimura, Maiko; Nagahori, Masakazu; Ohtsuka, Kazuo; Watanabe, Mamoru
Tacrolimus is a calcineurin inhibitor used for the treatment of corticosteroid-refractory ulcerative colitis (UC). Two randomized controlled trials and a number of retrospective studies have assessed the therapeutic effect of tacrolimus in UC patients. These studies showed that tacrolimus has excellent short-term efficacy in corticosteroid-refractory patients, with the rates of clinical response ranging from 61% to 96%. However, the long-term prognosis of patients treated with tacrolimus is disappointing, and almost 50% of patients eventually underwent colectomy in long-term follow-up. Tacrolimus can achieve mucosal healing in 40-50% of patients, and this is associated with a favorable long-term prognosis. Anti-tumor necrosis factor (TNF)-? antibodies are another therapeutic option in corticosteroid-refractory patients. A prospective head-to-head comparative study of tacrolimus and infliximab is currently being performed to determine which treatment is more effective in corticosteroid-refractory patients. Several retrospective studies have demonstrated that switching between tacrolimus and anti-TNF-? antibody therapy was effective in patients who were refractory to one of the treatments. Most adverse events of tacrolimus are mild; however, opportunistic infections, especially pneumocystis pneumonia, are the most important adverse events, and these should be carefully considered during treatment. Several issues on tacrolimus treatment in UC patients remain unsolved (e.g., use of tacrolimus as remission maintenance therapy). Further controlled studies are needed to optimize the use of tacrolimus for the treatment of UC. PMID:26130996
Biomechanical modeling to prevent ischial pressure ulcers.
Luboz, Vincent; Petrizelli, Marion; Bucki, Marek; Diot, Bruno; Vuillerme, Nicolas; Payan, Yohan
With 300,000 paraplegic persons only in France, ischial pressure ulcers represent a major public health issue. They result from the buttocks? soft tissues compression by the bony prominences. Unfortunately, the current clinical techniques, with - in the best case - embedded pressure sensor mats, are insufficient to prevent them because most are due to high internal strains which can occur even with low pressures at the skin surface. Therefore, improving prevention requires using a biomechanical model to estimate internal strains from skin surface pressures. However, the buttocks? soft tissues? stiffness is still unknown. This paper provides a stiffness sensitivity analysis using a finite element model. Different layers with distinct Neo Hookean materials simulate the skin, fat and muscles. With Young moduli in the range [100-500 kPa], [25-35 kPa], and [80-140 kPa] for the skin, fat, and muscles, respectively, maximum internal strains reach realistic 50 to 60% values. The fat and muscle stiffnesses have an important influence on the strain variations, while skin stiffness is less influent. Simulating different sitting postures and changing the muscle thickness also result in a variation in the internal strains. PMID:24873863
Painful Skin Ulcers in a Hemodialysis Patient
Summary Calciphylaxis, also referred to as calcific uremic arteriolopathy, is a relatively rare but well described syndrome that occurs most commonly in patients with late stage CKD. It is characterized by very painful placques or subcutaneous nodules and violaceous, mottled skin lesions that may progress to nonhealing ulcers, tissue necrosis, and gangrene with a 1-year mortality rate >50%. The pathogenesis of calciphylaxis is poorly understood. Risk factors include female sex, obesity, hyperphosphatemia, hypercalcemia, hyperparathyroidism, longer dialysis vintage, hypercoagulable states, and use of calcium-containing phosphate binders and warfarin. Treatment strategies for calciphylaxis are limited by inadequate understanding of its pathophysiology. Therapy is generally focused on correcting disturbances of calcium, phosphorus, and parathyroid hormone metabolism. Additional therapy focuses on decreasing inflammation and on dissolution of tissue calcium deposits with sodium thiosulfate and/or bisphosphonates. Successful treatment generally results in improvement of pain and healing of the lesions within 2–4 weeks, but the disorder generally takes many months to completely resolve. PMID:24202137
Management of acute severe ulcerative colitis
Kedia, Saurabh; Ahuja, Vineet; Tandon, Rakesh
The management strategy of acute severe ulcerative colitis has evolved over the past decade from being entirely restricted to twin choices of intravenous steroids or colectomy to include colon rescue therapies like cyclosporin as well as infliximab. However it still remains a medical emergency requiring hospitalization and requires care from a multidisciplinary team comprising of a gastroenterologist and a colorectal surgeon. The frame shift in management has been the emphasis on time bound decision making with an attempt to curtail the mortality rate to below 1%. Intravenous corticosteroids are the mainstay of therapy. Response to steroids should be assessed at day 3 of admission and partial/non-responders should be considered for alternative medical therapy/surgery. Medical rescue therapies include intravenous cyclosporin and infliximab. Cyclosporin is administered in a dose of 2 mg/kg per day and infliximab is administered as a single dose intravenous infusion of 5 mg/kg. Approximately 75% patients have short term and 50% patients have long term response to cyclosporin. Long term response to cyclosporin is improved in patients who are thiopurine naďve and are started on thiopurines on day 7. Infliximab also has a response rate of approximately 70% in short term and 50% in long term. Both cyclosporin and infliximab are equally efficacious medical rescue therapies as demonstrated in a recent randomized control trial. Patients not responding to infliximab or cyclosporin should be considered for colectomy. PMID:25401001
Painful skin ulcers in a hemodialysis patient.
Sprague, Stuart M
Calciphylaxis, also referred to as calcific uremic arteriolopathy, is a relatively rare but well described syndrome that occurs most commonly in patients with late stage CKD. It is characterized by very painful placques or subcutaneous nodules and violaceous, mottled skin lesions that may progress to nonhealing ulcers, tissue necrosis, and gangrene with a 1-year mortality rate >50%. The pathogenesis of calciphylaxis is poorly understood. Risk factors include female sex, obesity, hyperphosphatemia, hypercalcemia, hyperparathyroidism, longer dialysis vintage, hypercoagulable states, and use of calcium-containing phosphate binders and warfarin. Treatment strategies for calciphylaxis are limited by inadequate understanding of its pathophysiology. Therapy is generally focused on correcting disturbances of calcium, phosphorus, and parathyroid hormone metabolism. Additional therapy focuses on decreasing inflammation and on dissolution of tissue calcium deposits with sodium thiosulfate and/or bisphosphonates. Successful treatment generally results in improvement of pain and healing of the lesions within 2-4 weeks, but the disorder generally takes many months to completely resolve. PMID:24202137
Tacrolimus for the Treatment of Ulcerative Colitis
Matsuoka, Katsuyoshi; Saito, Eiko; Fujii, Toshimitsu; Takenaka, Kento; Kimura, Maiko; Nagahori, Masakazu; Ohtsuka, Kazuo
Tacrolimus is a calcineurin inhibitor used for the treatment of corticosteroid-refractory ulcerative colitis (UC). Two randomized controlled trials and a number of retrospective studies have assessed the therapeutic effect of tacrolimus in UC patients. These studies showed that tacrolimus has excellent short-term efficacy in corticosteroid-refractory patients, with the rates of clinical response ranging from 61% to 96%. However, the long-term prognosis of patients treated with tacrolimus is disappointing, and almost 50% of patients eventually underwent colectomy in long-term follow-up. Tacrolimus can achieve mucosal healing in 40-50% of patients, and this is associated with a favorable long-term prognosis. Anti-tumor necrosis factor (TNF)-? antibodies are another therapeutic option in corticosteroid-refractory patients. A prospective head-to-head comparative study of tacrolimus and infliximab is currently being performed to determine which treatment is more effective in corticosteroid-refractory patients. Several retrospective studies have demonstrated that switching between tacrolimus and anti-TNF-? antibody therapy was effective in patients who were refractory to one of the treatments. Most adverse events of tacrolimus are mild; however, opportunistic infections, especially pneumocystis pneumonia, are the most important adverse events, and these should be carefully considered during treatment. Several issues on tacrolimus treatment in UC patients remain unsolved (e.g., use of tacrolimus as remission maintenance therapy). Further controlled studies are needed to optimize the use of tacrolimus for the treatment of UC. PMID:26130996
Design and control of multimodal single-legged vehicles with variable geometry reaction wheel arrays
Schmidt-Wetekam, Christopher
Stance Phase Disturbance Rejection Antisymmetric Actuation [%] LegStance Phase Disturbance Rejection Antisymmetric 0 Actuation [%] LegStance Image Tracking Marker Occlusions Applied Disturbances time [sec] Leg Angle, 2 ? [ deg] Symmetric Actuation [%
33 CFR 147.837 - Marco Polo Tension Leg Platform safety zone.
Code of Federal Regulations, 2014 CFR
...2014-07-01 2014-07-01 false Marco Polo Tension Leg Platform safety zone...ACTIVITIES SAFETY ZONES § 147.837 Marco Polo Tension Leg Platform safety zone. (a) Description. Marco Polo Tension Leg Platform, Green...
