RESUMEN
The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety, and systematizing treatment, employing evidence-based medicine (EBM) techniques and aimed at improvement of the outcomes. Clinical questions (CQs) were decided based on the important clinical issues. For document retrieval, key words for literature searches were set for each CQ and literature published from 1980 to the end of September 2014 was searched in Pubmed, Cochrane Library, and Japana Centra Revuo Medicina (JCRM). The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution System (MINDS) technique. A total of 33 CQs were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy, and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, and pathological diagnosis deciding the diagnosis. Thus, the Japanese Clinical Practice Guidelines for Vascular Anomalies 2017 have been prepared as the evidence-based guidelines for the management of vascular anomalies.
Asunto(s)
Hemangioma/terapia , Malformaciones Vasculares/terapia , Malformaciones Arteriovenosas/terapia , Embolización Terapéutica/métodos , Medicina Basada en la Evidencia , Humanos , Terapia por Láser/métodos , Escleroterapia/métodos , Resultado del TratamientoAsunto(s)
Anticuerpos Monoclonales Humanizados/efectos adversos , Fármacos Dermatológicos/efectos adversos , Erupciones por Medicamentos/etiología , Psoriasis/inducido químicamente , Psoriasis/tratamiento farmacológico , Piel/efectos de los fármacos , Anciano , Biopsia , Clobetasol/uso terapéutico , Erupciones por Medicamentos/diagnóstico , Erupciones por Medicamentos/tratamiento farmacológico , Glucocorticoides/uso terapéutico , Humanos , Masculino , Psoriasis/diagnóstico , Piel/patología , Resultado del TratamientoRESUMEN
There are few studies on predictive validity of methods to monitor the healing process of pressure ulcers. We evaluated whether the change of DESIGN-R (rating) score could predict subsequent healing, and determined the optimal cutoff points. In a multicenter prospective cohort study, patients were followed until wound healing or censoring. Wound severity was evaluated by the DESIGN-R tool every week, and the score change was calculated over 1-4 weeks (n = 411, 286, 224, and 170, respectively). In the multivariate analyses stratified by depth, a one-point improvement in DESIGN-R score over any period was positively associated with healing within the next 30 days independent of initial wound severity (hazard ratios over each 1-4 weeks ranging from 1.16 to 1.33 for superficial ulcers and from 1.21 to 1.27 for deep ulcers; all p < 0.05). The optimal cutoff points over 1-4 weeks were set as negative change for superficial ulcers and as positive change of ≥two points for deep ulcers. Nonhealing rate was higher for ulcers with DESIGN-R score change below the cutoff points than that aforementioned for both depths. Weekly monitoring by the DESIGN-R tool will be advantageous for evaluating prognosis of pressure ulcers independent of initial wound severity and depth.
Asunto(s)
Úlcera por Presión/patología , Cicatrización de Heridas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Curva ROC , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
DESIGN is a seven-item (depth, exudates, size, inflammation/infection, granulation, necrosis, and pocket) monitoring scale for pressure ulcers developed in 2002 by the scientific education committee of the Japanese Society of Pressure Ulcers. DESIGN is a very useful tool for chronological monitoring of each pressure ulcer, but a key limitation of this tool is its inability to compare the wound-healing process among different pressure ulcers in different patients due to a lack of statistical item weighting. Our aim was to weight DESIGN items by statistical analysis and develop a new validated tool to overcome this limitation. Subjects comprised 3,601 patients with pressure ulcers. Patients were followed every week during the study period. To establish the weighting of each item and grade, we estimated the probabilities of wound healing at 12-month follow-up using multivariable Cox's regression analysis. Weighting (-ß value) for each item in order of the highest rank was: pocket, 2.289; size, 1.573; inflammation/infection, 0.778; granulation tissue, 0.682; exudate, 0.543; and necrotic tissue, 0.529. Based on these findings, a new, validated "DESIGN-Rating tool" for monitoring the progression of pressure ulcer healing was developed, implying the development of an absolute evaluation tool and clinical indicator to assess the quality of medical care.
