Can individualised nutritional support improve healing in therapy-resistant leg ulcers?

OBJECTIVE: This study investigated whether an individually designed programme of nutritional support can improve healing in otherwise therapy-resistant venous leg ulcers. METHOD: Six primary health-care patients, aged between 79 and 93 years, with venous ulcers that had been open for one year or more (range: 1.5-8 years) were recruited into the study. The patients were asked to follow an individualised diet plan which included the use of liquid dietary supplements. Ulcer area, anthropometric and biochemical variables, and energy and nutrient intake were assessed before intervention and then regularly for nine months. RESULTS: At nine months ulcer healing had occurred in two patients, of whom one had had ulcers on both legs. In a third patient the ulceration on one leg had healed and that on the other leg had almost healed. In a fourth patient, the ulcer area reduced by approximately 90%. CONCLUSION: The use of nutritional support might have assisted the wound healing in these patients. Although the relationship between nutritional supplementation and wound healing is not well defined, an appropriate nutritional plan is recommended if undernourishment is suspected and leg ulcers are not healing.

Injuries to pathologically changed cervical vertebrae.

Three cases of fatal injuries to the upper cervical spinal cord and underlying cervical spine pathology are presented. It is stressed that the slightest suspicion concerning injuries to the upper part of the neck must lead not only to microscopic examination of the cervical spinal cord and medulla oblongata, but also to careful preparation (or maceration) of the upper cervical spine, in order not to overlook fractures or misinterpret old fractures and diseases as fresh fractures.

Fractures of the arches of the atlas: a study of their causation.

The autopsy findings in 32 accidental deaths which showed fracture(s) of the arches of the atlas have been correlated to reconstructions of the course of events in the accidents. Flexion of the head causing fracture(s) of the neural arch or odontoid process of the axis also resulted in fracture(s) of the posterior arch due to downward traction. Extension of the head causing fracture of the odontoid process of the axis gave rise to fractures of the posterior arch due to pressure from below. Tilting of the head caused marginal fractures of the anterior arch due to oblique traction. Tilting of the head also caused fracture(s) of the anterior and/or posterior arch due to transverse extension of the atlas ring and/or superior dislocation of one lateral mass in relation to the other. Oblique flexion or extension of the head resulted in similar fractures. Flexion of the head with some rotation combined with compression of the neck can cause the anterior margin of one upper joint surface of the axis to act as a wedge separating the anterior arch of the atlas from below. Extension of the head with some rotation combined with compression of the neck can lead to a fracture running through one lateral mass due to its tilting-dislocation in posterior direction. It is striking that there was no fracture of the atlas which could be ascribed to a simple and symmetric compression of the neck (classical Jefferson's fracture).

Sagittal fractures of the cervical spine.

Two cases of sagittal fracture of cervical vertebral bodies have been studied. The findings indicate that the fractures were a consequence of forces directed forwards against the posterior surfaces of the vertebral bodies due to flattening of the vertebral rings in an anterior--posterior direction.

Fractures of the axis caused by hanging.

Prerequisities for fractures of the neural arch of the axis in the region of the isthmus (hangman's fracture) during hanging are considered to be a long drop and a submental knot. A case is presented showing that hangman's fracture arising in hanging can result from stretching of the neck combined with anteroflexion of the head.

Spinal injuries in belt-wearing car occupants killed by head-on collisions.

In 34 post-mortem examinations of car occupants wearing seat belts and killed in straight or oblique head-on collisions, a thorough investigation of the spine was performed. The autopsy results were correlated with the findings in the cars in order to reconstruct the events when the occupant's body struck the interior of the car. In 2 cases the victims had worn lap belts, in 15 cases shoulder belts and in 17 cases combined shoulder-lap belts (three-point belts). In victims involved in head-on collisions while wearing lap belts, fractures of the neural arch of the axis were found which were probably due to flexion of the neck pivoting round the lower part of the impacting face and simultaneous stretching of the neck. Severe injuries to the cervical spine in those victims wearing shoulder belts were mainly due to the occupant sliding under the belt which then caught the neck and mandible. Such injuries were also caused by the impact of the head against forward parts of the car. In those wearing shoulder-lap belts injuries to the upper part of the cervical spine resulted from the impact of the head against internal parts of the car. When a slight impact of the head occurred minor injuries to the lower cervical spine were seen. Injuries to the thoracolumbar spine in the cases examined were the consequence of a violent extension between the upper part of the trunk held back by the shoulder belt and the pelvis restrained by the lap belt or by the knees striking the fascia panel. In front seat occupants this extension can be increased if either rear seat occupants without belts or heavy objects on the rear seat are projected forwards against their backs.