OBJECTIVE: To determine the effect of guidelines on vascular assessment, compression usage, dressing selection, and healing rates of patients with a venous ulcer. DESIGN: Prospective descriptive intervention evaluation. SETTING: Oxfordshire Community National Health Service (NHS) Trust, United Kingdom. PATIENTS: 40 consecutive prospective patients seen by Oxfordshire district nurses, either at home or at a wound clinic coordinated by district nurses located in a surgery office. INTERVENTION: The Guideline for Diagnosis and Treatment of Venous Leg Ulcers (University of Pennsylvania) and the Oxfordshire Leg Ulcer Guideline. MAIN OUTCOME MEASURES: Time to healing, compliance with vascular assessment, compression usage, and nursing costs. MAIN RESULTS: 91% of patients had a vascular assessment; all patients were treated with compression. Mean time to healing was 8 weeks and was not related to dressing selection or type of compression (short- versus long-stretch bandage). Nursing costs were slightly higher for wounds that healed after 12 weeks and were treated with a long-stretch bandage (Pound Sterling 170.00 [$250.00] vs Pound Sterling 272.00 [$395.00]). CONCLUSION: Use of compression was influenced by guidelines that emphasize a vascular assessment. Choice of dressing or type of compression was not a significant factor in healing rates.

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Venous leg ulcers: the role of the GP and district nurse.

AIM: To identify the healing rates for patients with venous leg ulcers (VLUs) who are nursed by district nurses. METHOD: The researchers performed a retrospective chart review of patients treated for VLU disease by district nurses to determine the healing rate, time to heal and variables associated with diagnosis. Forty random charts were abstracted from seven surgeries in Oxfordshire. RESULTS: Forty per cent of patients healed in less than 12 weeks and a further 42.5 per cent healed in 6.5 months. Some trusts and GPs lack understanding of what the district nursing service can offer patients with VLUs. CONCLUSION: If district nurses work collaboratively with GPs, either in the home or in a weekly clinic, they can provide good care to patients with VLUs.

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Upregulation of adhesion complex proteins and fibronectin by human keratinocytes treated with an aqueous extract from the leaves of Chromolaena odorata (Eupolin).

The fresh leaves and extract of the plant Chromolaena odorata are a traditional herbal treatment in developing countries for burns, soft tissue wounds and skin infections. We have previously shown that the extract had an effect on the growth and proliferation of keratinocytes and fibroblasts in culture. This study has demonstrated that Eupolin extract increased expression of several components of the adhesion complex and fibronectin by human keratinocytes. Using indirect immunofluorescence we found increased expression (dose-dependent) of laminin 5, laminin 1, collagen IV, and fibronectin. The expression of the b1 and b4 integrins was upregulated by the extract at low concentrations (0.1 and 1 microg/ml), but the expression was decreased at higher doses of Eupolin (10 microg-150 microg/ml). A number of clinical studies carried out by Vietnamese and international medical investigators have demonstrated the efficacy of this extract on the wound healing process. In this study we have shown that Eupolin stimulated the expression of many proteins of the adhesion complex and fibronectin by human keratinocytes. The adhesion complex proteins are essential to stabilise epithelium and this effect could contribute to the clinical efficacy of Eupolin in healing.

Cell Adhesion↗

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Mandibular metastasis from renal cell carcinoma. A case report.

Renal cell carcinoma (RCC) metastasizing to the mandible and subsequently spreading to oropharynx in a 62 year old man is reported. The patient presented with solitary mandibular lesion with hematuria, which on further investigation was diagnosed to be RCC with no other systemic involvement. Clinical manifestation of the mandibular metastasis from RCC is rarely seen. A case is reported and literature regarding extracranial head and neck metastasis by RCC is reviewed.

Carcinoma, Renal Cell↗

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Contact dermatitis in leg ulcer patients.

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