Asunto(s)
Úlcera por Presión/patología , Úlcera por Presión/fisiopatología , Índice de Severidad de la Enfermedad , Anciano , Anciano de 80 o más Años , Femenino , Tejido de Granulación , Humanos , Masculino , Persona de Mediana Edad , Necrosis , Evaluación en Enfermería/métodos , Investigación en Evaluación de Enfermería , Evaluación de Resultado en la Atención de Salud , Cicatrización de HeridasRESUMEN
There are few clinical tools with both predictive validity for pressure ulcer healing and availability in broad populations. We evaluated whether the total scores from DESIGN-R tool could predict pressure ulcer healing. We followed 3,196 patients with pressure ulcers from two multicenter cohort studies until wound healing, patient death, or discharge. Wound severity was evaluated by DESIGN-R tool from 0 (healed) to 66 (greatest severity). In the multivariate Cox proportional hazard model, higher DESIGN-R total scores at baseline were associated with lower healing rates (hazard ratio 0.90, 95% confidence interval 0.89-0.92), independent of the patient's characteristics, setting types, and wound depth or location. DESIGN-R had discriminative value for wound healing up to 90 days; the area under the receiver-operating characteristics curve from univariate analysis was 0.81 for healing within 30 days and 0.74 for healing within 30-90 days. The cutoff points were 9 for healing within 30 days and 18 within 30-90 days (positive and negative predictive value 78.8 and 74.1%; 63.9 and 81.1%, respectively). These points were validated for both superficial and deep ulcers. DESIGN-R can be a useful tool to predict pressure ulcer healing for a wide range of patient populations, settings, and wound locations.
Asunto(s)
Úlcera por Presión/patología , Cicatrización de Heridas , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Valor Predictivo de las Pruebas , Úlcera por Presión/clasificación , Modelos de Riesgos Proporcionales , Curva ROC , Sensibilidad y Especificidad , Índice de Severidad de la EnfermedadRESUMEN
The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety, and systematizing treatment, employing evidence-based medicine (EBM) techniques and aimed at improvement of the outcomes. Clinical questions (CQs) were decided based on the important clinical issues. For document retrieval, key words for literature searches were set for each CQ and literature published from 1980 to the end of September 2014 was searched in Pubmed, Cochrane Library, and Japana Centra Revuo Medicina (JCRM). The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution System (MINDS) technique. A total of 33 CQs were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy, and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, and pathological diagnosis deciding the diagnosis. Thus, the Japanese Clinical Practice Guidelines for Vascular Anomalies 2017 have been prepared as the evidence-based guidelines for the management of vascular anomalies.
Asunto(s)
Hemangioma/terapia , Enfermedades Vasculares/terapia , Malformaciones Vasculares/terapia , Factores de Edad , Embolización Terapéutica , Medicina Basada en la Evidencia/métodos , Humanos , Japón , Terapia por Láser/métodos , Escleroterapia , Factores de Tiempo , Malformaciones Vasculares/clasificaciónRESUMEN
The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety and systematizing treatment, employing evidence-based medicine techniques and aimed at improvement of the outcomes. Clinical questions (CQ) were decided based on the important clinical issues. For document retrieval, key words for published work searches were set for each CQ, and work published from 1980 to the end of September 2014 was searched in PubMed, Cochrane Library and Japana Centra Revuo Medicina databases. The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution System technique. A total of 33 CQ were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, and pathological diagnosis deciding the diagnosis. Thus, the Japanese Clinical Practice Guidelines for Vascular Anomalies 2017 have been prepared as the evidence-based guidelines for the management of vascular anomalies.
