Tratamento da úlcera plantar devido à hanseníase / Treatment of leprosy-induced plantar ulcers

Introdução: A úlcera plantar por hanseníase é uma lesão no pé resultante da falta de sensibilidade plantar. O objetivo é descrever o tratamento realizado em portadores de úlceras plantares por hanseníase. Métodos: Estudo de prontuários de portadores de úlcera plantar atendidos no Hospital Sarah em Brasília, de 2006 a 2016, quanto ao sexo, idade, etiologia, localização e tratamento. Resultados: Foram atendidos 27 pacientes, 17(62,96%) homens e 10 (37,04%) mulheres, procedentes de Goiás e DF, na faixa etária de 41 a 60 anos (40,74%). Todos necessitaram de um ou mais procedimentos cirúrgicos. Conclusão: Observou-se maior frequência no sexo masculino, grau avançado, localizadas no primeiro artelho. Todos necessitaram de procedimentos cirúrgicos e não cirúrgicos, evoluindo com cicatrização completa da ferida, amputação transtibial em um caso e de artelhos em sete casos, e 90% dos casos apresentaram recorrência da úlcera após um ano.

Introduction: Leprosy-induced plantar ulcers result from a lack of plantar sensitivity. Objective: This study aimed to describe the treatment provided to patients with leprosy-induced plantar ulcers. Methods: We retrospectively reviewed the medical records of patients with plantar ulcers treated at Sarah Hospital in Brasilia from 2006 to 2016 and collected information about sex, age, etiology, location, and treatment. Results: A total of 27 patients (17 [62.96%] men, 10 [37.04%] women; 40.74% were aged 41­60 years) were treated from Goiás and the Federal District. All required ≥1 surgical procedure. Conclusion: A higher frequency of advanced grade was observed in men, primarily on the first toe. All needed surgical and non-surgical procedures and achieved complete wound healing. Transtibial amputation was required in 1 case and toe amputation in 7 cases; 90% patients developed ulcer recurrence after 1 year.

Fatores de risco para mortalidade em pacientes submetidos a amputações maiores por pé diabético infectado / Risk factors for mortality among patients undergoing major amputations due to infected diabetic feet

A lesão no pé de pacientes com diabetes é um importante problema de saúde pública que frequentemente está associado a amputações em membros inferiores e mortalidade nessa população. Objetivos: Investigar os fatores de risco associados a mortalidade em pacientes com pé diabético infectado submetidos a amputação maior. Métodos: Estudo observacional, retrospectivo e caso-controle. Amostra composta por 78 pacientes com pé diabético e úlcera infectada submetidos a amputação maior em um serviço de cirurgia vascular em um hospital universitário no período de 5 anos. Resultados: A média de idade da amostra estudada foi de 63,8 ± 10,5 anos, com 54 (69,2%) pacientes do sexo masculino, com creatinina sérica média de 2,49 ± 2,4 mg/dL e hemoglobina sérica média de 7,36 ± 1,7 g/dL. Houve 47,4% de reinternação. Foi realizada amputação transtibial em 59,0% e transfemoral em 39,7% da amostra estudada. Nesta amostra, 87,2% dos pacientes apresentaram cultura positiva, predominantemente monomicrobiana (67,9%), e 30,8% presentaram infecção hospitalar da úlcera. Os gêneros de bactérias mais frequentes foram Acinetobacter spp. (24,4%), Morganella spp. (24,4%) e Proteus spp. (23,1%). Nenhum gênero bacteriano foi identificado como fator de risco para óbito. O nível de creatinina ≥ 1,3 mg/dL (OR 17,8; IC 2,1-150) e a amputação transfemoral (OR 4,5; C: 1,3-15,7) foram fatores de risco para o óbito. Conclusões: Os níveis séricos de creatinina ≥ 1,3 mg/dL e amputação transfemoral foram fatores de risco para óbito

