SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
The current management of decubitus ulcers, factors in wound healing and the role of enzymes in treatment are discussed. The therapeutic benefits of collagenase (Santyl) ointment in 21 patients are described, supplemented by serial color photographs. Statistical evidence is provided for the conclusion that collagenase ointment is an excellent adjunct to therapy.
Despite a large volume of literature particularly directed toward treatment, pressure sores (including decubitus ulcers) remain a difficult problem, especially in the nursing home environment. The treatment of pressure sores is somewhat controversial and quite diversified. Selection of a successful therapeutic modality must be preceded by correct evaluation, i.e., whether the sore is superficial or deep, open or closed. The treatment of superficial sores is conservative and directed toward cleanliness, relief of pressure, and exposure to air. Surgical debridement may be indicated. Proteolytic enzymes often are employed as adjunctive therapy, although there are some major drawbacks to their use. The plethora of therapeutic agents suggested for the treatment of deep pressure sores probably is related to the difficulties in achieving success. Surgical debridement is indicated, and proteolytic enzymes are widely used. Possible interactions. and factors leading to the inactivation of these enzymes are discussed, as is the use of various solutions, ointments, gold leaf, oxygen, dry heat, and other adjunctive devices. Of paramount importance in the management of pressure sores is the maintenance of cleanliness and dryness.
The efficacy of topical applications of povidone-iodine (Betadine solution and ointment) for the control of infection associated with decubitus and stasis ulcers was evaluated in 18 male outpatients (age range, 33--68 years). Dressings were changed twice daily over a period of 42 days. Statistically significant improvement was noted in the following signs and symptoms: edema, pain, erythema, ulcer size, and ulcer depth. All patients experienced some degree of symptomatic relief and clinical improvement within two weeks after starting therapy. At the end of the study, 67 percent of the ulcers were clinically cured and 33 percent showed improvement. Acceptance by the patients was excellent, with no reported side effects or sensitization reactions. Povidone-iodine used in a daily regimen of ulcer care can reduce the level of infection and promote healing.
BACKGROUND AND OBJECTIVE: Superior cluneal nerve (SCN) entrapment is one of the infrequent etiologies of low back pain (LBP), which is rarely diagnosed. Few clinical reports have been published in the literature. We present a case of severe LBP radiating to the ipsilateral buttock after decubitus surgery. CASE REPORT: A 62-year-old man weighing 85 kg presented to the algology department, suffering from severe LBP of 6 months duration. The pain was in the right iliac crest region with radiation to the ipsilateral buttock. After admission, his history was taken, physical examination was performed, and further evaluations were made. He was suspected of having facet and right sacroiliac joint pain. Two tender points were found 6.5 and 7.5 cm to the right of the midline over the iliac crest. Local anesthetic with corticosteroid was injected at the tender points over the right iliac crest. Five minutes after the injection, the pain dissipated. CONCLUSION: SCN entrapment should be considered in patients who suffer from LBP radiating to the iliac crest and buttock after other causes of LBP have been excluded.
Forty tissue samples, primarily of skin and bone, were obtained from 29 patients undergoing excision of decubitus ulcers after intravenous injection of 600 mg of clindamycin. Antibiotic concentrations exceeded 2.5 mug/g in 80% of the samples. In 50% of the instances, tissue levels were greater than those simultaneously present in the serum.
The authors describe a shelf attachment to a pluridirectional tomography table which makes decubitus tomography possible. This device is used for contrast medium filling of the internal auditory canal.
In routine computed tomography (CT) of scoliotic patients, multiple scans through each intervertebral disk level must be made, which can make interpretation of disks and neural foramina difficult. Use of lateral decubitus positioning for postmyelography CT allows use of gantry angulation to achieve true axial scans through disks, which permits easier evaluation of individual disks and foramina.
Although a number of operative positions have been described for approaching midline posterior fossa tumors, all have potential disadvantages and complications. We describe a modified lateral decubitus position for the removal of posterior fossa tumors. The position allows blood and cerebrospinal fluid to drain from the operative wound and provides a straight-on view of the posterior fossa contents. It also allows the surgeon to sit comfortably during tumor removal, thereby reducing operator fatigue. We have found this to be a reliable and valuable approach for posterior fossa pathology.