33 CFR 147.837 - Marco Polo Tension Leg Platform safety zone.
Code of Federal Regulations, 2013 CFR
...2013-07-01 2013-07-01 false Marco Polo Tension Leg Platform safety zone...ACTIVITIES SAFETY ZONES § 147.837 Marco Polo Tension Leg Platform safety zone. (a) Description. Marco Polo Tension Leg Platform, Green...
33 CFR 147.837 - Marco Polo Tension Leg Platform safety zone.
Code of Federal Regulations, 2012 CFR
...2012-07-01 2012-07-01 false Marco Polo Tension Leg Platform safety zone...ACTIVITIES SAFETY ZONES § 147.837 Marco Polo Tension Leg Platform safety zone. (a) Description. Marco Polo Tension Leg Platform, Green...
33 CFR 147.837 - Marco Polo Tension Leg Platform safety zone.
Code of Federal Regulations, 2011 CFR
...2011-07-01 2011-07-01 false Marco Polo Tension Leg Platform safety zone...ACTIVITIES SAFETY ZONES § 147.837 Marco Polo Tension Leg Platform safety zone. (a) Description. Marco Polo Tension Leg Platform, Green...
33 CFR 147.837 - Marco Polo Tension Leg Platform safety zone.
Code of Federal Regulations, 2010 CFR
...2010-07-01 2010-07-01 false Marco Polo Tension Leg Platform safety zone...ACTIVITIES SAFETY ZONES § 147.837 Marco Polo Tension Leg Platform safety zone. (a) Description. Marco Polo Tension Leg Platform, Green...
Emulating Human Leg Impairments and Disabilities on Humanoid Robots Walking
Paris-Sud XI, Université de
Emulating Human Leg Impairments and Disabilities on Humanoid Robots Walking S´ebastien Lengagne for emulating human walking motions with leg impairments or disabilities using humanoid robots. Our optimal by the application of humanoid robots to human study and diagnosis. If we are able to pa- rameterize the disabled
Bill Goodwine and Joel Burdick Gait Controllability for Legged Robots
Goodwine, Bill
Bill Goodwine and Joel Burdick Gait Controllability for Legged Robots Bill Goodwine Joel Burdick to the legged case, where the relevant mechanics are not smooth. #12;Bill Goodwine and Joel Burdick Introduction to a class of nonsmooth systems we call stratified. #12;Bill Goodwine and Joel Burdick Stratified Control
OCEAN DRILLING PROGRAM LEG 174A SCIENTIFIC PROSPECTUS CONTINUING THE NEW JERSEY MID-ATLANTIC SEA. Mitchell Malone Staff Scientist, Leg 174A Ocean Drilling Program Texas A&M University Research Park 1000 purposes; however, republication of any portion requires the written consent of the Director, Ocean
OCEAN DRILLING PROGRAM LEG 171A SCIENTIFIC PROSPECTUS BARBADOS ACCRETIONARY PRISM LOGGING WHILE Sciences Department Santa Cruz California 95064 U.S.A. Dr. Adam Klaus Staff Scientist, Leg 171A Ocean the written consent of the Director, Ocean Drilling Program, Texas A&M University Research Park, 1000
Leg stiffness and stride frequency in human running
Claire T. Farley; Octavio González
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,
Kinetics of stiff-legged gait: induced acceleration analysis
Patrick O. Riley; D. Casey Kerrigan
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
X-Ray Exam: Lower Leg (Tibia and Fibula)
X-Ray Exam: Lower Leg (Tibia and Fibula) KidsHealth > Parents > Doctors & Hospitals > Medical Tests & Exams > X-Ray Exam: Lower Leg (Tibia and Fibula) Print ... If You Have Questions What It Is An X-ray of the tibia and fibula is a ...
1998 Special Issue Oscillatory network controlling six-legged locomotion.
Borisyuk, Roman
1998 Special Issue Oscillatory network controlling six-legged locomotion. Optimization of model reserved. Keywords: Legged locomotion; Stick insect model; Oscillatory network 1. Introduction The problem the widely accepted basic scheme of locomotion control has been formulated. It is assumed that control
Reflex control of the prototype leg during contact and slippage
Ho Cheung Wong; David E. Orin
A formulation of reflex control is presented which has been developed and used in the control of a prototype leg of the adaptive suspension vehicle to implement reflex actions. In particular, the concept of reflex control has been demonstrated experimentally in high-speed contact and foot slippage. A constraint analysis of the leg-environment interaction is found to be especially useful in
Parker, Gary B.
were not designed to take advantage of the full capa- bilities of the servo motor actuators. Each servo by dividing the prob- lem into two parts: leg cycle learning and gait cycle learning. Servo pulses required movement by the servos. The best means of combining these leg cycles into a gait cycle is learned
Towards active actuated natural walking humanoid robot legs
Ren C. Luo; Chwan Hsen Chen; Yi Hao Pu; Jia Rong Chang
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
A modular network for legged locomotion
NASA Astrophysics Data System (ADS)
Golubitsky, Martin; Stewart, Ian; Buono, Pietro-Luciano; Collins, J. J.
In this paper we use symmetry methods to study networks of coupled cells, which are models for central pattern generators (CPGs). In these models the cells obey identical systems of differential equations and the network specifies how cells are coupled. Previously, Collins and Stewart showed that the phase relations of many of the standard gaits of quadrupeds and hexapods can be obtained naturally via Hopf bifurcation in small networks. For example, the networks they used to study quadrupeds all had four cells, with the understanding that each cell determined the phase of the motion of one leg. However, in their work it seemed necessary to employ several different four-oscillator networks to obtain all of the standard quadrupedal gaits. We show that this difficulty with four-oscillator networks is unavoidable, but that the problems can be overcome by using a larger network. Specifically, we show that the standard gaits of a quadruped, including walk, trot and pace, cannot all be realized by a single four-cell network without introducing unwanted conjugacies between trot and pace - conjugacies that imply a dynamic equivalence between these gaits that seems inconsistent with observations. In this sense a single network with four cells cannot model the CPG of a quadruped. We also introduce a single eight-cell network that can model all of the primary gaits of quadrupeds without these unwanted conjugacies. Moreover, this network is modular in that it naturally generalizes to provide models of gaits in hexapods, centipedes, and millipedes. The analysis of models for many-legged animals shows that wave-like motions, similar to those obtained by Kopell and Ermentrout, can be expected. However, our network leads to a prediction that the wavelength of the wave motion will divide twice the length of the animal. Indeed, we reproduce illustrations of wave-like motions in centipedes where the animal is approximately one-and-a-half wavelength long - motions that are consistent with this prediction. We discuss the implications of these results for the development of modular control networks for adaptive legged robots.
Effective management of patients with diabetes foot ulcers: outcomes of an Interprofessional Diabetes Foot Ulcer Team.
