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1.
Angiol Sosud Khir ; 26(1): 62-68, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32240138

RESUMO

AIM: The study was undertaken to evaluate efficacy of comprehensive treatment with the use of erbium laser radiation in patients suffering from venous trophic ulcers of lower limbs. PATIENTS AND METHODS: The study included a total of seventy-six 45-to-80-year-old patients. Of these, there were 43 (56.6%) women and 33 (43.4%) men. The duration of the disease averagely amounted to 10.8±4.8 years. In 38 patients, the bottom of the ulcerative defect was with pronounced periulcerative inflammation and various degree of purulent discharge. All patients were admitted to the surgical department and underwent meticulous examination. Erbium laser irradiation was carried out with consideration for the ulcer size. Laser irradiation was performed at a wavelength of 2940 nm, pulse duration - 0.3 ms, laser beam diameter - 7 mm with radiation power of 2.19 J/cm2. RESULTS: Efficacy of treatment was assessed in dynamics by the degree of pain syndrome, ulcer size upon completion of treatment, as well as the rate of trophic ulcer epithelialisation. In 15 (19.7%) patients with varicose disease the vertical and horizontal reflux was eliminated with performing phlebectomy and echosclerotherapy. The obtained findings demonstrated that 42 (91.3%) patients of the study group had decreased terms of the beginning of purification of the fundus of the ulcer. After 6 months of rehabilitation and follow up, complete ulcer healing was achieved in 18 (64.3%) patients of the control group and in 39 (86.7%) patients of the study group. CONCLUSION: The obtained findings showed that laser radiation proved to be an effective method of treatment in patients presenting with indolent trophic ulcers. Comprehensive treatment made it possible to effectively influence the microflora and the state of regional lymph drainage, to stimulate the processes of reparative regeneration.


Assuntos
Úlcera Varicosa/etiologia , Feminino , Seguimentos , Humanos , Masculino , Resultado do Tratamento , Úlcera , Veias
5.
BMJ Open ; 9(12): e032091, 2019 12 23.
Artigo em Inglês | MEDLINE | ID: mdl-31874878

RESUMO

INTRODUCTION: Chronic venous insufficiency (CVI) is an anomaly of the normal functioning of the venous system caused by valvular incompetence with or without the obstruction of venous flow. This condition can affect either or both of the superficial and the deep venous systems. Venous dysfunction can even result in congenital or acquired disorders, and its complications include venous leg ulcers (VLUs). The objective of this systematic review is to determine the effectiveness of Unna boot in the treatment of wound healing of VLU by assessing the quality of the available evidence. METHODS AND ANALYSIS: A literature search in PubMed, CINAHL, Scopus, Web of Science, Cochrane Library, BVS/BIREME, Embase, ProQuest, BDTD, Thesis and Dissertation Catalog, Sao Paulo Research Foundation/Thesis and dissertation, OPEN THESIS, A service of the US National Institute of Health, Center for Reviews and Dissemination-University of New York and SciElo published in the last 10 years, the period from January 1999 to March 2019. The review will include primary studies (original), and Controlled Trials or Observational studies (cross-sectional, case-control or longitudinal studies) with VLU. The exclusion will include leg ulceration due to different causes, such as pressure, arterial, diabetic or mixed-aetiology leg ulcers. Data synthesis will be performed using a narrative summary and quantitative analysis. ETHICS AND DISSEMINATION: This systematic review does not require approval by the ethics committee, as individual patient data will not be collected. Dissemination of findings will be through publications in peer-reviewed journals and/or via conference presentations. PROSPERO REGISTRATION NUMBER: CRD42019127947.


Assuntos
Curativos Oclusivos/normas , Úlcera Varicosa/terapia , Humanos , Extremidade Inferior/irrigação sanguínea , Úlcera Varicosa/etiologia , Insuficiência Venosa/complicações , Cicatrização
6.
J Thromb Thrombolysis ; 48(4): 603-609, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31432450

