Recalcitrant Ulcers Research Articles

Medical treatment of peptic ulcer disease

The past year's literature on the treatment of peptic ulcer disease can be conveniently divided into four categories: 1) comparison of traditional antisecretory and topical agent therapy, which ranges from antacids to potent agents like omeprazole, 2) Helicobacter pylori treatment, 3) treatment options for recalcitrant ulcers or ulcers due to nonsteroidal anti-inflammatory drugs, and 4) some safety information.

A CASE OF NON-CLOSTRIDIAL GAS GANGRENE ASSOCIATED WITH DIABETES MELLITUS

A case of non-clostridial gas gangrene (NCGG) developing in a plantar recalcitrant ulcer associated with diabetes mellitus (DM) is reported. A 63-year-old female was admitted to the hospital, because of a recalcitrant ulcer in the right first toe associated with DM. Following admission her right foot swelled, and plantar gangrene, excretion of pus with a foul smell, crepitation on pressing, and a gas picture on XP were noted. Therefore, a diagnosis of NCGG was made. Conservative treatment including administration of antibiotics and random skin cutting was carried out. However, her right leg was amputated after CT indicated expansion of the gas picture. NCGG often occurs in association with such underlying diseases as DM. Since this patient did not have her DM under adequate control, it is thought that the ulcer in the right first tow was the source of infection for the NCGG. The pathological progression of NCGG is relatively gradual, and the suitable period when it can be cured may be easily missed. Prognosis may become unfavorable. It is important to determine the causative bacteria in an early stage by gram-staining of the pus in order to make the differential diagnosis between NCGG and clostridial gas gangrene (CGG). If a curative tendency by conservative treatment is not observed, one should not hesitate to amputate the affected limb.

熱傷はん痕上に生じた悪性線維性組織球腫の１例

We presented a 58-year-old female with malignant fibrous histiocytoma developing in a burn scar. She had sustained thermal burn on the right side of her head when she was a baby. An atrophic scar with loss of hair had been present since that time. For the last 10 years, she had suffered from a recalcitrant ulcer in the burn scar. In 1982, the ulcer was resected and covered with a local skin flap. The histologic section showed large, atypical tumor cells with slit-like spaces among them, and extravasation of erythrocytes. A tentative diagnosis of malignant hemangioendothelioma was made. After 9 years of a disease-free period, a small ulcer recurred after minor trauma near the previous lesion. In the following 2 months, a fist-sized, easily bleeding tumor developed rapidly. Examination by CT-scan and MRI revealed the tumor destroyed cranial bone and invaded dura mater. A course of extensive radiotherapy consisting of 80Gy of 15MeV electron-beam was instituted and the tumor regressed clinically. The remaining ulcerative lesion was excised, including bone and dura underneath. The histological examination of this lesion revealed proliferaton of atypical, spindle cells in a storif orm pattern. Immunohistochemical stainings of specimens obtained before and after irradiation showed that the tumor cells were positive for α1-antichymotrypsin, while negative for factor VIII related antigen and UEA-1. Pulmonary metastases were detected in a short time. In spite of a combination chemotherapy (CYVA-DIC) and X-ray irradiation to lung lesions, the patient's condition rapidly deteriorated and she died of respiratory failure. Extensive irradiation in combination with excision may be the choice of treatments for primary lesions of malignant fibrous histiocytoma. This is the tenth case of malignant fibrous histiocytoma developing in a burn scar among Japanese.

Cultured Allografts as an Adjunct to the Medical Treatment of Problematic Leg Ulcers

REPORT OF CASES Case 1.— A 33-year-old black woman had a 15-year history of multiple recalcitrant skin ulcers on the lower extremities. The skin biopsy specimen showed typical features of sarcoidosis. Also, pulmonary involvement with lethargy, dyspnea on exertion, bilateral hilar lymphadenopathy, and diffuse interstitial shadowing on chest roentgenogram were present. Her leg ulcers were initially treated with hydroxychloroquine, with temporary healing. Subsequent recurrences of the ulcers were unresponsive to hydroxychloroquine therapy, and systemic corticosteroids were prescribed. The ulcers did not respond either to therapy with intralesional triamcinolone or to increasing doses of oral prednisone up to 60 mg/d. Her steroid therapy was complicated by hypertension and insulin-dependent diabetes. Because of recurring ulcerations on her legs, hydroxychloroquine (800 mg/d) was added to the patient's steroid regimen. The ulcers healed temporarily for 2 months but recurred when the antimalarial dosage was reduced to 400 mg/d. A trial of topical cromolyn sodium