UNLABELLED: In 23 subjects with chronic obstructive pulmonary disease (COPD) who wheezed when changing their position from sitting to dorsal decubitus (DD), we recorded lung volumes and flow volume loops in sitting (S1), DD and immediately after resuming sitting (S2). We found three main patterns of ventilatory changes associated with wheezing in DD: (1) acute obstruction (AO) in 14 subjects characterized by FEV1 > or = -10% and %FEV1/FVC > or = -3%; functional residual capacity or residual volume was increased, decreased or unchanged; (2) acute restriction (AR) in 7 subjects characterized by absence of obstruction spirographically and FVC and/or FRC > -10%; (3) indeterminate response (IR) in 2 subjects. Except for 3 subjects, the changes recorded in DD returned to baseline in S2. Both AO and AR responses in DD and their rapid resolution in S2 were reproducible (11 subjects). IN CONCLUSION: (1) in COPD, DD may trigger wheezing; (2) the physiologic changes during DD wheezing are reproducible, rapidly reversible when the sitting position is resumed and unlike those recorded during bronchoprovocation, heterogeneous.
The aim of this paper is to demonstrate that the VIPS-model, a model for nursing documentation, can be used as a tool and as a structure for analyzing and categorizing literature and emprical data. The usefulness of the model is demonstrated with data from a study concerning nursing interventions to prevent decubitus.
We studied the effect of topically applied phenytoin on the healing of a decubitus ulcer in the sacral region of an immobile patient with stroke. Another similar, but smaller, ulcer was treated with conventional treatment only and served as a control. The ulcers were measured once a week and biopsies were taken from the margins before, 1 week and 2 weeks after commencing treatment with phenytoin. Clinically, phenytoin substantially accelerated the rate of healing. Microscopic examination of the biopsies showed increased lymphocytic infiltration of the phenytoin-treated lesion. Anti-CD31 immunohistochemistry revealed dense CD31+ lymphocytic infiltration and increased angiogenesis only in the phenytoin-treated lesion. Our findings suggest that phenytoin enhances wound healing by stimulating lymphocytic chemotaxis and up-regulation of angiogenesis.
UNLABELLED: We designed the present study to examine the influence of lumbosacral cerebrospinal fluid (CSF) volume on the spread and duration of hyperbaric bupivacaine spinal anesthesia when the injection is made with the patient in the lateral position compared with that when the patient is in a seated position. Seventy-four patients undergoing peripheral orthopedic or urogenital surgery with spinal block were enrolled. Lumbosacral CSF volumes were calculated from axial magnetic resonance images. Patients were randomly assigned to 1 of 2 groups: the lateral (L) and seated (S) groups (n = 37 each). Spinal anesthesia (3 mL hyperbaric 0.5% bupivacaine) was administered using a 25-gauge pencil-type needle with the needle aperture directed cephalad and the patient in the lateral decubitus position with the non-operated side up (L group) or with the patient in a seated position (S group). Patients were turned supine immediately after spinal injection (L group) or after remaining seated for 2 min (S group). Statistical correlation coefficients (rho) were assessed using Spearman's rank correlation. There were negative correlations between CSF volume and peak sensory block level in both the L (rho = -0.69, P < 0.0001) and S groups (rho = -0.68, P < 0.0001). In the S group, but not in the L group, CSF volume significantly correlated with onset time of peak sensory block level (rho = -0.48, P = 0.004), and time required for regression to L1-4 (P < 0.05-0.01). We conclude that CSF volume influences the spread of spinal anesthesia with hyperbaric bupivacaine regardless of patient position when the spinal injection is made. CSF volume influenced the duration of spinal sensory anesthesia when the injection was made with the patient in a seated position, but not in the lateral position. IMPLICATIONS: Patient position during the spinal injection does not alter the influence of cerebrospinal fluid (CSF) volume on the spread of hyperbaric bupivacaine spinal anesthesia. However, CSF volume influences the duration of spinal sensory anesthesia when the injection is made with the patient in a seated position, but not in the lateral position.
