Atención de la úlcera de pie como manifestación clínica de la esclerosis sistémica / Managing foot ulcers as a clinical manifestation of systemic sclerosis

Las úlceras pueden aparecer sobre protuberancias óseas, como las falanges proximales o los codos, pero es más probable que sean secundarias a la piel tensa y al trauma y no respondan a la terapia vasodilatadora. Todas las úlceras son muy dolorosas. El propósito de este trabajo es presentar aspectos relacionados con la atención de las úlceras digitales en la esclerodermia, según la experiencia de diferentes autores. En reumatología, se recomienda, en todo paciente con dolor reumático crónico, calcular la intensidad del dolor, tanto para la elección primera del tratamiento analgésico como para la medición de la respuesta. Y, para ello, se han propuesto varios métodos de cuantificación. El manejo de las úlceras digitales en la esclerodermia incluye la intervención no farmacológica, farmacológica y quirúrgica. El uso de nitratos, infusiones de acetilcisteína, el gel de vitamina E, entre otros métodos mejoran el tiempo de curación en pacientes con esclerodermia. La falta de terapias aprobadas por la Administración de Alimentos y Medicamentos de los Estados Unidos para las ulceraciones digitales garantiza un enfoque y una atención renovados para encontrar opciones de tratamiento significativas. Los médicos deberán emplear un enfoque terapéutico multifacético para optimizar el tratamiento de úlceras digitales existente y evitar la formación de nuevas lesiones para proporcionar a los pacientes la mejor calidad de vida(AU)

Ulcers can occur on bony bumps, such as the proximal phalanges or elbows, but are more likely to be secondary to tight skin and trauma and not responsive to vasodilator therapy. All ulcers are characteristically very painful. To present aspects related to the management of digital ulcers in scleroderma based on the experience of different authors. The management of digital ulcers in scleroderma includes non-pharmacological, pharmacological and surgical intervention. The use of nitrates, infusions of acetylcysteine, Vitamin E Gel, among other methods, improve the healing time in patients with scleroderma. The lack of US Food and Drug Administration approved therapies for digital ulcerations ensures a renewed focus and attention on finding meaningful treatment options. Clinicians should employ a multi-faceted therapeutic approach to optimize existing digital ulcers treatment and avoid new lesion formation to provide patients with the best quality of life(AU)

Trombosis venosa profunda en cirugías de tobillo y pie. Algoritmo de profilaxis / A prophylaxis algorithm for deep vein thrombosis in ankle and foot surgery

Introducción: La enfermedad tromboembólica es una de las complicaciones serias en la cirugía ortopédica. La tromboprofilaxis para las cirugías de tobillo y pie no está estandarizada, porque la incidencia es baja, según la bibliografía. El objetivo de este estudio es aportar un algoritmo de prevención para la trombosis venosa profunda y una revisión de la bibliografía. Materiales y Métodos: Se llevó a cabo una revisión de las historias clínicas de los pacientes operados entre 2011 y 2017. La muestra estaba integrada por 696 hombres (28,98%) y 1706 mujeres (71,02%), con un promedio de edad de 51 años (rango 20-82). Se realizaron 2402 procedimientos, 575 (23,94%) fueron por patologías traumáticas y 1827 (76,06%), por patologías ortopédicas. Resultados: Nueve pacientes (0,37%) presentaron trombosis venosa profunda y solo dos, tromboembolismo pulmonar (0,08%). Los procedimientos en los que ocurrieron fueron: artroscopia, reparación aguda del tendón de Aquiles, hallux valgus y fractura del 5.° metatarsiano. Conclusiones: Se recomienda un enfoque multimodal para la profilaxis de la trombosis venosa profunda. Esto incluye abordar los factores de riesgo modificables, mediante la profilaxis mecánica, la movilización temprana y la profilaxis química. La heparina de bajo peso molecular es eficaz para reducir la tasa de trombosis venosa profunda y tromboembolismo pulmonar. Nivel de Evidencia: IV