Subcutaneous Calcification in Venous Ulcers: Report of a Case

We report on a 77-year-old woman with a recalcitrant leg ulcer that contained and extruded calcified material. Roentgenograms of the involved leg showed extensive subcutaneous calcification. The literature concerning subcutaneous calcification in venous insufficiency is reviewed. The patient responded to surgical debridement of the calcified tissue and subsequent skin grafting.

Bilateral Squamous Cell Carcinomas Arising in Long-Standing Necrobiosis lipoidica

We describe the second case of bilateral squamous cell carcinoma arising in long-standing necrobiosis lipoidica. The occurrence of squamous cell carcinoma in necrobiosis lipoidica is rare, but should be considered in recalcitrant ulcers, especially when infiltrated.

Surgical management of corneal ulceration and perforation

Corneal ulceration leading to perforation can occur secondary to a number of conditions, including infection, trauma, corneal dryness, and exposure keratitis. Because the ocular morbidity of corneal perforations is high, prompt diagnosis and treatment is critical. When persistent corneal ulceration does not respond to medical treatment, including antibiotics, therapeutic soft contact lenses, or tarsorrhaphy, surgical intervention is indicated. In this review, the evaluation of patients with recalcitrant ulceration or perforation is summarized, and indications and techniques for surgical treatment (epithelial transplantation, conjunctival flaps, lamellar and penetrating keratoplasty, tissue adhesives, periosteal grafts) are described.

The technique and current status of pinch grafting.

Small split-thickness skin grafts, also known as pinch grafts, can provide an effective form of therapy for recalcitrant ulcers of the skin. Several of the new surgical dressings can be combined with the traditional pinch grafting technique to shorten the time for the development of granulation tissue within a clean ulcer base and improve the survival of the grafts themselves. This paper will summarize the surgical technique employed in pinch grafting.

Autosomal recessive prolidase deficiency. Three patients with recalcitrant ulcers

Autosomal recessive prolidase deficiency. Three patients with recalcitrant ulcers

CHRONIC LEG ULCERS.

IN THE DISCUSSION to follow there may be few, if any, original concepts developed. However, it will be my object to present a working classification of chronic leg ulcers, to outline a plan to establish the proper diagnosis, and to suggest a logical approach to successful management. Among the treatment procedures discussed, emphasis will be placed on the use of pinch grafts by the dermatologist to hasten the involution of large recalcitrant leg ulcers. Classification will reflect the combined experience of many clinicians. A detailed differential diagnosis and clinical description of each entity would require an extensive monograph, which is outside the scope of this presentation. Also, certain conditions which affect the feet predominantly, such as diabetic gangrene and so-called neurotropic ulcers, will not be considered. Only ulcerations which predominantly affect the legs will be included. Any classification of ulcerations of the leg must be arbitrary, and this will

Treatment of chronic leg ulcers with absorbable gelatin sponge (gelfoam) powder; report of one hundred six cases.

Many reports in the literature describe local remedies for chronic ulcers of the leg. 1 In evaluating these and other medicaments, it has become increasingly evident that definite criteria should be applied before any medicament is considered useful as well as successful. The medicament must promote tissue growth and healing and should be nontoxic, have a low sensitizing index, relieve symptoms if any are present, be easy to apply, and be economically acceptable. A study of 106 patients with chronic recalcitrant ulcers of the leg was initiated in June, 1951, at the New York Skin and Cancer Unit after reports that absorbable gelatin sponge (Gelfoam) had a tissue-stimulating effect on the skin 2 and aided in the healing of deeper wounds. 3 Absorbable gelatin sponge, a heat-sterilized foam sponge made of animal gelatin, was introduced in 1945 as an absorbable hemostatic agent. 4 It has been found that antibiotics such