1/9. A case of pyoderma gangrenosum on the stump of an amputated right leg.We present here a case of pyoderma gangrenosum (PG) on the stump of an amputated leg. The patient was a 69-year-old woman who had both of her legs amputated due to acute arterial occlusion. An ulcer first appeared nine years later, after which point it continued to fluctuate in size. Complications included regional blood flow disorder at the amputated stump, diabetes, and secondary infection. Despite various therapies, the ulcer exacerbated, and hypoproteinemia, increased CRP, and fever were confirmed. The patient was diagnosed as having PG based on her clinical symptoms and because the ulcer did not respond to various therapies. The ulcer improved significantly in response to administration of 40 mg/day of prednisolone, and complete epithelialization was later achieved. Given the presence of multiple complications, it was extremely difficult to confirm PG. Therefore, it is important for physicians to consider PG as one of the causes of intractable ulcers.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/9. Malignancy in chronic ulcers and scars of the leg (Marjolin's ulcer): a study of 21 patients.OBJECTIVE: To study the imaging features of patients with chronic ulcers of the leg that were associated with malignancy. DESIGN AND PATIENTS: All patients who on biopsy were proven to have malignancy--the majority of which were squamous cell carcinoma-were included in a prospective study. Ulcers limited to the foot were excluded but ulcers of the leg which extended into the foot were included. amputation was performed in all but two patients, due to pain, bleeding or tissue necrosis. RESULTS: The etiology was multifactorial. The mean duration of the ulcers was 36 years including venous ulcers, extensive scarring of the leg secondary to infection, injury or burns. One ulcer was secondary to a snake bite. The remainder, usually in the upper part of the leg, had repeated episodes of blunt trauma or knife wounds, which were also complicated by infections which failed to heal or, if they healed, regularly recurred. Although arterial insufficiency was not primary in any patient, most were of advanced age and it may have been an element in some patients. Despite infection, osteomyelitis was present in only one patient. The essential features were bone destruction, soft tissue mass and periosteal reaction. The bone destruction was visible on the radiographs in all but one case. The soft tissue masses varied in size but in general were very large. The periosteal reaction varied in type but most commonly was lamellated. The classic undulating solid periosteal reaction of venous stasis was only occasionally present. The periosteal reaction was nonspecific in the majority of cases and did not aid in the diagnosis or etiology. MRI and CT studies were performed in six patients. These were helpful in defining the extent of bone destruction and periosteal reaction but were not essential in management. CONCLUSION: Chronic ulcer present for decades that then undergoes malignant change is a disease of developing countries where patients only consult physicians when they have developed complications such as pain, bleeding or tissue necrosis. Chronic ulcers may require to be biopsied at regular intervals as malignant change in these ulcers is directly related to their duration.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/9. A preliminary study of the feasibility of wound telecare for the elderly.We have developed a method for remote wound assessment in the elderly. Wound images were taken with a digital camera at a resolution of 640x480 pixels. JPEG compression was then used to produce images of about 100 kByte. Selected clinical data were transmitted by email, together with standardized digital images of wounds. The remote physician then read the clinical data and viewed the digital images on a 38 cm colour display monitor, at a resolution of 800x600 pixels, in 16-bit colour, using standard software. Three elderly inpatients with pressure sores or leg ulcers had both bedside and remote examinations, by different physicians. The diagnosis and therapeutic recommendations proposed after each of the two examinations were compared qualitatively. There was reasonable agreement between the two physicians in the assessment of wound size, anatomical classification, wound bed and status of infection. However, the lack of palpation represented a major limitation to remote wound assessment, despite the use of probes to delineate the depth of any opening in the wound bed.- - - - - - - - - - ranking = 3keywords = physician (Clic here for more details about this article) |
