Progress in clinical diagnosis and treatment of diabetic Charcot neuroarthropathy of foot and ankle / 中国修复重建外科杂志

OBJECTIVE@#To summarize the progress of clinical diagnosis and treatment of diabetic Charcot neuroarthropathy (CNO) of foot and ankle to provide reference for clinical treatment.@*METHODS@#The research literature on diabetic CNO of foot and ankle at home and abroad was widely reviewed, and the stages and classification criteria of CNO were summarized, and the treatment methods at different stages of the disease course were summarized.@*RESULTS@#CNO is a rapidly destructive disease of bone and joint caused by peripheral neuropathy, which leads to the formation of local deformities and stress ulcers due to bone and joint destruction and protective sensory loss, which eventually leads to disability and even life-threatening. At present, the modified Eichenholtz stage is a commonly used staging criteria for CNO of foot and ankle, which is divided into 4 stages by clinical and imaging manifestations. The classification mainly adopts the modified Brodsky classification, which is divided into 6 types according to the anatomical structure. The treatment of diabetic CNO of foot and ankle needs to be considered in combination with disease stage, blood glucose, comorbidities, local soft tissue conditions, degree of bone and joint destruction, and whether ulcers and infections are present. Conservative treatment is mainly used in the active phase and surgery in the stable phase.@*CONCLUSION@#The formulation of individualized and stepped treatment regimens can help improve the effectiveness of diabetic CNO of foot and ankle. However, there is still a lack of definitive clinical evidence to guide the treatment of active and stable phases, and further research is needed.

Research advances on the clinical characteristics and diagnosis and treatment of autoimmune disease-related ulcers / 中华烧伤杂志

Studies have shown that autoimmune disease (AID)-related ulcers are disease complications that lead to serious poor prognosis such as infection and disability. It is difficult to make a clear diagnosis and there are contradictions between the applications of immunosuppressive therapy and anti-infectious therapy. Improper diagnosis and immunosuppressive therapy can easily delay the timing of anti-infectious therapy and surgery for patients, which bring adverse effects on the prognosis of patients. This paper reviews the concept, clinical characteristics and treatment suggestions of each subtype of AID-related ulcers, in order to provide more ideas for AID-related ulcers' clinical diagnosis and treatment.

Diagnostic challenge between Crohn's disease and intestinal tuberculosis in chronic diarrhea with ulcerated jejunal stenosis: a case report / Desafío diagnóstico entre la enfermedad de Crohn y la tuberculosis intestinal en la diarrea crónica con estenosis yeyunal ulcerada: reporte de un caso

ABSTRACT Intestinal tuberculosis and Crohn's disease are a diagnostic challenge because of the clinical, radiological and endoscopic similarity. The histological and microbiological findings are positive in less than 50%, which delays the correct treatment, putting the patient at risk. We reported a 34-year-old immunocompetent patient with 4 years of malabsorptive diarrhea, weight loss, nocturnal diaphoresis, abdominal pain and an ulcer with stenosis in the jejunum was found; she received empirical anti- tuberculosis treatment with clinical improvement. Later the culture was positive for M. tuberculosis.

RESUMEN La tuberculosis intestinal y la enfermedad de Crohn son un desafío diagnóstico debido a la similitud clínica, radiológica y endoscópica. Los hallazgos histológicos y microbiológicos son positivos en menos del 50%, lo que retrasa el correcto tratamiento, poniendo en riesgo al paciente. Reportamos un paciente de 34 años inmunocompetente con 4 años de diarrea malabsortiva, pérdida de peso, diaforesis nocturna, dolor abdominal y se encontró una úlcera con estenosis en yeyuno; recibió tratamiento empírico antituberculoso con mejoría clínica. Posteriormente el cultivo fue positivo para M. tuberculosis.

