Introduction: Cutaneous manifestations of systemic sclerosis (SSc) include skin ulceration;4% - 12% of patients with SSc develop lower extremity ulcers of various etiologies. Limited data, significant morbidity, and s...Introduction: Cutaneous manifestations of systemic sclerosis (SSc) include skin ulceration;4% - 12% of patients with SSc develop lower extremity ulcers of various etiologies. Limited data, significant morbidity, and substantial cost of wound care led us to undertake this study to describe and identify risk factors. Methods: After Institutional Review Board approval, we identified 30 patients with SSc and lower extremity ulcers over a 10-year period at a single center with an SSc clinic, which were included in a descriptive analysis. Results: Median age of onset of lower extremity ulcers was 59.5 years (range 20 - 84). Ninety percent of patients were female, 60% were Caucasian, 63% had limited SSc, 13% diffuse SSc and 23% an overlap syndrome. Immunomodulators or steroids were prescribed in 53%;hypercoagulable state identified in 16%. Ulcers were attributed to venous stasis (27%), SSc (20%), trauma (20%), arterial disease (17%), and multifactorial/unknown (17%). In patients with ulcers attributed to SSc, age at onset was lower (45.5 vs 59.5 years). Biopsies generally did not contribute to management. Multidisciplinary treatment was routine;20% required amputation, 10% endovascular intervention, 20% frequent surgical debridement, 10% hyperbaric oxygen, 26% local treatment and antibiotics and 13% received immunosuppression for wound treatment. Conclusion: Lower extremity ulcers are a serious clinical problem in patients with SSc. The clinical exam, venous dopplers, ankle-brachial indices and assessment of vascular risk factors helped define causality. In younger patients, ulcers were more frequently attributed to SSc and these patients were more likely to be on immunosuppressants/DMARDS, possibly indicating severe phenotype of SSc.展开更多
Deep vein thrombosis (DVT) is a common and potentially fatal vascular event when it leads to pulmonary embolism. Occurring as part of the broader phenomenon of Venous Thromboembolism (VTE), DVT classically arises when...Deep vein thrombosis (DVT) is a common and potentially fatal vascular event when it leads to pulmonary embolism. Occurring as part of the broader phenomenon of Venous Thromboembolism (VTE), DVT classically arises when Virchow’s triad of hypercoagulability, changes in blood flow (e.g. stasis) and endothelial dysfunction, is fulfilled. Although such immobilisation is most often seen in bedbound patients and travellers on long distance flights, there is increasing evidence that prolonged periods of work or leisure related to using computers while seated at work desks, is an independent risk factor. In this report, we present two cases of “e-thrombosis” from prolonged sitting while using a computer.展开更多
目的探讨多团队协作护理预防髋关节置换术患者下肢深静脉血栓的效果。方法随机选取2016年1月～2017年12月我院收治的髋关节置换术患者60例,采用SPSS21.0将入组患者按先后序列号(1～60)随机分为两组:一组常规健康教育组(30例),一组常规...目的探讨多团队协作护理预防髋关节置换术患者下肢深静脉血栓的效果。方法随机选取2016年1月～2017年12月我院收治的髋关节置换术患者60例,采用SPSS21.0将入组患者按先后序列号(1～60)随机分为两组:一组常规健康教育组(30例),一组常规健康教育基础上多团队协作组(多团队协作组,30例),统计分析两组患者下肢深静脉血栓相关知识掌握程度、预防下肢深静脉血栓的健康信念水平、下肢深静脉血栓、关节脱位、下肢肿胀疼痛、肺栓塞发生情况。结果多团队协作组患者的下肢深静脉血栓相关知识掌握程度评分显著高于常规健康教育组(P<0.05);感知疾病的易感性、严重性、健康行为障碍、益处、健康动力、自我效能评分均显著高于常规健康教育组(P<0.05);下肢深静脉血栓发生率为6.7%(2/30),显著低于常规健康教育组的23.3%(7/30)(P<0.05);关节脱位发生率0显著低于常规健康教育组10.0%(3/30)(P<0.05);但两组患者的下肢肿胀疼痛、肺栓塞发生率3.3%(1/30)、0 vs 6.7%(2/30)、3.3%(1/30)之间的差异均不显著(P>0.05)。结论多团队协作能够对髋关节置换术患者下肢深静脉血栓进行有效预防,同时降低患者的关节脱位发生率,值得在临床推广。展开更多
