1/21. An impressive therapeutic result of class III compression stockings in a patient with longstanding, extensive, combined leg ulcers.BACKGROUND: Only a few publications are available in the literature concerning the treatment of venous leg ulcers by means of medical compression stockings. SUBJECT: A 59-year-old female patient with longstanding, extensive bilateral leg ulcers due to venous insufficiency, arteriolosclerosis and secondary lymphoedema, was treated successfully by flat-knitted medical compression stockings of compression-class III. CONCLUSION: The great advantage of this treatment is the fact that it is comfortable and easy to carry out at home. Furthermore, the costs of compression therapy with medical compression stockings are only a fraction of those of conventional therapy by means of compressive non-elastic bandages. Once or twice weekly visits of the patient to the hospital are not necessary and less specialized dermatological nurses are needed.- - - - - - - - - - ranking = 1keywords = venous insufficiency, insufficiency (Clic here for more details about this article) |
2/21. calciphylaxis in moderate renal insufficiency: changing disease concepts.calciphylaxis is a rare but frequently fatal complication in patients with end-stage renal disease. Original concepts regarding groups at risk for the disease, predisposing factors, and associated morbidity have changed significantly in the past few years as more cases are reported. We present a patient who developed fatal calciphylaxis in the setting of moderate renal insufficiency to illustrate some of the evolving concepts in this disease process.- - - - - - - - - - ranking = 0.0013290174980729keywords = insufficiency (Clic here for more details about this article) |
3/21. Recurrent leg ulcers and arterial thrombosis in a 33-year-old homozygous variant of antithrombin.We report here a homozygous variant case of antithrombin (AT) associated with arterial thrombosis and recurrent leg ulcers. The deep vein thrombosis was recognized by the venogram of his pelvic veins. His leg ulcers were scattered around his left ankle and accompanied by lipodermatosclerosis, which was evident in venous insufficiency. The propositus had developed cerebral infarction 12 years prior to his leg ulcers. Coagulation study showed low heparin cofactor activity of his AT with a normal level of immunoreactive AT. Nucleotide sequence analysis of the exon 2 of his AT gene showed Arg47-Cys mutation, leading to the lack of affinity of AT for heparin. The propositus is a homozygote for this abnormality.- - - - - - - - - - ranking = 1keywords = venous insufficiency, insufficiency (Clic here for more details about this article) |
4/21. 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 = 0.00026580349961458keywords = insufficiency (Clic here for more details about this article) |
5/21. 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 = 1.0002658034996keywords = venous insufficiency, insufficiency (Clic here for more details about this article) |
6/21. Persistent leg ulcers in an obese patient with venous insufficiency and elephantiasis.Options in Practice presents different management approaches to the same clinical situation. You are invited to submit a brief case description, including the specialty nursing care provided, and several glossy color photographs of the clinical situation. The case material will then be sent to another wound, ostomy, or continence care nurse, who will also address management concerns. Alternative solutions to difficult wound, ostomy, or incontinence clinical situations will be published.- - - - - - - - - - ranking = 4keywords = venous insufficiency, insufficiency (Clic here for more details about this article) |
7/21. Use of sugar in the treatment of infected leg ulcers.Mrs R is an 84-year-old retired shop-keeper with a 17-year history of recurrent leg ulceration. She has received treatment in both primary and secondary care settings, including specialist dermatology and vascular clinics. Mrs R has a long history of non-compliance to treatment regime, removing bandages and rucking them down causing compression injuries that almost resulted in amputation of her right leg. On assessment by the author, she had two partial thickness ulcers to each leg, signs of venous insufficiency and malnutrition, and swabs cultured positive for a range of bacteria. Resistance to topical antimicrobials and allergy to systemic antibiotics meant that another solution had to be tried to relieve the bacterial load on Mrs R's wounds.- - - - - - - - - - ranking = 1keywords = venous insufficiency, insufficiency (Clic here for more details about this article) |
