No More Venous Ulcers—What More Can We Do? Stanek, Agata; Mosti, Giovanni; Nematillaevich, Temirov Surat ...
Journal of clinical medicine,
09/2023, Letnik:
12, Številka:
19
Journal Article
Recenzirano
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Venous leg ulcers (VLUs) are the most severe complication caused by the progression of chronic venous insufficiency. They account for approximately 70–90% of all chronic leg ulcers (CLUs). A total of ...1% of the Western population will suffer at some time in their lives from a VLU. Furthermore, most CLUs are VLUs, defined as chronic leg wounds that show no tendency to heal after three months of appropriate treatment or are still not fully healed at 12 months. The essential feature of VLUs is their recurrence. VLUs also significantly impact quality of life and could cause social isolation and depression. They also have a significant avoidable economic burden. It is estimated that the treatment of venous ulceration accounts for around 3% of the total expenditure on healthcare. A VLU-free world is a highly desirable aim but could be challenging to achieve with the current knowledge of the pathophysiology and diagnostic and therapeutical protocols. To decrease the incidence of VLUs, the long-term goal must be to identify high-risk patients at an early stage of chronic venous disease and initiate appropriate preventive measures. This review discusses the epidemiology, socioeconomic burden, pathophysiology, diagnosis, modes of conservative and invasive treatment, and prevention of VLUs.
Priporočila za obravnavo bolnikov z limfedemom Planinšek Ručigaj, Tanja; Kozak, Matija; Slana, Ana ...
Zdravniški vestnik (Ljubljana, Slovenia : 1992),
09/2018, Letnik:
87, Številka:
7-8
Journal Article
Recenzirano
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V prispevku so predstavljena priporočila za obravnavo bolnikov z limfedemom. Prikazana je klinična slika, diagnosticiranje in različni načini obravnave.
Lymphoedema is caused by an imbalance between fluid production and transport by the lymphatic system. This imbalance can be either caused by reduced transport capacity of the lymphatic system or too ...much fluid production and leads to swelling associated with tissue changes (skin thickening, fat deposition). Its main common complication is the increased risk of developing cellulitis/erysipelas in the affected area, which can worsen the lymphatic function and can be the cause of raised morbidity of the patient if not treated correctly/urgently. The term primary lymphoedema covers a group of rare conditions caused by abnormal functioning and/or development of the lymphatic system. It covers a highly heterogeneous group of conditions. An accurate diagnosis of primary lymphoedema is crucial for the implementation of an optimal treatment plan and management, as well as to reduce the risk of worsening. Patient care is diverse across Europe, and national specialised centres and networks are not available everywhere. The European Reference Network on Rare Multisystemic Vascular Diseases (VASCERN) gathers the best expertise in Europe and provide accessible cross-border healthcare to patients with rare vascular diseases. There are six different working groups in VASCERN, which focus on arterial diseases, hereditary haemorrhagic telangiectasia, neurovascular diseases, lymphoedema and vascular anomalies. The working group Paediatric and Primary Lymphedema (PPL WG) gathers and shares knowledge and expertise in the diagnosis and management of adults and children with primary and paediatric lymphoedema. The members of PPL WG have worked together to produce this opinion statement reflecting strategies on how to approach patients with primary and paediatric lymphoedema. The objective of this patient pathway is to improve patient care by reducing the time to diagnosis, define the best management and follow-up strategies and avoid overuse of resources. Therefore, the patient pathway describes the clinical evaluation and investigations that lead to a clinical diagnosis, the genetic testing, differential diagnosis, the management and treatment options and the patient follow up at expert and local centres. Also, the importance of the patient group participation in the PPL WG is discussed.
The goal of our study was to determine clinical characteristics of women cancer survivors treated for secondary lymphedema, the time from cancer treatment to the development of lymphedema, and the ...effect of therapy on reduction of lymphedema and occurrence of erysipelas. We performed a retrospective study of women with secondary lymphedema after breast cancer (BR) and gynecological (cervical, uterine, ovarian, vulvar) cancers (GYN) treated at our Department from 2004 to 2010. The average time from cancer treatment to the development of lymphedema in our patients was 2.2 and 4.75 years in the BR and GYN groups, respectively, ranging from within days after the procedure to as long as 31 years. The duration of lymphedema in our patients before they first received appropriate therapy was on average 4.1 and 2.65 years in the BR and GYN groups, respectively. In our series, untreated lymphedema was a strong predisposing risk factor for erysipelas, whereas no cases of erysipelas were noticed after the establishment of therapy. Compression therapy was shown to be an effective measure to reduce lymphedema. The duration of required initial decongesting therapy with short-stretch elastic bandages was longer in patients with more long-standing edema. Lymphedema may first appear several years after the cancer procedure. Our findings emphasize the need for awareness of lymphedema as a possible long-term iatrogenic complication in cancer survivors to avoid a delay in diagnosis and therapy. Physicians in care of cancer survivors should actively look for lymphedema. Untreated lymphedema is a strong predisposing risk factor for erysipelas.