文摘Introduction: Cutaneous manifestations of systemic sclerosis (SSc) include skin ulceration;4% - 12% of patients with SSc develop lower extremity ulcers of various etiologies. Limited data, significant morbidity, and substantial cost of wound care led us to undertake this study to describe and identify risk factors. Methods: After Institutional Review Board approval, we identified 30 patients with SSc and lower extremity ulcers over a 10-year period at a single center with an SSc clinic, which were included in a descriptive analysis. Results: Median age of onset of lower extremity ulcers was 59.5 years (range 20 - 84). Ninety percent of patients were female, 60% were Caucasian, 63% had limited SSc, 13% diffuse SSc and 23% an overlap syndrome. Immunomodulators or steroids were prescribed in 53%;hypercoagulable state identified in 16%. Ulcers were attributed to venous stasis (27%), SSc (20%), trauma (20%), arterial disease (17%), and multifactorial/unknown (17%). In patients with ulcers attributed to SSc, age at onset was lower (45.5 vs 59.5 years). Biopsies generally did not contribute to management. Multidisciplinary treatment was routine;20% required amputation, 10% endovascular intervention, 20% frequent surgical debridement, 10% hyperbaric oxygen, 26% local treatment and antibiotics and 13% received immunosuppression for wound treatment. Conclusion: Lower extremity ulcers are a serious clinical problem in patients with SSc. The clinical exam, venous dopplers, ankle-brachial indices and assessment of vascular risk factors helped define causality. In younger patients, ulcers were more frequently attributed to SSc and these patients were more likely to be on immunosuppressants/DMARDS, possibly indicating severe phenotype of SSc.
文摘Deep vein thrombosis (DVT) is a common and potentially fatal vascular event when it leads to pulmonary embolism. Occurring as part of the broader phenomenon of Venous Thromboembolism (VTE), DVT classically arises when Virchow’s triad of hypercoagulability, changes in blood flow (e.g. stasis) and endothelial dysfunction, is fulfilled. Although such immobilisation is most often seen in bedbound patients and travellers on long distance flights, there is increasing evidence that prolonged periods of work or leisure related to using computers while seated at work desks, is an independent risk factor. In this report, we present two cases of “e-thrombosis” from prolonged sitting while using a computer.
文摘目的探讨多团队协作护理预防髋关节置换术患者下肢深静脉血栓的效果。方法随机选取2016年1月～2017年12月我院收治的髋关节置换术患者60例,采用SPSS21.0将入组患者按先后序列号(1～60)随机分为两组:一组常规健康教育组(30例),一组常规健康教育基础上多团队协作组(多团队协作组,30例),统计分析两组患者下肢深静脉血栓相关知识掌握程度、预防下肢深静脉血栓的健康信念水平、下肢深静脉血栓、关节脱位、下肢肿胀疼痛、肺栓塞发生情况。结果多团队协作组患者的下肢深静脉血栓相关知识掌握程度评分显著高于常规健康教育组(P<0.05);感知疾病的易感性、严重性、健康行为障碍、益处、健康动力、自我效能评分均显著高于常规健康教育组(P<0.05);下肢深静脉血栓发生率为6.7%(2/30),显著低于常规健康教育组的23.3%(7/30)(P<0.05);关节脱位发生率0显著低于常规健康教育组10.0%(3/30)(P<0.05);但两组患者的下肢肿胀疼痛、肺栓塞发生率3.3%(1/30)、0 vs 6.7%(2/30)、3.3%(1/30)之间的差异均不显著(P>0.05)。结论多团队协作能够对髋关节置换术患者下肢深静脉血栓进行有效预防,同时降低患者的关节脱位发生率,值得在临床推广。
