1/15. Maggot debridement therapy in outpatients.OBJECTIVE: To identify the benefits, risks, and problems associated with outpatient maggot therapy. DESIGN: Descriptive case series, with survey. SETTING: Urban and rural clinics and homes. PARTICIPANTS: Seven caregivers with varying levels of formal health care training and 21 ambulatory patients (15 men, 6 women; average age, 63 yr) with nonhealing wounds. INTERVENTION: Maggot therapy. MAIN OUTCOME MEASURE: Therapists' opinions concerning clinical outcomes and the disadvantages of therapy. RESULTS: More than 95% of the therapists and 90% of their patients were satisfied with their outpatient maggot debridement therapy. Of the 8 patients who were advised to undergo amputation or major surgical debridement as an alternative to maggot debridement, only 3 required surgical resection (amputation) after maggot therapy. Maggot therapy completely or significantly debrided 18 (86%) of the wounds; 11 healed without any additional surgical procedures. There was anxiety about maggots escaping, but actual escapes were rare. pain, reported by several patients, was controlled with oral analgesics. CONCLUSIONS: Outpatient maggot debridement is safe, effective, and acceptable to most patients, even when administered by nonphysicians. Maggot debridement is a valuable and rational treatment option for many ambulatory, home-bound, and extended care patients who have nonhealing wounds.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/15. Approach to skin ulcers in older patients.OBJECTIVE: To provide family physicians with an approach to managing skin ulcers in older patients. SOURCES OF INFORMATION: Clinical practice guidelines and best practice guidelines were summarized to describe an evidence-based approach. MAIN MESSAGE; Preventing ulcers is important in frail older patients. Using guidelines can help prevent ulcers in institutions. Clarifying the cause and contributing factors is the first step in management. pressure and venous ulcers are common in elderly people. Poor nutrition, edema, arterial insufficiency, and anemia often impair wound healing. Adequate debridement is important to decrease risk of infection and to promote healing. There are guidelines for cleaning ulcers. Choice of dressings depends on the circumstances of each wound, but dressings should provide a moist environment. Options for dressings are summarized. CONCLUSION: family physicians can manage skin ulcers effectively by applying basic principles and using readily available guidelines.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
3/15. Genital ulcers after treatment with all-trans-retinoic acid in a child with acute promyelocytic leukemia.All-trans-retinoic acid (ATRA) has been shown to improve the outcome of patients with acute promyelocytic leukemia (APL). However, various adverse effects of ATRA treatment have been noted, such as scrotal and genital ulcers in adult patients. The authors report genital ulcers that developed in a child with APL after ATRA treatment. An 8-year-old girl with APL was treated with ATRA for 21 days and after discontinuation of ATRA treatment she developed genital ulcers. Systemic and local antibiotic pomades were applied and the lesions improved within 15 days. In conclusion, genital ulcers may develop in children with APL as a complication of ATRA treatment and physicians should be alert to this possibility.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/15. Paraffinoma and ulcer of the external genitalia after self-injection of vaseline.We present a 42-year-old circumcised man with a 10-cm firm, irregular penile mass associated with multiple penile ulcers, voiding difficulty, and erectile dysfunction. He reluctantly admitted that 8 months previously, he had multiple mineral-oil (vaseline) self-injections to the penis, for penile enlargement purposes. Histopathological examination revealed the condition was consistent with mineral-oil granuloma (paraffinoma). The patient did not accept surgical intervention; therefore, we performed local therapy (intralesional triamcinolone) and hot-water baths. Paraffinoma results from mineral-oil injections. Such injections are rare; however, they are still being performed in some countries in Eastern europe and the far east such as korea. Increased physician and public awareness are needed for prevention and treatment of complications of this physically and psychologically debilitating and destructive problem.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/15. hip ulcer secondary to foreign body reaction and vacuum-assisted closure therapy: report of a case.Patients who have a foreign body reaction are at risk of developing chronic ulcers secondary to necrosis, due to the inflammation present in the affected tissues or trauma, worsened by alterations in the vascular perfusion. These ulcers represent a therapeutic challenge for both physicians and patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/15. Gel wheelchair cushions: a potential cold weather hazard.paraplegia and quadriplegia with concomitant impairment of cutaneous sensation predisposes to secondary skin damage, most commonly due to pressure or heat. Cold exposure, however, can also damage the skin. This report describes a 19-year-old man with myelodysplasia and L3 incomplete paraplegia who sustained extensive freeze burns of the buttocks from sitting on a gel wheelchair cushion that had been left outside in freezing weather. When he initially presented for medical care, the lesions were described by his physician as ischial pressure sores. On careful further questioning, prompted because of the unusual margins of the lesions, the true etiology was determined. The medical and surgical management of this patient's cold thermal injury, the thermomechanical properties of gel wheelchair cushions, and the literature pertaining to cold injury in the population with impaired spinal cord function are discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/15. pyoderma gangrenosum after reduction mammoplasty.The authors report a case of pyoderma gangrenosum in a 37-year-old woman that occurred at surgical sites after reduction mammoplasty. The diagnosis was delayed, but treatment with intralesional triamcinolone resulted in complete resolution o the condition. pyoderma gangrenosum in this setting can mimic infectious causes of wound necrosis. Early recognition of its characteristics features may prevent unnecessary and ineffective treatment, thereby avoiding frustration for both patient and physician.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/15. Trigeminal trophic syndrome.Trigeminal trophic syndrome is an unusual condition also known as trigeminal neurotrophic ulceration or trigeminal neuropathy with nasal ulceration. The diagnosis is suggested when ulceration of the face, especially of the ala nasi, occurs in a dermatome of the trigeminal nerve that has been rendered anesthetic by a surgical or other process involving the trigeminal nerve or its central sensory connections. A history of paresthesias and self-induced trauma to the area further support the diagnosis. Neurological deficits causing trigeminal trophic syndrome may result from surgical trigeminal ablation, vascular disorders and infarction of the brainstem, acoustic neuroma, postencephalitic parkinsonism, and syringobulbia. The following etiologies of nasal ulceration should be excluded: postsurgical herpetic reactivation and ulceration, syphilis, leishmaniasis, leprous trigeminal neuritis, yaws, blastomycosis, paracoccidioidomycosis, lethal midline granuloma, pyoderma gangrenosum, Wegener's granulomatosis, and basal cell carcinoma. In the case reported here, the diagnosis of TTS was made primarily as a result of previous experience with the syndrome, underscoring the importance of physician recognition of this unusual disorder.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/15. Complications of liquid nitrogen cryosurgery for verrucae over bony prominences.Liquid nitrogen cryosurgery is the most frequently used surgical treatment for verrucae. Its success rate is high and complications are rare. However, liquid nitrogen should be used with great care over bony prominences where skin and subcutaneous tissues are thin. We present 3 patients in whom the treatment of simple warts over bony prominences by liquid nitrogen resulted in full-thickness loss of skin. In 2 of them, extensor tendons of fingers were exposed and had to be covered with flaps. We conclude that expertise of the physician is of paramount importance in preventing similar complications in cryosurgery of verrucae.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/15. pyoderma gangrenosum in a kindred. Precipitation by surgery or mild physical trauma.Five cases of pyoderma gangrenosum occurring in a kindred are presented. Three of the cases occurred after abdominal surgery and tended to be confused with postoperative wound infections. Two cases occurred after superficial injury to the leg and were also thought to represent a peculiar form of cellulitis. None of the patients are known to have any of the underlying diseases usually associated with pyoderma gangrenosum. The cases are presented to alert the physician to this entity and to document the unusual familial occurrence.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
| | Next -> |