Suvremene obloge možemo podijeliti u skupine prema svojstvima (upijanja izlučevine), i s obzirom na to u kojim su fazama cijeljenja najučinkovitije. Jedna od podjela je podjela na osnovne obloge ili, ...bolje rečeno, materijale, koji se koriste za tretiranje svih vrsta rana (kao sekundarne obloge); obloge koje znatno apsorbiraju; alginatne obloge; obloge, koje djeluju antimikrobno (s dodatkom DACC, inadina, PHMB, srebra); fi lmovi; pjene; obloge s medom; hidrokoloidi; hidrogeli; obloge za suzbijanje neprijatnog vonja; obloge s modulatorima proteaza; obloge koje upotrebljavamo na brazgotinama; obloge za zaštitu kože; druge obloge koje su biocelulozne, obloge s kolagenom, obloge s poliuretanskim matriksom.
Primary lymphoedema is a rare genetic disorder characterized by swelling of different parts of the body and highly heterogenic clinical presentation. Mutations in several causative genes characterize ...specific forms of the disease. FOXC2 mutations are associated with lymphoedema of lower extremities, usually distichiasis and late onset.
Subjects from three generations of a family with lymphoedema of lower limbs without distichiasis were searched for mutations in the FOXC2 gene.
All affected family members with lymphoedema of lower limbs without distichiasis, and still asymptomatic six years old girl from the same family, carried the same previously unreported insertion of adenosine (c.867insA) in FOXC2.
Identification of a novel mutation in the FOXC2 gene in affected family members of three generations with lymphoedema of lower limbs without distichiasis, highlights the high phenotypic variability caused by FOXC2 mutations.
Bacteria organized in biofilms are insensitive to the usual treatment with dressings or antibiotics. Most successful is surgical debridement to remove their colonies, but this option may not be ...possible in all environments. Dressings with silver and other antiseptics are often the only tools available to nurses at patient homes or to dermatologists at outpatient clinics. In our clinical studies conducted several years ago, we demonstrated that dressings with antiseptics were an effective tool in daily clinical practice to remove bacteria/biofilms from chronic wounds.
Background
Dermoscopy is a widely used technique, recommended in clinical practice guidelines worldwide for the early diagnosis of skin cancers. Intra-European disparities are reported for early ...detection and prognosis of skin cancers, however, no information exists about regional variation in patterns of dermoscopy use across Europe.
Objective
To evaluate the regional differences in patterns of dermoscopy use and training among European dermatologists.
Materials & Methods
An online survey of European-registered dermatologists regarding dermoscopy training, practice and attitudes was established. Answers from Eastern (EE) versus Western European (WE) countries were compared and their correlation with their respective countries’ gross domestic product/capita (GDPc) and total and government health expenditure/capita (THEc and GHEc) was analysed.
Results
We received 4,049 responses from 14 WE countries and 3,431 from 18 EE countries. A higher proportion of WE respondents reported dermoscopy use (98% vs. 77%,
p
<0.001) and training during residency (43% vs. 32%) or anytime (96.5% vs. 87.6%) (
p
<0.001) compared to EE respondents. The main obstacles in dermoscopy use were poor access to dermoscopy equipment in EE and a lack of confidence in one’s skills in WE. GDPc, THEc and GHEc correlated with rate of dermoscopy use and dermoscopy training during residency (Spearman rho: 0.5–0.7,
p
<0.05), and inversely with availability of dermoscopy equipment.
Conclusion
The rates and patterns of dermoscopy use vary significantly between Western and Eastern Europe, on a background of economic inequality. Regionally adapted interventions to increase access to dermoscopy equipment and training might enhance the use of this technique towards improving the early detection of skin cancers.
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