RESUMO

Venous ulcers are the most severe manifestation of post-thrombotic syndrome (PTS). We have previously demonstrated that formation of compact fibrin clots resistant to lysis is observed in patients following deep-vein thrombosis (DVT) who developed PTS. The current study investigated whether unfavourable fibrin clot properties can predict post-thrombotic venous ulcers. In a cohort study on 186 consecutive patients following DVT, we determined plasma fibrin clot characteristics, including clot permeability and lysability, inflammatory markers, thrombin generation, fibrinolysis proteins at 3 months since the index event. Occurrence of PTS and venous ulcers was recorded during follow-up (median, 53; range 24 to 76 months). Fifty-seven DVT patients (30.6%) developed PTS, including 12 subjects (6.45%) with a venous ulcer (4 individuals with recurrent ulcers). Patients who developed ulcers compared with the remainder had at enrolment 13.0% lower clot permeability (Ks), 17.4% longer clot lysis time (CLT), 13.1% longer lag phase of clot formation, and 5.0% higher maximum absorbance, with no difference in fibrinogen, C-reactive protein, and thrombin generation. The baseline prothrombotic fibrin clot phenotype (Ks ≤ 6.5 × 10-9 cm2 and CLT > 100 min) was associated with a higher risk of ulcers [hazard ratio (HR), 5.37; 95% confidence interval (CI), 1.3-21.5]. A multivariate model adjusted for age, sex, and fibrinogen showed that independent predictors of the ulcer occurrence were body mass index (HR 1.53; 95% CI 1.30-1.86), CLT (HR 1.43; 95% CI 1.04-2.05), and α2-antiplasmin (HR 0.95; 95% CI 0.90-0.99). This study suggests that formation of denser fibrin clots with impaired fibrinolysis predisposes to post-thrombotic venous ulcers.


Assuntos
Úlcera Varicosa/diagnóstico , Trombose Venosa/complicações , Adulto , Índice de Massa Corporal , Estudos de Coortes , Feminino , Fibrina/metabolismo , Tempo de Lise do Coágulo de Fibrina , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome Pós-Trombótica/etiologia , Fatores de Risco , Úlcera Varicosa/etiologia , alfa 2-Antiplasmina/análise
7.
BMJ Open ; 9(1): e023313, 2019 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-30610020

RESUMO

INTRODUCTION: Chronic venous insufficiency (CVI) affects up to one-third of the adult population yet venous leg ulcers (VLU), a significant complication of CVI, only affect 1%-2% of adults in the USA. Why some develop VLU and others do not is unclear. VLU have a significant impact on quality of life and are extremely costly and difficult to treat. Moreover, VLU prevalence is increasing, doubling in the last 20 years. In order to characterise the differences between people with CVI and those who ultimately develop VLU, we aim to set up the unique venous insufficiency in South Florida cohort. METHODS AND ANALYSIS: Subjects will be recruited from the University of Miami Hospital and Clinic's vascular laboratory database, which began in July 2011. Any adult age 18-95 who has had venous reflux detected on duplex ultrasound of the lower extremities is included. Approximately 2500 patients are already in the database that meet these criteria, with an estimated 2500 additional potential subjects to be recruited from the vascular laboratory database over the next 5 years. Subjects with a history of VLU prior to the duplex study date will be excluded. Data will be collected via review of the Doppler study report, patient phone interview and review of the electronic medical record. Subjects will be contacted for follow-up every 3 months for at least 5 years until the study endpoint, development of first VLU (fVLU), is reached. In order to estimate the time from reflux documentation to fVLU, Kaplan-Meier survival curves will be constructed. Cox proportional hazard regression models will be constructed to investigate possible risk factors. ETHICS AND DISSEMINATION: This study is approved by the University of Miami's Institutional Review Board. We hope to present the results of this study to the scientific community at conferences and in peer-reviewed journals.


Assuntos
Progressão da Doença , Úlcera Varicosa/etiologia , Insuficiência Venosa/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Florida , Humanos , Perna (Membro)/irrigação sanguínea , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco
8.
J Vasc Surg Venous Lymphat Disord ; 7(2): 260-271.e1, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30660582