Asunto(s)
Malformaciones Arteriovenosas/terapia , Medicina Basada en la Evidencia/normas , Hemangioma/terapia , Linfangioma/terapia , Neoplasias Cutáneas/cirugía , Medicina Basada en la Evidencia/métodos , Humanos , Japón , Sociedades Médicas/normasRESUMEN
The Japanese Dermatological Association prepared the clinical guidelines for the "Wound, pressure ulcer and burn guidelines", second edition, focusing on treatments. Among them, "Guidelines for wounds in general" is intended to provide the knowledge necessary to heal wounds, without focusing on particular disorders. It informs the basic principles of wound treatment, before explanations are provided in individual chapters of the guidelines. We updated all sections by collecting references published since the publication of the first edition. In particular, we included new wound dressings and topical medications. Additionally, we added "Question 6: How should wound-related pain be considered, and what should be done to control it?" as a new section addressing wound pain, which was not included in the first edition.
Asunto(s)
Úlcera por Presión , Vendajes , Humanos , Úlcera por Presión/terapia , Cicatrización de HeridasRESUMEN
The Japanese Dermatological Association prepared guidelines focused on the treatment of skin ulcers associated with connective tissue disease/vasculitis practical in clinical settings of dermatological care. Skin ulcers associated with connective tissue diseases or vasculitis occur on the background of a wide variety of diseases including, typically, systemic sclerosis but also systemic lupus erythematosus (SLE), dermatomyositis, rheumatoid arthritis (RA), various vasculitides and antiphospholipid antibody syndrome (APS). Therefore, in preparing the present guidelines, we considered diagnostic/therapeutic approaches appropriate for each of these disorders to be necessary and developed algorithms and clinical questions for systemic sclerosis, SLE, dermatomyositis, RA, vasculitis and APS.
Asunto(s)
Enfermedades del Tejido Conjuntivo , Lupus Eritematoso Sistémico , Úlcera por Presión , Enfermedades Cutáneas Vasculares , Úlcera Cutánea , Vasculitis , Humanos , Úlcera Cutánea/diagnóstico , Úlcera Cutánea/tratamiento farmacológico , Úlcera Cutánea/etiología , Vasculitis/diagnóstico , Vasculitis/tratamiento farmacológicoRESUMEN
"Wound, pressure ulcer and burn guidelines - 6: Guidelines for the management of burns, second edition" is revised from the first edition which was published in the Japanese Journal of Dermatology in 2016. The guidelines were drafted by the Wound, Pressure Ulcer and Burn Guidelines Drafting Committee delegated by the Japanese Dermatological Association, and intend to facilitate physicians' clinical decisions in preventing, diagnosing and treating burn injury. All sections are updated by collecting documents published since the publication of the first edition. Especially, the recommendation levels of dressing materials newly covered by the Japanese national health insurance are mentioned. In addition, the clinical questions (CQ) regarding the initial treatment of electrical (CQ15) and chemical burns (CQ16), and also the use of escharotomy (CQ22), are newly created.
Asunto(s)
Úlcera por Presión , Vendajes , Humanos , Úlcera por Presión/diagnóstico , Úlcera por Presión/terapiaRESUMEN
The Wound/Burn Guidelines Committee consists of members commissioned by the Board of Directors of the Japanese Dermatological Association (JDA). It held several meetings and evaluations in writing since October 2008, and drafted five guidelines for the diagnosis and treatment including commentaries on wounds in general and the Guidelines for the Diagnosis and Treatment for Pressure Ulcers by taking opinions of the Scientific Committee and Board of Directors of JDA into consideration.
