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Maksymchuk, D., V. Mamchych, and V. Maksymchuk. "Surgical treatment of complicated duodenal ulcers with different variants of their localization." Journal of Education, Health and Sport 11, no. 9 (September 30, 2021): 773–80. http://dx.doi.org/10.12775/jehs.2021.11.09.093.
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Purpose: To analyze and highlight the most effective methods of surgical treatment of complicated duodenal ulcer (DU) depending on its location. Material and methods. 86 patients underwent surgery for complicated combined pyloroduodenal ulcers. All patients with signs of gastrointestinal bleeding and perforation were examined according to clinical protocols. Patients were operated on by various surgical techniques depending on the location of DU. Further the analysis of different methods of surgical treatment of the pathology under study at its various localizations was carried out. Results. It has been established that in complicated combined pyloroduodenal ulcers with localization in the pyloric canal antrumectomy is the method of priority. If duodenum ulcer is complicated by bleeding, excision with pyloroplasty is the method of priority. Suture ulceration with pyloroplasty can be considered as an alternative method of treatment. It has been verified that in complicated duodenal ulcers, exteriorization and suturing of the ulcer have the lowest efficiency. The most frequently used method of duodenal ulcers of any localization treatment was excision of the ulcer with pyloroplasty. 6 (41.8 ± 0.053%).patients had been operated on by this method. In the second place in terms of universality was ulcer’s suturing with pyloroplasty - 22 patients or (25.5 ± 0.047%). The third was the method of exteriorization and suturing of ulcers, which accounted for 10 patients (11.6 ± 0.034%).
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Peetsalu, Margot, Ülle Kirsimägi, and Ants Peetsalu. "Giant Prepyloric Ulcer Haemorrhage: Patient Characteristics, Treatment, and Outcome in 2003–2012." Ulcers 2014 (April 10, 2014): 1–5. http://dx.doi.org/10.1155/2014/326065.
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The aim of the study was to characterize patients with giant prepyloric ulcer haemorrhage, their treatment, and outcome. The data for 929 peptic ulcer haemorrhage (PUH) patients were divided into three groups according to ulcer location: group I: 165 prepyloric ulcer patients, group II: 353 gastric ulcer patients, and group III: 411 duodenal ulcer patients. Among these groups giant ulcer (ulcer diameter ≥ 2 cm) haemorrhage cases were selected for the study and the data for group I were compared with the data for groups II and III. The study shows that the proportion of giant ulcers in all prepyloric ulcers was significantly 2.2 times lower compared with the proportion of giant ulcers in all gastric ulcers and 1.5 times lower than the proportion of giant ulcers in all duodenal ulcers. The share of surgical therapy for haemorrhages from giant prepyloric ulcers did not differ from the share of surgical therapy in the case of giant gastric ulcers but was 3.5 times lower than in the case of giant duodenal ulcers. Generally, treatment for PUH from giant prepyloric ulcers was successful not involving inhospital mortality.
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Kamada, Tomoari, Kiichi Satoh, Toshiyuki Itoh, Masanori Ito, Junichi Iwamoto, Tadayoshi Okimoto, Takeshi Kanno, et al. "Evidence-based clinical practice guidelines for peptic ulcer disease 2020." Journal of Gastroenterology 56, no. 4 (February 23, 2021): 303–22. http://dx.doi.org/10.1007/s00535-021-01769-0.
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AbstractThe Japanese Society of Gastroenterology (JSGE) revised the third edition of evidence-based clinical practice guidelines for peptic ulcer disease in 2020 and created an English version. The revised guidelines consist of nine items: epidemiology, hemorrhagic gastric and duodenal ulcers, Helicobacter pylori (H. pylori) eradication therapy, non-eradication therapy, drug-induced ulcers, non-H. pylori, and nonsteroidal anti-inflammatory drug (NSAID) ulcers, remnant gastric ulcers, surgical treatment, and conservative therapy for perforation and stenosis. Therapeutic algorithms for the treatment of peptic ulcers differ based on ulcer complications. In patients with NSAID-induced ulcers, NSAIDs are discontinued and anti-ulcer therapy is administered. If NSAIDs cannot be discontinued, the ulcer is treated with proton pump inhibitors (PPIs). Vonoprazan (VPZ) with antibiotics is recommended as the first-line treatment for H. pylori eradication, and PPIs or VPZ with antibiotics is recommended as a second-line therapy. Patients who do not use NSAIDs and are H. pylori negative are considered to have idiopathic peptic ulcers. Algorithms for the prevention of NSAID- and low-dose aspirin (LDA)-related ulcers are presented in this guideline. These algorithms differ based on the concomitant use of LDA or NSAIDs and ulcer history or hemorrhagic ulcer history. In patients with a history of ulcers receiving NSAID therapy, PPIs with or without celecoxib are recommended and the administration of VPZ is suggested for the prevention of ulcer recurrence. In patients with a history of ulcers receiving LDA therapy, PPIs or VPZ are recommended and the administration of a histamine 2-receptor antagonist is suggested for the prevention of ulcer recurrence.
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Wakiya, R., Y. Ushio, K. Ueeda, H. Shimada, S. Nakashima, M. Kato, T. Miyagi, et al. "POS1362 THE EFFICACY AND CYTOKINE PROFILES DURING TREATMENT WITH APREMILAST IN PATIENTS WITH BEHÇET ‘S DISEASE." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 1020.1–1020. http://dx.doi.org/10.1136/annrheumdis-2022-eular.4181.
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BackgroundApremilast has been shown to be effective in patients with Behçet’s disease (BD) in domains other than oral ulcers; however, its long-term efficacy is yet to be determined. Although serum cytokine modulation by increasing intracellular cAMP levels has been suggested as a mechanism for the efficacy of apremilast on skin areas of psoriasis [1], the relationship between efficacy and cytokine on various domains in BD has not been fully investigated.ObjectivesThis study aims to evaluate the long-term clinical efficacy of apremilast in BD and its effect on serum cytokines.MethodsIn this study, patients with BD who received apremilast for active oral ulcers were included. For 12 months, the improvement rates of oral and genital ulcers, skin lesions, and arthritis were assessed every three months. Serum levels of cytokines, including interferon-gamma (IFN-γ), interleukin 10 (IL-10), and IL-17A were determined using Simple Plex (Protein Simple, CA, USA) at baseline and three months after apremilast treatment. Other cytokines, including tumor necrosis factor-alpha (TNF-a), IL-6, IL-8, and IL-23, were also measured in serum using a multiplex immunoassay (Luminex Assay, R&D Systems).ResultsFifteen patients were included in this study. Table 1 shows the characteristics of the patients who participated in this study. Oral ulcers disappeared in 66.7% and 92.3% of the patients after 3 and 6 months of apremilast treatment, respectively. Genital ulcers disappeared in all patients after 6 months of apremilast treatment and were maintained for 12 months. The efficacy of apremilast in oral ulcers could be divided between two groups: 8 patients in the oral ulcer remission group (OU-R group) whose oral ulcers completely disappeared after 3 months of apremilast administration and persisted for 1 year, and 7 patients in the oral ulcer non-remission group (OU-NR group) whose oral ulcers persisted after 3 months of apremilast treatment. Genital ulcers improved more rapidly in the OU-R group than in the OU-NR group, and completely disappeared within 3 months. Skin and joint lesions generally improved after 6 months, but recurred after 9 months.Table 1.Baseline characteristics of the studied patients with Behçet’s diseaseCharacteristicsN = 15Age (years), mean ± SD46.7 ± 13.0Sex (female), n (%)11 (73.3)Disease duration (years), mean ± SD10.4 ± 8.8Active Behçet’s disease manifestation at the time of enrollment, n (%) Oral ulcer15 (100) Genital ulcer5 (33.3) Skin lesion (erythema nodosum or pustules)10 (66.7) Arthralgia9 (60.0) Arthritis5 (33.3) Ocular involvement0 (0) Gastrointestinal involvement1 (6.7) Neurological involvement0 (0) Vascular involvement0 (0)SD, standard deviation; n, number.Serum cytokines could be analyzed in seven of the 15 cases. There was no significant association between serum baseline cytokine levels and the presence of lesions or severity of disease. Compared to baseline, TNF-α and IL-23 levels were significantly lower after apremilast treatment and IFN-γ levels were trending upwards; however, IL-6, IL-8, and IL-10 levels showed no constant trend (TNF-α and IL-23: p <0.05, IFN-γ: p = 0.078). In addition, the rate of decrease in serum IL-6, IL-10, and IL-23 levels was significantly greater in the OU-R group than in the OU-NR group (Figure 1). However, the rate of change in serum cytokines was not associated with efficacy of apremilast for skin lesions, arthralgia, or arthritis.Figure 1.The rate of change in serum interleukin (IL)-6, IL-10, and IL-23 levels up to 3 months after apremilast treatment in the oral ulcer remission group and the oral ulcer non-remission group.ConclusionApremilast has shown long-term efficacy in the treatment of oral and genital ulcers in patients with BD. The efficacy of apremilast against oral ulcers in BD may be attributed to its modulatory effect on serum cytokines as previously reported. Future exploratory studies for biomarkers associated with the presence of efficacy against genital ulcer and arthritis are needed.References[1]Gottlieb AB, Matheson RT, Menter AM, et al. J Drugs Dermatol. 2013;12:888-97.Disclosure of InterestsNone declared
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Rasajnam, Neethu, Sreejith Kalathummarathu, Shehadad Kammili, and Sreedevi Menon. "Clinical Outcome of Chronic Leg and Foot Ulcers Treated with Autologous Platelet Rich Fibrin." Journal of Evolution of Medical and Dental Sciences 11, no. 1 (January 13, 2022): 33–38. http://dx.doi.org/10.14260/jemds/2022/7.
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BACKGROUND Chronic leg and foot ulcers are a major health problem and leads to negative physical, social and psychological impact on patients and families. A high percentage of chronic ulcers do not adequately heal or quickly relapse with conventional treatment. They need advanced treatment modalities. Emerging cellular therapies such as platelet-rich concentrate therapy is an advanced modality. Platelet rich fibrin (PRF) is a second-generation platelet concentrate, consists of fibrin three-dimensional polymerized matrix, with the incorporation of platelets and leukocytes. The objective of the study was to assess clinical outcome of chronic leg and foot ulcers treated with autologous platelet rich fibrin. METHODS This prospective study included 30 patients with chronic leg or foot ulcers of various aetiologies, 19 patients had diabetic foot ulcers, 7 venous ulcers, 1 trophic ulcer, 2 pressure ulcers and 1 traumatic ulcer. Autologous PRF treatment outcome was measured by percentage of improvement in area and volume of the ulcer. We also studied other ulcer characteristics including exudate type, pus culture and sensitivity status, presence of undermining, type of tissue in ulcer bed and comorbidities. RESULTS From the 30 ulcers treated with PRF, the mean percentage of improvement in area and volume of ulcers were 98.3% and 98.8% respectively at the end of 2 months. 80% ulcers healed completely. There was also reduction of pain and exudate after first week of treatment. Other than increased callus formation in some ulcers, no other adverse events were reported following PRF treatment. CONCLUSIONS PRF is a safe, easy-to-use, cost-effective treatment method with significant potential for healing chronic ulcers. KEY WORDS PRF-Platelet Rich Fibrin
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Kulkarni, S. R., M. S. Gohel, M. R. Whyman, and K. R. Poskitt. "Significance of limb trauma as an initiating factor in chronic leg ulceration." Phlebology: The Journal of Venous Disease 23, no. 3 (June 2008): 130–36. http://dx.doi.org/10.1258/phleb.2007.007024.
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Objectives To assess differences in clinical outcomes between patients with traumatic and spontaneous leg ulcers. Methods Consecutive leg ulcer follow-up patients seen between April 2004 and October 2005 in a specialist leg ulcer clinic were asked about the mechanism of the original ulceration. Twenty-four-week healing and 12-month recurrence rates were calculated using Kaplan-Meier analysis and outcomes were compared between groups with traumatic and spontaneous ulcers. Results Of the 300 patients assessed, 38 were excluded (incomplete data). In the remaining 262 patients, cause of ulceration was traumatic in 116/262 (44%) and spontaneous in 146/262 (56%). Age, ankle brachial pressure index <0.85 and venous reflux were equally distributed between groups with traumatic and spontaneous ulcers ( P = 0.470, 0.793, 0.965 respectively, Chi-square test). Twenty-four-week healing rates were 81% for traumatic and 67% for spontaneous ulcers ( P = 0.015, Log-Rank test). Twelve-month recurrence rates were 32% for traumatic and 33% for spontaneous ulcers ( P = 0.970, Log-rank test). Patients with traumatic ulcers suffered a total of 53 ulcer recurrences (median 0, range 0–4) compared with 89 in patients with spontaneous ulcers (median 0, range 0–8) ( P < 0.001, Mann-Whitney U test). Conclusion Approximately half of all leg ulcer patients recall a traumatic event. When managed in leg ulcer clinic, traumatic ulcers heal faster and recur less frequently than spontaneous ulcers.
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Laborde, James M. "Midfoot Ulcers Treated with Gastrocnemius-Soleus Recession." Foot & Ankle International 30, no. 9 (September 2009): 842–46. http://dx.doi.org/10.3113/fai.2009.0842.
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Background: Foot ulcers in patients with neuropathy are a common cause of hospital admission for infection sometimes resulting in amputation in patients with neuropathy. Tendon lengthening alone has been reported to be successful in treating neuropathic forefoot ulcers. Tendon lengthening has also been recommended as an adjunct to bony procedures (exostectomy or fusion) for treating midfoot ulcers. The author reports the results of gastrocnemius-soleus recession as the sole treatment of diabetic midfoot ulcers. Materials and Methods: This study evaluated the results of 11 patients with 11 neuropathic plantar midfoot ulcers who were treated primarily with gastrocnemius-soleus recession with an average followup of 39 months. Potentially risky bony procedures were done after tendon lengthening if ulcers did not heal or recurred. Results: Ten of the ulcers healed but one patient was lost to followup after his ulcer healed. One ulcer did not heal and one ulcer recurred but healed again after midfoot fusion. One patient later had a transfemoral amputation due to gangrene. Two patients later died from medical problems unrelated to their surgery. There were no incision problems, or transfer ulcers. Conclusion: The author believes gastrocnemius-soleus recession as a primary treatment of diabetic midfoot ulcers is a low risk method of promoting ulcer resolution. Level of Evidence: IV, Retrospective Case Series
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Cheng, Hsiu-Chi, Hsiao-Bai Yang, Wei-Lun Chang, Wei-Ying Chen, Yi-Chun Yeh, and Bor-Shyang Sheu. "Expressions of MMPs and TIMP-1 in Gastric Ulcers May DifferentiateH. pylori-Infected from NSAID-Related Ulcers." Scientific World Journal 2012 (2012): 1–9. http://dx.doi.org/10.1100/2012/539316.
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Background. Two major causes of gastric ulcers areHelicobacter pylori(H. pylori) infection and nonsteroidal anti-inflammatory drug (NSAID) use.Aims. This study aimed to determine if there were different expressions of matrix metalloproteinases (MMPs) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) betweenH. pylori-infected and NSAID-related ulcers.Methods. The 126 gastric ulcer patients (H. pyloriinfectedn=46; NSAID relatedn=30; combined with two factorsn=50) provided ulcer and nonulcer tissues for assessment of MMP-3, -7, and -9 and TIMP-1 expression by immunohistochemical staining.Results. Gastric ulcer tissues had significantly higher MMP-3, -7, and -9 and TIMP-1 expressions than nonulcer tissues (P<0.05).H. pylori-infected gastric ulcers had even higher MMP-7, MMP-9, and TIMP-1 expressions in epithelial cells than NSAID-related gastric ulcers (P<0.05). In patients with the two combined factors, gastric ulcers expressed similar proportions of antral ulcers and MMP-7 and MMP-9 intensities to NSAID-related gastric ulcers, but lower MMP-9 and TIMP-1 thanH. pylori-infected gastric ulcers (P<0.05).Conclusions. H. pylori-infected gastric ulcers express higher MMP-7, MMP-9, and TIMP-1 than NSAID-related ulcers. In patients with the two combined factors, ulcer location and MMP-7 and MMP-9 intensities are similar to NSAID use.
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Iamandii, Inga, Abram Beatrice Kouassi, Davide Simonazzi, Cristina Marchesi, Marco Vinceti, and Tommaso Filippini. "Healing Time of Skin Ulcers in Homecare Residents in the Province of Reggio Emilia, Northern Italy." Life 12, no. 12 (November 28, 2022): 1989. http://dx.doi.org/10.3390/life12121989.
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The growing phenomenon of skin ulcers represents an important health problem; therefore, we conducted a pilot study to evaluate the ulcer healing time among adult subjects followed by the Home Nursing Service of the AUSL-IRCCS of Reggio Emilia, Northern Italy, and diagnosed with at least one skin ulcer during the period of January–August 2020. We recruited 138 subjects (45.5% men) with a mean age of 86.1 years. The subjects presented with 232 ulcers, of which 76.7% were pressure ulcers (60.1% were stage II), 18.1% were vascular ulcers, and 4.7% were diabetic foot ulcers. Ulcer management required only one weekly access for the majority of subjects, with a recovery frequency of 53.6% at the end of the observation period. The median ulcer healing time was 3.6 months and was shorter in women (2.6 months) than men (5.1 months), with an increasing trend according to the number of ulcers and the severity of pressure ulcers for vascular and diabetic foot ulcers. In conclusion, this is the first study carried out in an Italian population describing the distribution and characteristics of homecare residents with skin ulcers and highlighting the factors influencing the healing time and as consequence the duration of nursing care.
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Lindholm, C., M. Bjellerup, O. B. Christensen, and B. Zederfeldt. "Leg and foot ulcers. Nursing care in Malmö, Sweden." Acta Dermato-Venereologica 72, no. 3 (January 1, 1992): 224–26. http://dx.doi.org/10.2340/0001555572224226.
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Questionnaires concerning nursing care of leg and foot ulcer patients in three major care-giving sectors of the national health service, namely the Department of Dermatology, general hospital wards/clinics, and primary care, have been analysed. The overall response rate was 88% (primary care: 100%). Forms regarding 193 patients with leg ulcers and 64 patients with foot ulcers were analysed. Substantial differences in nursing care were noted between the three sectors. In 55% of the leg ulcers and 45% of the foot ulcers fibrin slough was present in the ulcer. Black, necrotic tissue was present in 8% of the leg ulcers and 22% of the foot ulcers. Profuse ulcer-exudation was most commonly reported for leg ulcer patients treated at the Department of Dermatology, while the majority of foot ulcers had only a mild exudation. Frequency of dressing changes varied between 1.4 times/week for leg ulcers at the Department of Dermatology and 9.2 times/week (foot ulcers 11.6) at general hospital clinics. Local wound dressings were exclusively chosen by physicians at the Department of Dermatology, mainly by physicians at general hospital clinics, and equally often by physicians and nurses in primary care. Time since last evaluation of the ulcer by a physician varied. At the general hospital clinics, 89% of the patients with leg ulcers had been seen by a physician within the last 2-month period. At the Department of Dermatology, 89% and in primary care 61% of the patients were examined within this period. 11% of the patients in primary care had never consulted a physician for their ulcers.(ABSTRACT TRUNCATED AT 250 WORDS)
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Sari, Vida Cahlia Novita, Medhi Denisa Alinda, Subur Prajitno, and Cita Rosita Sigit Prakoeswa. "Distribution of Leprosy Patients with and without Plantaris Ulcers." Berkala Ilmu Kesehatan Kulit dan Kelamin 34, no. 1 (March 30, 2022): 23–28. http://dx.doi.org/10.20473/bikk.v34.1.2022.23-28.
