Cases reported "Pressure Ulcer"

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1/286. Atypical decubital fibroplasia associated with bizarre parosteal osteochondromatous proliferation (Nora's reaction).

    We describe recurring bizarre parosteal osteochondromatous proliferation (Nora's reaction) associated with atypical decubital fibroplasia in the region of the greater trochanter of the femur in a 52-year-old man. We hypothesize that these two recently introduced entities may represent two forms of tissue response to injury (ischemia) inducing proliferative reaction of bone and cartilage in the vicinity of periosteum, and necroses with hyperplastic granulation tissue and myxoid stroma in the subcutaneous tissues. ( info)

2/286. Pressure area risk assessment in intensive care.

    risk assessment tools have been in use for many years now but debate still exists about their effectiveness Several tools exist that try to meet the specific needs of intensive care patients Differences can be highlighted between the use of a general tool (Waterlow, 1995) and an ITU-specific one (Sunderland (Lowery, 1995)) Not all risk assessment tools are suitable for all areas of practice: the most appropriate one must be selected for each area ( info)

3/286. Modified hamstring musculocutaneous flap for the coverage of ischial pressure sores.

    Ischial pressure sores can be efficiently covered with a modification of the traditional V-Y advancement flap, the musculocutaneous hatchet flap. Results of operations performed on 10 patients prove its reliability. ( info)

4/286. Necrotizing fasciitis: an uncommon consequence of pressure ulceration.

    Pressure ulcers may occur in patients with chronic illnesses, especially in those who are bed-bound or chair-bound. Local measures usually suffice to allow primary ulcer healing and support skin grafting or tissue transfer reconstruction. On rare occasions, however, pressure ulcers may progress to invasive infection and necrosis of adjacent soft tissues, possibly leading to necrotizing fasciitis. Early recognition and aggressive medical and surgical therapy are required to halt disease progression and prevent patient mortality. Two cases are presented to describe the severity of this soft-tissue infection. ( info)

5/286. skin care of the pediatric patient.

    Several factors influence the chronically ill child's susceptibility for skin breakdown. nurses are an integral part of the care team that has the responsibility for identification of these factors, as well as pressure ulcer prevention and early intervention. An important aspect of this responsibility is identification of individuals at risk. This article provides a guide for assessment and early intervention for skin breakdown in chronically ill children. A care plan and consultation recommendations are included. ( info)

6/286. The efficacy of single-stage surgical management of multiple pressure sores in spinal cord-injured patients.

    The practice of multiple-stage management in the treatment of patients with multiple pressure ulcers has long represented the standard of care in many specialty centers. The authors have observed that an aggressive surgical approach has proved necessary for control of this devastating problem in these patients. Their experience with one-stage reconstruction of multiple pressure sores over a 10-year period (between 1986 and 1996) in 120 spinal cord-injured patients has revealed certain advantages of this comprehensive method of surgical management. Although cumulative operating time and intraoperative blood loss were somewhat increased, the number of anesthetic episodes and the hospital stay were less than that seen in patients managed in multiple stages. Accordingly, rehabilitation and societal reintegration can be initiated earlier, and overall hospital cost may be better contained. ( info)

7/286. Application of trauma concepts in the medical-surgical client.

    Concepts related to fluid administration, hemodynamic monitoring, bladder pressure monitoring, acid-base status, and temperature management are applicable in all clients, not just those with traumatic injury. Two case studies are illustrated showing how trauma care concepts are also relevant to the acutely ill client. nurses are challenged to identify how the content presented in this symposium can be used for all clients. ( info)

8/286. Treating stage IV pressure ulcers with negative pressure therapy: a case report.

    Decubitus ulcers remain a significant healthcare concern today, especially in the elderly and immobile population. Following the observation of three Stage IV decubitus ulcers refractory to standard medical and surgical therapy for 10 months, a new vacuum-assisted closure device (V.A.C.) was initiated to speed wound healing. The V.A.C. was initiated in August 1996. The three Stage IV ulcers were located on the patient's right ischium, left ischium, and sacrum. On initiation, they measured 7 1/2 cm x 2 1/2 cm x 2 1/2 cm, 8 cm x 3 1/2 cm x 2 1/2 cm, and 3 1/2 cm x 2 cm x 2 cm respectively. The treatment consisted of insertion of sterile sponge into the wound bed connected to the negative pressure device by suction hose. The device operated at a negative pressure of 125 mm Hg with a 5-minute-on 2-minute-off-cycle. Dressing changes were performed every 48 hours during the treatment period. Successful closure of the sacral ulcer occurred in October 1996. The ischial ulcers were small enough to be taken off V.A.C. therapy in early November 1996. While we are encouraged by the results of this study, further additional clinical studies are warranted. ( info)

9/286. The ethics of using contingency management to reduce pressure ulcers: data from an exploratory study.

    Although there is a widely held argument that pressure ulcers are preventable, they continue to cause major healthcare and financial problems. The blame for pressure ulcers has typically focused on the patient's self-neglect or self-destructiveness. However, more recently, there has been a call for a paradigm shift from the current "paternalistic" medical model to one that includes the patient as a participant in his or her own care. Contingency management, a procedure well known in behaviorism, is presented as one such possibility. Controversy about the use of monetary reward, as well as discussion of initial efficacy in a current study, are discussed. ( info)

10/286. paraplegia: prolonged standing using closed-loop functional electrical stimulation and Andrews ankle-foot orthosis.

    One T10 paraplegic male (CS) implanted in 1991 with a Nucleus FES-22 stimulator has been able to achieve closed-loop standing for 1 h. The knee angles are monitored by electrogoniometers, resulting in the quadriceps stimulation time being less than 10%. Stance stability is achieved by the Andrews anterior ankle-foot orthosis (AFO). The use of accelerometers for trunk inclination and vertical acceleration during controlled stand-to-sit, diminishes slamming onto the seat. CS does one-handed tasks with objects of 2.2 kg. In another T10 paraplegic male (FR), surface stimulation was applied over 1.5 years to both femoral nerves at the groin for conditioning and prolonged standing. With quadricep conditioning, 55 Nm at 45 degrees of knee flexion is produced. With the AFO and knee monitoring, FR can stand uninterrupted for up to 70 min and perform one-handed tasks. In August 1998, he was implanted with the multifunctional Praxis FES 24-A stimulator for restoration of limb movements, bladder and bowel function, and pressure sore prevention. ( info)
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