RESUMO

OBJECTIVE: This systematic review and meta-analysis aimed to assess whether compression stockings or other interventions reduce the incidence of venous ulceration after acute deep venous thrombosis. METHODS: We searched PubMed and Embase for randomized controlled trials (RCTs), restricted to English, Spanish, and Hebrew, related to post-thrombotic syndrome and venous ulceration in participants with confirmed deep venous thrombosis. Our primary statistical assessment was the Peto odds ratio (OR). RESULTS: Our search generated 23 RCTs meeting inclusion and exclusion criteria, summing 6162 patients and 146 ulcerative events. Trials were categorized into compression, low-molecular-weight heparin (LMWH), procedural thrombolysis, medical thrombolysis, or miscellaneous. Six compression trials were identified, of which five were included in meta-analysis. Compression compared with placebo did not reduce venous ulceration (OR, 0.915; 95% confidence interval [CI], 0.475-1.765), and long-term compression was not superior to short-term compression (OR, 1.36; 95% CI, 0.014-1.31). Four LMWH trials were identified but were not subjected to meta-analysis because of intertrial heterogeneity. One trial, comparing extended tinzaparin with warfarin, demonstrated eight ulcers in the warfarin group and one ulcer in the LMWH group (relative risk, 0.125; P < .05). Three procedural thrombolysis trials were pooled into meta-analysis; fewer ulcerative events occurred in procedural thrombolysis patients, but the effect was not significant (OR, 0.677; 95% CI, 0.338-1.358). Eight medical thrombolysis trials were identified. Pooled analysis of five trials demonstrated a protective effect on ulceration in streptokinase patients vs standard heparinization (OR, 0.125; 95% CI, 0.021-0.739). However, these trials were of poor-quality study design, had small sample size, and had poor overall outcomes. Miscellaneous studies included a trial of hidrosmina, a vasoactive flavonoid, and a trial comparing 6-month warfarin treatment with 6 weeks; neither trial had significant outcomes. Intertrial heterogeneity was not adequately assessed with the I2 value as venous ulceration is a rare event; the Grading of Recommendations Assessment, Development, and Evaluation evidence for most trials was very low, with the exception of procedural thrombolysis trials, for which it was low. CONCLUSIONS: We found insufficient evidence to assess whether compression or other interventions protect against venous ulceration. To develop guidelines for treatment decisions related to prevention of venous ulceration, high-powered RCTs investigating venous leg ulcers as a primary outcome are required.


Assuntos
Anticoagulantes/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Síndrome Pós-Trombótica/prevenção & controle , Meias de Compressão , Terapia Trombolítica , Úlcera Varicosa/prevenção & controle , Trombose Venosa/terapia , Anticoagulantes/efeitos adversos , Heparina de Baixo Peso Molecular/efeitos adversos , Humanos , Síndrome Pós-Trombótica/diagnóstico por imagem , Síndrome Pós-Trombótica/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Meias de Compressão/efeitos adversos , Terapia Trombolítica/efeitos adversos , Resultado do Tratamento , Úlcera Varicosa/diagnóstico por imagem , Úlcera Varicosa/etiologia , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagem
9.
Clin Dermatol ; 37(5): 487-506, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31896404

RESUMO

Brown diseases comprise disorders leading to hyperpigmentation in skin and nails. Melasma is an acquired skin disorder that is characterized by brownish macules that typically occur on the face. Schamberg disease, also known as progressive pigmented purpura, is characterized by brown pigmentation with pepper spots on their edges. We summarize the epidemiology, pathogenesis, histologic features, and treatment choices for additional brown diseases, including melasma, pigmented purpuric dermatoses, postinflammatory hyperpigmentation, drug-induced hyperpigmentation, and pigmentations due to systemic or physiologic conditions.


Assuntos
Doenças da Unha/etiologia , Doenças da Unha/terapia , Transtornos da Pigmentação/etiologia , Transtornos da Pigmentação/terapia , Doença de Addison/complicações , Doença de Addison/diagnóstico , Cor , Síndrome de Cushing/complicações , Síndrome de Cushing/diagnóstico , Humanos , Inflamação/complicações , Ceratose Seborreica/epidemiologia , Ceratose Seborreica/etiologia , Ceratose Seborreica/terapia , Melanose/epidemiologia , Melanose/etiologia , Melanose/terapia , Membrana Mucosa , Doenças da Unha/diagnóstico , Transtornos da Pigmentação/diagnóstico , Transtornos da Pigmentação/epidemiologia , Púrpura/epidemiologia , Púrpura/etiologia , Úlcera Varicosa/diagnóstico , Úlcera Varicosa/etiologia
10.
Ann Plast Surg ; 82(1S Suppl 1): S103-S107, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30461460