4/9. mycobacterium chelonae: nonhealing leg ulcers treated successfully with an oral antibiotic.BACKGROUND: mycobacterium chelonae is an important human pathogen and should be considered when a physician is faced with nonhealing cutaneous wounds, including ulcers of the lower leg. methods: The medical literature was searched from 1965 to the present using the key words "mycobacterium chelonae" and "leg ulcers." A case of mycobacterium chelonae infection is reported. RESULTS AND CONCLUSION: clarithromycin as single-agent oral therapy has been effective in treating these infections once the proper diagnosis is established. Diagnosis of M. chelonae infection requires being alert to this infectious agent and obtaining cultures for mycobacteria. Aggressive surgical debridement with direct excision of the wound might now be unnecessary because of the effectiveness of oral clarithromycin administered as a single oral agent.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/9. obesity: impediment to postsurgical wound healing.PURPOSE: To provide physicians and nurses with an overview of the impact of obesity on postoperative wound healing and how preplanning protocols can minimize skin and wound care problems in this patient population. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in reducing skin and wound care problems in their patients who are obese. OBJECTIVES: After reading the article and taking the test, the participant will be able to: 1. Identify obesity-related changes in body systems and how these impede wound healing. 2. Identify complications of postoperative wound healing in obese patients and the assessments and intervention strategies that can reduce these complications. 3. Identify skin and wound care considerations for obese patients and the role of preplanning protocols in avoiding problems.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
6/9. hydroxyurea induced perimalleolar ulcers.hydroxyurea (HU) is an antineoplastic drug commonly used to treat chronic myeloproliferative disorders. Common dermatological side effects include hyperpigmentation, scaling, erythema, alopecia, desquamation of face and hands. leg ulceration following HU therapy is less common and very few cases have been reported so far. Objective of this paper is to increase the awareness of hydroxyurea induced leg ulcers which will aid in the early diagnosis and appropriate treatment. The first case was a chronic myeloid leukemia (CML) patient on HU 1.5 g/day for 5 yr, who had bilateral painful perimalleolar ulcers for 6 months. The second case was a CML patient on HU 1.5 g/day for 3 yr who developed bilateral lateral malleolar ulcers. Third case was a polycythemia vera (PV) patient on HU 1 g/day for 5 yr who presented with painful medial malleolar ulcer of 2 months. The last case of our report was an elderly PV patient on HU 1.5 g/day for 2 yr and presented with lateral malleolar ulcer which persisted on reducing the dose of HU. In all the 4 cases the ulcers healed on stopping HU. Our report confirms the association of chronic hydroxyurea therapy and perimalleolar ulcers which respond promptly after discontinuation of the drug. The heightened awareness among the physicians will promote early diagnosis and prompt relief from the agonizing ulcers.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/9. Bullae in the donor site of a split-thickness skin graft.A patient developed bullae in a donor site 3 weeks after a split-thickness skin graft was taken. No reference to blistering in the donor site of a recently taken split-thickness skin graft could be found in the surgical literature, and a computerized search of the world's medical literature revealed only a single report of a similar case. The mechanism of bulla formation has not been elucidated. We alert physicians to this phenomenon and urge that each case that is seen be studied in an orderly manner by histologic, electron microscopic, and immunofluorescent techniques.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/9. Werner's syndrome as a cause of chronic leg ulcers.Werner's syndrome is believed to be an autosomal-recessive inherited disorder. Among other manifestations of premature aging, patients with Werner's syndrome frequently develop chronic leg ulcers that heal poorly. We present a patient who suffered from this rare syndrome and developed typical leg ulcers. We wish to alert physicians to this syndrome so that its attendant problems can be considered when treatments are being planned for patients with chronic leg ulcers.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/9. Necrotic arachnidism--Pacific Northwest, 1988-1996.Although spider bites are common in many parts of the United States, most domestic spiders are not substantially venomous to man. The best known exceptions are widow spiders (Latrodectus spp., including the black widow L. mactans) and brown spiders (Loxesceles spp., particularly the brown recluse, Lox. reclusa). However, cases of arachnid envenomation from the hobo spider (Tegenaria agrestis) are being reported increasingly in the Pacific Northwest. This report summarizes investigations of three cases of T. agrestis bites among persons in idaho, oregon, and washington; spider bites reported to U.S. poison-control centers during 1994; and emphasizes the need for physicians in the northwestern united states to consider the species as a cause of toxic arachnidism.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |