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Relationship of visual impairment and peripheral artery disease with the occurrence of diabetic foot ulcers in Dr. Moewardi Hospital

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Frontiers of Nursing 2019年第2期6卷 157-160页

作者： Okti Sri Purwanti Krisna Yetti Tuti Herawati School of Nursing Faculty of Health ScienceUniversitas Muhammadiyah SurakartaKartasura 57162Indonesia Faculty of Nursing Universitas IndonesiaDepok 16424Indonesia

Objective: One of the diabetes mellitus (DM) complications is foot ulcers. Foot ulcers are influenced by many factors. DM puts patients at risk of injury because of visual impairment. Hyperglycemia can damage blood vessels, which results in peripheral artery disease (PAD). The purpose of this study was to find the relationship of visual impairment and PAD with diabetic foot ulcers. Methods: This research used observational analytic study with case–control methods. It used purposive sampling in 34 DM patients with foot ulcers and 34 DM patients without foot ulcers. The research instruments were an interview guide to assess visual impairment, physical examination to assess PAD, and documentation study, which was used to know the incidence of diabetic ulcers. Results: The results showed that the respondents who experienced ulcers with visual impairment were 44.1% and the respondents who had foot ulcers with PAD were 73.5%. The results of statistical tests showed that there was no relationship between visual impairment and the incidence of ulcers (P = 0.166). The respondents with PAD will have a chance to suffer from foot ulcers 5.808 times higher than those who do not have PAD. Conclusions: There is no relationship between visual impairment and the incidence of diabetic foot ulcers in Dr. Moewardi Hospital, but there is relationship between PAD and the incidence of diabetic foot ulcers in Dr. Moewardi Hospital. Suggestions of this study are to do foot screening and educate about the importance of foot care to prevent the occurrence of diabetic ulcers.

关键词： visual impairment peripheral artery disease foot ulcers diabetes mellitus artery disease retinopathy

Confusing untypical intestinal Behcet's disease:Skip ulcers with severe lower gastrointestinal hemorrhage

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World Journal of Gastrointestinal Endoscopy 2014年第1期6卷 27-31页

作者： Zhen-Kai Wang Hui Shi Shao-Dong Wang Jiong Liu Wei-Ming Zhu Miao-Fang Yang Chan Liu Heng Lu Fang-Yu Wang Department of Gastroenterology and Hepatology Jinling Hospital Department of General Surgery Jinling Hospital

Behcet's disease(BD) is a rare and life-long disorder characterized by inflammation of blood vessels throughout the body. BD was originally described in 1937 as a syndrome involving oral and genital ulceration in addition to ocular inflammation. Intestinal BD refers to colonic ulcerative lesions documented by objective measures in patients with BD. Many studies have shown that over 40% of BD patients have gastrointestinal complaints. Symptoms include abdominal pain, diarrhea, nausea, anorexia and abdominal distension. Although gastrointestinal symptoms are common, the demonstration of gastrointestinal ulcers is rare. This so-called intestinal BD accounts for approximately 1% of cases. There is no specific test for BD, and the diagnosis is based on clinical criteria. The manifestations of intestinal BD are similar to those of other colitis conditions such as Crohn's disease or intestinal tuberculosis, thus, it is challenging for gastroenterologists to accurately diagnose intestinal BD in patients with ileocolonic ulcers. However, giant ulcers distributed in the esophagus and ileocecal junction with gastrointestinal hemorrhage are rare in intestinal BD. Here, we present a case of untypical intestinal BD. The patient had recurrent aphthous ulceration of the oral mucosa, and esophageal and ileo-colonic ulceration, but no typical extra-intestinal symptoms. During examination, the patient had massive acute lower gastrointestinal bleeding. The patient underwent ileostomy after an emergency right hemicolectomy and partial ileectomy, and was subsequently diagnosed with incomplete-type intestinal BD by pathology. The literature on the evaluation and management of this condition is reviewed.

关键词： Intestinal Behcet’s disease Hemorrhage Skip ulcers

Successful treatment of ileal ulcers caused by immunosuppressants in two organ transplant recipients

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World Journal of Gastroenterology 2016年第24期22卷 5616-5622页

作者： Yun-Wei Guo Hua-Ying Gu Kodjo-Kunale Abassa Xian-Yi Lin Xiu-Qing Wei Department of Gastroenterology the Third Affiliated Hospital of Sun Yat-Sen University

Although gastroduodenal ulcers are common in solid organ transplant patients, there are few reports on multiple giant ulcers in the distal ileum and ileocecal valve caused by immunosuppressants Herein, we report on a liver transplant recipient and a renal transplant recipient with multiple large ulcers in the distal ileum and ileocecal valve who rapidly achieved ulcer healing upon withdrawal of sirolimus or tacrolimus and administration of thalidomide. In case 1, a 56-yearold man with primary hepatocellular carcinoma had received a liver transplantation. Tacrolimus combined with sirolimus and prednisolone was used as the anti-rejection regimen. Colonoscopy was performed because of severe abdominal pain and diarrhea at postoperative month 10. Multiple giant ulcers were found at the ileocecal valve and distal ileum. The ulcers healed rapidly with withdrawal of sirolimus and treatment with thalidomide. There was no recurrence during 2 years of follow-up. In case 2, a 34-year-old man with end-stage kidney disease received kidney transplantation and was put on tacrolimus combined with mycophenolate mofetil and prednisolone as the anti-rejection regimen. Twelve weeks after the operation, the patient presented with hematochezia and severe anemia. Colonoscopy revealed multiple large ulcers in the ileocecal valve and distal ileum, with massive accumulation of fresh blood. The bleeding ceased after treatment with intravenous somatostatin and oral thalidomide. Tacrolimus was withdrawn at the same time. Colonoscopy at week 4 of follow-up revealed remarkable healing of the ulcers, and there was no recurrence of bleeding during 1 year of follow-up. No lymphoma, tuberculosis, or infection of cytomegalovirus, Epstein-Barr virus, or fungus wasfound in either patient. In post-transplantation cases with ulcers in the distal ileum and ileocecal valve, sirolimus or tacrolimus should be considered a possible risk factor, and withdrawing them or switching to another immunosuppressant might be effective to treat these ulcers.

关键词： Ileal ulcers Liver transplantation Kidney transplantation Sirolimus Tacrolimus

Rectal ulcers and massive bleeding after hemorrhoidal band ligation while on aspirin

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World Journal of Clinical Cases 2014年第4期2卷 86-89页

作者： Shruti Patel Ghulamullah Shahzad Kaleem Rizvon Krishnaiyer Subramani Prakash Viswanathan Paul Mustacchia Department of Internal Medicine Nassau University Medical Center Department of Gastroenterology Nassau University Medical Center

Endoscopic hemorrhoidal band ligation is a well-established nonoperative method for treatment of bleeding internal hemorrhoids(grade 1 to 3). It is a safe and effective technique with a high success rate. Complications with this procedure are uncommon. Although rectal ulceration due to band ligation is a rare complication, it can cause life-threatening hemorrhage especially when patients are on medications which impair hemostasis like aspirin or non steroidal antiinflammatory drugs. We present 2 cases of massive lower gastro-intestinal bleeding in patients who had a band ligation procedure performed 2 wk prior to the presentation and were on aspirin at home. Both the patients were hemodynamically unstable requiring resuscitation. They required platelet and blood transfusions and were found to have rectal ulcers on colonoscopy done subsequently. The rectal ulcers corresponded to the site of band ligation. The use of aspirin by these patients would have caused defects in the hemostasis and may have predisposed them to massive bleeding in the presence of rectal ulcers occurring after the band ligation procedure. Managing aspirin before and after the ligation may be difficult especially since adequate guidelines are unavailable. Stopping aspirin in all the cases might not be safe and the decision should be individualized.

