1/81. Low power laser therapy and analgesic action.OBJECTIVE: The semiconductor or laser diode (GaAs, 904 nm) is the most appropriate choice in pain reduction therapy. SUMMARY BACKGROUND DATA: Low-power density laser acts on the prostaglandin (PG) synthesis, increasing the change of PGG2 and PGH2 into PG12 (also called prostacyclin, or epoprostenol). The last is the main product of the arachidonic acid into the endothelial cells and into the smooth muscular cells of vessel walls, that have a vasodilating and anti-inflammatory action. methods: Treatment was performed on 372 patients (206 women and 166 men) during the period between May 1987 and January 1997. The patients, whose ages ranged from 25 to 70 years, with a mean age of 45 years, suffered from rheumatic, degenerative, and traumatic pathologies as well as cutaneous ulcers. The majority of patients had been seen by orthopedists and rheumatologists and had undergone x-ray examination. All patients had received drug-based treatment and/or physiotherapy with poor results; 5 patients had also been irradiated with He:Ne and CO2 lasers. Two-thirds were experiencing acute symptomatic pain, while the others suffered long-term pathology with recurrent crises. We used a pulsed diode laser, GaAs 904 nm wavelength once per day for 5 consecutive days, followed by a 2-day interval. The average number of applications was 12. We irradiated the trigger points, access points to the joint, and striated muscles adjacent to relevant nerve roots. RESULTS: We achieved very good results, especially in cases of symptomatic osteoarthritis of the cervical vertebrae, sport-related injuries, epicondylitis, and cutaneous ulcers, and with cases of osteoarthritis of the coxa. CONCLUSIONS: Treatment with 904-nm diode laser has substantially reduced the symptoms as well as improved the quality of life of these patient, ultimately postponing the need for surgery.- - - - - - - - - - ranking = 1keywords = ulcer (Clic here for more details about this article) |
2/81. Frozen allogeneic human epidermal cultured sheets for the cure of complicated leg ulcers.BACKGROUND: skin ulcers due to venous stasis or diabetes are common among the elderly and are difficult to treat. Repeated applications of cell-based products have been reported to result in cure or improvement of leg ulcers of small size in a fraction of patients. OBJECTIVE: To examine the effects of frozen human allogeneic epidermal cultures for the treatment of acute and chronic ulcers. methods: We treated a series of 10 consecutive patients with leg ulcers of different etiology and duration with frozen human allogeneic epidermal cultures stored frozen and thawed for 5-10 minutes at room temperature before application. Three patients had ulcers with exposed Achilles or extensor tendon. The ulcers treated were as large as 160 cm2 in area and of up to 20-years' duration. After preliminary preparation of the wounds by debridement to remove necrotic tissue and application of silver sulfadiazine to control infection, thawed cultures were applied biweekly from 2 to 15 times depending on the size and complexity of the ulcer. RESULTS: All ulcers healed, including those with tendon exposure. After the first few applications, granulation tissue formed in the ulcer bed and on exposed tendons, and epidermal healing took place through proliferation and migration of cells from the margins of the wound. The time required for complete healing ranged from 1 to 31 weeks after the first application. CONCLUSION: The use of frozen human allogeneic epidermal cultures is a safe and effective treatment for venous or diabetic ulcers, even those with tendon exposure. It seems possible that any leg ulcer will be amenable to successful treatment by this method.- - - - - - - - - - ranking = 7.5keywords = ulcer (Clic here for more details about this article) |
3/81. Controlling the pain of venous leg ulceration.Compression therapy can often exacerbate the pain of venous leg ulceration. A pain management programme using a team approach to care can promote compliance with compression therapy. nurses need to be sensitive and responsive to an individual's pain.- - - - - - - - - - ranking = 2.5keywords = ulcer (Clic here for more details about this article) |
4/81. Infiltrating basal cell carcinoma in the setting of a venous ulcer.A 77-year-old man was referred with a 5-year history of an intermittently painful, nonhealing right medial ankle ulcer. The ulcer had not responded to multiple treatment modalities, including Unna boots, compression therapy, sclerotherapy, and split-thickness skin grafting. The past medical history was significant for a deep venous thrombosis in the right leg 30 years earlier (treated with warfarin for 3 months) and a history of greater saphenous vein harvesting for coronary bypass grafting 28 years previously. After the vein stripping, the patient had suffered from increasing right leg edema and stasis changes in the right leg. His history was also remarkable for coronary artery disease, dyslipidemia, and lymphoma treated with chemotherapy 8 years before presentation, with no evidence of recurrence. He had stopped smoking approximately 20 years earlier. Medications included atenolol, simvastatin, nicardipine, nitroglycerin, and aspirin. skin examination revealed a 3.0 x 3.5-cm ulcer adjacent to the medial malleolus. The edges of the ulcer appeared raised and rolled (Fig. 1). Centrally, there was granulation tissue, which appeared healthy. There were surrounding dermatitic changes. Dorsalis pedis and the posterior tibial pulses were normal. Noninvasive vascular studies revealed severe venous incompetence of the right popliteal and superficial veins. Arterial studies and transcutaneous oximetry were normal. Computed tomographic scan of the pelvis did not reveal any adenopathy, and radiographic imaging did not reveal any bony changes suggestive of osteomyelitis. biopsy of the ulcer edge and base showed infiltrating basal cell carcinoma (Fig. 2). Mohs' micrographic surgery required three layers; the final extent of the ulcer was 7.8 x 6.9 cm. A split-thickness skin graft was placed.- - - - - - - - - - ranking = 5keywords = ulcer (Clic here for more details about this article) |