RESUMO

BACKGROUND: The objective of this study was to assess the efficacy and safety of endovenous laser photocoagulation (EVLP) at a wavelength of 810 nm for treating complicated venous insufficiency associated with venous ulcers. MATERIALS AND METHODS: A retrospective review of 110 patients with 180 legs having chronic venous insufficiencies associated with varicose veins treated over an 8-year period was conducted. Patients ranged from 16 to 80 years of age and included 85 women and 25 men. Of the 110 patients, 32 (29.10%) patients with 40 legs having varicose veins were defined as having complicated varicose veins associated with venous ulcers. All 32 patients received EVLP treatment using a diode laser. Complications were evaluated at 3 weeks (early), 6 weeks (late), and 6 months (final) after EVLP treatment. The primary efficacy and final outcome measurement were determined through quantitative assessment using Hach's and clinical, etiological, anatomical, and pathophysiological classification. Safety was evaluated for each treatment group by monitoring adverse effects. RESULTS: Early complications were swelling, local paresthesia, pigmentation, minor superficial thermal injury, superficial phlebitis, and localized hematomas. All complications and ulcerations resolved completely within 2 weeks. No recurrence occurred after the study's 6-month follow-up period. Based on paired t test analysis, clinically significant differences in severity scores were discovered, which were based on Hach's classification before and after EVLP treatment at a wavelength of 810 nm. All patients achieved improvement from clinical, etiological, anatomical, and pathophysiological class C6 to C5. Permanent adverse effects were not observed. CONCLUSIONS: Endovenous laser photocoagulation at the wavelength of 810 nm permitted the use of appropriate light doses for treating complicated varicose veins associated with venous ulcers and resulted in significant improvement in lesions.


Assuntos
Procedimentos Endovasculares/métodos , Fotocoagulação a Laser/métodos , Lasers Semicondutores/uso terapêutico , Úlcera Varicosa/cirurgia , Cicatrização/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Humanos , Fotocoagulação/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Resultado do Tratamento , Úlcera Varicosa/etiologia , Varizes/etiologia , Varizes/cirurgia , Insuficiência Venosa/complicações , Insuficiência Venosa/diagnóstico , Adulto Jovem
11.
Rev Esc Enferm USP ; 52: e03394, 2018 Nov 29.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30517291

RESUMO

OBJECTIVE: To analyze the literature related to the types of therapies for venous injuries with emphasis on use of the Unna boot, and to investigate and discuss the main aspects related to its use compared to other techniques. METHOD: Integrative review of the literature of the last five years through searches in the following databases: VHL, LILACS, BDENF, SciELO, MEDLINE/PubMed. RESULTS: Twenty-two publications were identified, with 15,931 cases among adult or elderly individuals, whose mean age was 60 (35-78) years or greater with no sex differences. The Unna boot presented a shorter healing time than the single and two-layer elastic bandage. CONCLUSION: Although other compression techniques may prove to be more efficient than the Unna boot by adding more technology, the boot stands out as a traditional low-cost dressing. Multilayer bandage is a gold standard technique. This review demonstrated the best option may not be the Unna boot, because it requires a higher healing time compared to the multilayer bandage, but it meets the expectation with a high rate of treatment efficiency, also when compared to simple dressing, single or two-layer bandage.


Assuntos
Bandagens Compressivas , Úlcera Varicosa/terapia , Insuficiência Venosa/terapia , Humanos , Úlcera Varicosa/etiologia , Insuficiência Venosa/complicações , Cicatrização
12.
Br J Community Nurs ; 23(Sup12): S14-S17, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30521363

RESUMO

Venous leg ulceration is the most common form of leg ulceration, affecting 1.5% of the UK adult population. This was reviewed within the latest best practice statement (2016) which set out to create clear guidance on the assessment, management and preventing the reoccurrence of venous leg ulceration. With a growing elderly population at risk of venous insufficiency, early identification of those at risk is vital in the fight to reduce the number of people suffering with chronic venous ulceration. This article looks at the need for early assessment and commencement of appropriate treatment in order to reduce the occurrence of venous ulceration and improve clinical processes across the UK.