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Background: Leprosy is a chronic infectious disease caused by obligate intracellular Mycobacterium leprae, impacting public health. Leprosy causes deformity, and disability can lead to ulcer disease. Nerve involvement is essential in the emergence of ulcers on the feet, including in neuropathic ulcers. Neuropathic ulcers can be found on the soles of the feet and are often called plantar ulcers. The slow healing process of the ulcer will cause the plantar ulcer to become chronic. Purpose: To evaluate the characteristics of leprosy patients with and without plantar ulcers at the Leprosy Division of Dermatology and Venereology Outpatient Clinic of Dr. Soetomo General Academic Hospital, Surabaya, 2015-2019. Methods: A retrospective study were conducted by examining medical records for five years (2015-2019) at the Leprosy Division of Dermatology and Venereology Outpatient Clinic of Dr. Soetomo General Academic Hospital Surabaya. Results: A total of 511 patients met inclusion criteria. In leprosy patients without plantar ulcers group, the characteristics were male (68%), female (32%), aged 26-35 years (25.4%), paucibacillary (8.1%) and multibacillary (91.8%), patients without leprosy reactions (58%), and patients under treatment (49%). In leprosy patients with plantar ulcers group, the characteristics were male (64.3%), female (35.7%), aged 26-35 years (31%), multibacillary (92.9%), patients without leprosy reactions (61.9%), patients in the RFT category (76%), the ulcer duration group with highest prevalence rate 1-6 months (38.1%), and the most common location of plantar ulcers was on the forefoot (95.2%). Conclusion: Leprosy without plantar ulcers was more common than leprosy with plantar ulcers, mostly in male, dominated in the 26-35 years old for patients leprosy without plantar ulcers, type MB (multibacillary) was most history of leprosy type. Leprosy without reaction was common in leprosy patients with and without plantar ulcers. Patients without plantar ulcers majority was MDTL therapy, patients with plantar ulcers was common RFT (Release From Treatment).
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Cwajda-Białasik, Justyna, Paulina Mościcka, Arkadiusz Jawień, and Maria Teresa Szewczyk. "Microbiological Status of Venous Leg Ulcers and Its Predictors: A Single-Center Cross-Sectional Study." International Journal of Environmental Research and Public Health 18, no. 24 (December 8, 2021): 12965. http://dx.doi.org/10.3390/ijerph182412965.
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Venous leg ulcers are frequently colonized by microbes. This can be particularly devastating if the ulcer is infected with alert pathogens, i.e., highly virulent microorganisms with well-developed mechanisms of antibiotic resistance. We analyzed the microbiological status of venous leg ulcers and identified the clinicodemographic predictors of culture-positive ulcers, especially in ulcers with colonization by alert pathogens. Methods: This study included 754 patients with chronic venous leg ulcers. Material for microbiological analysis was collected by swabbing only from patients who did not receive any antibiotic treatment. Results: A total of 636 (84.3%) patients presented with culture-positive ulcers. Alert pathogens, primarily Pseudomonas aeruginosa, were detected in 28.6% of the positive cultures. In a logistic regression model, culture-positive ulcers were predicted independently by age > 65 years, current ulcer duration > 12 months, and ulceration area greater than 8.25 cm2. Two of these factors, duration of current ulcer > 12 months and ulceration area > 8.25 cm2, were also identified as the independent predictors of colonization by alert pathogens. Conclusions: Colonization/infection is particularly likely in older persons with chronic and/or large ulcers. Concomitant atherosclerosis was an independent predictor of culture-negative ulcers.
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Ghafoor Chaudhary, Muhammad Aamir, Syed Hammad Azeem Rizvi, Afsheen Zakir, Rummana Aqeel, Faiza Awais, Syeda Mahnoor Rauf, and Khezran Qamar. "Commonest location of traumatic ulcers in edentulous patients after denture insertion." Pakistan Journal of Medical and Health Sciences 16, no. 9 (September 30, 2022): 178–80. http://dx.doi.org/10.53350/pjmhs22169178.
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Aim: To evaluate frequency of commonest location of traumatic oral ulcers after complete denture insertion and find out their association with age, gender and arch type. Study design: Cross sectional observational study Place and duration: Prosthodontic department of Islamic International Dental College, Riphah International University Islamabad, from 11th Feb.,2022 till 11th April 2022. Methodology: A sample of 150 completely edentulous patients were clinically checked for traumatic ulcer development after insertion of complete denture. Frequently involved anatomical sites were noted in both arches. Denture surfaces were assessed to find out the frequently existing denture problems responsible for ulcers. Results: Out of total 150 patients 37.3% with oral ulcers were males and 62.7 % were female. 61-70 years old age group reported with frequent ulcers 48.7%. Frequently observed oral ulcer site in maxilla was sulci 10.0% and in mandible was ridge 24.7%. Frequently observed denture problem responsible for ulcer formation was denture surface roughness 46.7%. Association with age, gender and arch type was significant; p<0.05. Conclusion: Frequent ulcers develop in mandibular arch as compared to maxilla and commonest sites of ulcer developments are the ridges and sulci. Old age and female predisposition have been seen in ulcer development. Keywords: Complete dentures, Mandibular arch, Maxillary arch, oral ulcers, traumatic ulcers, post insertion complains
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RaviKKumar, V. R., Sanjesh Rathi, Shubham Singh, Bhoomi Patel, Sakshi Singh, Kumkum Chaturvedi, and Bhawna Sharma. "A Comprehensive Review on Ulcer and Their Treatment." Chinese Journal of Applied Physiology 39 (2023): e20230006. http://dx.doi.org/10.62958/j.cjap.2023.006.
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A peptic ulcer is a lesion (sore) on the stomach lining, or duodenum. Peptic ulcers are probably a twentieth-century condition. The ulcer disease continues to be a significant source of worldwide morbidity and mortality. The Gastrointestinal ulcers and duodenal ulcers are considered the two most extreme types of peptic ulcers. Peptic ulcers are found to be caused by an excess of violent factors including Hydrochloric acid (HCL) pepsin, refluxed bile leukotrienes (LT), reactive oxygen species (ROS) and protective factors, these include mucus-bicarbonate barrier functions, prostaglandins (PGs), mucosal blood flow, cell regeneration and migration, non-enzymatic and enzymatic and certain growth factors. The primary cause of peptic ulcer disease is pylori infection and the use of NSAIDs. This review article underscores the importance of a multidisciplinary approach in the management of ulcers to improve patient outcomes and quality of life.
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Londoño, Sergio, Carolina Viloria, Sandra Pérez-Buitrago, Javier Murillo, Deivid Botina, Artur Zarzycki, Johnson Garzón, et al. "Temporal Evaluation of the Surface Area of Treated Skin Ulcers Caused by Cutaneous Leishmaniasis and Relation with Optical Parameters in an Animal Model: A Proof of Concept." Sensors 23, no. 13 (June 24, 2023): 5861. http://dx.doi.org/10.3390/s23135861.
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Cutaneous leishmaniasis (CL) is a neglected disease caused by an intracellular parasite of the Leishmania genus. CL lacks tools that allow its understanding and treatment follow-up. This article presents the use of metrical and optical tools for the analysis of the temporal evolution of treated skin ulcers caused by CL in an animal model. Leishmania braziliensis and L. panamensis were experimentally inoculated in golden hamsters, which were treated with experimental and commercial drugs. The temporal evolution was monitored by means of ulcers’ surface areas, as well as absorption and scattering optical parameters. Ulcers’ surface areas were obtained via photogrammetry, which is a procedure that allowed for 3D modeling of the ulcer using specialized software. Optical parameters were obtained from a spectroscopy study, representing the cutaneous tissue’s biological components. A one-way ANOVA analysis was conducted to identify relationships between both the ulcers’ areas and optical parameters. As a result, ulcers’ surface areas were found to be related to the following optical parameters: epidermis thickness, collagen, keratinocytes, volume-fraction of blood, and oxygen saturation. This study is a proof of concept that shows that optical parameters could be associated with metrical ones, giving a more reliable concept during the assessment of a skin ulcer’s healing.
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Nelzén, O., D. Bergqvist, I. Fransson, and A. Lindhagen. "Prevalence and Aetiology of Leg Ulcers in a Defined Population of Industrial Workers." Phlebology: The Journal of Venous Disease 11, no. 2 (June 1996): 50–54. http://dx.doi.org/10.1177/026835559601100204.
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Objective: To assess leg ulcer prevalence and aetiology in people below retirement age. Design: A validated cross-sectional questionnaire survey. Respondents with a history of leg ulcers were examined. Setting: A defined population of industrial workers. Subjects: All 2785 employees, aged 30–65 years, at the Volvo motor engine factories in Skövde were included. Men predominated (81%) and the median age was 44 years in both men and women. A questionnaire was used to select people with a history of ulceration. A leg ulcer was defined as ‘any wound below the knee (foot ulcers included) that did not heal within a 6-week period after onset of ulceration’. Main outcome measures: Point prevalence of open leg ulcers, overall prevalence of leg ulcer history and aetiological classification. Results: The overall response rate was 87%, and 131 out of 153 subjects with a ‘history of leg ulcers’ were examined (86%). In 98% of positive responders the answers were validated. The overall false-positive response rate was 64%. Fifty-four had a true history of ulcers, of whom 16 had open ulcers. Of the latter, 12 were self-caring (75%). Overall venous causation dominated (41%). The ratio of open to healed ulcers was 1:2. The point prevalence for open ulcers was 0.6% and the overall prevalence of ulcer history was 1.6%, if excluding pure traumatic ulcers. The point prevalence was tenfold higher in people aged below 50 years and seven times higher in the age decade 50–59 years if compared with previous estimates based on patients known to health-care professionals. Conclusion: Leg ulcer prevalence has been underestimated in people of working age because they are often self-caring. Since many ulcers have curable causes it is necessary to inform the public of the importance of seeking professional help early.
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Rosmarwati, Ervina, and Nurrachmat Mulianto. "Retrospective Study of Decubitus Ulcer in Hospitalized Patients." Berkala Ilmu Kesehatan Kulit dan Kelamin 35, no. 1 (March 31, 2023): 46–51. http://dx.doi.org/10.20473/bikk.v35.1.2023.46-51.
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Background: Decubitus ulcer is an area of necrotic tissue due to compression of protrusion because of prolonged immobilization. Decubitus ulcer is complication that often occur due to prolonged bed rest. Decubitus ulcer can interfere with patient’s recovery process and prolonged hospital stay. Purpose: To investigate profile of decubitus ulcer in hospitalized patients in Dr. Moewardi General Hospital Surakarta during 2017- 2020. Methods: This descriptive retrospective study was conducted by using medical record of decubitus ulcers (ICD 10 L89.0, L89.1, L89.2, L89.3) in Dr. Moewardi General Hospital Surakarta during 1st January 2017-31st December 2020. Result: There were 375 decubitus ulcer patients, mostly aged 70 years or more (29.1%) and dominated by women (56%). Patients with decubitus ulcers often hospitalized in the regular ward (75.2%) with the longest length of stay being around 0-10 days (49.6%) and the most common comorbidities was malignancy (20.5%). Systemic antibiotic ceftriaxone was most often given to decubitus ulcer patients (21.6%). Most of the patients with decubitus ulcers had stage 2 decubitus ulcers (53.6%) with a predisposition to the affected area being the sacrum area (33%). The most frequently used therapy for decubitus ulcers was hydrogel dressing (33.9%). Conclusion: Decubitus ulcers are often found in patients over 70 years of age with comorbid malignancies. The most common diagnosis was stage 2 decubitus ulcers, predisposing to the sacral region and the most frequently used therapy was hydrogel dressing with ceftriaxone as a systemic antibiotic.