关键词： Hemorrhoids Rubber band ligation Rectal ulcers Massive bleeding Aspirin

A systematic literature review of the management of chronic venous ulcers with autologous fibrin matrix with or without growth factors

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Plastic and Aesthetic Research 2018年第4期5卷 28-35页

作者： Alejandra García Botero Jorge Ernesto Cantini Ardila Luis David Devoz Borja Viviana Gómez-Ortega Plastic and Reconstructive Surgery Department Hospital de San JoséFundación Universitaria de Ciencias de la SaludBogotá110111Colombia Plastic and Reconstructive Surgery Department Fundación Santa Féde BogotáBogotá110111Colombia

Aim: To evaluate available evidence for the effective management of venous leg ulcers with fibrin matrix with or without growth factors. Methods: A systematic review of the literature was performed to evaluate the use of fibrin matrices with or without growth factors for the management of chronic venous ulcers in lower limbs. Article searches were performed in MEDLINE, EMBASE, COCHRANE, LILACS and ongoing clinical trials at ClinicalTrial.gov. Results: The search in MEDLINE and EMBASE identified three articles;one was a pilot study evaluating the use of fibrin matrix and autologous growth factors that included patients with chronic ulcers of different etiology. The second article was a description of the product used in the previous study, and the third consisted of a series case reports of patient treated with cultured keratinocytes in a fibrin matrix. A COCHRANE searched resulted in one study assessing the cost effectiveness of using different fibrin matrices. The search in ClinicalTrial.gov and LILACS did not result in any findings. Conclusion: The study did not provide a conclusive evidence for the use of fibrin matrices in patients with venous leg ulcers.

关键词： Venous ulcers legs fibrin matrix growth factors

Assessment of Serum Magnesium Level in Type 2 Diabetes Mellitus with Diabetic Foot ulcers (Grade I and II) at Nawabshah, Pakistan

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International Journal of Clinical Medicine 2018年第2期9卷 104-116页

作者： Anwar Ali Jamali Ghulam Mustafa Jamali Niaz Hussain Jamali Bhojo Mal Tanwani Arslan Ahmer Rajput Ameer Ali Jamali epartment of Medicine Peoples University of Medical and Health Sciences for Women Nawabshah Pakistan Institute of Pharmaceutical Sciences Peoples University of Medical and Health Sciences for Women Nawabshah Pakistan Deapartment of Physiology Peoples University of Medical and Health Sciences for Women Nawabshah Pakistan Deapartment of Paediatrics Medicine Peoples University of Medical and Health Sciences for Women Nawabshah Pakistan

Diabetes Mellitus is a metabolic disorder increasing morbidity and mortality worldwide, which needs exact identification and proper management. Aim of this study was to analyze the serum Mg (magnesium) level in patients with Type 2 Diabetes Mellitus with grade I & II diabetic foot ulcers. This descriptive cross sectional study was conducted at Medicine Department, PMCH Nawabshah from June 2015 to December 2016. A total of 110 Type 2 Diabetes Mellitus with foot ulcer patients, 51 with grade I and 59 with grade II out of total were included by purposive sampling. After consultation, subjects were categorized as gender, age, Type 2 DM and foot ulcer duration, foot ulcer grading and grouping for analyses. Wagner’s classification of diabetic foot ulcers used to analyze the data and blood samples were collected for research purpose in fasting state for serum Magnesium level analyses. Out of 110, 67 (65.5%) males and 43 (34.5%) females were reported with Type 2 diabetic patients. Hypomagnesaemia was reported in 59% patients out of total, 24 found with grade I and 38 found with grade II from the studied subjects. P value ≤0.000 was in the studied population in relation to hypomagnesaemia. In conclusion, Hypomagnesaemia is common in Type 2 Diabetes Mellitus patients with grade I & II foot ulcers. As the duration of Diabetes along with duration of diabetic foot ulcer in Grade I and II increases, the level of serum magnesium decreases. As the duration of Diabetes Mellitus increases, the severity of complications might also increase.

关键词： Magnesium Hypomagnesaemia Type 2 Diabetes Mellitus Foot ulcers

Evaluation of Peripheral Neuropathy in Diabetic Adults with and without Foot ulcers in an African Population

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Journal of Biosciences and Medicines 2018年第12期6卷 71-78页

作者： Osita Ede Gabriel O. Eyichukwu Kenechi A. Madu Iheuko S. Ogbonnaya Kelechukwu A. Okoro Chinonso Basil-Nwachuku Kelechi A. Nwokocha Department of Orthopaedics Plastic and Reconstructive Surgery National Orthopaedic Hospital Enugu Nigeria

