Cases reported "Chronic Disease"

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1/139. Use of topical recombinant human platelet-derived growth factor-BB (becaplermin) in healing of chronic mixed arteriovenous lower extremity diabetic ulcers.

    lower extremity ulcers cause significant morbidity and mortality in patients with diabetes. The primary factors that contribute to the development of this type of ulcer are peripheral neuropathy and peripheral vascular disease, which are often accompanied by infection. lower extremity diabetic ulcers are chronic and difficult to treat, in part due to underlying pathologic conditions in individuals with diabetes that can contribute to impaired wound healing. This article reports the author's experience with treatment of chronic lower extremity ulcers of mixed etiologies with recombinant human platelet-derived growth factor--BB [rhPDGF-BB, REGRANEX (becaplermin) Gel 0.01%] in a patient with multiple risk factors including long-standing insulin-dependent type 2 diabetes.
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ranking = 1
keywords = wound
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2/139. Percutaneous endoscopic gastrostomy for continuous feeding in children with chronic cholestasis.

    BACKGROUND: malnutrition associated with chronic cholestasis in children often requires continuous enteral feeding through a nasogastric tube, which may be poorly tolerated. METHOD: Percutaneous endoscopic gastrostomy was performed in five children (age range, 20 months to 13 years) with severe cholestasis (alagille syndrome in four; biliary atresia in one) and severe malnutrition (mean weight, -2.6 standard deviations; mean height, -2.7 standard deviations) who were awaiting liver transplantation. The pull-through technique was used in patients under general anesthesia, and the button was set within 2 months. RESULTS: Minor wound infection required antibiotic therapy in one patient. In the four children with alagille syndrome, enteral feeding by means of percutaneous endoscopic gastrostomy was used until liver transplantation for a mean period of 14 months with a mean weight gain of 350 g/mo and a mean height gain of 0.53 cm/mo. Seventeen months to 3 years, 3 months after liver transplantation, all four children were alive and in good clinical condition with normal readings in liver function tests. The technique had to be discontinued in the child with biliary atresia because of secondary occurrence of ascites, gastric intolerance, and refractory wound infection. CONCLUSION: Percutaneous endoscopic gastrostomy may be a valuable alternative to nasogastric tube for nutritional support in children with cholestasis and mild portal hypertension.
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ranking = 3.4426900271844
keywords = wound, wound infection
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3/139. candida lambica polyarthritis in a patient with chronic alcoholism.

    We describe a patient with an indolent polyarthritis over a period of several years caused by candida lambica probably acquired from a contaminated wound. C. lambica has not been previously reported to cause infectious arthritis. Hematogenous spread was manifest by 4 separate sites of involvement. Chronic alcoholism was the only apparent risk factor for dissemination. The infection seems to be environmentally acquired.
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ranking = 1
keywords = wound
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4/139. Chronic sternal wound infection and endocarditis with coxiella burnetii.

    Chronic q fever is most commonly associated with culture-negative endocarditis and less frequently with infection of vascular grafts, infection of aneurysms, hepatitis, pulmonary disease, osteomyelitis, and neurological abnormalities. We report a case of chronic sternal wound infection, polyclonal gammopathy, and mixed cryoglobulinemia in which q fever endocarditis was subsequently diagnosed. polymerase chain reaction analysis of the wound tissue was positive for Coxiella burnetii dna, and treatment of the endocarditis resulted in prompt healing of the wound. Chronic q fever can occur without epidemiological risk factors for C. burnetii exposure and can produce multisystem inflammatory dysfunction, aberrations of the immune system, and persistent wound infections.
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ranking = 12.328070081553
keywords = wound, wound infection
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5/139. Maggot therapy for the treatment of intractable wounds.

    BACKGROUND: Fly maggots have been known for centuries to help debride and heal wounds. Maggot therapy was first introduced in the USA in 1931 and was routinely used there until the mid-1940s in over 300 hospitals. With the advent of antimicrobiols, maggot therapy became rare until the early 1990s, when it was re-introduced in the USA, UK, and israel. The objective of this study was to assess the efficacy of maggot therapy for the treatment of intractable, chronic wounds and ulcers in long-term hospitalized patients in israel. methods: Twenty-five patients, suffering mostly from chronic leg ulcers and pressure sores in the lower sacral area, were treated in an open study using maggots of the green bottle fly, Phaenicia sericata. The wounds had been present for 1-90 months before maggot therapy was applied. Thirty-five wounds were located on the foot or calf of the patients, one on the thumb, while the pressure sores were on the lower back. Sterile maggots (50-1000) were administered to the wound two to five times weekly and replaced every 1-2 days. Hospitalized patients were treated in five departments of the Hadassah Hospital, two geriatric hospitals, and one outpatient clinic in Jerusalem. The underlying diseases or the causes of the development of wounds were venous stasis (12), paraplegia (5), hemiplegia (2), Birger's disease (1), lymphostasis (1), thalassemia (1), polycythemia (1), dementia (1), and basal cell carcinoma (1). Subjects were examined daily or every second day until complete debridement of the wound was noted. RESULTS: Complete debridement was achieved in 38 wounds (88.4%); in three wounds (7%), the debridement was significant, in one (2.3%) partial, and one wound (2.3%) remained unchanged. In five patients who were referred for amputation of the leg, the extremities was salvaged after maggot therapy. CONCLUSIONS: Maggot therapy is a relatively rapid and effective treatment, particularly in large necrotic wounds requiring debridement and resistant to conventional treatment and conservative surgical intervention.
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ranking = 15
keywords = wound
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6/139. neuroimaging of a wooden foreign body retained for 5 months in the temporalis muscle following penetrating trauma with a chopstick--case report.