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Wethers, DL, GM Ramirez, M. Koshy, MH Steinberg, G. Jr Phillips, RS Siegel, JR Eckman, and JT Prchal. "Accelerated healing of chronic sickle-cell leg ulcers treated with RGD peptide matrix. RGD Study Group." Blood 84, no. 6 (September 15, 1994): 1775–79. http://dx.doi.org/10.1182/blood.v84.6.1775.1775.
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Abstract Leg ulcers are a chronic manifestation of sickle-cell disease (SCD) and are often painful, disabling, and difficult to treat. RGD peptide matrix treatment is a novel therapy designed to provide a topical synthetic extracellular matrix that can act as a temporary substitute for the damaged natural matrix at the ulcer site. In this randomized, placebo-controlled, double-blind, prospective, multicenter investigation, SCD patients with full-thickness leg ulcers were treated with standard therapy plus RGD peptide matrix or saline placebo once weekly for up to 10 weeks. Healing in patients with chronic ulcers (2 months or greater in duration) was significantly accelerated (P = .0085) in RGD peptide matrix recipients compared with the placebo group. In these chronic ulcer cases, the average percent ulcer closure (decrease in ulcer surface area) in the RGD peptide matrix group (54.4% +/- 8.9%) exceeded that in the placebo group (19.0% +/- 24.3%) nearly threefold by study endpoint. Furthermore, RGD peptide matrix was equally effective in promoting healing of long persistent ulcers and ulcers of shorter duration. In contrast, standard therapy plus placebo was significantly less effective (P = .001) in promoting healing for ulcers of progressively greater duration. The results of this study provide preliminary evidence that RGD peptide matrix treatment may significantly accelerate healing of chronic sickle-cell leg ulcers.
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Wethers, DL, GM Ramirez, M. Koshy, MH Steinberg, G. Jr Phillips, RS Siegel, JR Eckman, and JT Prchal. "Accelerated healing of chronic sickle-cell leg ulcers treated with RGD peptide matrix. RGD Study Group." Blood 84, no. 6 (September 15, 1994): 1775–79. http://dx.doi.org/10.1182/blood.v84.6.1775.bloodjournal8461775.
Full textAbstract:
Leg ulcers are a chronic manifestation of sickle-cell disease (SCD) and are often painful, disabling, and difficult to treat. RGD peptide matrix treatment is a novel therapy designed to provide a topical synthetic extracellular matrix that can act as a temporary substitute for the damaged natural matrix at the ulcer site. In this randomized, placebo-controlled, double-blind, prospective, multicenter investigation, SCD patients with full-thickness leg ulcers were treated with standard therapy plus RGD peptide matrix or saline placebo once weekly for up to 10 weeks. Healing in patients with chronic ulcers (2 months or greater in duration) was significantly accelerated (P = .0085) in RGD peptide matrix recipients compared with the placebo group. In these chronic ulcer cases, the average percent ulcer closure (decrease in ulcer surface area) in the RGD peptide matrix group (54.4% +/- 8.9%) exceeded that in the placebo group (19.0% +/- 24.3%) nearly threefold by study endpoint. Furthermore, RGD peptide matrix was equally effective in promoting healing of long persistent ulcers and ulcers of shorter duration. In contrast, standard therapy plus placebo was significantly less effective (P = .001) in promoting healing for ulcers of progressively greater duration. The results of this study provide preliminary evidence that RGD peptide matrix treatment may significantly accelerate healing of chronic sickle-cell leg ulcers.
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Chanda, Arnab, and Vinu Unnikrishnan. "Novel insole design for diabetic foot ulcer management." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 232, no. 12 (November 2, 2018): 1182–95. http://dx.doi.org/10.1177/0954411918808330.
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Around the world, over 400 million people suffer from diabetes. In a chronic diabetic condition, the skin underneath the foot often becomes extremely soft and brittle, resulting in the development of foot ulcers. In literature, a plethora of footwear designs have been developed to reduce the induced stresses on a diabetic foot and to consequently prevent the incidences of foot ulcers. However, to date, no insole design exists which can handle post-ulcer diabetic foot conditions without hindering the mobility of the patients. In the current work, a novel custom insole design with arch support and ulcer isolations was tested for effective stress reduction in a diabetic foot with ulcers using finite element modeling. A full-scale model of the foot was developed with ulcers of different geometries and sizes at the heel and metatarsal regions of the foot. The stresses at the ulcer locations were quantified for standing and walking with and without the novel custom insole model. The effect of material properties of the insole on the ulcer stress reduction was quantified extensively. Also, the effectivity of a novel synthetic skin material as the insole material was tested for stress offloading at the ulcers and the rest of the foot. From the analyses, peak stress reductions were observed at the ulcers up to 91.5% due to the ulcer isolation in the novel custom insole design and the skin-like material. Specifically, the ulcer isolation feature in the insole was found to be approximately 25% more effective in peak stress reduction for commonly occurring ulcers with irregular geometry, over the tested regular circular ulcer geometry. Also, a threshold material stiffness was found for the custom insole, below which the peak stresses at the ulcers did not decrease any further. Based on this information, a working prototype of the custom insole was developed with custom ulcer isolations, which will be subjected to further testing. The results of this study would inform better custom insole designing and material selection for post-ulcer diabetic conditions, with effective stress reduction at the ulcers, and the possibilities of preventing further ulceration.
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Jan, Syed Rohi, Humaira Qadir, and Sameer Ahmad Dar. "A STUDY TO ASSESS THE KNOWLEDGE AND ATTITUDE OF B.Sc. NURSING STUDENTS REGARDING PREVENTION OF PRESSURE ULCERS IN SELECTED NURSING COLLEGES OF KASHMIR." International Journal of Engineering Applied Sciences and Technology 7, no. 10 (February 1, 2023): 141–43. http://dx.doi.org/10.33564/ijeast.2023.v07i10.019.
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Title: A study to assess the knowledge and attitude of B.Sc. Nursing Students regarding prevention of Pressure Ulcers in selected Nursing Colleges of Kashmir. Objectives: To assess the level of knowledge and attitude regarding prevention of pressure ulcers among B.Sc. Nursing Students. Materials and Methods: A descriptive cross-sectional design was used. With the non-probability consecutive sampling 60 study participants from B.Sc. Nursing 2nd and 3rd year were selected. Tool used in this study included three sections, Section-I including demographic Performa of students such as age, gender, area of residence and family type. Section-II including standardized Pressure ulcer knowledge assessment tool with 25 item questionnaire on knowledge and prevention of pressure ulcers. Section-III including standardized Likert Scale to assess attitude regarding prevention of pressure ulcers Data was analyzed by using descriptive and inferential statistical technique. Result: The data analysis revealed that the majority of study subjects 68.3% had poor knowledge and 83.3% of study subjects have neutral attitude, regarding prevention of pressure ulcers. Conclusion: The study concluded that study subjects had average knowledge and neutral attitude regarding prevention of pressure ulcers and there should be more awareness regarding prevention of pressure ulcers which can be achieved by giving more knowledge to students regarding prevention of pressure ulcers. All specialized nursing courses should cover pressure ulcer prevention issues in order to provide better knowledge of pressure ulcer prevention to students. To advance nursing knowledge of pressure ulcer prevention in Jammu Kashmir, further studies should be conducted to evaluate the course material of pressure ulcer prevention in the nursing curriculum.
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Nelzèn, O. "Leg Ulcers: Economic Aspects." Phlebology: The Journal of Venous Disease 15, no. 3-4 (December 2000): 110–14. http://dx.doi.org/10.1177/026835550001500305.
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Objective: To review what is known about the cost of leg ulcers, and venous leg ulcers in particular. Method: Searches of the Medline and Cochrane Library databases. Reviewing reference lists of personally gathered articles in the field of chronic leg ulcers. Synthesis: Most publications dealing with the economics of leg ulcers are cost studies assessing the cost of different dressings or bandages, and only a few have given estimates of the total costs of leg ulcer management. The latter, in conjunction with accurate epidemio-logical data, are essential to estimate the nationwide costs of leg ulcer management. The costs consist of direct and indirect costs for society. Direct costs are mainly staff costs for managing dressing-changes. Based on the few estimates made, approximately 1% of the total health care costs in the western world are likely to be used for management of chronic leg ulcers. To reduce the costs of leg ulcer management a reduction in the frequency of dressing-change is recommended. Improved use of high technology, such as duplex Doppler diagnostics and varicose vein surgery, is also likely to be cost-effective. On the basis of two health economic analyses leg ulcer clinics alone do not appear to reduce the costs of leg ulcer management, mainly because of an inability to prevent recurrent ulceration. Conclusion: The cost implications of chronic leg ulcers are insufficiently studied but there is no doubt that managing patients with leg ulcers takes a substantial proportion of the health care budget. More health economic analyses are needed to define the best treatment in order to reduce total costs.
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Rubianti, Marissa Astari, Evy Ervianti, Muhammad Yulianto Listiawan, Diah Mira Indramaya, Rahmadewi Rahmadewi, Esti Hendradi, and Cita Rosita Sigit Prakoeswa. "Efficacy of 5% Tea Tree Oil Hydrogel on Healing Morbus Hansen's Chronic Plantar Ulcer." Berkala Ilmu Kesehatan Kulit dan Kelamin 33, no. 1 (March 31, 2021): 28. http://dx.doi.org/10.20473/bikk.v33.1.2021.28-33.