Asunto(s)
Quemaduras/diagnóstico , Quemaduras/terapia , Úlcera por Presión/diagnóstico , Úlcera por Presión/terapia , Cicatrización de Heridas , Administración Cutánea , Vendajes , Desbridamiento , Dermatología/normas , Diagnóstico Diferencial , Práctica Clínica Basada en la Evidencia/normas , Humanos , Japón , Pomadas , Manejo del Dolor/métodos , Posicionamiento del Paciente , Úlcera por Presión/prevención & control , Úlcera por Presión/cirugía , Cuidados de la Piel/métodosRESUMEN
The Japanese Dermatological Association prepared guidelines focused on the treatment of skin ulcers associated with connective tissue disease/vasculitis practical in clinical settings of dermatological care. Skin ulcers associated with connective tissue diseases or vasculitis occur on the background of a wide variety of diseases including, typically, systemic sclerosis but also systemic lupus erythematosus (SLE), dermatomyositis, rheumatoid arthritis (RA), various vasculitides and antiphospholipid antibody syndrome (APS). Therefore, in preparing the present guidelines, we considered diagnostic/therapeutic approaches appropriate for each of these disorders to be necessary and developed algorithms and clinical questions for systemic sclerosis, SLE, dermatomyositis, RA, vasculitis and APS.
Asunto(s)
Calcinosis/complicaciones , Enfermedades del Tejido Conjuntivo/complicaciones , Úlcera Cutánea/tratamiento farmacológico , Vasculitis/complicaciones , Antitrombinas/uso terapéutico , Calcinosis/diagnóstico , Calcinosis/terapia , Bloqueadores de los Canales de Calcio/uso terapéutico , Dapsona/uso terapéutico , Antagonistas de los Receptores de Endotelina/uso terapéutico , Glucocorticoides/uso terapéutico , Humanos , Inmunosupresores/uso terapéutico , Leucaféresis , Inhibidores de Fosfodiesterasa 5/uso terapéutico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Prostaglandinas/uso terapéutico , Úlcera Cutánea/etiología , Úlcera Cutánea/cirugía , Factor de Necrosis Tumoral alfa/antagonistas & inhibidoresRESUMEN
The Japanese Dermatological Association determined to prepare the Wound/Burn Guidelines focusing on treatments, catering to needs for the clinical practice of dermatology. Among these guidelines, "Wounds in General" was intended to explain knowledge necessary "to heal wounds" without specifying particular disorders.
Asunto(s)
Antiinfecciosos Locales/uso terapéutico , Quemaduras/terapia , Desinfección/métodos , Irrigación Terapéutica/métodos , Cicatrización de Heridas , Heridas y Lesiones/terapia , Administración Cutánea , Antiinfecciosos Locales/administración & dosificación , Enfermedad Crónica , Humanos , Japón , Sociedades Médicas , Irrigación Terapéutica/normas , Heridas y Lesiones/clasificación , Heridas y Lesiones/diagnósticoRESUMEN
We aimed to prepare guidelines for the management of diabetic ulcer/gangrene with emphasis on the diagnosis and treatment of skin symptoms. They serve as a tool to improve the quality of the diagnosis and treatment in each patient and, further, to improve the level of the care for diabetic ulcer in Japan by systematically presenting evidence-based recommendations for clinical judgments by incorporating various viewpoints.
Asunto(s)
Pie Diabético/terapia , Gangrena/terapia , Aldehído Reductasa/antagonistas & inhibidores , Antibacterianos/administración & dosificación , Eliminación de Componentes Sanguíneos , Desbridamiento , Pie Diabético/complicaciones , Pie Diabético/diagnóstico , Nefropatías Diabéticas/diagnóstico , Gangrena/diagnóstico , Gangrena/etiología , Humanos , Oxigenoterapia Hiperbárica , Isquemia/diagnóstico , Isquemia/etiología , Terapia de Presión Negativa para Heridas , Aparatos Ortopédicos , Osteomielitis/diagnóstico por imagen , Osteomielitis/tratamiento farmacológico , Osteomielitis/etiología , Diálisis Renal/efectos adversos , Cicatrización de HeridasRESUMEN
Varicose veins are treated at multiple clinical departments, but as patients often visit the dermatology clinic first due to leg ulcers, the present Guidelines for the Management of Lower Leg Ulcers/Varicose Veins were prepared in consideration of the importance of the dermatologist's role. Also, the disease concept of chronic venous insufficiency or chronic venous disorders and the CEAP classification of these disorders are presented. The objective of the present guidelines is to properly guide the diagnosis and treatment of lower leg ulcers/varicose veins by systematically presenting evidence-based recommendations that support clinical decisions.