Assuntos
Diagnóstico Precoce , Úlcera Varicosa/prevenção & controle , Insuficiência Venosa/diagnóstico , Doença Crônica , Humanos , Medição de Risco , Reino Unido , Úlcera Varicosa/etiologia , Úlcera Varicosa/enfermagem , Insuficiência Venosa/complicações , Insuficiência Venosa/enfermagem
13.
Artigo em Russo | MEDLINE | ID: mdl-30499483

RESUMO

AIM: The objective of the present study was the evaluation of the effectiveness of the combined treatment of the patients presenting with trophic ulcers associated with chronic venous insufficiency of the lower extremities of venous etiology with the application of low-intensity laser therapy (LILT) at different wavelengths. MATERIAL AND METHODS: The study included the patients presenting with chronic venous insufficiency (CVI) (class C6 in accordance with the CEAP clinical classification). The ultrasonic Doppler examination (USDG) of the lower extremities revealed valvular insufficiency in the saphenous veins in 98.8% of the examined patients, in the deep venous system in 58% of them, and in the perforating veins in 72% of the cases. The laser Doppler flowmetry technique was used to assess the state of the microcirculation. Group 1 was comprised of 34 (43.59%) patients undergoing the traditional conservative treatment that consisted of pharmacotherapy (including antibiotic therapy, depending on the sensitivity of microflora assessed by the culture technique), the local treatment in the form of dressing in compliance with the standard surgical treatment schemes depending on the phase of the wound healing process, and elastic compression of the lower extremities. The main group 2 consisted of 44 patients (56.41%) who were treated, in addition to the traditional conservative therapy, with the use of LILT according to the new technique that combines the external laser exposure of the trophic ulcer region using the 'LASMIK' laser device during a single 2 minute session per zone in the pulsed mode (light pulse duration of 100-130 ns, frequency 80 Hz), at a wavelength of 635 nm, by a matrix emitter (consisting of eight laser diodes with the surface area of 8 cm2), at a distance up to 7 cm, with pulsed power of 40 W, power density of 5 W/cm2, and the intravenous laser blood illumination (fiber output power 2 mW) with a wavelength of 365 nm (UV range) and 525 nm (green spectrum) alternately, every other day. Each patient underwent 12 daily procedures per course. RESULTS: Combined low-intensity laser therapy promoted the rapid recovery of the sympathetic regulation of the microvascular tone and normalization of arteriolar-venular relationships which contributed to the improvement of blood supply to the tissues, the reduction of inflammation, enhanced activation of the reparative processes, and acceleration of epithelialization of trophic ulcerous defects. CONCLUSION: The combined strategy makes it possible to carry out the more effective treatment of the patients presenting with trophic ulcers with the three-fold reduction of the ulcer healing time and the pronounced stimulation of the persistent adaptation of the physiological responses preventing the development of the relapses.


Assuntos
Terapia a Laser/métodos , Úlcera Varicosa/terapia , Insuficiência Venosa/complicações , Doença Crônica , Humanos , Extremidade Inferior , Resultado do Tratamento , Úlcera Varicosa/etiologia
14.
Br J Haematol ; 183(5): 703-716, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30488425

RESUMO

Chronic venous disease (CVD) represents a significant healthcare burden. Thrombophilia is proposed as a risk factor, particularly for post-thrombotic CVD. A systematic review was performed to determine the relationship between thrombophilia and non-thrombotic CVD. MEDLINE® and Embase® databases were searched from 1946 up to March 2018. Case-control studies, cohort studies or randomised clinical trials reporting on thrombophilias in non-thrombotic lower limb CVD in adult patients were included. Non-English and post-thrombotic syndrome studies were excluded. Study selection and data extraction were performed by two reviewers. Fifteen studies were included, reporting on 916 cases and 1261 controls. Studies largely focused on venous ulceration and investigated multiple haemostatic factors. An association between thrombophilia and non-thrombotic CVD was identified, with greater prevalence and factor concentration alteration reported in patients compared to controls. Concomitant thrombophilia presence was associated with earlier CVD onset. Relationship strength varied, with commoner aetiologies showing clearer correlation than rarer ones. Thrombophilia is associated with non-thrombotic CVD but the mechanism is unclear and causation cannot be determined. Future research should focus on prospective studies with larger populations and identify adjunct therapies targeting thrombophilia.


Assuntos
Extremidade Inferior/irrigação sanguínea , Trombofilia/complicações , Doenças Vasculares/etiologia , Veias , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos/sangue , Antitrombinas/metabolismo , Fatores de Coagulação Sanguínea/metabolismo , Doença Crônica , Feminino , Fibrinólise/fisiologia , Humanos , Hiper-Homocisteinemia/complicações , Inibidor de Coagulação do Lúpus/imunologia , Masculino , Pessoa de Meia-Idade , Mutação/genética , Protrombina/genética , Fatores de Risco , Úlcera Varicosa/etiologia , Adulto Jovem
15.
Br J Community Nurs ; 23(Sup9): S6-S15, 2018 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30156878

RESUMO

Venous leg ulcers are open lesions between the knee and the ankle joint, which occur in the presence of venous insufficiency. There are theories to explain the causes of venous insufficiency, which ultimately leads to venous hypertension and can result in leg ulceration. Although many patients present with evidence of venous hypertension, others do not, except for the manifestation of the ulcer. There are risk factors associated with venous insufficiency and a holistic approach must be taken in order to influence the management approach of venous leg ulceration. This article discusses venous insufficiency as a disease process, and explores the nursing assessment process, when assessing venous leg ulcers related to venous insufficiency.