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Background: The damage of the peripheral nerves that occurs in Morbus Hansen (MH) patients can cause disability due to loss of sensory, motor and autonomic functions can cause wounds, infections, ulcers and disability. Ulcers are the most common cause of disability complications in MH patients and requires a certain time of healing. As many as 10-20% of MH patients experience ulcers on the soles. Tea Tree Oil (TTO) is extracted from steam distillation of the leaves and twigs of the Australian native shrub Melaleuca Alternifolia. In ulcers, TTO can work as an antimicrobial, anti-inflammatory, and antioxidant. TTO preparation in the form of hydrogel is believed to help the wound healing process. Purpose: To investigate the effect of TTO hydrogel 5% on the healing of Chronic Plantar Ulcer of Leprosy (CPUL). Methods: Tea tree oil hydrogel 5% was applied every 3 days for up to 8 weeks in 22 subjects with chronic MH plantar ulcers. Ulcer size, side effects, and possible side effects are evaluated weekly. Result: There were significant clinical and statistical differences in ulcer size (p = 0.000) and in ulcer depth (p = 0.000) after TTO hydrogel 5%. No side effects occurred in this study. The ulcer healed was 59%, the ulcer improved by 36.4%, the persistent ulcer was 4.6%, and there was no ulcer that got worse. Conclusion: TTO hydrogel 5% is effective in the healing process of chronic MH plantar pedis ulcers.
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Christiansen, J., L. Ek, and E. Tegner. "Pinch grafting of leg ulcers. A retrospective study of 412 treated ulcers in 146 patients." Acta Dermato-Venereologica 77, no. 6 (December 12, 1997): 471–73. http://dx.doi.org/10.2340/0001555577471473.
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In a retrospective study of 412 leg ulcers in 146 patients treated with pinch grafting, with a mean duration of follow-up of 32 months (range 2-84), the overall healing rate was 38%. The healing rate was best in the vasculitic ulcers (56%), followed by venous ulcers (38%), arteriosclerotic ulcers (33%), mixed ulcers (33%) and "other ulcers" (20%). In the series as a whole, the mean duration of ulcer problems was 8 years, and that of the 412 ulcers treated 2.5 years
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Fistal’, E. Ya, N. Т. Vatutin, G. G. Taradin, M. S. Goncharuk, I. S. Grischenko, and I. V. Vasilenko. "Martorell’s ulcers." Vestnik dermatologii i venerologii 94, no. 3 (August 23, 2018): 51–55. http://dx.doi.org/10.25208/0042-4609-2018-94-3-51-55.
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There is description in the article of a case of hypertensive ulcer pathology of legs or Martorell’s ulcers diagnostics, which are complications of long-standing and poor-controlled essential hypertension. The patient 42 years old male presented with complaints of long-standing, non-healing and painful ulcer on the left leg, sustained blood pressure elevation (up to 230/120 mm Hg). History disease revealed blood pressure elevations since 16 years old age, but the patient sought medical advice extremely seldom and did not take antihypertensive treatment in fact. He noted when was 35 years old a painful ulcer located on anterolateral surface of the leg. Concerning it he treated by himself unsuccessfully and then — in differ ent health care centers. The condition deteriorated in 2016, when ulcer defect become larger and more painful. On admission at examination the ulcer of oval shape (size 7 × 4 cm and depth 0.6 cm) on anterolateral surface of the lower third of left leg is present. In clinical and biochemistry analyses no pathology was found. There were signs of left ventricle hypertrophy on the data of electroand echocardiographic inves tigations. No alterations during complex ultrasound examination of vessels of both lower extremities were revealed. Examination of angiosurgeon: no pathology. With the purpose to diagnosis specification path omorphologic study of tissue fragments of injured zone was performed. The results of this study showed that revealed changes are relevant for hypertensive ulcers of legs or Martorell’s ulcers. The presented case illustrates the necessity of more broad informing medical community about possibility of incidence of Martorell’s ulcers that in turn assumes application of adequate measures of local treat ment, including dermatoplasty, and effective antihypertensive therapy.
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Nasio, James M., Nico J. D. Nagelkerke, Anthony Mwatha, Stephen Moses, Jackoniah O. Ndinya-Achola, and Frank A. Plummer. "Genital ulcer disease among STD clinic attenders in Nairobi: association with HIV-1 and circumcision status." International Journal of STD & AIDS 7, no. 6 (October 1, 1996): 410–14. http://dx.doi.org/10.1258/0956462961918374.
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In previous studies, genital ulcers in men have been found to be associated with increased risk of HIV-1 seroconversion. To further explore this association male patients attending a sexually transmitted disease STD clinic in Nairobi for either urethritis controls, n 276 or a genital ulcer cases, n 607 were compared with respect to sexual behaviour, presence of HIV-1 antibody and circumcision status. Patients were followed to study risk factors for incident genital ulcers and HIV-1 seroconversion. At entry, being married was associated with higher prevalence of HIV-1 OR 1.76 and genital ulcers OR 1.42 . Lack of circumcision was associated with both HIV-1 infection OR 4.67 and the presence of a genital ulcer OR 2.23 . Genital ulcers were also associated with HIV-1 infection OR 1.87 independent of circumcision status. On follow-up, HIV-1 seropositivity was associated with incident genital ulcers. It is argued that the association between genital ulcers and HIV-1 infection may be more complex than ulcers simply being a risk factor for HIV-1 infection, and that HIV-1 infection may either increase the risk of acquiring a genital ulcer, or HIV-1 infection and genital ulcers may have some unknown risk factor in common.
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Singh, Raghuvendra, Anubha Gupta, and Shweta Patel. "Pharmacological Screening Model and Its Treatment of Peptic Ulcer Disease." Journal for Research in Applied Sciences and Biotechnology 1, no. 5 (December 1, 2022): 36–47. http://dx.doi.org/10.55544/jrasb.1.5.4.
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Peptic ulcer is a ceaseless sickness influencing up to 10% of the total population. Peptic ulcer created by the unevenness of gastric juice pH and mucosal protections. Two fundamental components delivered Peptic ulcer. Frist is central point it included bacterial disease, for example, Helicobacter Pylori (H. Pylori) and medicine non-steroidal anti-inflammatory medication and synthetic E.g., HCL, Ethanol. Second is minor factor it included pressure, smoking, fiery food and nourishment lopsidedness. Ordinary treatment of Peptic ulcer, for example, proton siphon inhibitor (PPI) and Histamine-2 (H2) Receptor Antagonist. Also, other Hand therapeutic plant and their concoction compound are valuable in the counteraction and treatment of peptic ulcer infection. Various creature models are utilizing to influenced ulcer to identifying the antiulcer activity of many new existed drugs such as Pylorus ligated (shay) rats, Stress ulcers, Restraint ulcer in rats, Water immersion-induced restraint ulcers, Cold and restraint ulcers, Gastric mucosal damage induced by NSAID in rats, Induced solitary chronic gastric ulcer, Acetic acid induced kissing gastric ulcers in rats Histamine induced gastric ulcer in guinea pig, Duodenal anti-ulcer activity, Gastric cytoprotective action.
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Toussaint, Frédéric, Michael Erdmann, Carola Berking, and Cornelia Erfurt-Berge. "Malignant Tumours Presenting as Chronic Leg or Foot Ulcers." Journal of Clinical Medicine 10, no. 11 (May 22, 2021): 2251. http://dx.doi.org/10.3390/jcm10112251.
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Our purpose was to collect data on the incidence of malignant skin tumours presenting as chronic leg or foot ulcers in a tertiary centre, and to analyse the frequency and type of initial clinical misdiagnoses in these cases. A retrospective chart review of cases with melanoma or other malignant neoplasms of the skin of the lower extremity treated in a tertiary centre during January 2010 until February 2020 was conducted to identify cases that presented as chronic ulcers. Out of 673 cases, 26 (3.9%) were identified with a total of 27 malignant tumours presenting as chronic ulcers of the lower leg or foot. Therefrom, seven were diagnosed as melanoma, eight as squamous cell carcinoma, and twelve as basal cell carcinoma. The mean interval until diagnosis for all tumour types was 44.4 months (median 24 months). A delay in correct treatment occurred in 12 out of 26 cases (46%) as a result of misdiagnosis with subsequent treatment as chronic leg or foot ulcers of a different etiology. Misdiagnoses were venous ulcer, traumatic wound, mixed arterial and venous ulcer, arterial ulcer, and ulcer of an unknown origin. Malignant ulcers presenting as chronic ulcers are rare, but often lead to misdiagnosis.
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Pannier, F., and E. Rabe. "Differential diagnosis of leg ulcers." Phlebology: The Journal of Venous Disease 28, no. 1_suppl (March 2013): 55–60. http://dx.doi.org/10.1177/0268355513477066.
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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.
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Ho, Chester, Jason Jiang, Cathy A. Eastwood, Holly Wong, Brittany Weaver, and Hude Quan. "Validation of two case definitions to identify pressure ulcers using hospital administrative data." BMJ Open 7, no. 8 (August 2017): e016438. http://dx.doi.org/10.1136/bmjopen-2017-016438.
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ObjectivePressure ulcer development is a quality of care indicator, as pressure ulcers are potentially preventable. Yet pressure ulcer is a leading cause of morbidity, discomfort and additional healthcare costs for inpatients. Methods are lacking for accurate surveillance of pressure ulcer in hospitals to track occurrences and evaluate care improvement strategies. The main study aim was to validate hospital discharge abstract database (DAD) in recording pressure ulcers against nursing consult reports, and to calculate prevalence of pressure ulcers in Alberta, Canada in DAD. We hypothesised that a more inclusive case definition for pressure ulcers would enhance validity of cases identified in administrative data for research and quality improvement purposes.SettingA cohort of patients with pressure ulcers were identified from enterostomal (ET) nursing consult documents at a large university hospital in 2011.ParticipantsThere were 1217 patients with pressure ulcers in ET nursing documentation that were linked to a corresponding record in DAD to validate DAD for correct and accurate identification of pressure ulcer occurrence, using two case definitions for pressure ulcer.ResultsUsing pressure ulcer definition 1 (7 codes), prevalence was 1.4%, and using definition 2 (29 codes), prevalence was 4.2% after adjusting for misclassifications. The results were lower than expected. Definition 1 sensitivity was 27.7% and specificity was 98.8%, while definition 2 sensitivity was 32.8% and specificity was 95.9%. Pressure ulcer in both DAD and ET consultation increased with age, number of comorbidities and length of stay.ConclusionDAD underestimate pressure ulcer prevalence. Since various codes are used to record pressure ulcers in DAD, the case definition with more codes captures more pressure ulcer cases, and may be useful for monitoring facility trends. However, low sensitivity suggests that this data source may not be accurate for determining overall prevalence, and should be cautiously compared with other prevalence studies.
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Cahyanto, Heri Nur. "IDENTIFIKASI DAN STRATEGI PERAWATAN ULKUS DIABETIK BERBASIS SISTEM PAKAR." Jurnal Biosains Pascasarjana 17, no. 2 (August 1, 2015): 105. http://dx.doi.org/10.20473/jbp.v17i2.2015.105-109.