Puntos de encuentro entre las teorías de Roy y Orem en la atención a ancianos con úlcera neuropática / Coinciding Points between Roy's and Orem's Theories in the Care of Elderly Patients with Neuropathic Ulcer

RESUMEN Introducción: El envejecimiento poblacional es un problema demográfico a nivel mundial, esto trae consigo el aumento de enfermedades crónicas no trasmisibles, como la diabetes mellitus, con complicaciones asociadas por daño en los nervios periférico como la úlcera neuropática. Por todo esto, es responsabilidad del personal de enfermería de buscarle solución a las necesidades de estos pacientes utilizando las teorías de Sor Callista Roy y Dorothea E. Orem para mejorar del estado de salud y adaptarse a la situación de cronicidad del padecimiento, para continuar con el diario vivir con el mayor grado de independencia posible y el menor grado de discapacidad. Objetivo: Analizar los puntos de encuentro entre las teorías de Roy y Orem en la atención al anciano con úlcera neuropática. Métodos: Revisión bibliográfica sistemática para desarrollar un análisis crítico reflexivo del contenido de artículos originales y de revisión. La estrategia de búsqueda adoptada fue la utilización de las palabras clave o descriptores, conectados por intermedio del operador booleano AND, en las bases de datos SciELO, (Scientific Electronic Library Online), Ebsco (Elton Bryson Stephens Company), LILACS (Literatura Latino-Americana e do CaribeemCiências da Saúde); y MEDLINE/Pubmed (Medical Literature Analysis and Retrieval System Online); durante el mes de enero de 2017. Conclusiones: La meta de la enfermería es promocionar modos de adaptación que apoyen la integridad psicofísica, identidad grupal de autoconcepto, función de rol e interdependencia para lograr la salud global de los ancianos con úlcera neuropática(AU)

ABSTRACT Introduction: Population aging is a demographic concern worldwide and causes the increase of chronic noncommunicable diseases, such as diabetes mellitus, with complications associated with peripheral nerve damage such as neuropathic ulcer. Because of all this, it is the responsibility of the nursing staff to find a solution to the needs of these patients, by using the theories of Sister Callista Roy and Dorothea E. Orem, in order to improve the state of health and make them adapt to the chronicity of the condition, to continue with their daily live with the highest possible degree of independence and the lowest degree of disability. Objective: To analyze the coinciding points between Roy and Orem's theories in the care of the elderly with neuropathic ulcer. Methods: Systematic bibliographic review for carrying out a critical reflexive analysis of the content of original and review articles. The search strategy adopted was the use of keywords or descriptors, connected through the Boolean operator AND, in the SciELO, Ebsco, LILACS and MEDLINE/Pubmed databases, during the month of January 2017. Conclusions: The purpose of nursing is to promote ways of adaptation that support psychophysical integrity, group identity for self-concept, the function of role and interdependence to achieve the overall health of the elderly with neuropathic ulcer(AU)

Diagnostic delay in a patient with reactional lepromatous leprosy treated as testicular tuberculosis

Abstract Leprosy is a chronic neglected and stigmatizing disease. Due to involvement of the peripheral nerves, it can result in physical disabilities, deformities, and emotional damage if not diagnosed and treated promptly. This is the case of a young patient with testicular pain and swelling and no improvement after a specific therapeutic scheme for tuberculosis. Clinical and laboratory reevaluation revealed hypoesthetic skin patches associated with post-burn crusted ulcers on the left arm, thickening of ulnar nerves, atrophy of interosseous muscles of the hands, positive skin smear microscopy, and testicular histopathology with numerous bacilli forming globi. These findings indicated lepromatous leprosy with type II reaction.

