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1.
Hematol Oncol Clin North Am ; 19(5): 943-56, viii-ix, 2005 Oct.
Article in English | MEDLINE | ID: mdl-16214654

ABSTRACT

Leg ulceration is now recognized as an important complication of sickle cell disease, especially of the SS genotype. Since there is no convincing evidence of delayed healing of operation scars or of wounds elsewhere in the body, it must be concluded that factors specific to the lower leg render patients prone to delayed healing at this site. Many lesions are traumatic in origin and since there is considerable variation in healing rates among the normal population, it is useful to define chronic leg ulceration on the basis of a minimal duration, which in Jamaican studies has required at least 3 months and sometimes 6 months before healing. This minimal duration avoids the difficulties of interpreting the significance of briefer lesions since the moment of final healing may be poorly defined (patients may conclude that a scab represents healing whereas small lesions persist beneath) and often goes undocumented as patients may not report and medical attendants may not enquire, the date of final healing.


Subject(s)
Anemia, Sickle Cell/complications , Leg Ulcer/diagnosis , Leg Ulcer/therapy , Anemia, Sickle Cell/therapy , Chronic Disease , Disease Progression , Humans , Jamaica , Leg Ulcer/complications , Risk Factors
2.
Br J Haematol ; 119(2): 567-71, 2002 Nov.
Article in English | MEDLINE | ID: mdl-12406102

ABSTRACT

Chronic leg ulceration is a common cause of morbidity in Jamaican patients with homozygous sickle cell (SS) disease. Ulcers heal more rapidly on bed rest and deteriorate on prolonged standing, suggesting a role of venous hypertension in their persistence. This hypothesis has been tested by Doppler detection of venous competence in SS patients and in matched controls with a normal haemoglobin (AA) genotype in the Jamaican Cohort Study. Venous incompetence was significantly more frequent in SS disease [137/183 (75%)] than in non-pregnant AA controls [53/137 (39%)]. Past or present ulceration occurred in 78 (43%) SS patients, with a highly significant association between leg ulceration and venous incompetence in the same leg (P < 0.001). Prominence and/or varicosities of the veins and spontaneous leg ulcers were more common among patients with multiple sites of incompetence. The association of venous incompetence with chronic leg ulceration identifies a further pathological mechanism contributing to the morbidity of SS disease. The cause of venous incompetence is unknown but the sluggish circulation associated with dependency, turbidity and impaired linear flow at venous valves, hypoxia-induced sickling, the rheological effects of high white cell counts, and activation of components of the coagulation system may all contribute. Venous hypertension in SS patients with leg ulceration suggests that firm elastic supportive dressings might promote healing of chronic leg ulcers.


Subject(s)
Anemia, Sickle Cell/complications , Leg Ulcer/etiology , Venous Insufficiency/complications , Adult , Anemia, Sickle Cell/diagnostic imaging , Case-Control Studies , Chronic Disease , Female , Humans , Jamaica , Leg Ulcer/diagnostic imaging , Male , Ultrasonography, Doppler , Venous Insufficiency/diagnostic imaging
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