RESUMO
Hard-to-heal or recurrent leg ulcers can have multiple aetiologies. One of these is incompetent veins. The main focus of this article is to discuss the common treatment for venous leg ulcers with the use of sclerotherapy. This simple surgical procedure obliterates smaller veins and telangiectasia. Veins with larger diameters (varicosities) can be treated with ablation therapy. The intent of sclerosis or ablation therapy is to destroy the incompetent veins and allow the collateral circulation to improve venous return, decreasing venous hypertension, which then enhances skin closure, wound healing and the resolution of the ulcer.
Assuntos
Hipertensão , Úlcera da Perna , Úlcera Varicosa , Humanos , Escleroterapia , Úlcera da Perna/etiologia , Úlcera da Perna/terapia , Pele , Úlcera Varicosa/terapiaRESUMO
Heel pain, whether plantar or posterior, is predominantly a mechanical pathology although an array of diverse pathologies including neurologic, arthritic, traumatic, neoplastic, infectious, or vascular etiologies must be considered. This clinical practice guideline (CPG) is a revision of the original 2001 document developed by the American College of Foot and Ankle Surgeons (ACFAS) heel pain committee.
Assuntos
Fasciíte Plantar/complicações , Calcanhar , Manejo da Dor , Dor/diagnóstico , Guias de Prática Clínica como Assunto , Tendinopatia/complicações , Tendão do Calcâneo , Doença Crônica , Terapia Combinada , Fasciíte Plantar/diagnóstico , Fasciíte Plantar/cirurgia , Feminino , Seguimentos , Doenças do Pé/diagnóstico , Doenças do Pé/terapia , Humanos , Imageamento por Ressonância Magnética , Masculino , Procedimentos Ortopédicos/métodos , Dor/etiologia , Exame Físico , Medição de Risco , Índice de Gravidade de Doença , Tendinopatia/diagnóstico , Tendinopatia/terapia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
PURPOSE: To provide an overview of the literature related to the treatment of diabetic foot ulcers. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in wound care. OBJECTIVES: After reading this article and taking this test, the reader should be able to:
Assuntos
Algoritmos , Árvores de Decisões , Pé Diabético/diagnóstico , Pé Diabético/cirurgia , Seleção de Pacientes , Amputação Cirúrgica , Desbridamento , Pé Diabético/classificação , Drenagem , Procedimentos Cirúrgicos Eletivos , Objetivos , Humanos , Controle de Infecções , Avaliação em Enfermagem/métodos , Osteotomia , Medição de Risco/métodos , Fatores de Risco , Higiene da Pele/métodos , Cicatrização , Infecção dos Ferimentos/etiologia , Infecção dos Ferimentos/prevenção & controleRESUMO
Heme oxygenase-1 (HO-1) mRNA and protein levels are diminished in Alzheimer disease (AD) blood, cerebrospinal fluid (CSF) and choroid plexus. Herein, the presence of a heme oxygenase-1 suppressor (HOS) factor was ascertained by astroglial bioassay, biochemical techniques and immunofluorescence confocal microscopy. We report significantly augmented plasma HOS activity in AD patients relative to healthy elderly and neurological controls. The HOS factor was determined to be a 50-100 kDa heat-labile, heparin-binding glycoprotein that is unrelated to antioxidant ingestion, plasma total antioxidant capacity, circulating cortisol levels or apolipoprotein E epsilon4 carrier status. HOS bioactivity was recapitulated by exogenous alpha(1)-antitrypsin. alpha(1)-antitrypsin levels were significantly increased in AD plasma and correlated with HOS activity and MMSE scores. alpha(1)-antitrypsin immunodepletion attenuated HOS activity of AD plasma. In AD brain, alpha(1)-antitrypsin immunoreactivity was augmented and co-distributed with HO-1. HOS activity of alpha(1)-antitrypsin may curtail HO-1-dependent derangement of cerebral iron homeostasis and account for diminished HO-1 expression in AD peripheral tissues.
Assuntos
Doença de Alzheimer/sangue , Doença de Alzheimer/genética , Heme Oxigenase-1/genética , Heme Oxigenase-1/fisiologia , alfa 1-Antitripsina/genética , alfa 1-Antitripsina/fisiologia , Idoso , Animais , Antioxidantes/metabolismo , Northern Blotting , Encéfalo/patologia , Plexo Corióideo/metabolismo , Cromatografia de Afinidade , Transtornos Cognitivos/sangue , Transtornos Cognitivos/genética , Transtornos Cognitivos/metabolismo , DNA Complementar/biossíntese , DNA Complementar/genética , Imunofluorescência , Genes Supressores , Humanos , Hidrocortisona/sangue , Microscopia Confocal , Pessoa de Meia-Idade , Testes Neuropsicológicos , RNA Mensageiro/biossíntese , RNA Mensageiro/genética , Ratos , Ratos Sprague-DawleyRESUMO
The prevalence of diabetes mellitus is growing at epidemic proportions in the United States and worldwide. Most alarming is the steady increase in type 2 diabetes, especially among young and obese people. An estimated 7% of the US population has diabetes, and because of the increased longevity of this population, diabetes-associated complications are expected to rise in prevalence. Foot ulcerations, infections, Charcot neuroarthropathy, and peripheral arterial disease frequently result in gangrene and lower limb amputation. Consequently, foot disorders are leading causes of hospitalization for persons with diabetes and account for billion-dollar expenditures annually in the US. Although not all foot complications can be prevented, dramatic reductions in frequency have been achieved by taking a multidisciplinary approach to patient management. Using this concept, the authors present a clinical practice guideline for diabetic foot disorders based on currently available evidence, committee consensus, and current clinical practice. The pathophysiology and treatment of diabetic foot ulcers, infections, and the diabetic Charcot foot are reviewed. While these guidelines cannot and should not dictate the care of all affected patients, they provide evidence-based guidance for general patterns of practice. If these concepts are embraced and incorporated into patient management protocols, a major reduction in diabetic limb amputations is certainly an attainable goal.
Assuntos
Pé Diabético/terapia , Artropatia Neurogênica/diagnóstico , Artropatia Neurogênica/terapia , Pé Diabético/complicações , Pé Diabético/diagnóstico , Pé Diabético/epidemiologia , Pé Diabético/prevenção & controle , Pé Diabético/cirurgia , Humanos , Infecções , Fatores de RiscoRESUMO
PURPOSE: To provide physicians and nurses with an overview of diabetic foot assessment. TARGET AUDIENCE: This continuing-education activity is intended for physicians and nurses with an interest in learning about proper diabetic foot assessment. OBJECTIVES: After reading the article and taking the test, the participant will be able to: 1. Review the epidemiology of diabetes, diabetic foot ulcers, and lower-extremity amputation related to diabetes. 2. Identify risk factors for foot ulceration in patients with diabetes. 3. Identify normal and abnormal findings in the dermatologic, vascular, neurologic, and musculoskeletal assessment of the foot in patients with diabetes.