Adaptación de la teoría de Dorothea Orem a personas con diabetes mellitus complicada con úlcera neuropática / Dorothea E. Orem's Self-Care Deficit Theory's Adaptation to People with Diabetes Mellitus and Complicated Neuropathic Ulcer

RESUMEN Introducción: Las actividades de autocuidado se aprenden conforme el individuo madura, y son afectadas por creencias culturales, hábitos, costumbres de la familia y la sociedad. La edad, las etapas del desarrollo y el estado de salud, pueden afectar la capacidad del individuo para realizar actividades de autocuidado. Objetivo: Mostrar la adaptación de la teoría del déficit de autocuidado de Dorothea E. Orem a personas con diabetes mellitus complicada con úlcera neuropática. Métodos: Revisión bibliográfica sistemática para desarrollar un análisis crítico reflexivo del contenido de artículos originales y de revisión. La estrategia de búsqueda adoptada fue la utilización de las palabras clave o descriptores, conectados por intermedio del operador booleano AND. La búsqueda fue realizada en las bases de datos SciELO, (ScientificElectronic Library Online), Ebsco (Elton Bryson Stephens Company), LILACS (Literatura Latino-Americana e do CaribeemCiências da Saúde); y MEDLINE/Pubmed (Medical LiteratureAnalysis and RetrievalSystem Online); durante el mes de enero de 2017. Conclusiones: Se fundamenta la relevancia del autocuidado de personas diabéticas complicadas con úlcera neuropática en la comunidad y se pone de manifiesto la carencia de estudios específicos de este tipo desde la perspectiva de Enfermería. El logro de la toma de conciencia del autocuidado que requiere la persona afectada con diabetes mellitus complicadas con úlcera neuropática en función de mejorar o mantener el estado de salud, a través de las posibilidades que le brinda al enfermero de la comunidad(AU)

ABSTRACT Introduction: Self-care activities are learned as the individual matures, and are affected by cultural beliefs, habits, customs within the family and the society. Age, stages of development and health status can affect the individual's ability to perform self-care activities. Objective: To describe Dorothea E. Orem's self-care deficit theory's adaptation to people with diabetes mellitus complicated by neuropathic ulcer. Methods: Systematic bibliographic review for carrying out a reflexive critical analysis of the content of original and review articles. The search strategy adopted was the use of keywords or descriptors, connected through the Boolean operator AND. The search was carried out in the databases SciELO (Scientific Electronic Library Online), Ebsco (Elton Bryson Stephens Company), LILACS (Latin American Literature and Caribeem Ciências da Saúde), and MEDLINE/Pubmed (Medical Literature Analysis and Retrieval System Online), during the month of January 2017. Conclusions: The relevance is supported regarding the self-care of diabetic people with complicated neuropathic ulcer in the community. The lack is shown of specific studies of this type from the nursing perspective. The achievement represented by raising awareness about self-care as required by the person affected with diabetes mellitus with complicated neuropathic ulcer for improving or maintaining the state of health, through the possibilities offered to the community nurse(AU)

Níveis plasmáticos de homocisteína em mulheres idosas com úlceras nos pés / Plasma levels of homocystein in women elderly with ulcers in the foot

Introdução: A homocisteína é um amino ácido produzido no fígado e seus níveis elevados apresentam relação com aterosclerose e úlceras. Objetivo: Avaliar os níveis plasmáticos de homocisteína de mulheres idosas com úlceras nos membros inferiores. Métodos: Participaram 40 mulheres idosas, idade média 67,4±6,49 anos, divididas em grupo com úlcera (GU) e controle (GC). A avaliação da presença de úlcera foi realizada por observação, a avaliação da concentração de homocisteína (µmol/L) foi realizada por high performance liquid chromatography (HPLC) e a aferição da pressão arterial foi realizada pelo uso de um esfigmomanômetro aneroide ­ HICO HM 1001. Resultados: Níveis de homocisteína mais elevados para o grupo úlcera 17,69 ± 6,82 versus controle 11,70 ± 1,51. As pressões arteriais sistólica e diastólica não apresentaram diferenças entre os grupos ulcera 134,16±19,28/74,16±11,64 e controle 136,15±16,09/77,69 ± 5,99 respectivamente. Conclusão: Conclui-se que os níveis plasmáticos de homocisteína em mulheres idosas com úlcera estão aumentados.

