Download the Free Unbound MEDLINE PubMed App to your smartphone or tablet.
Available for iPhone, iPad, iPod touch, and Android.
Venous Insufficiency Ulcers [keywords]
- Leg ulcer study to look at exercise. [Journal Article]
- Nurs Stand 2014 Aug 6; 28(49):11.
Scientists are examining whether exercising can help improve outcomes for patients with leg ulcers caused by chronic venous insufficiency.
- Effectiveness of prostaglandin E1 in patients with mixed arterial and venous ulcers of the lower limbs. [JOURNAL ARTICLE]
- Int Wound J 2014 Aug 5.
Mixed arterial and venous ulcers of the lower limbs are present in around 15-30% of patients with chronic venous ulcers (CVUs) and are considered difficult-to-heal wounds. The aim of this study was to evaluate the results of the treatment of mixed arterial and venous ulcers of the lower limbs with prostaglandin E1 (PGE1) infusion. This study was carried out in 48 consecutive patients. Patients who showed intolerability to PGE1, and patients with peripheral neuropathy, blood or systemic diseases, malignancy and acute wound infections or necrotic tissue on the wound bed were excluded. The patients were separated at random into two main groups: group I (25 patients) received standard treatment and PGE1 infusion. Group II (23 patients) received only standard treatment. Pre-treatment data indicated the area of ulceration. The number of healed ulcers and the variation in the area of ulceration were considered as endpoints. The endpoints were noticed after 120 days from the beginning of treatment. Healing occurred in 80% of limbs of group I and in 52·2% of limbs of group II patients. The average reduction in area was 92% versus 60% in patients of group I and II, respectively. During the whole treatment period, the incidence of adverse events was 8% in group I: there was one case of headache and one case of headache and hypotension combined. No side effects were recorded in patients of group II. In conclusion, PGE1 infusion is a determinant in the reduction of the healing time of mixed ulcers of the lower limbs.
- Vascular Leg Ulcers: Histopathologic Study of 293 Patients. [JOURNAL ARTICLE]
- Am J Dermatopathol 2014 Jul 28.
: Vascular leg ulcers remain a challenge for the modern health care, and a systematic pathological study on this kind of lesions has not been reported so far. A total of 293 consecutive white patients with chronic leg ulcers (present for a minimum of 6 months and up to several years) referred to the Wound Care Unit (Dermatology, University of Bologna) between March 2008 and June 2011. Thirty-four patients affected by other than vascular ulcers, neoplastic or inflammatory conditions, were excluded. The remaining 259 patients affected by vascular leg ulcers were enrolled in this study. Assessment of the patients general health, skin biopsy, and vascular Doppler of the lower limbs were performed to determine the etiology and to formulate an appropriate management plan, whereas 2 punch biopsies of 3 mm were performed on the border and on the bed of each ulcer. Doppler evaluation showed the presence of vascular hemodynamic impairment in 259 patients. Of these, 181 (69.9%) patients were affected by venous insufficiency, 58 (22.4%) by venous and arterial insufficiency, and 20 (7.7%) by arterial insufficiency. Histopathologic features revealed significant differences, thus, reflecting the clinicopathologic correlation with the underlying hemodynamic impairments. In conclusion, histopathologic and hemodynamic data correlation could provide the basis for future analysis of leg ulcers pathogenesis and may improve treatment protocols. We should underline that this observational study represents a single-institute experience and that larger series are needed to confirm our observations.
- Chronic venous insufficiency. [Journal Article]
- Circulation 2014 Jul 22; 130(4):333-46.
- Leg ulcers in antiphospholipid syndrome secondary to systemic lupus erythematosus treated with intravenous immunoglobulin. [Journal Article]
- J Dermatol Case Rep 2014 Jun 30; 8(2):38-41.
Despite encouraging reports on the efficacy of intravenous immunoglobulin (IVIg) in antiphospholipid syndrome, the clinical value of this treatment is not well established, and most of the data are based on case reports and small series of patients.We describe the significant improvement of leg ulcers with IVIg in a 61-year-old female, with diabetes mellitus, venous peripherical insufficiency and secondary antiphospholipid syndrome to systemic lupus erythematosus.This case illustrates a rare cause of leg ulcers and documents that IVIg may be an effective adjuvant treatment in the management of selected patients with antiphospholipid syndrome when conventional strategies using subcutaneous heparin and low-dose aspirin are insufficient.
- Endovenous laser with miniphlebectomy for treatment of varicose veins and effect of different levels of laser energy on recanalization. A single center experience. [JOURNAL ARTICLE]
- Lasers Med Sci 2014 Jul 4.