Assuntos
Avaliação em Enfermagem , Úlcera Varicosa/etiologia , Úlcera Varicosa/enfermagem , Insuficiência Venosa/etiologia , Insuficiência Venosa/enfermagem , Humanos , Fatores de Risco
16.
Ann Vasc Surg ; 52: 315.e7-315.e10, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29886209

RESUMO

Venous ulcers can be a chronic debilitating condition with a high rate of recurrence. Herein, we describe a case of a patient who successfully underwent an arterial bypass for rest pain but returned with lower extremity swelling and venous ulcers. Venography demonstrated a focal common femoral vein stenosis due to scarring from the surgical exposure. This was treated with endovenous stenting and resulted in resolution of the swelling and ulceration.


Assuntos
Implante de Prótese Vascular/efeitos adversos , Cicatriz/etiologia , Veia Femoral/cirurgia , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/cirurgia , Úlcera Varicosa/etiologia , Pressão Venosa , Angioplastia com Balão/instrumentação , Cicatriz/diagnóstico por imagem , Veia Femoral/diagnóstico por imagem , Veia Femoral/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/fisiopatologia , Flebografia , Stents , Resultado do Tratamento , Ultrassonografia de Intervenção , Úlcera Varicosa/diagnóstico , Úlcera Varicosa/terapia , Grau de Desobstrução Vascular , Cicatrização
17.
Ann Vasc Surg ; 51: 324.e1-324.e6, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29655813

RESUMO

Synovial chondromatosis (SC) is a rare, benign synovial growth most frequently involving the knee or hip joint. Common presenting symptoms include pain throughout the affected joint, reduced range of motion, and a palpable mass. We present an unusual case of SC presenting with symptoms of chronic venous stasis ulcer. A 49-year-old patient presented with swelling, hyperpigmentation, and ulcerations of his right lower extremity. Work-up including duplex and computed tomography scan revealed a calcified mass in the hip joint, highly suspicious for SC. A joint surgical approach from a vascular and orthopedic surgeon successfully removed the growths and decompressed the surrounding vessels. The mass effect of the SC on overlying veins resulted in obstruction of venous return due and subsequent venous stasis ulcerations and symptoms of venous hypertension. We present this case due to the unique vascular sequelae related to the SC to explore this as a new diagnosis to consider in patients who present with venous stasis ulceration and radiographic findings consistent with SC.


Assuntos
Condromatose Sinovial/complicações , Úlcera Varicosa/etiologia , Velocidade do Fluxo Sanguíneo , Condromatose Sinovial/diagnóstico por imagem , Condromatose Sinovial/cirurgia , Doença Crônica , Angiografia por Tomografia Computadorizada , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos , Flebografia/métodos , Fluxo Sanguíneo Regional , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Ultrassonografia Doppler de Pulso , Úlcera Varicosa/diagnóstico por imagem , Úlcera Varicosa/fisiopatologia , Úlcera Varicosa/cirurgia , Procedimentos Cirúrgicos Vasculares
18.
Surg Clin North Am ; 98(2): 337-347, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29502775

RESUMO

Chronic venous disease and venous leg ulceration are a common disease affecting millions of individuals. The fundamental problem is venous hypertension with resultant clinical manifestations of venous disease including varicose veins, skin changes, and venous leg ulceration. The pathophysiology leading to venous hypertension is complex and multifactorial, involving genetic predisposition, environmental factors, hormones, endothelial dysfunction, inflammatory cells and molecules and activation on the endothelium and vein wall, and disturbances in the balance of cytokines and matrix metalloproteinases. Understanding the pathophysiology of chronic venous disease and venous leg ulcers identifies cellular pathways, biomarkers, metabolic signatures, and cellular cross-talk for targeted therapy.