Introduction: Homocysteine is an amino acid produced in the liver and its elevated levels are related to atherosclerosis and ulcer. Objective: To evaluate the plasma levels of homocysteine of elderly women with ulcers in the lower limbs. Methods: Participated 40 elderly women, mean age 67.4 ± 6.49 years, separated into ulcer (GU) and control (CG) groups. The evaluation of the presence of ulcer was performed by observation, the homocysteine concentration (µmol/L) was evaluated by high performance liquid chromatography (HPLC) and blood pressure was measured using an aneroid sphygmomanometer HICO HM 1001. Results: Higher homocysteine levels for the ulcer group 17.69 ± 6.82 vs control 11.70 ± 1.51. The systolic and diastolic blood pressures did not differences between the ulcer group 134,16±19,28/74,16±11,64 and control group 136,15±16,09/77,69±5,99, respectively. Conclusion: It is concluded that plasma levels of homocysteine in elderly women with ulcer are increased.

Herpes genital crônico: relato de caso e revisão da literatura / Chronic genital herpes: case report and literature review

Úlceras genitais são manifestações clínicas de etiologias diversas, o que pode dificultar o diagnóstico. Este relato de caso trata­se de mulher de 64 anos, com histórico de úlcera genital dolorosa há 4 meses, progressiva apesar do uso prévio de antiviral. Apresentava lesão ulcerada com comprometimento perianal. Histopatológico revelou neovascularização, edema e infiltrado inflamatório. Realizou tratamento com aciclovir endovenoso por 14 dias, com melhora parcial. O herpes simples crônico manifesta­se como verruga ou úlcera de pelo menos um mês, geralmente em imunossuprimidas. A resistência a agentes antivirais é uma complicação encontrada, mas a resposta ao tratamento costuma ser mais lenta do que nas infecções comuns.

Genital ulcers are clinical manifestations of diverse etiologies, which can make diagnosis difficult. This case report is about a 64­year­old woman with a history of progressive genital ulcer pain for 4 months, despite prior antiviral use. The ulcerated lesion showed perianal involvement. Histopathology revealed neovascularization, edema and inflammatory infiltrate. Despite the use of intravenous acyclovir for 14 days, the improvement was partial. Chronic herpes simplex reveals wart or ulcer of at least one month, usually in immunosuppressed patients. A resistance to antiviral agents is a complication factor, but the treatment response to common infections is usually slower.

Multiple Pyogenic Liver Abscesses Caused by Microperforation of an Idiopathic Cecal Ulcer / 대한소화기학회지

Idiopathic cecal ulcer is a rare disease entity of unknown cause diagnosed by ruling out other known causes of cecal ulceration. The most common complication of an idiopathic cecal ulcer is bleeding; perforation, peritonitis, abscess, and stricture formation have been noted. The authors treated a 53-year-old woman who presented with fever and intermittent right upper quadrant abdominal pain. Multiple pyogenic liver abscess and a solitary cecal ulcer were diagnosed by radiologic, endoscopic, and pathologic examination, followed by laparoscopic cecectomy. After extensive study, we concluded that this patient's liver abscesses were a complication of the idiopathic cecal ulcer. Herein, we report a case of multiple pyogenic liver abscess caused by microperforation of idiopathic cecal ulcer.

Atividade antiulcerogênica do extrato aquoso de Salvia officinalis L. (Lamiaceae) / Antiulcerogenic activity of aqueous extract of Salvia officinalis L. (Lamiaceae)