Varicose veins, associated with great saphenous vein (GSV) incompetence, are traditionally treated with conventional surgery. In recent years, minimally invasive alternatives to surgical treatment such as the endovenous laser ablation (EVLA) and radiofrequency (RF) ablation have been developed with promising results. Residual varicose veins following EVLA, regress untouched, or phlebectomy or foam sclerotherapy can be concomitantly performed. The aim of the present study was to investigate the safety and efficacy of EVLA with different levels of laser energy in patients with varicose veins secondary to saphenous vein reflux. From February 2006 to August 2011, 740 EVLA, usually with concomitant miniphlebectomies, were performed in 552 patients. A total of 665 GSV, 53 small saphenous veins (SSV), and 22 both GSV and SSV were treated with EVLA under duplex USG. At 84 patients, bilateral intervention is made. In addition, miniphlebectomy was performed in 540 patients. A duplex ultrasound (US) is performed to patients preoccupying chronic venous insufficiency (with visible varicose veins, ankle edema, skin changes, or ulcer). Saphenous vein incompetence was diagnosed with saphenofemoral, saphenopopliteal, or truncal vein reflux in response to manual compression and release with patient standing. The procedures were performed under local anesthesia with light sedation or spinal anesthesia. Endovenous 980-nm diode laser source was used at a continuous mode. The mean energy applied per length of GSV during the treatment was 77.5 ± 17.0 J (range 60-100 J/cm). An US evaluation was performed at first week of the procedure. Follow-up evaluation and duplex US scanning were performed at 1 and 6 months, and at 1 and 2 years to assess treatment efficacy and adverse reactions. Average follow-up period was 32 ± 4 months (3-55 months). There were one patient with infection and two patients with thrombus extension into the femoral vein after EVLA. Overall occlusion rate was 95 %. No post-procedural deep venous thrombosis or pulmonary embolism occurred. Laser energy, less than 80 J/cm, was significantly associated with increased recanalization of saphenous vein, among the other energy levels. EVLA seems a good alternative to surgery by the application of energy of not less than 80 J/cm. It is both safe and effective. It is a well-tolerated procedure with rare and relatively minor complications.
- [Venous ulcer--patience and consequence are demanded]. [Journal Article]
- MMW Fortschr Med 2014 May 28; 156(10):68-9.
- Early activation of fibroblasts during PDT treatment in leg ulcers. [JOURNAL ARTICLE]
- G Ital Dermatol Venereol 2014 Jun 13.
This pilot study was aimed to assess the variations of some microscopical parameters in skin ulcers, caused by chronic venous insufficiency of the lower extremities (chronic leg ulcers), in 15 patients refractory to previous conventional treatments during Photodynamic therapy (PDT).Samples of control, wounded and PDT treated skin were taken and analyzed by immunohistochemistry. RESULTS:The cellular infiltrate, as well as the thickness of epidermis, vascularization, mast cell and fibroblast numbers, were increased in chronic wounds as compared to healthy skin. After completion of PDT, fibroblasts appeared further increased in number. Mast cells, closely clustered with fibroblasts, also showed an increase in their numbers, degranulation index and expression of basic fibroblast growth factor.The present findings support a primary role of fibroblasts in the wound healing process upon PDT treatment, given their early and intense reaction to injury. Mast cells seem to play an accessory yet important role, on the basis of their number and degranulation index variations and expression of basic FGF. In addition, the clustering of mast cells with fibroblasts around blood vessels suggest that these cells may stimulate angiogenesis and, in parallel, fibroblasts to secrete extracellular matrix during PDT therapy.
- [Treatment of venous trophic ulcers, using echoscleroobliteration of perforant veins]. [English Abstract, Journal Article]
- Klin Khir 2014 Feb; (2):5-7.
In 36 patients, suffering trophic ulcers on a chronic venous insufficiency background in a decompensated stage (C6 in accordance to CEAP), echoscleroobliteration of perforant veins, using a "foam-form" method in accordance to Tessari, was performed. In 29 patients postrombophlebitic syndrome in incomplete recanalization stage was diagnosed, in 7 recurrence of varicose disease of the lower extremities. In all the patients during echoscleroobliteration there was possible to obliterate the insufficient perforant veins, in 3 patients two perforant veins were obliterated in each of them. In a one week a pathological blood flow along perforant veins, in accordance to data of ultrasound duplex scanning, was absent. This effect lasted during 6 mo in 29 (80.6%) patients. In 25 (69.4%) patients a trophic ulcers healing was achieved in 1 - 3 mo. In a one year in 30 (83.3%) patients a stable obliteration was noted, in 3 (8.3%) - partial recanalization, in 3 (8.3%) - complete recanalization of perforant veins.
- [Update on current care guidelines: chronic leg ulcers]. [English Abstract, Journal Article]
- Duodecim 2014; 130(9):942-3.
Chronic leg ulcer is a common disorder affecting 1.3-3.6 % of people at some time of their life. The etiology of the ulcer can often be identified through careful clinical examination. The majority of leg ulcers are caused by venous or arterial insufficiency. The target of ulcer treatment should always be directed to the cause of the ulcer. Correction of the circulatory disorder is essential for ulcer healing. Since the probability of ulcer healing reduces as the ulcer becomes chronic, effective treatment should be initiated immediately. Skin grafting should be considered for ulcers > 20 cm2 and > 6 months duration.