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Abstract The occurrence of cases of amputation due to diabetic ulcers are caused by a lack of knowledge of high society, especially patients with diabetes mellitus on the ulcer treatment. This is due to lack of awareness of personal health check and some nurses are not experts in identifying diabetic ulcers. The identification process is not done properly resulting in an error treatment. Every medical personnel have the ability to identify different diabetic ulcers, treatment strategies and appropriate health education can prevent an increase in the degree of ulcers, amputation and the incidence of recurrent ulcer. Therefore, in this study, carried out to identify the application design with a diabetic ulcer-based expert system. The application design is done in several stages. Steps being taken is the collection of data for the knowledge base, mapping logic paths, manufacture Graphic User Interface (GUI), the making inference engine, weighting and system testing to determine the level of accuracy of the system. This study resulted in the identification of applications for intelligent systems based Diabetic Ulcers with the best accuracy rate amounted 81.25%, with the number of nodes traversed is 30 to 100 nodes. Keywords: Treatment Diabetic ulcers, ulcers Identification, Expert System.
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Chin-Lenn, Laura, David Ying, James Leong, David Ross, Terry Wu, Simon Nazaretian, Simon Donahoe, and Ram Silfen. "Mycobacterium Ulcerans Ulcers." Annals of Plastic Surgery 57, no. 1 (July 2006): 65–69. http://dx.doi.org/10.1097/01.sap.0000209031.57727.e4.
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Kathirvel, Manikandan, Viswakumar Prabakaran, Jayalakshmi Jayarajan, Ajay Sivakumar, and Vimalkumar Govindan. "Risk factors for the diabetic foot infection with multidrug-resistant microorganisms in South India." International Surgery Journal 5, no. 2 (January 25, 2018): 675. http://dx.doi.org/10.18203/2349-2902.isj20180374.
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Background: To analyse the risk-factors contributing to infection with multidrug-resistant organisms.Methods: 150 diabetic patients with foot ulcer were prospectively studied. Detailed clinical history and clinical examination of the ulcer were done for all patients. The microbiological profile was analyzed for each patient. Using internationally accepted criteria, the multidrug-resistant organisms were identified. Risk factors for acquiring MDRO infection were identified using appropriate statistical tools.Results: MDRO were isolated from 99 patients of 150 (66%). 54.8% (153 out of 279) of isolated organisms were multidrug-resistant organisms. By univariate analysis poor glycaemic control, previous hospitalisation, previous history of amputation, previous antibiotic usage, size of the ulcer, necrotic ulcer, recurrent ulcers, higher grade of ulcer, the presence of osteomyelitis, the presence of retinopathy, peripheral vascular disease, neuropathy and polymicrobial culture, were significantly associated with MDRO infected foot ulcers. Analysis by logistic regression indicated that only two factors significantly increased the risk of acquiring MDRO infection. They are recurrent ulcer (OR = 3.39, p <0.05, 95% CI = 1.081-10.664) and higher grade of ulcer (OR = 13.44, p <0.001, 95 % CI =3.595-50.278).Conclusions: The prevalence of MDRO is alarmingly high in infected diabetic foot ulcers. Recurrent ulcers and higher grade of ulcers are more prone to acquire MDROs.
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Hansson, C., J. Hoborn, A. Möller, and G. Swanbeck. "The microbial flora in venous leg ulcers without clinical signs of infection. Repeated culture using a validated standardised microbiological technique." Acta Dermato-Venereologica 75, no. 1 (January 1, 1995): 24–30. http://dx.doi.org/10.2340/00015555752430.
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The change of ulcer size in relation to the presence of species and quantities of microorganisms was analysed in 58 patients with venous leg ulcers, all without clinical signs of infection. Microbiological samples were taken on the day of inclusion and then repeated 4 times at monthly intervals or until the ulcer had healed or was too small to be cultured from. There was growth of microorganisms in all ulcers, and the numbers were below 10(4) per mm2 of ulcer surface in all cases. No correlation was found between ulcer size change and the species and amounts of microorganisms. Sixty-nine species were isolated. Staphylococcus aureus was found in 88%, Enterococcus faecalis in 74%, Enterobacter cloacae and Peptococcus magnus in 29%, and fungi in 11% of the samples. One or more obligate anaerobe species was found in 41% of the samples and in half of the ulcers and constituted 62% of all bacterial species. The colonising ulcer flora was markedly constant over time in the individual ulcers regardless of change in size. Resident bacterial species were found in 57 of the 58 ulcers. If all samples were considered, the microorganisms were associated with not more than one fifth of the variability in healing rate, as shown by linear multiple regression analysis. The same species of microorganisms were found in ulcers that decreased (or healed) and in those that increased in size. Although an association between the microorganisms and ulcer healing could not be ruled out in this study, there seems to be no indication for routinely performed culture in the absence of clinical signs of infection in venous leg ulcers.
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Sharp, Catherine, and Julie Campbell. "Preventing pressure ulcers in aged care by auditing, and changing, work practices." Asian Journal of Medical Sciences 13, no. 4 (April 1, 2022): 191–95. http://dx.doi.org/10.3126/ajms.v13i4.41855.
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Background: Two nurse consultants concerned with ongoing pressure ulcer development in a 44-bed residential aged care facility in Sydney, Australia, audited pressure ulcers and the use of air mattresses. Aims and Objectives: To measure and reduce the prevalence of pressure ulcers; audit air mattresses in use; reduce the physical workload for care staff repositioning residents; introduce an alternating pressure air mattress, allow residents to sleep undisturbed, and provide bedside education for all nursing staff. Materials and Methods: Pressure ulcer prevalence was determined, “air” mattresses were inspected, and repositioning regimes were considered. All residents at risk of pressure ulcers were provided with a “Nodec A” mattress, allowed to sleep undisturbed, and bedside training was given to staff. Results: Pressure ulcer prevalence was 18.1%. Eight of 44 residents had a total of 10 pressure ulcers; four sacral, three heel ulcers, two buttocks, and one hip. An audit of “air” mattresses showed half, seven of 14 (50%), was not working. Four alarm lights were on; two were set on static mode and one was deflated. Six months after the introduction of the “Nodec A” alternating pressure air mattress all pressure ulcers had healed, and the facility was pressure ulcer free. Conclusion: Residents nursed on the “Nodec A” were pressure ulcer free and slept for hours without being repositioned and woken.
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Armstrong, David G., Tze-Woei Tan, Andrew J. M. Boulton, and Sicco A. Bus. "Diabetic Foot Ulcers." JAMA 330, no. 1 (July 3, 2023): 62. http://dx.doi.org/10.1001/jama.2023.10578.
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ImportanceApproximately 18.6 million people worldwide are affected by a diabetic foot ulcer each year, including 1.6 million people in the United States. These ulcers precede 80% of lower extremity amputations among people diagnosed with diabetes and are associated with an increased risk of death.ObservationsNeurological, vascular, and biomechanical factors contribute to diabetic foot ulceration. Approximately 50% to 60% of ulcers become infected, and about 20% of moderate to severe infections lead to lower extremity amputations. The 5-year mortality rate for individuals with a diabetic foot ulcer is approximately 30%, exceeding 70% for those with a major amputation. The mortality rate for people with diabetic foot ulcers is 231 deaths per 1000 person-years, compared with 182 deaths per 1000 person-years in people with diabetes without foot ulcers. People who are Black, Hispanic, or Native American and people with low socioeconomic status have higher rates of diabetic foot ulcer and subsequent amputation compared with White people. Classifying ulcers based on the degree of tissue loss, ischemia, and infection can help identify risk of limb-threatening disease. Several interventions reduce risk of ulcers compared with usual care, such as pressure-relieving footwear (13.3% vs 25.4%; relative risk, 0.49; 95% CI, 0.28-0.84), foot skin measurements with off-loading when hot spots (ie, greater than 2 °C difference between the affected foot and the unaffected foot) are found (18.7% vs 30.8%; relative risk, 0.51; 95% CI, 0.31-0.84), and treatment of preulcer signs. Surgical debridement, reducing pressure from weight bearing on the ulcer, and treating lower extremity ischemia and foot infection are first-line therapies for diabetic foot ulcers. Randomized clinical trials support treatments to accelerate wound healing and culture-directed oral antibiotics for localized osteomyelitis. Multidisciplinary care, typically consisting of podiatrists, infectious disease specialists, and vascular surgeons, in close collaboration with primary care clinicians, is associated with lower major amputation rates relative to usual care (3.2% vs 4.4%; odds ratio, 0.40; 95% CI, 0.32-0.51). Approximately 30% to 40% of diabetic foot ulcers heal at 12 weeks, and recurrence after healing is estimated to be 42% at 1 year and 65% at 5 years.Conclusions and RelevanceDiabetic foot ulcers affect approximately 18.6 million people worldwide each year and are associated with increased rates of amputation and death. Surgical debridement, reducing pressure from weight bearing, treating lower extremity ischemia and foot infection, and early referral for multidisciplinary care are first-line therapies for diabetic foot ulcers.
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Huizing, Eline, Michiel A. Schreve, James WT Cohen Stuart, Jean-Paul PM de Vries, and Ünlü Çağdaş. "Treatment of clinically uninfected diabetic foot ulcers, with and without antibiotics." Journal of Wound Care 33, no. 2 (February 2, 2024): 118–26. http://dx.doi.org/10.12968/jowc.2024.33.2.118.
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Objective: Current guidelines do not recommend the use of antibiotics to treat clinically uninfected ulcers. However, physicians continue to prescribe antibiotics for clinically uninfected ulcers with the rationale ‘better to be safe than sorry’. Yet, antibiotic resistance is increasing, side-effects are common and treatment costs are rising. Evidence is needed to identify whether antibiotic treatment for clinically uninfected ulcers can be justified or we should stop prescribing them. The aim of this study was to evaluate whether antibiotic treatment in cases of clinically uninfected ulcers improved ulcer healing compared to treatment without antibiotics. Method: Consecutive patients treated in the outpatient clinic for clinically uninfected diabetic foot ulcer both in 2015 and in 2017 were retrospectively analysed. Primary outcome was ulcer healing at one year. Secondary outcomes were limb salvage, freedom from any amputation, amputation-free survival (AFS) and survival. Results: A total of 102 ulcers of 91 patients were included for final analyses. The non-antibiotics and antibiotics groups both consisted of 51 ulcers. Ulcer healing at one year was 77.3% in the non-antibiotics group and 74.7% in the antibiotics group (p=0.158). No difference was found for limb salvage (93.8% versus 95.9%, respectively; p=0.661), freedom from any amputation (85.6% versus 85.6%, respectively; p=1.000), AFS (85.4% versus 79.1%, respectively; p=0.460) or survival (89.6% versus 83.7%, respectively; p=0.426). Conclusion: In this study, no benefits of antibiotic treatment over non-antibiotic treatment for clinically uninfected ulcers were identified. The findings of this study emphasise the recommendation of current guidelines to not treat clinically uninfected ulcer with antibiotics.