Foot ulcers in patients with diabetes are a major public health problem and are often associated with lower limbs amputation and mortality in this population. Objectives: To investigate the risk factors associated with mortality in patients with infected diabetic foot ulcers and major lower limb amputations. Methods: This was an observational, retrospective, case-control study with a sample of 78 patients with infected diabetic foot ulcers who had major lower limb amputations at a Vascular Surgery Service at a university hospital. Results: The mean age of the study sample was 63.8 ± 10.5 years, 54 (69.2%) were male, mean serum creatinine was 2.49 ± 2.4 mg/dL and mean serum hemoglobin was 7.36 ± 1.7 g/dL.There was a 47.4% rate of readmissions to the same hospital.Transtibial amputation was performed in 59.0%; and transfemoral amputation in 39.7% of the sample. In this sample, 87.2% had a positive culture, predominantly (68.0%) monomicrobial and nosocomial infection of ulcers was observed in 30.8%. The most common bacterial genera were Acinetobacter spp. (24.4%), Morganella spp. (24.4%) and Proteus spp. (23.1%). No bacterial genus was identified as a predictor of death. Creatinine level ≥ 1.3 mg/dL (OR 17.8; IC 2.1-150) and transfemoral amputation (OR 4.5; IC: 1.3-15.7) were associated with death. Conclusions: Serum creatinine levels ≥ 1.3 mg/dL and transfemoral amputation were risk factors for death

Polyhexanide 0 2% in treatment of trophic foot ulcers in leprosy - preliminary study

Abstract: Leprosy is a chronic infectious disease caused by Mycobacterium leprae, which affects peripheral nerves, skin and mucous membranes. The impairment of neural function as well as sensory or sensory-motor disabilities in leprosy continue to be a problem that requires careful attention in the management of patients with the aim to avoid or minimize their progression to prevent sequelae. One of the most common characteristics of these ulcers is the tendency to chronicity, with variable therapeutic response. In this article, we shall discuss the therapeutic management of thirteen trophic leprosy ulcers in eight patients using polyhexanide 0.2% products.

Estudo comparativo da sensibilidade nos pés de diabéticos com e sem úlceras utilizando o PSSDÕ / Comparative study of the sensitivity of diabetic lower extremities with and without ulcers using the PSSDÕ

INTRODUÇÃO: Determinar e comparar limiares de sensibilidade cutânea nos pés de pacientes diabéticos com úlcera em apenas um dos membros inferiores. MATERIAIS E MÉTODOS: 20 pacientes foram estudados, a média de idade e de conhecimento do diabetes foi 61,6 e 12,4 anos, respectivamente. Todos os pacientes foram previamente testados com o monofilamento de Semmes-Weinstein nº 5,07. A sensibilidade foi avaliada usando o teste de discriminação entre dois pontos e o PSSDÕ (Pressure-Specified Sensory Device) para avaliar os limiares de sensibilidade de maneira quantitativa, em g/mm². Testadas três áreas da pele: polpa do hálux, dorso do pé e parte medial do calcâneo, incluindo-se quatro testes, um ponto estático, um ponto dinâmico, dois pontos estáticos e dois pontos dinâmicos. RESULTADOS: A distância média de discriminação de dois pontos em mm foi superior nos pés com úlceras, mas a diferença entre os membros inferiores teve significância estatística apenas para o hálux. Com o PSSDÕ, todos os pacientes tiveram limiares de pressão superior nos pés com úlcera, em comparação com os pés sem úlcera, em todos os testes e com significância estatística. CONCLUSÃO: O PSSDÕ foi capaz de diferenciar níveis de sensibilidade entre membros com e sem úlcera em pacientes diabéticos, com significância estatística.

INTRODUCTION: To determine and compare thresholds of cutaneous sensitivity of lower extremities in diabetic patients with an ulcer on only one lower extremity. METHODS AND MATERIALS: The study group included 20 patients with mean age of 61.6 and average time with diabetes of 12.4 years. All patients were previously tested using Semmes-Weinstein monofilament 5.07. Sensitivity was evaluated using the two point discrimination test and the PSSDÕ (Pressure-Specified Sensory Device) in order to assess touch thresholds in a quantitative manner, in g/mm². Three skin areas were tested: hallux pulp, dorsum of foot and medial heel, including four tests: 1 point static, 1 point moving, 2 points static and 2 points moving. RESULTS: Mean 2 point discrimination distance in mm was higher in feet with ulcers, but the difference between extremities was only statistically significant for the hallux. With the PSSDÕ, all patients had higher pressure thresholds in feet with ulcers when compared with feet without ulcers, in all tests, with statistical significance. CONCLUSION: The PSSDÕ was able to differentiate levels of sensation between extremities with and without ulcers in diabetic patients, with statistical significance.