Introduction: Deep vein thrombosis (DVT) is a major complication in orthopedic surgery. According to the literature, thromboprophylaxis in foot and ankle surgery is not a standardized practice due to the low incidence of DVT. Materials and Methods: We reviewed the medical records of surgical patients. Between 2011 and 2017, 1591 surgeries were performed, 6 of them due to symptomatic DVT. Results: The incidence of DVT in major orthopedic surgeries, such as knee and hip, is well documented, but there are only a few reports about its incidence in foot and ankle surgery. It is considered a relatively rare complication in many published studies; thus, preventive drug therapy is not routine practice. Conclusions: A multimodal approach to DVT prophylaxis for high-risk patients is recommended. All risk factors should be addressed, such as mechanical prophylaxis, early mobilization, and the use of chemoprophylaxis. Low molecular weight heparin is effective in reducing the rate of clinically significant DVT and is also likely to reduce the rate of pulmonary embolism. Level of Evidence: IV

Trismus in cephalic tetanus from a foot injury

No abstract available.

Injuries Associated with the 580 km University Student Grand Voluntary Road March: Focus on Foot Injuries

College student volunteers (n = 142) completed a 580 km road march for 21 consecutive days. Each volunteer carried a backpack that weighed 14.1 +/- 1.4 kg on the average. We investigated the incidence and location of blisters associated with the road march using a foot map along with other injuries. Overall, 95.1% of the subjects (135 of 142) sustained one or more injuries. All injured subjects had foot blisters, and 18% had other foot injuries. The most common locations of blister development were the right 5th toe (61%) and the left 5th toe (57%). The little toes seem to have been subjected to the greatest friction and shearing forces. March-related injuries, excluding foot injuries, were ankle pain (12.7%), knee pain (12.7%) and Achilles tendon pain (7.7%). Six subjects (4.2%) needed extra medical treatment for more than 2 weeks prior to returning to their daily lives after completion of the march due to associated injuries. The present study observed a very high incidence rate of injuries (95.1%) associated with the 580 km university students grand road march. These injuries posed an obstacle against completion of the road march and against returning to daily life. Active preventive interventions such as physical therapy and customized reinforced shoes and education program are recommended for reducing incidence rate and severity of injuries.

Pseudoaneurisma post traumático de la arteria pedia: caso clínico / Post traumatic pseudoaneurysm of the pedal artery: case report

Pseudoaneurysm of the pedal artery is an uncommon condition that is usually caused by a traumatic injury or an iatrogenic intervention. The patient usually complains of an enlarging painless, pulsatile mass. We report a previously healthy 49 years old male presenting with a pulsatile mass of his left foot and a history of a traumatic lesion in the zone three months ago. A Doppler ultrasound examination confirmed the presence of a pseudoaneurysm of the pedal artery of 2.6 x 1.5 cm diameter. The patient underwent surgical resection of the mass and suture ligation of the artery. The postoperative period was uneventful.

Los pseudoaneurismas de la arteria pedia son infrecuentes y habitualmente se generan secundariamente a un traumatismo o a una intervención iatrogénica. Presentamos el caso de un paciente sano de 49 años que presenta un aumento de volumen pulsátil 3 meses posterior al traumatismo contuso de su pie izquierdo. En el doppler color se evidencia la presencia de un pseudoaneurisma de la arteria pedia de 2,64 x 1,53 cm. El paciente fue intervenido con resección y ligadura de la arteria con buena evolución postoperatoria.