Ogrin, Rajna; Houghton, Pamela E; Thompson, G William
A longitudinal observational study on a convenience sample was conducted between 4 January and 31 December of 2010 to evaluate clinical outcomes that occur when a new Interprofessional Diabetes Foot Ulcer Team (IPDFUT) helps in the management of diabetes-related foot ulcers (DFUs) in patients living in a small urban community in Ontario, Canada. Eighty-three patients presented to the IPDFUT with 114 DFUs of average duration of 19·5 ± 2·7 weeks. Patients were 58·4 ± 1·4 years of age and 90% had type 2 diabetes, HbA1c of 8·3 ± 2·0%, with an average diabetes duration of 22·3 ± 3·4 years; in 69% of patients, 78 DFUs healed in an average duration of 7·4 ± 0·7 weeks, requiring an average of 3·8 clinic visits. Amputation of a toe led to healing in three patients (4%) and one patient required a below-knee amputation. Six patients died and three withdrew. Adding a skilled IPDFUT that is trained to work together resulted in improved healing outcomes. The rate of healing, proportion of wounds closed and complication rate were similar if not better than the results published previously in Canada and around the world. The IPDFUT appears to be a successful model of care and could be used as a template to provide effective community care to the patients with DFU in Ontario, Canada. PMID:23834390
Ulcerative jejunitis in a child with celiac disease
Background Celiac disease can present in children and adults with a variety of manifestations including a rare complication known as ulcerative jejunitis. The latter has been associated with refractory celiac disease in adult onset patients. The objective of this case report is to describe the first pediatric case of ulcerative jejunitis in celiac disease, diagnosed by capsule endoscopy, which was not associated with refractory celiac disease. Case presentation The 9 year old girl presented with a history of abdominal pain and vomiting. Laboratory investigations revealed a slightly elevated IgA tissue transglutaminase antibody level in the setting of serum IgA deficiency. Initial upper endoscopy with biopsies was not conclusive for celiac disease. Further investigations included positive IgA anti-endomysium antibody, and positive HLA DQ2 typing. Video capsule endoscopy showed delayed appearance of villi until the proximal to mid jejunum and jejunal mucosal ulcerations. Push enteroscopy with biopsies subsequently confirmed the diagnosis of celiac disease and ulcerative jejunitis. Immunohistochemical studies of the intraepithelial lymphocytes and PCR amplification revealed surface expression of CD3 and CD8 and oligoclonal T cell populations. A repeat capsule study and upper endoscopy, 1 year and 4 years following a strict gluten free diet showed endoscopic and histological normalization of the small bowel. Conclusion Ulcerative jejunitis in association with celiac disease has never previously been described in children. Capsule endoscopy was essential to both the diagnosis of celiac disease and its associated ulcerative jejunitis. The repeat capsule endoscopy findings, one year following institution of a gluten free diet, also suggest that ulcerative jejunitis is not always associated with refractory celiac disease and does not necessarily dictate a poor outcome. PMID:24524552
Metastable Legged-Robot Locomotion Submitted to the Department of Mechanical Engineering
Tedrake, Russ
Metastable Legged-Robot Locomotion by Katie Byl Submitted to the Department of Mechanical. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Lallit Anand Chairman, Department Committee on Graduate Students #12;2 #12;Metastable Legged
Restless Legs Syndrome in Opioid Dependent Patients
Ghosh, Abhishek; Basu, Debasish
Although frequently underdiagnosed, several epidemiological studies have estimated the prevalence of restless legs syndrome (RLS) in western countries at 5-15% of the general population. The diagnosis is usually made on a clinical basis, according to the criteria established by the international RLS study group. There are case reports of transient RLS in opiate withdrawal. We describe three opiate (dextropropoxyphene (DPP)) dependent young male patients; two of them had DPP intoxication/withdrawal seizure developing RLS during opiate withdrawal. However, their RLS persisted even after the remission of other withdrawal symptoms. Thyroid function test, hemogram, serum ferritin were normal in all of them. The cases responded well to a treatment with ropinirole. Hence, there might be a causal association, which required further well-designed studies to substantiate. The sleep disturbances and use of benzodiazepines can be minimized by increasing clinician's sensitivity to diagnose RLS. PMID:24701019
Chronic exertional compartment syndrome of the leg
Chronic exertional compartment syndrome (CECS) is an underdiagnosed cause of chronic exertional leg pain. The syndrome most commonly occurs in young adult recreational runners, elite athletes, and military recruits. CECS is caused by increased intracompartmental pressure within a fascial space; however, the mechanism of why pain occurs is unknown. Symptoms are classically pain in the affected compartment at the same time, distance, or intensity of exercise. CECS is a clinical diagnosis; however, it is confirmed by intracompartmental pressure testing. Fasciotomy is the treatment of choice for athletes who would like to maintain the same level of activity. Athletes who have a release of the anterior and lateral compartments have a high success rate. PMID:21063498
Concrete hulls for tension-leg platforms
De Oliveira, J.G. (Conoco Norway, Inc., Oslo (Norway)); Fjeld, S. (Norwegian Contractors A/S (NO))
This paper describes the main features of a concrete-hull tension-leg-platform (TLP) concept developed for the Heidrun field in the Haltenbanken area of the Norwegian sector of the North Sea. The hydrodynamic response and the methods adopted to optimize the hull dimensions, as well as the mooring system and hull mechanical outfitting, are discussed first. Then construction methods are briefly described. Inspection, maintenance, and repair are also addressed. Finally, the advantages of the concrete-hull TLP concept are summarized, including the concrete hull's adaptability to a large range of design requirements, low cost, and short construction time. This paper shows that the concrete-hull TLP is a very cost-efficient solution for the development of deepwater fields.
[Lipedema of the leg associated with dermatomyositis].
Ignjatovi?, M; Cerovi?, S
Lipedema represents a form of lipodistrophy, which consists of abnormal accumulation of fat in subcutaneous tissue of the lower limbs with consecutive development of lymphostasis and lymphedema. The aim of this article was to review one clear case of lower limbs lipedema, of unusual occurrence and appearance, which was associated with dermatomyositis. A moderately manifested lipedema in 8 years old little girl was reported with its expressive segmental distribution to upper and lower legs, without significant increase in its size during last 10 years and without signs of lymphostasis. The hereditary influence was not confirmed. Histological examination of lipedematous tissue revealed significant presentation of immune component of the disease. According to the available literature, association between lipedema and dermatomyositis, lower limbs lipedema with segmental distribution as noticed above and its appearance as a consequence of corticosteroid therapy have not yet been published. PMID:10528533
Leg weakness in a lung transplant patient.
Moua, T; Rizza, S A; Kennedy, C C
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
Genetic aspects of restless legs syndrome.
Dhawan, V; Ali, M; Chaudhuri, K R
Restless legs syndrome (RLS), also known as Ekbom syndrome, is a common movement disorder with sensorimotor symptoms occurring during sleep and quiet wakefulness. The underlying cause for RLS is unknown but genetic influences play a strong part in the pathogenesis of RLS, particularly when the condition starts at a young age. This review explores the genetic basis of RLS and related phenotypic variations. Recently, three loci showing vulnerability to RLS have been described in French-Canadian and Italian families in chromosomes 12q, 14q and 9q, emphasising on an autosomal dominant mode of inheritance. These have been labelled RLS1, RLS2 and RLS3, respectively. However, specific causative mutations remain elusive and no linkage analysis has been identified so far in the candidate genes investigated in RLS. PMID:17068272
Managing osteoporosis in ulcerative colitis: something new?
Piodi, Luca Petruccio; Poloni, Alessandro; Ulivieri, Fabio Massimo
The authors revise the latest evidence in the literature regarding managing of osteoporosis in ulcerative colitis (UC), paying particular attention to the latest tendency of the research concerning the management of bone damage in the patient affected by UC. It is wise to assess vitamin D status in ulcerative colitis patients to recognize who is predisposed to low levels of vitamin D, whose deficiency has to be treated with oral or parenteral vitamin D supplementation. An adequate dietary calcium intake or supplementation and physical activity, if possible, should be guaranteed. Osteoporotic risk factors, such as smoking and excessive alcohol intake, must be avoided. Steroid has to be prescribed at the lowest possible dosage and for the shortest possible time. Moreover, conditions favoring falling have to been minimized, like carpets, low illumination, sedatives assumption, vitamin D deficiency. It is advisable to assess the fracture risk in all UC patient by the fracture assessment risk tool (FRAX(®) tool), that calculates the ten years risk of fracture for the population aged from 40 to 90 years in many countries of the world. A high risk value could indicate the necessity of treatment, whereas a low risk value suggests a follow-up only. An intermediate risk supports the decision to prescribe bone mineral density (BMD) assessment and a subsequent patient revaluation for treatment. Dual energy X-ray absorptiometry bone densitometry can be used not only for BMD measurement, but also to collect data about bone quality by the means of trabecular bone score and hip structural analysis assessment. These two indices could represent a method of interesting perspectives in evaluating bone status in patients affected by diseases like UC, which may present an impairment of bone quality as well as of bone quantity. In literature there is no strong evidence for instituting pharmacological therapy of bone impairment in UC patients for clinical indications other than those that are also applied to the patients with osteoporosis. Therefore, a reasonable advice is to consider pharmacological treatment for osteoporosis in those UC patients who already present fragility fractures, which bring a high risk of subsequent fractures. Therapy has also to be considered in patients with a high risk of fracture even if it did not yet happen, and particularly when they had long periods of corticosteroid therapy or cumulative high dosages. In patients without fragility fractures or steroid treatment, a medical decision about treatment could be guided by the FRAX tool to determine the intervention threshold. Among drugs for osteoporosis treatment, the bisphosphonates are the most studied ones, with the best and longest evidence of efficacy and safety. Despite this, several questions are still open, such as the duration of treatment, the necessity to discontinue it, the indication of therapy in young patients, particularly in those without previous fractures. Further, it has to be mentioned that a long-term bisphosphonates use in primary osteoporosis has been associated with an increased incidence of dramatic side-effects, even if uncommon, like osteonecrosis of the jaw and atypical sub-trochanteric and diaphyseal femoral fractures. UC is a long-lasting disease and the majority of patients is relatively young. In this scenario primary prevention of fragility fracture is the best cost-effective strategy. Vitamin D supplementation, adequate calcium intake, suitable physical activity (when possible), removing of risk factors for osteoporosis like smoking, and avoiding falling are the best medical acts. PMID:25339798
Effects of gabapentin enacarbil on restless legs syndrome and leg pain in dementia with Lewy bodies.