8/21. Leg ulcers and hydroxyurea: report of three cases with essential thrombocythemia.CASE 1: A 65-year-old woman with essential thrombocythemia (ET) had been taking oral hydroxyurea (HU), 1,000 mg daily, for 7 years. Six months ago, she developed an ulcer on the outer part of her left ankle, which healed spontaneously within 2 months. She presented with a new, tender, shallow ulcer, 2 cm x 2 cm in size, at the same site. Doppler examination revealed thrombosis of the left common femoral vein and a calcified atheroma plaque of the left common femoral artery. The dosage of HU was decreased to 500 mg daily when the platelet counts were found to be within normal levels. The ulcer completely healed within 2 months with occlusive wound dressings, and has not recurred within the follow-up period of 1 year. CASE 2: A 56-year-old women presented with multiple, painful, leg ulcers of 1 year duration. She had been diagnosed as having ET and had been on HU therapy, 1,500 mg/day, for the past 5 years. interferon-alpha-2b was started 3 months ago, in addition to HU, which was tapered to 1,000 mg daily. She had suffered from hypertension for 20 years treated with nifedipine and enalapril, and had recently been diagnosed with diabetes mellitus which was controlled by diet. Examination revealed three ulcers located on the lateral aspects of both ankles and right distal toe. Arterial and venous Doppler examinations were within normal limits. Histopathology of the ulcer revealed nonspecific changes with a mixed inflammatory cell infiltrate around dermal vessels. The ulcers completely healed within 10 weeks with topical hydrocolloid dressings. After healing, she was lost to follow-up. A year later, it was learned that she had developed a new ulcer at her right heel, 3 months after her last visit (by phone call). This ulcer persisted for 8 months until HU was withdrawn. CASE 3: A 64-year-old woman with ET presented with a painful leg ulcer of 6 months' duration. She had been taking oral HU for 5 years. She had a 20-year history of hypertension treated with lisinopril. Examination revealed a punched-out ulcer of 2 cm x 2 cm over the right lateral malleolus. Doppler examination of the veins revealed insufficiency of the right greater saphenous and femoral veins. angiography showed multiple stenoses of the right popliteal and femoral arteries. As her platelet count remained high, HU was continued. During the follow-up period of 13 months, the ulcer showed only partial improvement with local wound care.- - - - - - - - - - ranking = 0.00026580349961458keywords = insufficiency (Clic here for more details about this article) |
9/21. A new autologous venous valve by intimal flap. One case report.Various surgical techniques have been proposed for the treatment of chronic venous insufficiency of post-thrombotic recanalized deep veins of the lower limbs. The preferable method seems to be represented by intravenous valvuloplasty except for the cases affected by extensive valvular damage. For this reason some experimental autologous, heterologous and prosthetic venous valves have been proposed. Such a problem emerged for 1 patient (male, aged 78 years, right limb, leg dystrophy, multiple ulcerations at the ankle) which was selected by duplex, Doppler venous pressure index, photoplethysmography and ascending phlebography. An iliac-femoral and popliteal post-thrombotic, recanalized, decompensated venous insufficiency and one Cockett's perforator incompetence were diagnosed (CEAP classification: C6s Es As2d14 Pr). A bicuspid apparently repairable popliteal valve was detected by phlebography. A traditional intravenous valvuloplasty was planned but the valve was not found at surgical exploration. A monocuspid valve reconstruction by intimal flap vein was performed. The following results were obtained and controlled after one year: stable ulceration healing, dystrophy reduction, improvement in the quality of life, normalization of the hemodynamic parameters and of the radiological morphology of the new valve. It can be concluded that monocuspid valvular repair by intimal flap can be successfully performed in cases affected by secondary valveless deep venous insufficiency of the lower limbs.- - - - - - - - - - ranking = 3keywords = venous insufficiency, insufficiency (Clic here for more details about this article) |
10/21. calciphylaxis in chronic, non-dialysis-dependent renal disease.BACKGROUND: calciphylaxis cutis is characterized by media calcification of arteries and, most prominently, of cutaneous and subcutaneous arterioles occurring in renal insufficiency patients. CASE REPORT: A 53-year-old woman with chronic cardiac and renal failure complained of painful crural, non-varicosis ulcers. She was hospitalized in an immobilized condition due to both the crural ulcerations and the existing heart-failure state (NYHA III-IV) having pleural and pericardial effusions, atrial fibrillation and weight loss of 30 kg over the past year. Despite normalization of calcium-phosphorus balance and improvement of renal function, the clinical course of crural ulcerations deteriorated during the following 3 months. After failure of surgical debridements, multiple courses of sterile-maggot therapy were introduced at a late stage to stabilize the wounds. The patient died of recurrent wound infections and sepsis paralleled by exacerbations of renal malfunction. CONCLUSIONS: The role of renal disease in vascular complications is discussed. Sterile-maggot debridement may constitute a therapy for the ulcerated calciphylaxis at an earlier stage, i.e. when first ulcerations appear.- - - - - - - - - - ranking = 0.00026580349961458keywords = insufficiency (Clic here for more details about this article) |
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