Chronic leg ulcer

Oxidant and Antioxidant Status of Patients with Chronic Leg Ulcer Before and After Low Intensity Laser Therapy... 

Keywords Antioxidants Catalase Chronic leg ulcer Glutathione peroxidase... 

The aim of the present study was to evaluate the effect of LLLT on oxidative markers in serum and tissue biopsies of healing ulcers before and after the 8th session of an LLLT course of chronic leg ulcer treatment. Oxidative damage was assessed in terms of lipid peroxidation reflected by serum malondialdehyde (MDA) level, protein oxidation was measured in terms of tissue protein carbonyls (PCb), and DNA damage was measured in terms of DNA fragmentation. Antioxidative activity was estimated by measuring activity of SOD, GPX and CAT enzymes. 

Twenty two chronic leg ulcers patients, not amenable to surgical interface or reconstruction and not responding to conventional treatment, were included in this study. The patients were of the middle class population of mean age 48.5 14.6 years. Their ulcers were umesponsive to conservative treatment for a duration that ranged between 3 to 17 years (mean of 14.67 4.66 years). 

LLLT Effects on Clinical Healing of Chronic Leg Ulcers... 

Fig. 27.1 Chronic leg ulcers of a 60 years old male patient before and after laser therapy, three sessions per week at energy fluence of 0.5 J cm , He-Ne laser. Duration of ulcer was 16 months...

PCb (Fig. 27.4) (percentage/total protein) was significantly higher among patients with chronic leg ulcer when compared to normal controls (0.85 0.14% vs... 

Fig. 27.2 Chronic leg ulcers on the lateral lower half of the leg of a 45 years old male patient before (a) and after laser therapy (b). Duration of ulcer was 2 years and the ulcer size before treatment was 5 cm. This patient received three sessions per week of 0.5 Jcm He-Ne laser LETT and complete healing was achieved in the 12th session...

Fig. 27.4 Level of tissue protein carbonyls, DNA fragmentation and serum MDA in normal and chronic leg ulcer patients before and after LLLT total, in low and high response groups...

It is concluded that chronic leg ulcer patients probably lack the mechanisms that normalise their levels of antioxidant enzymes, which normally decrease at early stages of wound healing in order to allow blood granulocytes and tissue macrophages to perform their function in cleansing the wounded area. Consequently re-epitheUalisation and matrix remodeling processes are delayed. LLLT stimulates... 

Hamer C, Cullum N, Roe B (1994) Patients perceptions of chronic leg ulcers. J Wound Care 3 99-101... 

El Batanouny M, Shokeir H, Zayed A, Korraa S, Kamali A (2004) Enhanced healing effects of low energy irradiation on chronic leg ulcers of different etiologies. Dermatology and Andrology 24(1-4) 11-22... 

Schmidtchen A (2000) Degradation of antiproteinases, complement and fibronectin in chronic leg ulcers. Acta Derm Venereol 80(3) 179-184... 

It is used in the treatment of scurvy, postoperative cases, and healing bedsores and chronic leg ulcers. Vitamin C increases the absorption of iron during anemia and is frequently combined with ferrous salts. It is used in urinary tract infections to acidify urine. Large doses of vitamin C have been tried to cure everything from the common cold to cancer, with not much success. The usefulness of vitamin C in asthma, cancer, atherosclerosis, psychologic symptoms, and fertility is doubtful. Ascorbic acid is well tolerated in large doses and may cause rebound scurvy on withdrawal. There is a possibility of forming urinary stones. 

Hydrocolloids are suitable for desloughing and for light to medium exuding wounds—but are contraindicated if an anaerobic infection is present. They have been used successfully in the treatment of chronic leg ulcers, pressure ulcers, minor burns, granulating wounds, and wounds exhibiting slough or necrotic tissue or wounds with moderate exudate, as well as skin barriers in the management of stoma. 

Pasche-Koo F, PUetta PA, Hunziker N, Hauser C. High sensitization rate to emulsifiers in patients with chronic leg ulcers. Contact Dermatitis 1994 31(4) 226-8. 

Hogan DJ. Widespread dermatitis after topical treatment of chronic leg ulcers and stasis dermatitis. Can Med Assoc J 1988 138 337-8. 

AG McKnight. A clinical trial of povidone-iodine in the treatment of chronic leg ulcers. Practitioner 195 230-234, 1965. 

Connective tissue destruction during inflammatory diseases, such as chronic wound, chronic leg ulcers, or rheumatoid arthritis, is the result of continuous supply of inflammatory cells and exacerbated production of inflammatory cytokines and matrix proteinases (Senni et al., 2006). According to the Senni et al. (2006), fucoidan from Ascophyllum nodosum is a potent modulator of connective tissue proteolysis. Further, the authors suggested that fucoidan could be used for treating some inflammatory pathology in which uncontrolled extracellular matrix degradation takes place. 

Benzoyl peroxide is used mainly in acne treatment and is an irritant. Allergic contact dermatitis to this compound is not infrequent. Eaglstiein (1968) reported two cases. The sensitization rate has been estimated to be 1 %-2.5%. In a human maximization test, 76% became sensitized (Leyden and Kligman 1977). Crossreactions to benzoic acid and related compounds were not found. The drug has been advocated for treatment of chronic leg ulcers. Eight of 16 patients showed positive patch tests to 2% benzoyl peroxide after 6 weeks of leg ulcer treatment with 10% benzoyl peroxide (Jensen et al. 1980). Patients sensitized to benzoyl peroxide may be at risk in certain occupations (e.g., baking and the plastics industry). 

International Contact Dermatitis Research Group (ICDRG) (1978) Triclocarbon - evaluation of contact dermatitis potential in man. Contact Dermatitis 4 283-288 Jensen O, Petersen SH, Vesterager L (1980) Contact sensitization to benzoyl peroxide following topical treatment of chronic leg ulcers. Contact Dermatitis 6 179-182 Jillson OF, Baughman RD (1963) Contact photodermatitis from bithionol. Arch Dermatol 88 409-418... 

E Z Hazarika, D E Wright, Chronic leg ulcers The effect of pneumatic intermittent compression . Practitioner, 1981 225 189-192. 

Brandjes DPM, Biiller HR, Heyboer H, Huisman MV, de Rijk M, Jagt H, ten Cate JW (1997) Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis. Lancet 349 759-762 Brantingham CR, Beekman BE, Moss CN, Gordon RB (1970) Enhanced venous pump activity as a result of standing on a varied terrain floor surface. J Occup Med 12 164-169 Callam MJ (1992) Prevalence of chronic leg ulceration and severe chronic venous disease in western countries. Phlebology Suppl 1 6-12... 

As the first population of insulin-treated diabetics aged, it soon became clear that insulin did not cure the disease. While it added dramatically to life expectancy, insulin-treated diabetics began to exhibit a wide variety of seemingly unrelated disorders such as chronic leg ulcers, blindness, kidney disorders, and cardiovascular problems. Further, this population of patients frequently developed comas with either a very high or very low level of blood glucose. 

Kaufman, C., Hirshowitz, B. (1983). Treatment of chronic leg ulcers with Op-site. Chirurgica Plastica, 7, 211-215. 

Epidex (Modex Therapeutics) None Autologous keratinocytes with silicone membrane support Chronic leg ulcers [41,42]... 

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