Breast radiotherapy is a technical challenge in women with pectus excavatum. We aim to assess isocentric lateral decubitus (ILD) technique as a means to irradiate breasts for patients with pectus excavatum. Four women presenting with left-sided breast cancers and found to have pectus excavatum were offered breast-conserving treatments. Post-operative breast radiotherapy was indicated (50 Gy) in two patients, with an additional boost to the tumour bed (16 Gy). Both ILD and supine techniques were simulated. We report the dosimetric comparison of these techniques and the acute skin toxicity of ILD radiotherapy. ILD permitted the same breast dose-homogeneity as the supine technique while decreasing breast thickness by 4.5-6.8 cm. The width of lung and/or heart receiving > 20 Gy ranged between 2.1 cm and 4.3 cm with the supine technique and between 0.5 cm and 1.1 cm with ILD. The estimated percentage of ipsilateral lung receiving > 20 Gy ranged from 21% to 34% with the supine technique and from 0% to 5% with ILD. Acute skin toxicity was scored 1 for all patients at completion of ILD radiotherapy. ILD is an effective breast radiotherapy technique for patients with pectus excavatum that preserves the underlying heart and lung from unnecessary toxicity.
A high incidence of plantar decubitus ulcers, 35% in males and 22 or 45% in females, respectively, occurred in rats of two carcinogenicity studies independent of the bedding used, hard or soft wood chips. Among rabbits kept in chrome-plated wire cages, about 2-year-old female breeders suffered from the plantar ulcers, but not their male partners of the same age group. The causes of the foot disease appear to be manifold, however, in our cases the lesions could be prevented in both species by housing on a cage floor made from flattened stainless wire.
In two cases where computed tomography (CT) and cerebral angiography failed to determine whether an arteriovenous malformation was within or directly adjacent to the atrium of a lateral ventricle, lateral decubitus pneumoencephalography combined with cerebral angiography successfully localized the lesions. This procedure may be necessary in the workup of angiographically vascular lesions in the atrial-paraatrial region if on CT the ventricular surface is poorly defined or surgical clips from a previous operation obscure the lesion or the adjacent ventricle. Interpretation of this study involves triangulation of the vascular lesions relative to the ventricle or observation of the movement of the lesion relative to the movement of the ventricle on differently angulated frontal projections. Since the surgical approach is influenced by the radiographic differentiation of an intraventricular from a paraventricular mass, this procedure is crucial in evaluating these vascular abnormalities.
A prospective study of the accuracy in diagnosing gallstones using ultrasonography in the absence of a fluid-filled gallbladder was done over a 20 month period; 91 patients were studied. A focal echo complex with acoustic shadowing was shown to be a highly reliable criterion for diagnosing gallstones in a contracted gallbladder when (1) it was demonstrated on longitudinal, transverse, and left lateral decubitus views, and (2) the configuration of the echo complex remained the same.
Despite the routine visualization of many of the major branches of the abdominal aorta using current state of the art sonography equipment, the renal arteries are still infrequently seen in normal patients and are rarely seen in patients with abdominal aortic aneurysms. Longitudinal scanning in the left lateral decubitus position will frequently visualize the origin of the renal arteries from the aorta and/or the right renal artery as it crosses under the inferior vena cava. Using this technique the renal arteries in 16 of 20 patients were visualized. The experience with this technique so far is limited to three patients with aortic aneurysm. In two, the relation of the aneurysm to the renal arteries could be delineated.
We were requested to perform IVR for uterine artery embolotherapy of a patient who was unable to take the decubitus position. Because of extreme overweight, the patient was limited to a sitting posture on a bed in the living environment. Therefore, a device to support her sitting posture on the IVR patient table was designed and created. The support device was used to hold the patient's body in a half-sitting posture and distribute her weight load appropriately so that the weight load applied to the patient's body could be minimized. Using this support device, IVR could be performed smoothly during a period of 2 hours 40 minutes.