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Dudhamal, T. S. "Wound healing activity of Arjuna bark powder in Dushta vrana (Non healing venous ulcers) - A Case Report." Journal of Ayurvedic and Herbal Medicine 2, no. 4 (August 25, 2016): 102–3. http://dx.doi.org/10.31254/jahm.2016.2402.
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A non-healing ulcer or chronic wound is defined as a wound that does not improve after four weeks or does not heal in eight weeks. These wounds include diabetic foot ulcers, venous-related ulcerations (varicose ulcers), pressure ulcers etc. Venous ulcers develop at medial part of lower leg and above the medial malleoli of foot and occur as a result of recanalization of DVT (deep vein thrombosis). These ulcers are often large in size, non-healing, tender and recurrent with secondary infection. In this case report a 65 years old male patient of non-healing multiple ulcers at left lower leg visited in OPD. Patient had complaints of severe pain, serous discharge, swelling of leg and multiple ulcers largest one ulcer (6cm x 4cm) at medial aspect of right leg. The pus culture report showed absence of microorganism (Bacteria and fungus). So this case was diagnosed as multiple varicose ulcers and was successfully treated with Arjuna bark powder (Terminalia arjuna) mixed with coconut oil. Wound was cleaned with normal saline and then applied paste of Arjuna bark powder mixed with coconut oil daily once in the morning. All wounds healed completely within one and half month of treatment without any complication. Hence this case highlighted that varicose ulcer can be treated with local application of Arjuna bark powder.
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Thomas, David R. "Prevention and management of pressure ulcers." Reviews in Clinical Gerontology 11, no. 2 (May 2001): 115–30. http://dx.doi.org/10.1017/s0959259801011236.
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A pressure ulcer is the visible evidence of pathological changes in blood supply to the dermal and underlying tissues, usually due to compression of the tissue over a bony prominence. Pressure ulcers are one of several types of chronic ulcers of the skin, including venous stasis, diabetic ulcers, and arterial insufficiency ulcers. The differential diagnosis of pressure ulcers is imperative, since the management of each wound type differs substantially.
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Zhurova, Svetlana Gennadyevna. "Neurotrophic corneal and conjunctival xerosis." Ophthalmology journal 7, no. 1 (March 15, 2014): 59–65. http://dx.doi.org/10.17816/ov2014159-65.
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Purpose: to develop a method of surgical treatment of patients with corneal ulcers of xerotic etiology and evaluate its efficacy in different time periods after operation. Materials and methods: 68 patients (86 eyes) with severe dry eye syndrome complicated by xerotic corneal ulcers were examined. In all patients, the ulcer defect was covered with conjunctiva and amniotic membrane. The operation was combined with an outer tarsorrhaphy and temporary blepharorraphy. Results: All 86 eyes (100%) achieved total closure of the ulcer defect, sealing of any perforation and maintaining of corneal transparency beyond the ulcer defect. Conclusion: Surgical closure of corneal ulcers with conjunctiva is an effective method of treatment of xerotic corneal ulcers. It could be recommended in patients with corneal perforation and tendency of descemetocele formation.
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Leichliter, Jami S., and David A. Lewis. "Correlates of bacterial ulcers and acute HSV-2 infection among men with genital ulcer disease in South Africa: age, recent sexual behaviours, and HIVi,ii." Southern African Journal of Infectious Diseases 31, no. 2 (July 1, 2016): 61–65. http://dx.doi.org/10.4102/sajid.v31i2.92.
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Data from baseline surveys and STI/HIV laboratory tests (n=615 men) were used to examine correlates of bacterial ulcers (Treponema pallidum, Haemophilus ducreyi, or Chlamydia trachomatis L1-L3 detected in ulcers) and acute HSV-2 ulcers (HSV-2 positive ulcer specimen, HSV-2 sero-negative, and negative for bacterial pathogens) versus recurrent HSV-2 ulcers (seropositive), separately. Men with bacterial ulcers had larger ulcers compared to men with recurrent HSV-2 ulcers, but were less likely to be HIV-positive; whereas, men with acute HSV-2 ulcers were younger with fewer partners. Acute HIV was higher among men with bacterial and acute HSV-2 ulcers; however, this difference was not statistically significant.
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Dave, Koushal. "Effectiveness of a Pressure Ulcer Prevention Package (PUPP) for Patients Admitted in Intensive Care Units: An Experimental Study." Nursing Journal of India CXI, no. 06 (2020): 269–73. http://dx.doi.org/10.48029/nji.2020.cxi605.
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Many critically ill patients admitted in ICUs sedated on mechanical ventilation are unable to change the position themselves. Therefore, these patients are at high risk of impaired skin integrity that leads to development of pressure ulcers. This study assessed the effectiveness of pressure ulcer prevention package in reducing the incidences of pressure ulcers among patients in ICUs. In this experimental design pre-test post-test control group study, 70 patients 35 each in experimental and control group from different ICUs of Dr RML Hospital, New Delhi were randomly allocated into two groups i.e. experimental and control groups. Experimental group received the intervention of pressure ulcer prevention package and the control group received routine skin care. Demographic and clinical data were collected by using demographic pro'Agrave;le tool, standardised skin assessment tool and pressure ulcer staging tool. All the subjects were followed every third day from admission to discharge, death and up to a maximum 20 days. Data were analysed using STATA 11.1 with the level of signi'Agrave;cance at p'lt;0.05. Descriptive and inferential statistics were used. The sacrum and then heels were the most common areas of pressure ulcers among ICU patients. Pressure ulcer prevention package was signi'Agrave;cantly effective (p'lt; 0.001) to delay the pressure ulcers-related adverse events among patients of experimental group. Pressure ulcers-related adverse events were developed earlier in control group i.e. 14 percent in experimental and 41 percent in control group. Number of pressure ulcers development were signi'Agrave;cantly (p'lt;0.001) lower in experimental group (08/35) compared to control group (20/35). The experimental group had signi'Agrave; cantly less Stage I and Stage II pressure ulcers development compared to control group (p'lt;0.001). Pressure ulcers prevention package was found to be signi'Agrave;cantly effective to reduce incidences, severity and total number of pressure ulcers among patients admitted in ICUs.
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Razani, Zahra, Marzieh Aslani, Gholamhosein Falahinia, Alireza Soltanian, and Mahnaz Khatiban. "The Effect of Planned Nursing Care on the Development and Severity of Pressure Ulcers in Elderly Patients: An Interventional Study." Avicenna Journal of Aging and Healthcare 1, no. 1 (December 29, 2023): 23–27. http://dx.doi.org/10.34172/ajah.5.
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Introduction: Pressure ulcer is one of the common problems in hospitals, especially in long-stay inpatient departments and intensive care units. This study was conducted with the aim of investigating the effect of planned nursing care on the occurrence and severity of pressure ulcers in patients admitted to the intensive care units. Methods: In this interventional study, 80 patients were gradually placed in two control and experimental groups. The participants of the experimental group received the care plan based, while the participants of the control group received only the daily and routine care plan. The rate of pressure ulcer development was evaluated based on the scale of the International Pressure Ulcer Society. The data were analyzed using chi-square test and Fisher’s exact test in SPSS version 16 software. Results: The relative and absolute frequency distribution of the research units according to the presence or absence of pressure ulcers after the intervention showed that pressure ulcers in the experimental group decreased significantly (P≤0.05). Also, the difference in the severity of pressure ulcers in the two groups indicated that the intervention reduced the degree, severity, and depth of pressure ulcers. Conclusion: Carrying out planned care in patients who have a high risk of pressure ulcers will reduce the possibility of pressure ulcers, especially with high severity and degree. Therefore, applying the principles of pressure ulcer prevention by the care team is emphasized and recommended for patients who are not able to do this themselves.
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Barker, S. G. E., D. G. Cooper, A. Ahmed, O. Agu, E. J. Challoner, and S. J. Hollingsworth. "The ‘Wound Boot’: A Preliminary Assessment of a Novel Device for the Management of Leg Ulcers." Phlebology: The Journal of Venous Disease 16, no. 2 (June 2001): 73–75. http://dx.doi.org/10.1177/026835550101600205.
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Objective: A preliminary assessment of a novel device, the ‘wound boot’, in the management of leg ulcers. Procedures: Eight subjects with ulcers wore the boot for 5–14 days. Ulcers were cleaned with saline only. No other dressings were applied. Questionnaires examined comfort and ease of use and asked for suggestions for modifications. Additionally, nurses examined ‘time taken to clean and dress ulcers’ in comparison with standard dressings. Although not a primary end-point, ulcer healing was noted. Results: For all, the boot was comfortable, easy to use and preferable to standard dressings. Ulcer-associated odour was eliminated entirely. A significant reduction was seen in the nursing time taken to clean and dress ulcers. Occasionally, excess exudate was problematic, with the boot's absorptive materials insufficient. In two cases, where the ‘boot’ was applied for 14 days, significant wound healing was seen. Conclusions: The prototype ‘boot’ helped significantly in leg ulcer management. Modifications based upon this assessment will allow a second prototype to be evaluated fully.
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Ergashov, Ozodjon Ilkhomovich. "The Importance of Plant Extract in Improving the Microflora of the Gastrointestinal Tract in the Treatment of Diseases of the Stomach and Duodenum." Aug-Sep 2023, no. 35 (August 8, 2023): 12–18. http://dx.doi.org/10.55529/jhtd.35.12.18.