Problemas en los pies de los pacientes con diabetes (segunda entrega): evaluación y manejo de las infecciones / Feet problems in diabetic patients (second part): evaluation and management of infections

La afección del pié en los pacientes con diabetes constituye por su importancia una entidad en si misma. En el espectro de su afectación encontraremos desde simples cambios en la sensibilidad y el trofismo de la piel, hasta úlceras de diferente magnitud, lesiones necróticas y osteomielitis, que pueden conducir a amputaciones y aún, comprometer la vida del paciente. En una entrega anterior desarrollamos aspectos generales del pié en las personas con diabetes y en particular, el abordaje de las ulceras no infectadas. En esta entrega se profundiza sobre el abordaje y manejo de las infecciones del pie, particularmente de las lesiones ulceradas y la osteomielitis.

Predictive values of risk factors in management of diabetic foot

Outcome of management of patients with diabetic foot is difficult to predict. Assessment of variables in history, examination and investigations were analyzed with outcome of management and whether can be assigned as prognostic factors. Prospective study of 300 patients with diabetic foot in Baghdad teaching hospital during the period from April 2000 to March 2004, certain criteria were taken in history and examination, these were investigated and treated either by conservative procedure or amputation. Most common age group was 50-59 years [33.3%]. The male to female ratio was 2:1. Conservative debridement was performed in [60%] of patients while amputation was employed in [40%]. Amputation was performed in 604 of patients above 60 years and in [75%] of patients who had diabetic foot lesions for > 2 weeks, and in 90% of smokers for 10 years or more. Amputation was needed in [71%] in those who had history of previous ulceration and 72.5% of patients who had positive history of previous amputation. Amputation was needed in [88%] of those who had their temperature >38°C, in [91%] of patients who had diabetic foot lesion of Wagner grade>III and 91% patients with X-ray findings of osteomyelitis. Highly significant association was found between amputations with following variables, smokers > 10 years, patients with a temperature of > 38°C, Hypertension > 140/90 mmHg Wagner grade >III, white blood cell count of > 20.000/cc and positive foot X-ray findings. Slight significant association of amputation and the following variables: Age >60 years, duration of foot lesion >2 weeks, history of previous amputation, previous ulceration, negative pedal pulses, deformed feet and patients who had impaired normal vision

Squamous cell carcinoma in plantar ulcers in leprosy: a study of 11 cases.

The objectives of our study were to describe and analyse the malignancies that occurred in plantar ulcers of leprosy patients. The possible predisposing conditions, duration and extent of the spread of the tumour were also studied. All patients with trophic ulcer of the foot attending the urban leprosy clinic in our hospital from January 1998 to January 2003 were screened for change to malignancy. During the study period, 79 cases of plantar ulcers in leprosy were seen. The mean age of these cases was 39.9 years with male-to-female ratio of 4:1. Eleven cases with plantar ulcers and malignant change were diagnosed in our hospital during the study period. The male-to-female ratio was 4.5:1. The mean age of these patients was 60.6 years. Their age ranged from 46 to 75 years. Nine of the cases were treated cases of borderline tuberculoid leprosy, while two had treated lepromatous leprosy. In our study, two distinct morphological types of malignant changes were seen. Histopathologically, all cases, except one, were of well-differentiated squamous cell carcinoma variation; one case had verrucous carcinoma. Though trophic ulcers are common in leprosy cases, only long-standing and neglected ones undergo malignancy.

Absorçäo óssea podal bilateral progressiva associada a mal perfurante, osteomielite e septicemia fatal / Progressive feet bone absorption in association with \"Mal Perforant\", osteomyelitis and fatal sepsis

Os autores relatam um caso seguido no Hospital das Clínicas da Faculdade de Medicina de Ribeiräo Preto da Universidade de Säo Paulo apresentando uma síndrome trófica cutânea e óssea associada a uma síndrome sensitivo-motora, que evoluiu com mal perfurante plantar e osteomielite complicada com septicemia fatal

Malignant transformation of plantar ulcers in leprosy.

Malignant transformation of plantar ulcers in leprosy is not uncommon. The apparent rarity of these neoplasms could be because many observed cases are not reported. To determine the extent of the problem, 133 consecutive cases of plantar ulcers seen over two years were studied clinically as well as histologically. Plantar ulcers were more common in the distal third of foot (64.67%) but malignant transformation was seen more often in plantar ulcers of proximal third of foot (64.29%). Malignant transformation was more common in plantar ulcers of long duration. Histologically, most of the lesions were benign, being instances of pseudo-epitheliomatous hyperplasia (57.89%) or atypical pseudo-epitheliomatous hyperplasia (13.53%). However, squamous cell carcinoma was observed in 10.53% cases. Thus it may be that more cases with this complication will be detected if it is borne in mind that malignant change may be encountered in such ulcers.