Fujishiro, Hiroshige
Restless legs syndrome (RLS) is a common neurological disorder. Dementia with Lewy bodies (DLB) is the second most common form of neurodegenerative dementia after Alzheimer's disease. Both RLS and DLB can be effectively treated by dopaminergic medications, suggesting the role of dopamine dysfunction in the pathogenesis of both diseases. Here, I report on a Japanese woman with probable DLB and RLS who was treated with gabapentin enacarbil, a non-dopaminergic agent. Because a dopamine agonist, a first-line therapy for moderate to severe RLS, caused the occurrence of metamorphopsia, an alternative treatment of gabapentin enacarbil was used; this treatment improved the patient's RLS without worsening her psychiatric symptoms. An alternative treatment is desirable for DLB patients with RLS because they often experience intolerable side-effects with a dopamine agonist, especially visual hallucinations. Administering gabapentin enacarbil also improved the continuous leg pain that occurred in conjunction with the development of RLS. Although the neurobiological mechanism in the development of pain remains unclear, a range of non-dopaminergic structures likely mediated pain processing in DLB in the present case based on neuropharmacological results. This is the first report reporting the effects of gabapentin enacarbil for RLS and leg pain in a DLB patient with psychiatric symptoms. PMID:24528871
Pulmonary function tests in ulcerative colitis
Amra, Babak; Ataabadi, Ghazal; Emami, Mohamad Hassan; Hassanzadeh, Akbar; Golshan, Mohammad; Soltaninejad, Forogh
Background: Pulmonary impairment in patients suffering ulcerative colitis (UC) has been suggested by several investigators using standard pulmonary function tests (PFTs). This changes in pulmonary function associated with minimal respiratory symptoms have been documented, especially in patients with active disease. The aim of this prospective study was to determine airway resistance and lung volumes in patients with UC who have no respiratory symptoms in comparisons to a healthy control group. Materials and Methods: We evaluated a total of 30 patients with UC by means of spirometry, body plethysmography, and impulse oscillometry. The patients were not complaining of any pulmonary symptoms and did not present any history of previous respiratory diseases. As controls we examined 30 healthy subjects matched for gender, age, and smoking status. The relationship between PFT, lung volume, and airway resistance; and the activity, localization, and duration of the UC disease were analyzed. Results: There was a significant difference between airway resistances (kPa/L/s) measured by body plethysmography in patients with UC and those of the controls (R5hz; 0.60 ± 0.44 vs. 0.39 ± 0.13; P < 0.001) and R20hz (0.37 ± 0.19 vs. 0.29 ± 0.1, P = 0.02). There were no correlation between PFT, airway resistance and site and scoring activity (P > 0.05). Conclusion: Despite the lack of pulmonary symptoms, increased airway resistance was found in UC patients. We also have not found correlation between PFT, lung volume and airway resistance values and scoring of UC activity. PMID:25364358
Pressure ulcer prevention: the role of the multidisciplinary team.
Samuriwo, Ray
Pressure ulcer prevention has long been a priority for health professionals; however, poor pressure-ulcer-related practices like poor documentation continue to be identified. Research has shown that the attitude and behaviour of some nurses towards pressure ulcer prevention are not conducive to the best possible patient outcomes.This article reviews the findings of a Straussian grounded theory study, which sought to ascertain the value that is placed on pressure ulcer prevention by nurses, but also revealed the role that other health professionals in the multidisciplinary team play in the maintenance of skin integrity. The findings of this study which are presented in this paper highlight a number of important issues. Firstly, nurses are expected to know how to prevent and manage pressure ulcers, but in reality they are very reliant on the advice and support of other health professionals to maintain their patients' skin integrity. In addition,the level of support that nurses get from other health professionals in the multidisciplinary varies tremendously. Therefore, nurses in clinical practice need to be proactive in seeking input from other health professionals, as there are many members of the multidisciplinary team who are able to give them the advice and support that they need in prevention and management. PMID:22489336
Clinical Trials in Ulcerative Colitis: A Historical Perspective.
Hindryckx, Pieter; Baert, Filip; Hart, Ailsa; Magro, Fernando; Armuzzi, Alessandro; Peyrin-Biroulet, Laurent
The clinical trial landscape in ulcerative colitis has evolved significantly in recent decades. Study endpoints have been shifting from mere clinical response to mucosal healing. It has become clear that the choice of combined clinical and endoscopic outcome criteria leads to a reduction in placebo responses, especially when central reading of the endoscopic images is performed. Accumulating evidence suggests that histological remission yields better long-term outcomes for ulcerative colitis patients than mucosal healing alone, and clinical trials with prolonged follow-up will have to address whether histological remission should be the ultimate treatment goal in ulcerative colitis. In recent years there has also been increasing interest in the implementation of patient-reported outcomes in clinical practice and research, and the regulatory authorities have set up guidelines for the development of such outcomes. This paper aims to provide a comprehensive review of historical aspects of clinical trials in ulcerative colitis and to discuss challenges and perspectives for clinical trials in the near future. A thorough analysis of all available landmark literature (both original papers and reviews) on clinical trials in ulcerative colitis was performed. PMID:25913641
Pressure ulcers: Current understanding and newer modalities of treatment.
Bhattacharya, Surajit; Mishra, R K
This article reviews the mechanism, symptoms, causes, severity, diagnosis, prevention and present recommendations for surgical as well as non-surgical management of pressure ulcers. Particular focus has been placed on the current understandings and the newer modalities for the treatment of pressure ulcers. The paper also covers the role of nutrition and pressure-release devices such as cushions and mattresses as a part of the treatment algorithm for preventing and quick healing process of these wounds. Pressure ulcers develop primarily from pressure and shear; are progressive in nature and most frequently found in bedridden, chair bound or immobile people. They often develop in people who have been hospitalised for a long time generally for a different problem and increase the overall time as well as cost of hospitalisation that have detrimental effects on patient's quality of life. Loss of sensation compounds the problem manifold, and failure of reactive hyperaemia cycle of the pressure prone area remains the most important aetiopathology. Pressure ulcers are largely preventable in nature, and their management depends on their severity. The available literature about severity of pressure ulcers, their classification and medical care protocols have been described in this paper. The present treatment options include various approaches of cleaning the wound, debridement, optimised dressings, role of antibiotics and reconstructive surgery. The newer treatment options such as negative pressure wound therapy, hyperbaric oxygen therapy, cell therapy have been discussed, and the advantages and disadvantages of current and newer methods have also been described. PMID:25991879
Developing eLearning for pressure ulcer prevention and management.