RESUMO As úlceras pépticas são decorrentes de um desequilíbrio entre os agentes agressores endógenos, exógenos e agentes protetores. Neste estudo avaliou-se a atividade antiulcerogênica in vivo para o extrato aquoso de Salviaofficinalis (EAS). Após os tratamentos (n = 6; v.o) com o controle (C) água; pantoprazol (30 mg/kg) e EAS (100, 250 e 400 mg/kg, respectivamente) os ratos receberam uma solução de HCl 0,3 M em etanol 60% (v.o) e realizaram-se avaliações morfológicas dos estômagos por meio de uma tabela de escores de lesão (ANOVA; one way e Tukey). EAS (400 mg/kg) apresentou atividade antiulcerogênica (31,47%) semelhante ao pantoprazol (33,83%) em comparação (p<0,0001) com o grupo C. A análise fitoquímica por cromatografia líquida de alta eficiência revelou uma elevada concentração de ácido rosmarínico (3,53%) para EAS. Os flavonoides (0,25%) e os fenóis totais (309,0 EAG) foram quantificados por espectrofotometria de UV/Vis. EAS e ácido rosmarínico apresentaram elevadas atividades antioxidantes por DPPH (Concentração Efetiva 50%-CE50 9,2 e 0,7 mg/mL, respectivamente) justificando pelo menos em parte, o efeito antiulcerogênico do extrato.

ABSTRACT Peptic ulcers are caused by an unbalance among endogenous, exogenous damaging agents and protective agents. In this study we evaluated the in vivo antiulcerogenic activity for the aqueous extract of Salvia officinalis (EAS). After treatments (n = 6; v.o) with control (C) water; pantoprazole (30 mg/kg) and EAS (100, 250 and 400 mg/kg, respectively) the rats received a 0.3 M HCl solution in ethanol 60% (v.o) and it were performed morphological evaluations of the stomachs through the use of a table of injury scores (ANOVA, one way and Tukey). The EAS (400 mg/kg) showed an antiulcerogenic activity (32.53%). Similar to the pantoprazole (29.91%), in comparison with (p<0.0001) the group C. The phytochemical analysis through high performance liquid chromatography revealed high acid rosmarinic (3.53%) for the EAS. The flavonoids (0.25%) and the total phenolics (GAE 309.0) were quantified by spectrophotometry UV/Vis. The EAS and the rosmarinic acid exhibited elevated antioxidant activities by DPPH (Effective Concentration 50% -EC50 9.2 and 0.7 mg/mL, respectively,) at least partially explaining the antiulcerogenic effect of the extract.

Successful Management of Recurrent Colon Ulcer in Hemodialysis Patient after Conversion to Peritoneal Dialysis / 대한소화기학회지

Lower gastrointestinal complications often develop in end stage renal disease patients, and among the more problematic is recurrent colon ulcer. The exact pathogenesis of this condition is not known and there were no specific therapeutic modalities concerning this type of disease entity. We report, with a literature review, a case of recurrent colon ulcer with intermittent hematochezia in an end stage renal disease patient on long term hemodialysis that improved after conversion to peritoneal dialysis.

First Report of Myiasis Caused by Cochliomyia hominivorax (Diptera: Calliphoridae) in a Diabetic Foot Ulcer Patient in Argentina

Myiasis is usually caused by flies of the Calliphoridae family, and Cochliomyia hominivorax is the etiological agent most frequently found in myiasis. The first case of myiasis in a diabetic foot of a 54-year-old male patient in Argentina is reported. The patient attended the hospital of the capital city of Tucuman Province for a consultation concerning an ulcer in his right foot, where the larval specimens were found. The identification of the immature larvae was based on their morphological characters, such as the cylindrical, segmented, white yellow-coloured body and tracheas with strong pigmentation. The larvae were removed, and the patient was treated with antibiotics. The larvae were reared until the adults were obtained. The adults were identified by the setose basal vein in the upper surface of the wing, denuded lower surface of the wing, short and reduced palps, and parafrontalia with black hairs outside the front row of setae. The main factor that favoured the development of myiasis is due to diabetes, which caused a loss of sensibility in the limb that resulted in late consultation. Moreover, the poor personal hygiene attracted the flies, and the foul-smelling discharge from the wound favoured the female's oviposition. There is a need to implement a program for prevention of myiasis, in which the population is made aware not only of the importance of good personal hygiene and home sanitation but also of the degree of implication of flies in the occurrence and development of this disease.