Assuntos
Úlcera Varicosa/fisiopatologia , Insuficiência Venosa/fisiopatologia , Doença Crônica , Humanos , Fatores de Risco , Úlcera Varicosa/etiologia , Insuficiência Venosa/etiologia
19.
Wounds ; 30(3): E36-E40, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29584608

RESUMO

ntroduction. Chronic nonhealing wounds are a growing health care problem in the United States, afflicting more than 6.5 million patients annually. In particular, diseases that compromise skin integrity and impair normal wound healing processes, such as diabetes and peripheral vascular diseases, are becoming more common in the aging population and leading to ever-increasing incidence of these chronic nonhealing wounds. OBJECTIVE: The aim of this study is to evaluate a viable human amnion membrane allograft (vHAMA) for the treatment of chronic nonhealing wounds in elderly patients (aged > 65 years) with multiple comorbidities. MATERIALS AND METHODS: Four patients (age range, 69-85 years) with 5 chronic wounds of varying etiologies and sizes (2 traumatic wounds, 2 diabetic foot ulcers, and 1 venous leg ulcer) that persisted for at least 4 weeks and failed previous treatment with standard of care were included in this study. Comorbidities included diabetes mellitus, obesity, polymyalgia rheumatica, lymphedema, peripheral vascular disease, steroid use, and neuropathy. All patients received vHAMA once weekly or as deemed appropriate. RESULTS: All patients reached complete wound closure with no complications or adverse events. Mean time to closure was 4.8 weeks (range, 2-8 weeks) with an average of 4.2 grafts (range, 1-8). There was no wound recurrence. CONCLUSIONS: Successful closure of wounds indicates the use of vHAMA may be beneficial for treatment of chronic wounds in elderly patients with comorbidities.


Assuntos
Âmnio/transplante , Curativos Biológicos , Pé Diabético/cirurgia , Úlcera Varicosa/cirurgia , Técnicas de Fechamento de Ferimentos , Ferimentos e Lesões/cirurgia , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Comorbidade , Pé Diabético/etiologia , Feminino , Humanos , Extremidade Inferior/lesões , Masculino , Úlcera Varicosa/etiologia , Cicatrização , Ferimentos e Lesões/etiologia
20.
J Clin Nurs ; 27(5-6): e931-e939, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28793373

RESUMO

AIMS AND OBJECTIVES: To gain insight into the experience of recurrent venous leg ulcers from the individual's perspective and provide knowledge on potential risks of recurrence not previously investigated. BACKGROUND: Venous leg ulcers are a consequence of chronic venous disease and frequently recur. They are costly and can impact on physical and psychological health. Despite research suggesting the risk can be reduced through compression and lifestyle changes, recurrence rates are often high. This study provides an insight into individual's perceptions of the cause of their ulcers and how they try to avoid them. DESIGN: A qualitative design guided by the Chronic Illness Trajectory Model and Social Cognitive Theory. METHOD: A purposive sample of three males and four females were recruited from a community nursing clinic. Participants were ulcer free, had experienced at least two previous venous leg ulcers and could speak and comprehend English. An interpretive descriptive approach was taken using semi-structured interviews and thematic analysis. RESULTS: Three themes each containing three categories emerged: The Increasing Influence of the Recurring Wound on Mind and Body, Reflection on Past Experiences and Optimism in the Face of Adversity. Most participants reported traumatic injury and lower leg surgery triggered ulcer recurrence. Failure to replace compression stockings was also deemed a cause. Compression was reported essential, but some participants were unaware of the level they were wearing and how often it should be replaced. Other preventive activities included avoiding injury and securing immediate assistance if wounding occurred. CONCLUSION: Clinicians need to be aware that lower leg surgery may trigger recurrent venous ulceration and that individuals require ongoing emotional, physical and financial support throughout the trajectory of venous disease. The continued use of old compression stockings should be avoided and recurrence prevented by adoption of evidence-based practice rather than reflection on past experiences. RELEVANCE TO CLINICAL PRACTICE: This research raises the awareness of factors from the individual's perspective which can influence the recurrence of venous leg ulcers.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Úlcera Varicosa/etiologia , Úlcera Varicosa/prevenção & controle , Adulto , Doença Crônica , Feminino , Humanos , Traumatismos da Perna/complicações , Masculino , Pessoa de Meia-Idade , Recidiva , Risco , Prevenção Secundária , Meias de Compressão/estatística & dados numéricos , Úlcera Varicosa/psicologia
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