Cameron, Rosie; Rodgers, Angela; Welsh, Lynn; McGown, Katrina
The impact of pressure ulcers is psychologically, physically and clinically challenging for both patients and NHS staff. NHS Greater Glasgow and Clyde (NHS GGC), in line with the Scottish Best Practice Statement for the Prevention and Management of Pressure Ulcers ( Quality Improvement Scotland, 2009 ), and the NHS Health Improvement Scotland (2011) Preventing Pressure Ulcers Change Package, launched an awareness campaign throughout the organisation in April 2012 and has more recently adopted a 'zero-tolerance' approach to pressure damage. The tissue viability service in NHS GGC recognised that in order to achieve this aim, education of front-line staff is essential. An educational framework for pressure ulcer prevention was developed for all levels of healthcare staff involved in the delivery of patient care. As a means to support the framework, an initiative to develop web-based eLearning modules has been taken forward. This has resulted in the creation of an accessible, cost-effective, stimulating, relevant, and evidence-based education programme designed around the educational needs of all healthcare staff. In conjunction with the organisation's 'top ten tools' for pressure ulcer prevention and management, the modular online education programme addresses the aims of quality improvement and zero tolerance by supporting the provision of safe and effective person-centered care. PMID:25117595
Abnormal foot pressures alone may not cause ulceration.
Masson, E A; Hay, E M; Stockley, I; Veves, A; Betts, R P; Boulton, A J
Both rheumatoid arthritis and diabetes have been associated with the development of abnormally high pressures under the feet, and ulceration has been considered to be a problem in both conditions. In order to examine further the relationship between high foot pressure, neurological abnormalities, and ulceration, we have studied two groups of patients: (a) 38 diabetic patients and (b) 37 patients with rheumatoid arthritis who had similar clinical abnormalities of the feet. Thirty-two percent of diabetic patients had a history of plantar ulceration compared with none of the rheumatoid group (p less than 0.01). However, the diabetic group had considerably more severe neuropathy (peroneal nerve motor conduction velocity 35.4 +/- 4.8 m s-1 vs 44.4 +/- 5.2 m s-1 (mean +/- SD), p less than 0.001; vibration perception threshold 33.5 +/- 13.4 vs 16.9 +/- 10.9, p less than 0.001), with a similar frequency of elevated plantar pressures (51% vs 61%, NS). These data emphasize the importance of the loss of sensory awareness in the pathogenesis of diabetic foot ulceration, and suggest that high pressure alone is not a direct cause of ulceration. PMID:2527680
Interdigital ulcer: an unusual presentation of Candida infection.
Luo, Di-Qing; Yang, Wei; Wu, Liang-Cai; Liu, Jun-Hua; Chen, Wen-Na
Interdigital ulcer is an exceptionally rare condition while erosio interdigitalis blastomycetica is common for candidiasis. Four Chinese patients with Candida interdigital ulcers were reported. The exudates were examined directly and cultured for fungi. Skin biopsies were stained with haematoxylin-eosin and periodic acid Schiff. There were a man and three women (age range: 34-56 years) who presented with 1- to 3-month history of chronic cutaneous ulcer on the interdigital web of hand or foot. The lesions were located on hand for one woman, and on the left foot for the rest. The patients had poor response to the previous treatment of topical steroids and oral antimicrobials. Candida albicans was isolated from a man and two women, Candida tropicalis from another woman. Biopsy specimens revealed yeast and mycelium as well as inflammatory infiltrate in necrotic tissue in two patients; only inflammatory cells in the other two. The patients had complete remission with oral itraconazole and topical bifonazole cream therapy for 3- to 5-week. Candida species may cause interdigital ulcer on hand or foot. Oral itraconazole and topical bifonazole may be an optional therapy for such an ulcer. PMID:21615540
Pressure ulcers: Current understanding and newer modalities of treatment
Bhattacharya, Surajit; Mishra, R. K.
This article reviews the mechanism, symptoms, causes, severity, diagnosis, prevention and present recommendations for surgical as well as non-surgical management of pressure ulcers. Particular focus has been placed on the current understandings and the newer modalities for the treatment of pressure ulcers. The paper also covers the role of nutrition and pressure-release devices such as cushions and mattresses as a part of the treatment algorithm for preventing and quick healing process of these wounds. Pressure ulcers develop primarily from pressure and shear; are progressive in nature and most frequently found in bedridden, chair bound or immobile people. They often develop in people who have been hospitalised for a long time generally for a different problem and increase the overall time as well as cost of hospitalisation that have detrimental effects on patient's quality of life. Loss of sensation compounds the problem manifold, and failure of reactive hyperaemia cycle of the pressure prone area remains the most important aetiopathology. Pressure ulcers are largely preventable in nature, and their management depends on their severity. The available literature about severity of pressure ulcers, their classification and medical care protocols have been described in this paper. The present treatment options include various approaches of cleaning the wound, debridement, optimised dressings, role of antibiotics and reconstructive surgery. The newer treatment options such as negative pressure wound therapy, hyperbaric oxygen therapy, cell therapy have been discussed, and the advantages and disadvantages of current and newer methods have also been described. PMID:25991879
[Contact transendoscopic thermometry via a tube in active gastric and duodenal ulcer].
Tenev, T
The temperature of the gastric and duodenal mucosa was taken by a contact method in 473 patients with active ulcer disease, 118 of them being with gastric ulcers and 355--with duodenal ulcers. Sixty four of the gastric ulcers were with superficial gastritis, 54 gastric ulcers were with atrophic gastritis, 298 duodenal ulcers--with superficial inflammatory process and 57 duodenal ulcers with atrophic inflammatory process. The control group consisted of 31 healthy subjects without ulcer niche. In all patients, the temperature of the gastric and duodenal mucosa and in the periulcer niche was transendoscopically taken, at 6 separate levels. Four determinations were performed at each level (at the lesser curvature, greater curvature, anterior and posterior walls). A higher temperature, as compared with the control group, was found in the presence of ulcer defect in the region of duodenum and stomach. In case of superficial inflammatory process no temperature change developed in the mucosa, thus maintaining a statistically significant discrepancy in the region of the ulcer niche. The atrophic process reduced the temperature in the gastric zone in case of active gastric ulcer. The atrophic inflammatory process, in case of active duodenal ulcer, had no statistically significant effect on the higher temperature in the zones of duodenum and pylorous (T1 and T2) in the sites of the ulcer and around it, very likely due to the less manifested atrophic process in the duodenal mucosa as compared with the gastric one. PMID:7113182
Don't break a leg: running birds from quail to ostrich prioritise leg safety and economy on uneven terrain
Birn-Jeffery, Aleksandra V.; Hubicki, Christian M.; Blum, Yvonne; Renjewski, Daniel; Hurst, Jonathan W.; Daley, Monica A.
Cursorial ground birds are paragons of bipedal running that span a 500-fold mass range from quail to ostrich. Here we investigate the task-level control priorities of cursorial birds by analysing how they negotiate single-step obstacles that create a conflict between body stability (attenuating deviations in body motion) and consistent leg force–length dynamics (for economy and leg safety). We also test the hypothesis that control priorities shift between body stability and leg safety with increasing body size, reflecting use of active control to overcome size-related challenges. Weight-support demands lead to a shift towards straighter legs and stiffer steady gait with increasing body size, but it remains unknown whether non-steady locomotor priorities diverge with size. We found that all measured species used a consistent obstacle negotiation strategy, involving unsteady body dynamics to minimise fluctuations in leg posture and loading across multiple steps, not directly prioritising body stability. Peak leg forces remained remarkably consistent across obstacle terrain, within 0.35 body weights of level running for obstacle heights from 0.1 to 0.5 times leg length. All species used similar stance leg actuation patterns, involving asymmetric force–length trajectories and posture-dependent actuation to add or remove energy depending on landing conditions. We present a simple stance leg model that explains key features of avian bipedal locomotion, and suggests economy as a key priority on both level and uneven terrain. We suggest that running ground birds target the closely coupled priorities of economy and leg safety as the direct imperatives of control, with adequate stability achieved through appropriately tuned intrinsic dynamics. PMID:25355848
Don't break a leg: running birds from quail to ostrich prioritise leg safety and economy on uneven terrain.
