[Hypotensive syndrome during dorsal decubitus of pregnant women in the dental office].
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A retrospective presentation of the development of surgical treatment for pressure sores is given. Experimental research is described for the etiology and pathogenesis of decubital ulcers. Typical localizations and predisposing factors for pressure sores are mentioned.
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Gastroesophageal reflux (GER) may induce severe complications in infants: besides esophagitis numerous authors have established a relationship between GER and relapsing respiratory infections, between GER and apnea, cyanosis or bradycardia. This required a more precise estimation of the postural treatment than the clinical data of vomiting or the weight curve. Esophageal pH studies are considered to be the most valuable investigational technique in case of GER. It allowed us to study the importance of acid reflux in 43 patients under 1 year of age in different postures: 45 degrees upright in an infant-seat, horizontal prone and 30 degrees prone positions.
Six nursing home patients developed pressure sores of the foot and ankle, complicated by osteomyelitis of the underlying bone. All patients had advanced multi-infarct dementia with multiple contractures, and were bedridden, debilitated, and nutritionally deficient. All had arteriosclerotic heart and peripheral vascular disease, and other chronic illnesses. The pressure sores progressed rapidly and did not respond to medical and surgical therapy. Cultures yielded organisms usually associated with pressure sores. Diagnosis of osteomyelitis was initially made by radiography and eventually confirmed surgically. Patients with osteomyelitis of the metatarsal bones responded well to intravenous antibiotics and local amputation; all survived. The two patients with osteomyelitis of the calcaneal bone died after a short course. The diagnosis of osteomyelitis of the foot associated with pressure ulcers requires a high index of suspicion when a pressure sore does not respond to medical and surgical therapy in the appropriate clinical setting.
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