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Luca Martini - One of the best experts on this subject based on the ideXlab platform.

  • Treatment of Venous Leg Ulcers with Sulodexide
    Angiology, 1999
    Co-Authors: Gaetano Scondotto, Daniele Aloisi, Patrizio Ferrari, Luca Martini

    Venous Ulcers are still today one of the main socioeconomic problems of medical interest in terms of prevalence, morbidity, and costs to the health service. In the past, various studies have been carried out to identify a systemic pharmacologic treatment able to accelerate venous ulcer healing times, but frequently the results have not been satisfactory. The aim of this study was to evaluate the efficacy of sulodexide, a drug with profibrinolytic and antithrombotic activity, in accelerating venous ulcer's healing time. Ninety-four patients (32 men and 62 women), aged 72 years old on average, were randomly distributed between two groups. In the first group ("control group") a standard treatment was applied, which consisted of cleansing by washing with physiological solution and the application of elastic compression with short-extensibility, removable bandages. The second group ("sulodexide group") received the standard treatment plus sulodexide (600 lipoprotein lipase releasing units [LRU] by im route per day for 30 consecutive days, followed by 500 LRU by oral route per day for a further 30 days). After 2 months the venous Ulcers were found healed in 15 patients (36%) in the control group and in 30 patients (58%) in the sulodexide group (p = 0.03). The life table showed that the healing times were shorter in the sulodexide group in the first 2 months of treatment. Total healing times amounted to 110 days in the control group and 72 days in the sulodexide group (p = 0.08) and the results were in proportion to the initial severity of the lesion. A significant correlation was noted between ulcer healing times and severity of the initial ulcerous lesion, the duration of the ulcer, and the group the patient belonged to. No correlation was found between age, gender of the patient and the etiology of the ulcer. In conclusion sulodexide was shown effective in the treatment of venous leg Ulcers, yielding healing more quickly than the standard treatment.

Tania J. Phillips - One of the best experts on this subject based on the ideXlab platform.

  • Pressure Ulcers: Prevention and Management
    Journal of The American Academy of Dermatology, 2019
    Co-Authors: Joshua S. Mervis, Tania J. Phillips

    Prevention has been a primary goal of pressure ulcer research. Despite such efforts, pressure Ulcers remain common in hospitals and in the community. Moreover, pressure Ulcers often become chronic wounds that are difficult to treat and that tend to recur after healing. Especially given these challenges, dermatologists should have the knowledge and skills to implement pressure ulcer prevention strategies and to effectively treat pressure Ulcers in their patients. This continuing medical education article focuses on pressure ulcer prevention and management, with an emphasis on the evidence for commonly accepted practices.

  • Prognostic indicators in venous Ulcers
    Journal of the American Academy of Dermatology, 2000
    Co-Authors: Tania J. Phillips, Fidelis Machado, Richard Trout, John Porter, Jeffrey W. Olin, Vincent Falanga

    Abstract Background: Venous Ulcers can be difficult to heal, and prognostic factors for healing have not been fully elucidated. Objective: The objective of this study was to analyze the results of a large multicenter venous ulcer trial to retrospectively establish prognostic factors for venous ulcer healing. Methods: This study examined data from a previously published prospective randomized placebo-controlled trial of an oral medication versus placebo treatment for venous Ulcers. Local leg ulcer care involved the use of a moisture-retentive dressing and sustained graduated compression with a paste bandage and a self-adherent wrap. The oral medication or placebo was administered on a daily basis with the same dressings and bandage system in both groups for 12 weeks. A total of 165 patients completed the full 12-week treatment period; 83 received ifetroban, 82 received placebo. Results: There was no statistically significant difference in outcome between the two groups. The study showed that consistent local ulcer treatment with a clearly defined system of care was associated with an unexpectedly high percentage (55%) of long-standing large venous Ulcers (mean duration, 27 months; mean area, 15.9 cm 2 ) being healed in both groups. Baseline ulcer area and duration of leg ulcer were found to be important in predicting outcome. Ulcers of short duration were found to be most likely to heal. Percent healing and ulcer area at week 3 were good predictors of 100% healing. Ulcers that had at least 40% healing by week 3 predicted more than 70% of the outcomes correctly. Conclusion: From this large study it was determined that baseline ulcer area and ulcer duration are significant predictors of 100% healing and time to heal. Percent healing and ulcer area at week 3 are good predictors of complete ulcer healing. Ulcers that are large, long-standing, and slow to heal after 3 weeks of optimal therapy are unlikely to heal rapidly, and might benefit from alternative therapies. (J Am Acad Dermatol 2000;43:627-30.)