Birn-Jeffery, Aleksandra V; Hubicki, Christian M; Blum, Yvonne; Renjewski, Daniel; Hurst, Jonathan W; Daley, Monica A
Cursorial ground birds are paragons of bipedal running that span a 500-fold mass range from quail to ostrich. Here we investigate the task-level control priorities of cursorial birds by analysing how they negotiate single-step obstacles that create a conflict between body stability (attenuating deviations in body motion) and consistent leg force-length dynamics (for economy and leg safety). We also test the hypothesis that control priorities shift between body stability and leg safety with increasing body size, reflecting use of active control to overcome size-related challenges. Weight-support demands lead to a shift towards straighter legs and stiffer steady gait with increasing body size, but it remains unknown whether non-steady locomotor priorities diverge with size. We found that all measured species used a consistent obstacle negotiation strategy, involving unsteady body dynamics to minimise fluctuations in leg posture and loading across multiple steps, not directly prioritising body stability. Peak leg forces remained remarkably consistent across obstacle terrain, within 0.35 body weights of level running for obstacle heights from 0.1 to 0.5 times leg length. All species used similar stance leg actuation patterns, involving asymmetric force-length trajectories and posture-dependent actuation to add or remove energy depending on landing conditions. We present a simple stance leg model that explains key features of avian bipedal locomotion, and suggests economy as a key priority on both level and uneven terrain. We suggest that running ground birds target the closely coupled priorities of economy and leg safety as the direct imperatives of control, with adequate stability achieved through appropriately tuned intrinsic dynamics. PMID:25355848
Precise tuning of barnacle leg length to coastal wave action.
Arsenault, D. J.; Marchinko, K. B.; Palmer, A. R.
Both spatial and temporal variation in environmental conditions can favour intraspecific plasticity in animal form. But how precise is such environmental modulation? Individual Balanus glandula Darwin, a common northeastern Pacific barnacle, produce longer feeding legs in still water than in moving water. We report here that, on the west coast of Vancouver Island, Canada, the magnitude and the precision of this phenotypic variation is impressive. First, the feeding legs of barnacles from protected bays were nearly twice as long (for the same body mass) as those from open ocean shores. Second, leg length varied surprisingly precisely with wave exposure: the average maximum velocities of breaking waves recorded in situ explained 95.6-99.5% of the variation in average leg length observed over a threefold range of wave exposure. The decline in leg length with increasing wave action was less than predicted due to simple scaling, perhaps due to changes in leg shape or material properties. Nonetheless, the precision of this relationship reveals a remarkably close coupling between growth environment and adult form, and suggests that between-population differences in barnacle leg length may be used for estimating differences in average wave exposure easily and accurately in studies of coastal ecology. PMID:11600079
Perspectives on healing foot ulcers by Yaquis with diabetes.
de Vera, Noemi
The purpose of this pilot study was to describe the perspectives of 4 Yaqui Native Americans with diabetes regarding biomedical and traditional methods for healing foot ulcers. Leininger's sunrise model provided the conceptual framework for this study. Analysis of ethnographic data produced four cultural themes: (a) Belief in God is expressed in prayers for healing, (b) the way to keep healthy is to take care of oneself, (c) foot ulcer is a modern illness that takes time to heal, and (d) support is important to survive a difficult journey. Understanding cultural beliefs, perceptions, and healing practices of Yaqui individuals with foot ulcers may provide health care providers with a broader scope for providing culturally competent care. PMID:12593269
Prognosis of chronic ulcerative colitis in a community.
Stonnington, C M; Phillips, S F; Zinsmeister, A R; Melton, L J
Utilising the population based data resources of the Rochester Epidemiology Project, we estimated survival and risk of subsequent colon cancer in the 182 residents of Rochester, Minnesota, initially diagnosed with chronic ulcerative colitis (CUC) between 1985 and 1979. Twenty five (13.7%) had a proctocolectomy during the course of follow up. Three patients developed colorectal adenocarcinoma after the initial diagnosis of CUC (relative risk = 1.9, 95% CI 0.4-5.4). Excluding proctitis cases, the relative risk of cancer was 2.4 (95% CI 0.3-8.7). At last follow up, 37 (20.3%) were dead; only 10 patients had chronic ulcerative colitis mentioned on the death certificate. Overall survival was similar to that expected for the general population of like age and sex. Our results suggest that chronic ulcerative colitis in the community is typically a milder disease than would appear from hospital or referral centre series. PMID:3678956
SAPPIRE: a prototype mobile tool for pressure ulcer risk assessment.
Kim, Hyeoneui; Chung, Heejoon; Wang, Shuang; Jiang, Xiaoqian; Choi, Jeeyae
Accurate assessment and documentation of skin conditions facilitate communication among care providers and are critical to effective prevention and mitigation of pressure ulcer. We report developing a prototype mobile system called SAPPIRE (Skin Assessment for Pressure Ulcer Prevention, an Integrated Recording Environment) for an android device to assist nurses with skin assessment and documentation at bedside. SAPPIRE demonstrates (1) data documentation conforming to the relevant terminology standards, (2) data exchange using Continuity of Care Records (CCR) standard and (3) smart display of patient data relevant to risk parameters to promote accurate pressure ulcer risk assessment with the Braden scale. Challenges associated standardizing assessment data faced during this development and the approaches that SAPPIRE took to overcome them are described. PMID:24943578
Assessment of some Herbal Drugs for Prophylaxis of Peptic Ulcer.
Gohar, Ahmed A; Zaki, Ahmed A
Aqueous (hydrophilic) and chloroform (Lipophilic) extracts of nine medicinal plants currently used in Egyptian traditional medicine to treat some gastrointestinal tract (GIT) disorders were tested for their gastro-protective effect against the incidence of peptic ulcer. Indomethacin-induced ulcer in a rat model was used for this testing. Mentha microphylla, Brassica oleracea Capitata (Cabbage), B. oleracea Botrytis (cauliflower) aqueous fraction, Portolaca oleracea polysaccharide fraction, Oreganum marjoranum, Matricaria recutita, Solanum nigrum hydrophilic and lipophilic fractions, in addition to the chloroform fraction of Portolaca oleracea and Cicorium intybus afforded high protection against the incidence of gastric ulcer (~95%). O. syriacum hydrophilic and lipophilic fractions and gum arabic afforded moderate prophylactic effect. L. sicerarea, C. intybus hydrophilic fractions and M. microphylla lipophilic fraction were inactive. Herbs represent excellent resources for cost-effective and readily available gastro-protective remedies without side effects. PMID:25276211
Seasonal variations in the onset of ulcerative colitis.
Moum, B; Aadland, E; Ekbom, A; Vatn, M H
Several retrospective studies have reported seasonal variations in the relapse of ulcerative colitis, and two studies have found seasonality in the onset of ulcerative colitis, with a peak from August to January. This study was designed to investigate possible seasonal variations of onset of ulcerative colitis (UC) and Crohn's disease (CD). Patients with symptoms of one year or less were recruited from a prospective study of the incidence of inflammatory bowel disease, and the onset of symptoms was recorded month by month for four consecutive years. A total of 420 patients with UC and 142 patients with CD were included. There was monthly seasonality (p = 0.028) in symptomatic onset in December and January for UC but not for CD. It was found that environmental agents with known seasonality can be of importance for the seasonal variations of disease onset in UC. PMID:8675089
Gastroprotective effect of kefir on ulcer induced in irradiated rats.
Fahmy, Hanan A; Ismail, Amel F M
The current study was designed to investigate the protective effect of kefir milk on ethanol-induced gastric ulcers in ?-irradiated rats. The results of the present study revealed that treatment with ?-irradiation and/or ethanol showed a significant increase in ulcers number, total acidity, peptic, H(+)K(+)ATPase, MMP-2 and MMP-9 activities and MDA level, which were accompanied by a significant decrease in the mucus content, the stomach GSH level, the GSH-Px activity and DNA damage. Pre-treatment with kefir milk exert significant improvement in all the tested parameters. Kefir milk exerts comparable effect to that of the antiulcer drug ranitidine. In conclusion, the present study revealed that oral administration of kefir milk prevents ethanol-induced gastric ulcer in ?-irradiated rats that could attribute to its antioxidant, anti-apoptotic and radio-protective activities. PMID:25728227
Ulcerative colitis flair induced by mesalamine suppositories hypersensitivity.