Neoplasia maligna en cicatriz de quemadura: úlcera de Marjolin: informe de dos casos y revisión de la literatura / Malignant neoplasm in burn scar: Marjolin's ulcer: report of two cases and review of the literature

BACKGROUND: Marjolin's ulcer forms part of a group of neoplasms that originate in a burn scar, a phenomenon associated with superficial tissue trauma. The frequency of Marjolin's ulcer is low and represents between 2 and 5% of all squamous cell carcinomas of the skin. This condition is found three times more frequently in men than in women and is thought to be more aggressive than conventional squamous cell carcinoma of the skin. CLINICAL CASES: We present two cases of squamous cell carcinoma that originated on a burn scar. 41 year old woman with gasoline burn on the left foot, 3 months old, in whom an exofitic ulcerated lesion on the right calcaneum region has evolved since she was 32 years old. Left transtibial amputation was decided. Another woman who started its suffering 9 years after a thorax burn with a progressive fungus lesion on the scar area. For its size and as it was a high degree neoplasia, surgical resection and radiotherapy to the zone of the primary with 50 Gy in 25 fractions was decided. CONCLUSIONS: Marjolin's ulcer usually occurs in old burn sites that were not skin grafted and were left to heal secondarily. Although it is believed that there is a latency period of 25-40 years after burn injury before the occurrence of malignancy, this may occur in a period as short as 3 months. Recurrence after radical surgery is 14.7%. Nonetheless, because of the aggressive behavior of this type of cancer, appropriate radical treatment allows an adequate control of the disease. Early grafting of the burn site can prevent the formation a malignant neoplasm. This condition should be suspected in a non-healing chronic ulcer on a burn scar.

Fatal septicaemia caused by Chromobacterium violaceum.

We report a case of Chromobacterium violaceum septicaemia in a 10-year old boy admitted to hospital in September 2001, two weeks after he suffered a crush injury of the left foot. In spite of surgical debridement and antibiotics his condition worsened and he developed multiple liver and lung abscesses. He died one week after admission and a blood culture grew Chromobacterium violaceum.

Quality of care of patients with diabetic foot problems in Barbados

In Barbados diabetics with foot problems account for 80of the patients in the female and 50of those in the male general surgery wards, and many patients have major amputations for preventable problems. A six month prospective study was undertaken of all cases admitted with foot problems to the general surgical wards of the Queen Elizabeth Hospital (QEH) in order to determine the quality of foot care, particularly among diabetics. 67.5of the 195 patients (55female) admitted to the study were diabetic, most of whom were diagnosed 10 to 19 years previously. Most of the patients were 70 to 80 years old, but significantly more diabetics than non-diabetics were 40 to 70 years old. Foot problems in diabetics were precipitated by events that are considered trivial in non-diabetic patients. 87 (58) of 150 responding patients had their feet inspected by health personnel in the previous year. 47 (63.5) of the 74 who responded about the care of their nails said that they took care of their nails themselves. Nearly 40of diabetic and non-diabetic patients had no reported source of care before their admission. 14 patients (10 diabetic) sought care the same day and 11 (nine diabetics) the day after noticing foot problems. Most patients presented with infection as part of their problem; recognition of the early signs of infection should be an integral part of the education of the diabetic patient. Educational efforts for patients must be continually reinforced because many patients said they had had no education about the care of their feet in the previous year.

Ulcera cutánea provocada por hongos del género Fusarium / A cutaneous ulcer induced by fungi of the genus Fusarium

Se presenta el caso de un paciente oriundo y procedente del Paraguay, de 40 años de edad, portador de una ulceración crónica en cara externa del pie izquierdo, de 2 meses de evolución, debida a una hialohifomicosis por Fusarium oxysporum. Se destacan las características clínicas, métodos de diagnóstico y terapeútica de esta micosis, además de las diferentes etiologías a considerar en el diagnóstico diferencial de una úlcera en personas procedentes del área tropical o subtropical.

A case of cutaneous hyalohyphomycosis, due to Fusarium oxysporum, in a 40 years old man is presented. The patient came from Paraguay where he worked in a tropical rural area. His disease had begun 2 months before his admission as a skin ulcer located in the left leg. Clinical characteristics, diagnosis methods, differential diagnosis with other ulcers of the legs in tropical areas as well as therapeutic measures are discussed in this presentation.