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PubMed2000

['Decubitus' guideline of the Dutch College of Family Practitioners: response from internal medicine].

The guideline on pressure ulcers by the Dutch College of General Practitioners is good in the aspects of simplicity and giving very practical advice. It can be used as a guideline for prevention as well as treatment of pressure ulcers. Some aspects, however, are insufficiently dealt with. There is no summing up of the differences in anti-pressure ulcer devices such as mattresses and cushions. Use is made of the international classification of pressure ulcers in 4 stages, but also of a kind of rating in three colours (red-yellow-black), of which it is known that it underestimates the severity of pressure ulcers. There is an advice to use the knowledge of surgeons, dermatologists and nursing home doctors in difficult cases in the home care, where training and deployment of nurses specialised in this specific field might be preferable. Nevertheless, the guideline is well documented and useful in general practice.

Equipment and Supplies↗
PubMed2000

[Evaluation of lumbar canal stenosis: decubitus imaging methods versus flexion-extension myelography and surface measurements versus the diameter of the dural sac].

Though CT and MRI are presently the most frequently required noninvasive methods for the diagnosis of lumbar spinal stenosis (LSS), imaging of a supine patient may not demonstrate the maximal spinal stenosis shown by upright flexion-extension myelography (FEM). Our prospective study tries to assess the averaging discrepancies between the supine CT-myelograms and the upright FEM in 50 patients. Considering all L2-L3 to L4-L5 vertebral levels, a mean underestimation of 16% of the diameter of the dural sac is found when and CT-myelograms are compared with extension myelography. Meaningful clinical discrepancies of 30% and more are found in 15.5% of these levels, the L5-S1 level remaining rather stable. Marked variations--but of less critical diagnostic interest--are also found between flexion and extension with, for flexion, a mean underestimation of 20% and discrepancies of 30% and more in 18.33% of L2-L3 to L4-L5 levels. Paradoxical results--CT diameters inferior to extension diameters--concern 22% of all studied levels but are of little clinical significance; only small discrepancies of 8.2% are found in a majority of non stenotic levels--with a maximal intensity for the L5-S1 level rarely implicated in LSS-. Measuring the mean cross-sectional surface occupied by the neural elements in the dural sac on CT-myelograms (189 evaluations), our study also empirically confirms a 60 to 80 mm2 are++ being the landmark of absolute stenosis. Finally, measurements of the cross-sectional area of the dural sac-109 L2-L5 levels inferior to 8.5 mm on CT myelograms or CT studies--show a large dispersion of areas for diameters superior to 6.5 mm and confirm cross-sectional area of the dural sac to be a much reliable parameter of LSS than diameter of the dural sac. We conclude that upright FEM--while not a first-line imaging modality for LSS--should be performed to exclude functional or dynamic position-dependent LSS in the patients whose symptoms are not explained by routine cross-sectional imaging, as long as no other upright technology is available.

Adult↗
PubMedDate not supplied

[Decubitus lesions in patients referred to acute and post-acute home nursing care for the elderly in Genova].

The Elderly Services of USL 3 "Genovese" together with the team for Continuing Education designed and implemented a survey on the elderly clients referred to the home care and nursing home services. The aim of the study was to describe the frequency, distribution and severity of pressure ulcers. The data were collected during a period of seven months: from 1st November 1997 to 31st May 1998. One thousand seven hundred and twenty nine clients were observed; 705 (41%) had single or multiple pressure ulcers. Patients with multiple pressure ulcers accounted for 42% of the total. The sacrum was the most affected site (43% of the patients with a single ulcer and 33% with multiple ulcers). Patients with severe pressure ulcers (stages 3 degrees and 4 degrees NPUAP classification) accounted for 42% of the total. Pressure sores were observed in 15% of "at no risk" patients and in 40% of those at low risk (Norton Scale score). The study highlighted a lack of documentation (90% patients) on treatments performed in the hospital and prescribed at discharge for the pressure sores. These findings reflects possibly the fact that this aspect of care is unduly disregarded by nursing personnel, and that a goal-oriented retraining, underlining also the need of appropriate documentation, is warranted.

Acute Disease↗
PubMed2000

[How I treat...decubitus ulcers surgically].

Although pressure sores occur frequently during the evolution of paraplegic patients, they can present in patients confined to bed or in casts. Ischiatic, sacral and trochanteric sores are the most frequent. For stade III & IV lesions surgical excision followed by a coverage with healty tissue remain the only right principle. Usually, flap transfert meats these requirements. However, the selection of the surgical procedure and the post-op care are the main factors for a successful treatment.

Debridement↗