Ding, Hao; Liu, Xiao-Chang; Mei, Qiao; Xu, Jian-Ming; Hu, Xiang-Yang; Hu, Jing
Mesalamine suppositories have been used widely for the treatment of distal ulcerative colitis and considered to be safer than systemic administration for its limited systemic absorption. However, previous studies have shown that mesalamine suppository occasionally causes severe hypersensitivity reactions including fever, rashes, colitis exacerbation and acute eosinophilic pneumonia. Here we present a 25-year-old woman with ulcerative colitis with bloody diarrhea accompanied by abdominal pain and fever which were aggravated after introduction of mesalamine suppositories. In light of symptom exacerbation of ulcerative colitis, increased inflammatory injury of colon mucosa shown by colonoscopy and elevated peripheral eosinophil count after mesalamine suppositories administration, and the Naranjo algorithm score of 10, the possibility of hypersensitivity reaction to mesalamine suppositories should be considered, warning us to be aware of this potential reaction after administration of mesalamine formulations even if it is the suppositories. PMID:24707159
Ulcer in the basis of Zenker's diverticulum mimicking esophageal malignancy.
Odemis, Bolent; Ataseven, Hilmi; Basar, Omer; Ertugrul, Ibrahim; Yüksel, Osman; Turhan, Nesrin
Complications of Zenker's diverticulum are rare and include ulcer, bleeding and malignancy. Ulcer in the basis of diverticulum is a very rare complication and to date only four cases have been reported in the literature. Herein, we report a new case of ulcer in Zenker's diverticulum mimicking esophageal malignancy presumed to be due to aspirin and/or alcohol consumption. The exact diagnosis was troublesome and needed to perform diagnostic procedures repeatedly. The patient underwent external pharyngoesophageal diverticulectomy. We emphasize that endoscope should be withdrawn if any resistance is encountered during esophageal intubation-even with forward-viewing endoscope-especially when there is a Zenker's diverticulum suspicion and the patient receives ulcerogenic agents. Endoscopic examination should be performed prior to any definitive surgical procedure in all patients with Zenker's diverticulum. Images Figure 1 Figure 2 Figure 3 Figure 4 PMID:16895291
Assessment of some Herbal Drugs for Prophylaxis of Peptic Ulcer
Gohar, Ahmed A; Zaki, Ahmed A
Aqueous (hydrophilic) and chloroform (Lipophilic) extracts of nine medicinal plants currently used in Egyptian traditional medicine to treat some gastrointestinal tract (GIT) disorders were tested for their gastro-protective effect against the incidence of peptic ulcer. Indomethacin-induced ulcer in a rat model was used for this testing. Mentha microphylla, Brassica oleracea Capitata (Cabbage), B. oleracea Botrytis (cauliflower) aqueous fraction, Portolaca oleracea polysaccharide fraction, Oreganum marjoranum, Matricaria recutita, Solanum nigrum hydrophilic and lipophilic fractions, in addition to the chloroform fraction of Portolaca oleracea and Cicorium intybus afforded high protection against the incidence of gastric ulcer (~95%). O. syriacum hydrophilic and lipophilic fractions and gum arabic afforded moderate prophylactic effect. L. sicerarea, C. intybus hydrophilic fractions and M. microphylla lipophilic fraction were inactive. Herbs represent excellent resources for cost-effective and readily available gastro-protective remedies without side effects. PMID:25276211
CT findings in ulcerative, granulomatous, and indeterminate colitis
Gore, R.M.; Marn, C.S.; Kirby, D.F.; Vogelzang, R.L.; Neiman, H.L.
Eight patients with ulcerative colitis, three with colitis indeterminate, and 15 patients with Crohn disease were studied by computed tomography (CT) to establish CT criteria for each disorder in hopes of providing a new diagnostic perspective useful in the radiographic evaluation of inflammatory colitis. The CT findings in ulcerative colitis included thickening of the colon wall, which was characterized by inhomogeneous attenuation and a target appearance of the rectum, and proliferation of perirectal fat. Bowel wall thickening with homogeneous attenuation, fistula and abscess formation, and mesenteric abnormalities were observed in patients with Crohn colitis. Patients with colitis indeterminate showed colonic changes on CT observed in both disorders. Initial experience suggests that CT can differentiate patients with well established ulcerative and Crohn colitis.
Ocean Drilling Program Janus Database: Legs 174, 175 Data
NSDL National Science Digital Library
Data from Leg 174A (Cork Hole 395A), Leg 174B (Continuing the New Jersey Mid-Atlantic Sea-level Transect), and Leg 175 (Benguela Current) of the Ocean Drilling Program (ODP) are now available online. The Ocean Drilling Program (described in the August 5, 1998 Scout Report for Science & Engineering) conducts basic research into the "history of the ocean basins and the nature of the crust beneath the floor." ODP is funded principally by the National Science Foundation (NSF), along with large contributions from ODP's international partners.
"Painful legs and moving toes": the role of trauma.
Schott, G D
A new syndrome was recently reported with the descriptive title of "painful legs and moving toes". The present paper describes five patients who developed this syndrome following minor trauma to the legs, which in three patients was attributable to surgery. Various mechanisms that may underlie this unusual combination of severe leg pain with involuntary movements of the toes are discussed, as is the role of previous injury. The possibility is considered that whilst the condition may be generated peripherally, a persistent abnormality of the central nervous system consequently develops. PMID:6113273
Factors That Influence Perforator Thrombosis and Predict Healing Perforator Sclerotherapy for Venous Ulceration Without Axial Reflux
Kiguchi, Misaki M.; Hager, Eric S.; Winger, Daniel G.; Hirsch, Stanley A.; Chaer, Rabih A.; Dillavou, Ellen D.
OBJECTIVES Refluxing perforators contribute to venous ulceration. We sought to describe patient characteristics and procedural factors that (1) impact rates of incompetent perforator vein (IPV) thrombosis with ultrasound-guided sclerotherapy (UGS) and (2) impact the healing of venous ulcers (CEAP 6) without axial reflux. METHODS Retrospective review of UGS of IPV injections from 1/2010–11/2012 identified 73 treated venous ulcers in 62 patients. Patients had no other superficial/axial reflux and were treated with standard wound care and compression. Ultrasound was used to screen for refluxing perforators near ulcer(s), and these were injected with sodium tetradecyl sulfate or polidocanol foam and assessed for thrombosis at 2 weeks. Demographic data, comorbidities, treatment details and outcomes were analyzed. Univariate and multivariable modeling was performed to determine covariates predicting IPV thrombosis and ulcer healing. RESULTS 62 patients with active ulcers for an average of 28 months with compression therapy prior to perforator treatment had an average age of 57.1 years, were 55% male, 36% had a history of DVT and 30% had deep venous reflux. 32 patients (52%) healed ulcers, while 30 patients (48%) had non-healed ulcer(s) in mean follow-up of 30.2 months. Ulcers were treated with 189 injections, with average thrombosis rate of 54%. Of 73 ulcers, 43 ulcers healed (59%), and 30 ulcers did not heal (41%). Patients that healed ulcers had an IPV thrombosis rate of 69 % vs. 38% in patients who did not heal (P<.001). Multivariate models demonstrated male gender and warfarin use negatively predicted thrombosis of IPVs (P=.03, P=.01). Multivariate model for ulcer healing found complete IPV thrombosis was a positive predictor (P=.02), while large initial ulcer area was a negative predictor (P=.08). Increased age was associated with fewer ulcer recurrences (P=.05). Hypertension and increased follow-up time predicted increased ulcer recurrences (P=.04, P=.02). Calf vein thrombosis occurred after 3% (6/189) of injections. CONCLUSIONS Thrombosis of IPVs with UGS increases venous ulcer healing in a difficult patient population. Complete closure of all IPVs in an ulcerated limb was the only predictor of ulcer healing. Men and patients on warfarin have decreased rates of IPV thrombosis with UGS. PMID:24406088
Haemophilus ducreyi Cutaneous Ulcer Strains Are Nearly Identical to Class I Genital Ulcer Strains
Gangaiah, Dharanesh; Webb, Kristen M.; Humphreys, Tricia L.; Fortney, Kate R.; Toh, Evelyn; Tai, Albert; Katz, Samantha S.; Pillay, Allan; Chen, Cheng-Yen; Roberts, Sally A.; Munson, Robert S.; Spinola, Stanley M.