Avaliação da ação do uso tópico de heparina encapsulada em nanopartículas poliméricas recobertas com quitosana em modelo de úlcera de pele em ratos / Evaluation of the action of topical use of encapsulated heparin in polymeric nanoparticles recovered by chitosan in rat skin ulcer model

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Intestinal Paragonimiasis with Colonic Ulcer and Hematochezia in An Elderly Taiwanese Woman

A 94-year-old female with end-stage renal disease presents with fever, fatigue, and hematochezia. She had previously resided in Hunan Province, China, and Myanmar, and she immigrated to Taiwan 30 years ago. Colonoscopy revealed a colonic ulcer. Biopsy of the colonic ulcer showed ulceration of the colonic mucosa, and many Paragonimus westermani-like eggs were noted. Serum IgG antibody levels showed strong reactivity with P. westermani excretory-secretory antigens by ELISA. Intestinal paragonimiasis was thus diagnosed according to the morphology of the eggs and serologic finding. After treatment with praziquantel, hematochezia resolved. The present case illustrates the extreme manifestations encountered in severe intestinal paragonimiasis.

Esophageal Sinus Formation due to Cyanoacrylate Injection for Esophageal Variceal Ligation-induced Ulcer Bleeding in a Cirrhotic Patient / 대한소화기학회지

Intravariceal injection of N-butyl-2-cyanoacrylate is widely used for the hemostasis of bleeding gastric varices, but not routinely for esophageal variceal hemorrhage because of various complications such as pyrexia, bacteremia, deep ulceration, and pulmonary embolization. We report a rare case of esophageal sinus formation after cyanoacrylate obliteration therapy for uncontrolled bleeding from post-endoscopic variceal ligation (EVL) ulcer. A 50-year-old man with alcoholic liver cirrhosis presented with hematemesis. Emergent esophagogastroscopy revealed bleeding from large esophageal varices with ruptured erosion, and bleeding was initially controlled by EVL, but rebleeding from the post-EVL ulcer occurred at 17th day later. Although we tried again EVL and the injections of 5% ethanolamine oleate at paraesophageal varices, bleeding was not controlled. Therefore, we administered 1 mL cyanoacrylate diluted with lipiodol and bleeding was controlled. Three months after the endoscopic therapy, follow-up endoscopy showed medium to large-sized esophageal varices and sinus at lower esophagus. Barium esophagography revealed an outpouching in esophageal wall and endoscopic ultrasonography demonstrated an ostium with sinus. It is noteworthy that esophageal sinus can be developed as a rare late complication of endoscopic cyanoacrylate obliteration therapy.

Avaliação dos efeitos clínicos da fototerapia em úlceras venosas / Evaluation of clinical effects of phototherapy in venous ulcers

As úlceras venosas são lesões do sistema tegumentar de difícil cicatrização. Essas lesões são freqüentes em pacientes portadores de insuficiência venosa crônica e representam cerca de 80 por cento das lesões ulcerativas em membros inferiores. O objetivo deste trabalho foi avaliar os efeitos da ledterapia sobre o processo de cicatrização de úlceras venosas crônicas em uma paciente do gênero feminino, portadora de insuficiência venosa. Os resultados mostraram que todas as lesões apresentaram sinais de cicatrização, com redução da área das feridas após a introdução da ledterapia, sugerindo que esse recurso foi eficaz em aprimorar o processo de cicatrização das úlceras venosas da participante deste caso.

The venous ulcers are lesions of cutaneous tissue very difficult to heal. These lesions are frequent in patients with chronic venous insufficiency and about 80 percent of ulcerated lesions are on lower limbs. The objective of this study was to evaluate the effects of LED therapy on healing process of chronic venous ulcers of a female patient with venous insufficiency. The results showed that all lesions showed signs of healing, with wounds area reduction after beginning LED therapy, suggesting that this action was effective in improving healing process of venous ulcers of the participant of this case study.