Asunto(s)
Úlcera de la Pierna/terapia , Úlcera Varicosa/terapia , Várices/terapia , Algoritmos , Dermatología , Humanos , Japón , Úlcera de la Pierna/clasificación , Úlcera de la Pierna/diagnóstico , Escleroterapia , Sociedades Médicas , Medias de Compresión , Úlcera Varicosa/clasificación , Úlcera Varicosa/diagnóstico , Várices/clasificación , Várices/diagnóstico , Procedimientos Quirúrgicos VascularesRESUMEN
Burns are a common type of skin injury encountered at all levels of medical facilities from private clinics to core hospitals. Minor burns heal by topical treatment alone, but moderate to severe burns require systemic management, and skin grafting is often necessary also for topical treatment. Inappropriate initial treatment or delay of initial treatment may exert adverse effects on the subsequent treatment and course. Therefore, accurate evaluation of the severity and initiation of appropriate treatment are necessary. The Guidelines for the Management of Burn Injuries were issued in March 2009 from the Japanese Society for Burn Injuries as guidelines concerning burns, but they were focused on the treatment for extensive and severe burns in the acute period. Therefore, we prepared guidelines intended to support the appropriate diagnosis and initial treatment for patients with burns that are commonly encountered including minor as well as moderate and severe cases. Because of this intention of the present guidelines, there is no recommendation of individual surgical procedures.
Asunto(s)
Quemaduras/diagnóstico , Quemaduras/terapia , Fluidoterapia/métodos , Índice de Severidad de la Enfermedad , Cicatrización de Heridas , Administración Cutánea , Corticoesteroides/administración & dosificación , Corticoesteroides/uso terapéutico , Antibacterianos/uso terapéutico , Antiinfecciosos Locales/uso terapéutico , Vendajes , Broncoscopía , Quemaduras/clasificación , Quemaduras por Inhalación/diagnóstico , Quemaduras por Inhalación/terapia , Humanos , Hidroterapia , Pulmón/diagnóstico por imagen , Pomadas/administración & dosificación , Pomadas/uso terapéutico , Pronóstico , Radiografía , Sulfadiazina de Plata/uso terapéutico , Tétanos/prevención & control , Toxoide Tetánico/uso terapéutico , Infección de Heridas/prevención & controlAsunto(s)
Biotina/administración & dosificación , Biotina/deficiencia , Enfermedades Carenciales/tratamiento farmacológico , Enfermedades Carenciales/etiología , Eritema/etiología , Aminoácidos , Femenino , Humanos , Lactante , Fórmulas Infantiles/química , Masculino , Hipersensibilidad a la Leche , Perineo , Cuero Cabelludo , Gemelos DicigóticosRESUMEN
We present here a case of chronic perianal pyoderma (CPP), who was treated with a novel skin graft. The patient was a 28-year-old male who had suffered from painful abscesses and nodules on his buttocks for over 10 years. Although the abscesses and nodules were initially restricted to one buttock, they gradually spread over both buttocks. He visited our hospital in July of 2000. He was clinically diagnosed as CPP and treated with oral doses of antibiotics. When admitted to our hospital in September of 2000, an anal fistula was also found. The operations for CPP and anal fistula were simultaneously performed. After the anal fistula treatment, the lesions of CPP were totally resected. In this procedure, we removed the epidermis and upper dermis from the excised CPP lesions and grafted them on the defects of the excised lesion. There has been no recurrence of the CPP. This operation procedure, which we call the "recycled skin graft method" is less invasive, because a donor site for the skin graft is unnecessary. We considered it to be as one of the effective treatments for CPP.