Sukkyun Yang - One of the best experts on this subject based on the ideXlab platform.

  • degree of healing and healing associated factors of endoscopic submucosal dissection induced Ulcers after pantoprazole therapy for 4 weeks
    Digestive Diseases and Sciences, 2009
    Co-Authors: Taehoon Oh, Hwoonyong Jung, Kee Don Choi, Ho June Song, Kwisook Choi, Junwon Chung, Jeongsik Byeon, Seungjae Myung, Sukkyun Yang

    Background There is no consensus regarding the degree of healing of endoscopic submucosal dissection (ESD)-induced Ulcers and the optimal duration of proton pump inhibitor (PPI) treatment. Aim To evaluate the degree of healing and the factors associated with healing of ESD-induced Ulcers after PPI therapy for 4 weeks. Methods Fifty-six patients who underwent complete ESD for adenoma or early gastric cancer were enrolled. All patients underwent follow-up endoscopy to evaluate the degree of ulcer healing after pantoprazole therapy (40 mg per day) for 4 weeks. We evaluated change in size of ESD-induced Ulcers between baseline and 4 weeks, and correlated relevant factors with degree of healing of small and large Ulcers. Results At follow-up, 28 (50%) patients had large Ulcers (area > 10 mm2). Ulcer size at 4 weeks was closely correlated with initial ulcer size (P < 0.001) and abruptly increased when initial ulcer size was larger than 4 cm. Comorbidity, procedure time, and initial specimen size were significantly associated with healing rate, but multivariate analysis showed that initial ulcer size was the only significant parameter (P < 0.015). Conclusions Healing degree of ESD-induced Ulcers at 4 weeks is dependent on initial ulcer size, indicating that duration of treatment with PPI should be dependent on initial ulcer size.

Samina Seraj - One of the best experts on this subject based on the ideXlab platform.

  • Diagnosis and treatment of venous Ulcers.
    American family physician, 2010
    Co-Authors: Lauren Collins, Samina Seraj

    Venous ulcer, also known as stasis ulcer, is the most common etiology of lower extremity ulceration, affecting approximately 1 percent of the U.S. population. Possible causes of venous Ulcers include inflammatory processes resulting in leukocyte activation, endothelial damage, platelet aggregation, and intracellular edema. The primary risk factors for venous ulcer development are older age, obesity, previous leg injuries, deep venous thrombosis, and phlebitis. On physical examination, venous Ulcers are generally irregular, shallow, and located over bony prominences. Granulation tissue and fibrin are typically present in the ulcer base. Associated findings include lower extremity varicosities, edema, venous dermatitis, and lipodermatosclerosis. Venous Ulcers are usually recurrent, and an open ulcer can persist for weeks to many years. Severe complications include cellulitis, osteomyelitis, and malignant change. Poor prognostic factors include large ulcer size and prolonged duration. Evidence-based treatment options for venous Ulcers include leg elevation, compression therapy, dressings, pentoxifylline, and aspirin therapy. Surgical management may be considered for Ulcers that are large in size, of prolonged duration, or refractory to conservative measures.

Jonothan Earnshaw - One of the best experts on this subject based on the ideXlab platform.

  • Venous ulcer review.
    Clinical cosmetic and investigational dermatology, 2011
    Co-Authors: Paul Bevis, Jonothan Earnshaw

    CLINICAL QUESTION: What is the best treatment for venous Ulcers? RESULTS: Compression aids ulcer healing. Pentoxifylline can aid ulcer healing. Artificial skin grafts are more effective than other skin grafts in helping ulcer healing. Correction of underlying venous incompetence reduces ulcer recurrence. IMPLEMENTATION: POTENTIAL PITFALLS TO AVOID ARE: Failure to exclude underlying arterial disease before application of compression.Unusual-looking Ulcers or those slow to heal should be biopsied to exclude malignant transformation.