Background Although cutaneous ulcers (CU) in the tropics is frequently attributed to Treponema pallidum subspecies pertenue, the causative agent of yaws, Haemophilus ducreyi has emerged as a major cause of CU in yaws-endemic regions of the South Pacific islands and Africa. H. ducreyi is generally susceptible to macrolides, but CU strains persist after mass drug administration of azithromycin for yaws or trachoma. H. ducreyi also causes genital ulcers (GU) and was thought to be exclusively transmitted by microabrasions that occur during sex. In human volunteers, the GU strain 35000HP does not infect intact skin; wounds are required to initiate infection. These data led to several questions: Are CU strains a new variant of H. ducreyi or did they evolve from GU strains? Do CU strains contain additional genes that could allow them to infect intact skin? Are CU strains susceptible to azithromycin? Methodology/Principal Findings To address these questions, we performed whole-genome sequencing and antibiotic susceptibility testing of 5 CU strains obtained from Samoa and Vanuatu and 9 archived class I and class II GU strains. Except for single nucleotide polymorphisms, the CU strains were genetically almost identical to the class I strain 35000HP and had no additional genetic content. Phylogenetic analysis showed that class I and class II strains formed two separate clusters and CU strains evolved from class I strains. Class I strains diverged from class II strains ~1.95 million years ago (mya) and CU strains diverged from the class I strain 35000HP ~0.18 mya. CU and GU strains evolved under similar selection pressures. Like 35000HP, the CU strains were highly susceptible to antibiotics, including azithromycin. Conclusions/Significance These data suggest that CU strains are derivatives of class I strains that were not recognized until recently. These findings require confirmation by analysis of CU strains from other regions. PMID:26147869
Ulcerative colitis in Olmsted County, Minnesota, 1940–1993: incidence, prevalence, and survival
E V Loftus; M D Silverstein; W J Sandborn; W J Tremaine; W S Harmsen; A R Zinsmeister
BACKGROUNDThere is significant geographic variation in the reported incidence of ulcerative colitis.AIMSTo update the incidence and prevalence of ulcerative colitis in Olmsted County, Minnesota, examine temporal trends, and determine overall survival.PATIENTSAll Olmsted County residents diagnosed with ulcerative colitis between 1940 and 1993 (incidence cases), and all residents with ulcerative colitis alive on 1 January 1991 (prevalence cases).METHODSIncidence and prevalence rates
Eremomastax speciosa: effects of leaf aqueous extract on ulcer formation and gastric secretion in rats
Paul V. Tan; Ngeh G. Nditafon; Maurice P. Yewah; Theophile Dimo; Foyere J. Ayafor
The anti-ulcerogenic potential of the aqueous extract of Eremomastax speciosa leaves was investigated using two methods of ulcer induction: HCl\\/EtOH-induced ulceration and pylorus ligation. With both methods, the extract inhibited gastric ulceration in a dose-related manner. The highest oral dose tested (190 mg\\/kg) completely inhibited gastric ulceration and significantly reduced gastric acidity compared with the controls. Incubation of gastric juice
Hybrid Equation/Agent-Based Model of Ischemia-Induced Hyperemia and Pressure Ulcer Formation Predicts Greater Propensity to Ulcerate in Subjects with Spinal Cord Injury
Solovyev, Alexey; Mi, Qi; Tzen, Yi-Ting; Brienza, David; Vodovotz, Yoram
Pressure ulcers are costly and life-threatening complications for people with spinal cord injury (SCI). People with SCI also exhibit differential blood flow properties in non-ulcerated skin. We hypothesized that a computer simulation of the pressure ulcer formation process, informed by data regarding skin blood flow and reactive hyperemia in response to pressure, could provide insights into the pathogenesis and effective treatment of post-SCI pressure ulcers. Agent-Based Models (ABM) are useful in settings such as pressure ulcers, in which spatial realism is important. Ordinary Differential Equation-based (ODE) models are useful when modeling physiological phenomena such as reactive hyperemia. Accordingly, we constructed a hybrid model that combines ODEs related to blood flow along with an ABM of skin injury, inflammation, and ulcer formation. The relationship between pressure and the course of ulcer formation, as well as several other important characteristic patterns of pressure ulcer formation, was demonstrated in this model. The ODE portion of this model was calibrated to data related to blood flow following experimental pressure responses in non-injured human subjects or to data from people with SCI. This model predicted a higher propensity to form ulcers in response to pressure in people with SCI vs. non-injured control subjects, and thus may serve as novel diagnostic platform for post-SCI ulcer formation. PMID:23696726
Atorvastatin-induced severe gastric ulceration: A case report
El-Hajj, Ihab I; Mourad, Fadi H; Shabb, Nina S; Barada, Kassem A
A 41-year-old man presented with severe gastric ulceration 3 mo after beginning treatment with atorvastatin 20 mg once daily for hypercholesterolemia. The patient was not taking any ulcerogenic drugs and had no evidence of Helicobacter pylori infection. Proton pump inhibitor therapy was initiated and atorvastatin was replaced by simvastatin with complete resolution of gastrointestinal symptoms. To our knowledge, this is the first report of atorvastatin-induced gastric ulceration, which should be looked for in patients who develop abdominal pain while on this drug. PMID:15918210
Biological therapy in acute severe ulcerative colitis: Indian experience.
Sood, Ajit; Midha, Vandana; Singh, Arshdeep
Biologicals have a well established role as rescue therapy in management of steroid refractory cases of Ulcerative colitis and Crohn's disease. However, high cost and potential risk of infections like tuberculosis limits their use in developing countries. As there is paucity of data on the use of various biological agents from developing countries like India, we are reporting the limited Indian experience with the available agents. Infliximab has been used as a rescue therapy for severe refractory Ulcerative colitis while other agents have been used as a part of multicentre clinical trials. PMID:25735124
Driving hospital-acquired pressure ulcers to zero.
Morehead, Donna; Blain, Brenda
The prevention of hospital-acquired pressure ulcers remains a top priority for health care facilities worldwide. This article discusses a process improvement in an intensive care unit where the unit-acquired pressure ulcer rate was dropped from 30% to 0% by front-line staff nurses. The key areas addressed by the staff were education, creating a process for turning patients during bedside report, and the creation of a documentation tool for accurate skin/wound assessment. Involving front-line staff in the prevention methodology creates a process that is quickly adopted by staff, peer-to-peer accountability in accurate skin/wound assessment, and positive outcomes. PMID:25438897
Venous ulcer: late complication of a traumatic arteriovenous fistula.
Young, Calvin J; Dardik, Alan; Sumpio, Bauer; Indes, Jeff; Muhs, Bart; Ochoa Chaar, Cassius I
Arteriovenous fistula (AVF) formation after penetrating trauma is a well-described phenomenon. However, diagnosis of traumatic AVF is frequently delayed as patients often do not have hard signs of vascular injury at the initial presentation. Late complications of traumatic AVF include arterial and venous dilatation, distal ischemia, venous congestion, and congestive heart failure. This case report describes a traumatic femoral AVF causing distal venous ulceration 3 years after the injury. The AVF was treated with open repair. In the operating room, the Nicoladoni-Branham sign was elicited. The ulcer healed at 1 month and has not recurred at 1-year follow-up. PMID:25725283
The trigeminal trophic syndrome: an unusual cause of nasal ulceration.
Monrad, Seetha U; Terrell, Jeffrey E; Aronoff, David M
Trigeminal trophic syndrome (TTS) is an unusual complication after peripheral or central damage to the trigeminal nerve, characterized by anesthesia, paresthesias, and ala nasi ulceration. We describe a patient with classic TTS after trigeminal rhizotomy who underwent several extensive evaluations for nasal ulceration and received prolonged immunosuppressive therapy for a presumed autoimmune disorder before the correct diagnosis was made. An understanding of the predisposing factors and clinical presentation of TTS is important to ensure a timely diagnosis of this difficult-to-treat illness. Differentiation of TTS from malignancy, infection, or vasculitis is possible on the basis of clinical history, tissue biopsy, and serologic evaluation. PMID:15153901
[Stress ulcer after tonsillectomy and adenoidectomy: one case report].
Zhang, Xiangjun; Xiao, Yang; Wang, Zhiqin
A 11-year-old child diagnosed as chronic tonsillitis and adenoid hypertrophy underwent adeno-tonsillectomy under general anesthesia. After surgery, patient complained with abdominal discomfort, paleness and vomiting, which presented as the old black contents. Complete blood count showed: 45.2 g/L, hemoglobin of red blood cells 2.57 x 10(12)/L, An emergency gastroscopy confirmed gastric ulcer with hemorrage. Hemorrage was controlled and complete blood count results restored to normal after supportive therapy. Gastric ulcer completely recovered two weeks after discharge. PMID:25464579