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The paper presents the results of studying the anti-ulcer activity of a combination of complex plant extracts on experimental models of stress and acetylsalicylic gastric ulcers when administered per os extract at a dose of 150 mg/ kg to laboratory animals. The experiments were performed on nonlinear male rats and mongrel male mice. Determination of the Pauls index, the anti–ulcer action index (AUE) - the main criteria for evaluating the anti-ulcer activity of drugs. It is shown that in stress ulcers, the effectiveness of the extract is characterized by a decrease in large, point, stripe-shaped ulcers, a decrease in the number of ulcerative lesions in mice, the AUE index = 4.6. It was found that in the acetylsalicylic model of gastric ulcers against the background of the introduction of the extract, ulcers were detected only in 70% of animals, less pronounced damage to the gastric mucosa was observed, the AUE index is 4.5.
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Kamhawy, Adel Hussieny, Ahmed Husseiny Elbarbary, Mohamed Ahmed Elhenidy, and Ahmed Mohamed Morsy Elwagih. "Periulcer Foam Sclerotherapy Injection in Chronic Venous Leg Ulcers Using Near-Infrared Laser for Vein Visualization." International Journal of Lower Extremity Wounds 19, no. 1 (September 9, 2019): 63–69. http://dx.doi.org/10.1177/1534734619870680.
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High recurrence and high costs of treatment are the main problems with venous ulcer management. Therefore, it is of utmost importance to target the exact pathological cause. The role of cutaneous microvalves reflux in the pathogenesis of these ulcers has been confirmed. In this study, 20 chronic venous leg ulcers were prospectively subjected to foam sclerotherapy injection into periulcer veins using direct visualization by AccuVein AV400. Patients having infected ulcers, acute deep vein thrombosis, hypercoagulability, Ankle-Brachial Index <0.9, pregnancy, and/or allergy to the sclerosant were excluded. Endpoints included rates of ulcer size reduction, complete healing, ulcer recurrence, and procedure-related complications. Aethoxysklerol 1% was used in all cases to produce foam employing the double-syringe system. The mean reduction in ulcer surface area, postinjection, was 75% after 8 weeks and 91% after 12 weeks. Nineteen ulcers (95%) healed in a median time of 8 weeks, range 3 to 17 weeks. At 1 year of follow-up, 18 patients (90%) were still ulcer-free, while 1 patient’s ulcer (5%) recurred 19 weeks postinjection. No major complications were encountered. Periulcer foam sclerotherapy injection, guided by vein visualization technology, should be one of the main lines of treatment of venous leg ulcers. It offers good results with regard to rapid ulcer healing and low recurrence rate without major risk. Randomized controlled trials are needed to establish these conclusions.
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Krauze, Agnieszka, Witold Woźniak, and Robert Krzysztof Mlosek. "Usefulness of high-frequency ultrasound to assess the healing progress of shin ulcers." Journal of Ultrasonography 20, no. 83 (December 18, 2020): 254–60. http://dx.doi.org/10.15557/jou.2020.0045.
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Introduction: As the average lifespan becomes longer, the number of cases of chronic shin ulcers is rising, which is slowly becoming a societal problem. Currently, there no methods for objective evaluation of ulcer healing process. Aim of the study: The aim of the study was to assess the use of high-frequency ultrasound to monitor the healing of shin ulcers subjected to laser biostimulation. Material and methods: The study included 8 patients (4 men and 4 women) aged from 46 to 81 years with 9 shin ulcers in whom the healing process did not progress within 8 weeks despite effective causal treatment. The ulcers were subjected to laser biostimulation. The induced changes were monitored using high-frequency ultrasound and photographic records. Ultrasound examination was used to assess the depth of ulceration and the thickness of granulation tissue, migrating epidermis, subepidermal low-echogenic band (SLEB) and epidermis in the immediate vicinity. The wound severity index and ulcer vascularity were also assessed. Results: As a result of laser therapy, in 7 out of 9 cases the ulcers healed completely and in the remaining 2 cases ulcer size was reduced. During the ulcer healing process induced by laser therapy, ultrasound examination revealed decreasing ulcer depth, wound severity index and SLEB thickness. Granulation tissue increased in thickness and there was an epidermal formation effect (newly formed epidermis was much thicker than the one surrounding the wound and became thicker as a result of laser therapy sessions). During the healing of ulcers induced by laser therapy no significant changes were observed in ulcer vascularity and thickness of the surrounding epidermis. Conclusions: High-frequency ultrasound is a useful technique for the imaging of leg ulcers. It allows one to monitor their healing process induced by laser biostimulation. Further research on the subject needs to be pursued.
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Wallace, John L., and G. Webb McKnight. "Characterization of a simple animal model for nonsteroidal anti-inflammatory drug induced antral ulcer." Canadian Journal of Physiology and Pharmacology 71, no. 7 (July 1, 1993): 447–52. http://dx.doi.org/10.1139/y93-066.
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Most animal models of nonsteroidal anti-inflammatory drug (NSAID) induced gastric injury are characterized by acute, superficial erosions in the corpus region, whereas the clinically significant injury in man is the deep, antral ulcer. The purpose of this study was to characterize a model of NSAID-induced antral ulceration that more closely resembles the type of damage seen in man. Rabbits received indomethacin subcutaneously every 12 h. The progression of ulcer formation was followed by killing groups of animals after one to seven doses of indomethacin. The dose dependency of ulcer formation was assessed by giving indomethacin at doses of 1 to 20 mg/kg. Healing of antral ulcers was determined by examining the stomach at various times after administering the seventh dose of indomethacin (20 mg/kg). The effects of prophylactic treatment with misoprostol or ranitidine on ulcer formation were assessed. Indomethacin administration initially produced superficial erosions in the corpus and antrum, but with time, ulcers became apparent in the antrum. The formation of these ulcers was dependent upon the number of times indomethacin was administered and the dose. Similar ulcers could be induced with a second NSAID, diclofenac. Misoprostol treatment resulted in a significant reduction in the extent of indomethacin-induced antral ulceration, but ranitidine had no effect. Antral ulcers healed progressively following cessation of indomethacin administration and were almost completely resolved by 108 h after the final dose of indomethacin. These results demonstrate that subcutaneous NSAID administration to rabbits is a simple and reproducible method for producing ulcers that bear striking macroscopic resemblance to NSAID-induced antral ulcers in man. This model may be useful for studies of the pathogenesis of NSAID-induced ulcer and the factors that modulate the healing of these ulcers.Key words: gastric ulcer, nonsteroidal anti-inflammatory drug, prostaglandin, healing.
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Groenen, Marcel JM, Ernst J. Kuipers, Bettina E. Hansen, and Rob J. Th Ouwendijk. "Incidence of Duodenal Ulcers and Gastric Ulcers in a Western Population: Back to Where It Started." Canadian Journal of Gastroenterology 23, no. 9 (2009): 604–8. http://dx.doi.org/10.1155/2009/181059.
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BACKGROUND/OBJECTIVES: As recently as 40 years ago, a decline in the incidence of peptic ulcers was observed. The discovery of Helicobacter pylori had a further major impact on the incidence of ulcer disease. Our aim was to evaluate the trends in the incidence and bleeding complications of ulcer disease in the Netherlands.METHODS: From a computerized endoscopy database of a district hospital, the data of all patients who underwent upper gastrointestinal endoscopy from 1996 to 2005 were analyzed. The incidence of duodenal and gastric ulcers, with and without complications, were compared over time.RESULTS: Overall, 20,006 upper gastrointestinal endoscopies were performed. Duodenal ulcers were diagnosed in 696 (3.5%) cases, with signs of bleeding in 158 (22.7%). Forty-five (6.5%) of these ulcers were classified as Forrest I and 113 (16.2%) as Forrest II. Gastric ulcers were diagnosed in 487 cases (2.4%), with signs of bleeding in 60 (12.3%). A Forrest 1 designation was diagnosed in 19 patients (3.9%) and Forrest 2 in 41 patients (8.4%). The incidence of gastric ulcers was stable over time, while the incidence of duodenal ulcers declined.CONCLUSIONS: The incidence of duodenal ulcer disease in the Dutch population is steadily decreasing over time. Test and treatment regimens for H pylori have possibly contributed to this decline. With a further decline in the prevalence of H pylori, the incidence of gastric ulcers is likely to exceed the incidence of duodenal ulcers in the very near future, revisiting a similar situation that was present at the beginning of the previous century.
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Kappikeri, V. S., Nitin Kalaskar, Vijaykumar Puranik, and Mithun a. "A STUDY OF PREVALENCE, CLINICAL PRESENTATION AND MANAGEMENT OF LOWER LIMB ULCERS AT A TERTIARY HOSPITAL." International Journal of Advanced Research 12, no. 05 (May 31, 2024): 295–310. http://dx.doi.org/10.21474/ijar01/18717.
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Background: Lower limb ulcers are debilitating and painful, greatly reducing patients quality of life. These ulcers are often difficult to treat. The most common aetiologies for lower limb ulcers are venous, arterial, mixed venous and arterial, diabetic and pressure ulcers. However, atypical wounds comprise approximately 20% of chronic wounds and should be kept in mind during differential diagnosis.The successful ulcer management depends upon the accurate diagnosis and treatment of the underlying cause, and it often needs a multidisciplinary approach. Methods: This prospective cross-sectional study conductedin Department of General Surgery atBasaveshwara Teaching and General Hospital, Attached to Mahadevappa Rampure Medical College, Kalaburagi. The study was conducted during the period from June 2022 to December 2023 which included 97 patients presenting withlower limb ulcers and admitted in surgical wards of our hospital. Results: Most of the patients were engaged in agriculture (24%) followed by business (23%) and service (14%). 47.5% of the patients had habit of smoking,alcohol consumption and tobacco chewing. Most of the ulcers were diabetic (36.1%) followed by venous (22.6%) (Z=2.17 p=0). Only 4.1% and 3.1% were malignant and trophic ulcers. Peripheral neuropathy (26.8%) was the most common cause of ulcer followed by venous hypertension (24.7%).In most of the cases, debridement with dressing (32.9%) and Debreidment+dressing+skin grafting (19.6%) was done. At the end of study period, 90 ulcers were healed, 4 were disease free, 2 had recurrence and 1 patient died. Conclusion:A comprehensive assessment of patients general status, personal habits, skin, vascular status, limb, ulcer characteristics are required to determine the etiology and to formulate effective treatment plan. Thus, the study of various cases of lower limb ulcers arouses lot of interest and is mind boggling as far as the treatment of these cases are concerned. With the availability of arsenal of investigation, wide range of antibiotics and with ever improving dressing material, there is certainly a great improvement in treatment of lower limb ulcers. Education and training are vital for all those involved in caring of patients with ulcer.