Background: Foot ulcers frequently precede lower extremity amputations (LEA) in diabetic subjects. Peripheral neuropathy (PN) is a strong risk factor for diabetic foot ulceration. Majority of diabetic patients with PN are asymptomatic;hence foot ulceration may be the first clinical presentation. Early detection of PN can forestall the development of foot ulcers through active preventive strategies. Few studies have been done to assess PN in diabetic individuals in Africa. The study aims to evaluate the incidence and risk factors for PN in diabetic adults with and without foot ulcers in an indigenous African population. Method: This cross-sectional study involved 90 diabetic adults, 45 with foot ulcers and 45 without foot ulcers. Assessment of PN was done with the Michigan Neuropathy Screening Instrument (MNSI), the 10 g Semmes-Weinstein monofilament (SWM) and the 128-Hz vibrating tuning fork (VTF). Demographic data were collected by questionnaire. Associations between PN and risk factors such as age, alcohol consumption, duration of diabetes, cigarette smoking, BMI, height and sex were also investigated. Results: There were 59 males (65.6%) and 31 females (34.4%) in the study. The mean age of the subjects with foot ulcers was 59.62 years (SD = 6.47), while those without ulcers was 57.47 years (SD = 6.94). Forty-two subjects (93.33%) with foot ulcers have PN using the MNSI, while 33 subjects without foot ulcers (73.33%) have PN. Both the SWM and the VTF showed a high positive correlation with themselves and with the MNSI. Advancing age, duration of diabetes, alcohol intake, hyperglycaemia and cigarette smoking showed a significant association with peripheral neuropathy, while BMI, height and sex did not. Conclusion: The incidence of PN is quite high in diabetic adults in Africa. This calls for early screening and aggressive control of risk factors to prevent the development of diabetic foot ulceration.

关键词： Peripheral Neuropathy African Diabetic Adults Foot ulcers

Changes of Gastric Mucosal Blood Flow in the Healing Process of Peptic ulcers

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Journal of Medical Colleges of PLA(China) 1990年第2期5卷 181-186,196页

作者：李兆申周岱云许国铭陈菊初施雅芳姚光弼 Department of Gastroenterology Changhai HospitalSecond Military Medical UniversityShanghai 200433

Changes of gastro-duodenal mucosal blood flow (GDMBF) in the healingprocess of 82 patients with gastric ulcer,130 with duodenal ulcer and 9 with active ul-cer induced by gastric polypectomy were studied by endoscopic laser Doppler flowme-try.In 108 normal subjects,the mucosal blood flow at the angle and antrum of the les-ser curvature and on the anterior wall of the duodenal bulb was the smallest (Pulcers.

关键词： gastric mucosal blood flow laser Doppler flowmetry peptic ulcers

Management of Diabetic Foot ulcers Using Negative Pressure with Locally Available Materials

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Modern Plastic Surgery 2013年第3期3卷 84-88页

作者： Joseph Yorke Joseph Akpaloo Pius Agbenorku Department of Surgery Komfo Anokye Teaching Hospital School of Medical Sciences Kwame Nkrumah University of Science and Technology Kumasi Ghana Reconstructive Plastic Surgery & Burns Unit Department of Surgery Komfo Anokye Teaching Hospital School of Medical Sciences Kwame Nkrumah University of Science and Technology Kumasi Ghana

Introduction: Diabetic ulcers are one of the main causes of morbidity and hospitalisation and thereby affecting the quality of life of persons suffering from the condition. The aim of the study was to assess the level of satisfaction of persons who underwent treatment for diabetic ulcers using negative pressure produced from locally available materials. Materials and Methods: Creating negative pressure using locally available materials such as sterilized foam, tubes with diameter between 0.5 and 0.8 cm, transparent adhesive plaster and a suction machine. Results: Thirty-seven patients were enrolled in the current study;70.3% (n = 26) were known diabetic patients on regular treatment while 29.7% (n = 11) were diagnosed when they presented for the first time with ulcers. Patients were made to grade their level of satisfaction with therapy involving these locally used materials. Out of the 37 patients, 35 (94.6%) stated their therapy was excellent while 1 (2.7%) said the therapy was good;therapy was discontinued in one patient (2.7%) who had some complication. Conclusion: Desirable outcomes were obtained when patients were treated using negative pressure wound therapy (NPWT) produced using locally manufactured materials. Patients were able to pay for the therapy since the cost was reasonably low.

关键词： Diabetic ulcers Negative Pressure Therapy Cost Locally Manufactured Materials