    A 48-year-old female was stabbed by her husband with a chopstick made of wood in the left temporal region during a quarrel. She suffered laceration of the left temporal scalp. At initial examination, she concealed the assault with a chopstick. radiography showed no abnormality, so the wound was sutured. One month after the injury, a painless subcutaneous mass appeared in the left temporal region which grew rapidly for 3 months. She was then admitted to our department. Computed tomography (CT) on admission showed a hyperdense area at the center of the mass. This area was hypointense on both T1- and T2-weighted magnetic resonance (MR) images. Temporalis muscle tumor with accompanying central necrosis, old hematoma, and inflammatory granuloma was considered. The mass was totally resected for cosmetic purposes and was found to be wooden foreign body granuloma. High density on CT and hypointensity on both T1- and T2-weighted MR images are characteristic of a chronically retained wooden foreign body in the living body and are useful for detecting wooden foreign bodies in the chronic granulomatous phase.
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ranking = 1
keywords = wound
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7/139. Xanthogranulomatous tubo-ovarian abscess resulting from chronic diverticulitis.

    We report a case of xanthogranulomatous tubo-ovarian abscess which was preoperatively suspected to be an adnexal neoplasm. With foreign body material found in the abscess wall and vegetable fiber in the tubal lumen, a previously treated chronic diverticulitis was the presumed cause. culture studies showed polymicrobial isolates which included escherichia coli, an enteric pathogen. After surgery, administration of antibiotics, and revision of delayed subcutaneous wound healing, the patient is reportedly well.
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ranking = 1
keywords = wound
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8/139. Chronic intravascular coagulation associated with chronic myelocytic leukemia. Use of heparin in connection with a surgical procedure.

    A women with philadelphia chromosome-positive chronic myelocytic leukemia lived nearly 12 years from the time of diagnosis. During most of this period she received no therapy, and marked cyclic oscillations in the white blood cell count were documented. The last two years of her illness were marked by a hemorrhagic disorder associated with hypofibrinogenemia, thrombocytopenia, increased plasma fibrinopeptide a concentration and markedly elevated serum levels of fibrin degradation products. The coagulation disorder was rapidly reversible on several occasions with heparin therapy. After treatment with heparin and platelet transfusions, the patient underwent successful resection of a large ovarian cyst with excellent hemostasis during the procedure. Postoperatively, the administration of heparin and platelets was discontinued and a large wound hematoma developed. After resumption of therapy with heparin and platelets, the remainder of her postoperative course was uneventful. The literature on the subject is reviewed and tentative guidelines are offered concerning the management of patients with intravascular coagulation who require diagnostic or therapeutic surgical procedures.
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ranking = 1
keywords = wound
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9/139. Two-stage extensor tendon reconstruction after composite tissue loss from the dorsum of the hand.

    Restoration of digital extension after chronic extensor loss has not been detailed extensively in the literature. The present report details an unusual case of composite tissue loss from the dorsum of the hand after a chronic burn wound. After debridement for chronic carpal osteomyelitis and free-tissue transfer were performed, staged wrist fusion and two-stage extensor tendon reconstruction resulted in a stable, pain-free wrist and functional digital extension. The present case illustrates that two-stage extensor tendon reconstruction, when necessary, is indeed feasible.
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ranking = 1
keywords = wound
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10/139. An unusual long-term complication of burn injury: malignant fibrous histiocytoma developed in chronic burn scar.

    Development of malignant tumors in chronic burn wounds is a well-known complication. These tumors are almost always squamous cell carcinomas, although other types of malignancies such as basal cell carcinoma, malignant melanoma and sarcomas can be seen rarely. There are only three previously reported cases of malignant fibrous histiocytoma developed in chronic burn scar in the literature. Two cases with malignant fibrous histiocytoma developed in chronic, badly treated burn wounds are presented. One of the tumors was multifocal and overexpression of the p53 gene was present. Both tumors were excised widely and skin grafted. Regional lymph node dissection was performed in one case. One of the patients died due to tumor recurrence and lymphatic metastases. These cases represent a very uncommon complication of burn injury and indicate the importance of the appropriate primary treatment of the burn wound.
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ranking = 3
keywords = wound
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