5/81. Low intensity laser therapy for chronic venous leg ulcers.Ulceration of the lower extremities is one of the most important medicosocial problems (Skobelkin et al 1990). In this article, two case studies show that it is the length of time that laser therapy is used that can have a significant impact on ulcer size.- - - - - - - - - - ranking = 2.5keywords = ulcer (Clic here for more details about this article) |
6/81. A case report of low intensity laser therapy (LILT) in the management of venous ulceration: potential effects of wound debridement upon efficacy.OBJECTIVE: This single case report (ABA design) was undertaken as a preliminary investigation into the clinical effects of low intensity laser upon venous ulceration, applied to wound margins only, and the potential relevance of wound debridement and wound measurement techniques to any effects observed. methods: Ethical approval was granted by the University of Ulster's research Ethical Committee and the patient recruited was required to attend 3 times per week for a total of 8 weeks. Treatments were carried out using single source irradiation (830 nm; 9 J/cm2, CB Medico, Copenhagen, denmark) in conjunction with dry dressings during each visit. Assessment of wound surface area, wound appearance, and current pain were completed by an independent investigator. Planimetry and digitizing were completed for wound tracings and for photographs to quantify surface areas. Video image analysis was also performed on photographs of wounds. RESULTS: The primary findings were changes in wound appearance, and a decrease in wound surface area (range 33.3-46.3%), dependent on the choice of measurement method. Video image analysis was used, but rejected as an accurate method of wound measurement. Treatment intervention produced a statistically significant reduction in wound area using the C statistic on digitizing data for photographs (at Phase one only; Z = 2.412; p < 0.05). Wound debridement emerged as an important procedure to be carried out prior to measuring wounds. Despite fluctuating pain levels recorded throughout the duration of the study, VAS scores showed a decrease of 15% at the end of the study. This hypoalgesic effect was, however, statistically significant (using the C statistic) at Phase one only (Z = 2.554; p < 0.05). CONCLUSIONS: Low intensity laser therapy at this dosage, and using single source irradiation would seem to be an effective treatment for patients suffering venous ulceration. Further group studies are indicated to establish the most effective therapeutic dosage for this and other types of ulceration.- - - - - - - - - - ranking = 3.5keywords = ulcer (Clic here for more details about this article) |
7/81. Case study: a unique approach to compliance in a patient with venous ulcers.lower extremity venous ulcers affect 500,000 to 700,000 Americans, with a 10-week outpatient treatment cost of $1327 to $5289. recurrence rates are reported as 57% within 10.4 months. Many types of treatments are available, but the most successful treatment continues to be the most basic-elevation and compression. Innovative ideas to increase patient compliance can be the key to successful therapy.- - - - - - - - - - ranking = 2.5keywords = ulcer (Clic here for more details about this article) |
8/81. Adjuvant anabolic agents: a case report on the successful use of oxandrolone in an hiv-positive patient with chronic stasis ulceration.Chronic venous stasis ulcers and hiv represent 2 prevalent disease processes in the urban wound care setting. To best serve our patients, it is important that the wound care team carefully consider the impact of comorbidities and consider use of nutritional interventions. In this article we report the use of the anabolic agent oxandrolone to successfully treat an hiv-positive man with stasis ulceration.- - - - - - - - - - ranking = 3keywords = ulcer (Clic here for more details about this article) |
9/81. Improving the treatment of leg ulcers.Treatment of leg ulcers is often inadequate, with delayed diagnosis, overuse of antibiotics, and insufficient or inadequate use of compression therapy. Ulcers caused by arterial insufficiency will not heal unless the blood flow is improved. Ulcers caused by venous insufficiency will usually heal within a few months with appropriate compression therapy. Compression can be applied with stockings, bandages, or a pump. Class 2 compression stockings are required for treatment of ulcers; TED stockings and Class 1 stockings do not provide adequate compression. A four-layer compression bandage can be used if a patient cannot manage stockings. Applying the bandage with the correct pressure is a skill developed from practice. A pump can be used if neither stockings nor bandages are suitable. However, it must be used for six hours a day, which precludes use by active patients. An ulcer that does not heal with three months of adequate compression therapy requires further investigation.- - - - - - - - - - ranking = 3.5keywords = ulcer (Clic here for more details about this article) |
10/81. Additional follow-up with microvascular transfer in the treatment of chronic venous stasis ulcers.Nine patients presented with non-healing venous ulcers of the lower limb. All had failed both non-surgical and surgical therapies. Following wide wound excision, perforator ligation, and microsurgical reconstruction, all wounds were healed. In two instances, separation at the flap/wound perimeter interface occurred and required additional dressing care to obtain wound closure. This was probably the result of incomplete excision of surrounding liposclerotic soft tissue. At 26 postoperative months, all wounds remained healed. Microsurgical transfer for properly selected patients can achieve healing of recalcitrant venous wounds, both over the intermediate and long term.- - - - - - - - - - ranking = 2.5keywords = ulcer (Clic here for more details about this article) |
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