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Minor Trauma (minor + trauma)
Selected AbstractsA clinical analysis of diabetic patients with hand ulcer in a diabetic foot centreDIABETIC MEDICINE, Issue 7 2010C. Wang Diabet. Med. 27, 848,851 (2010) Abstract Aims, The aim of the study was to explore the prevalence and clinical characteristics of hand ulcer in hospitalized patients with diabetes. Methods, We analysed 17 subjects with hand ulcer among diabetic inpatients, who were admitted to the Diabetic Foot Care Center, Department of Endocrinology and Metabolism at the West China Hospital of Sichuan University from April 2003 to December 2008. Results, The prevalence of diabetic hand ulcer among hospitalized patients (0.37%) was significantly lower than that of diabetic foot ulcers (9.7%, P = 0.000). The mean age was 62.1 ± 9.4 years. The average known durations of diabetes and glycated haemoglobin (HbA1c) were 5.3 ± 4.9 years and 10.9 ± 2.4%, respectively. All patients lived in the subtropical zone. Fifteen patients (88.2%) were diagnosed with diabetic peripheral neuropathy. Ten patients had hand infection. After therapy, the ulcers healed in 13 patients (76.5%) and none of them experienced amputation. The average hospital stay for patients with local infection was characteristically longer than that for patients without infection (P = 0.012). The prognosis of the hand ulcer was poorer in the patients who had diabetes for > 3 years compared with those who had diabetes for < 3 years (P = 0.009). Conclusions, Diabetic hand ulcer is a relatively rare complication of diabetes in South-West China. Long duration of diabetes, poorly controlled blood glucose, minor trauma and delayed treatment are the risk factors. Diabetic peripheral neuropathy may play an important role in the pathogenesis of hand ulcer. Early control of blood glucose with insulin and early anti-microbial therapy with appropriate antibiotics are crucial. Debridement and drainage are necessary for hand abscesses. [source] The epidemiology of diabetic limb sepsis: an African perspectiveDIABETIC MEDICINE, Issue 11 2002Z. G. Abbas Abstract We review the epidemiology of foot and hand sepsis in adult diabetes patients in Africa. Limb sepsis in these patients is associated with significant morbidity and mortality. The pathogenesis of diabetic foot infections in these patient populations appears to be similar to that for patients in industrialized countries ,ulcers and underlying peripheral neuropathy being the most important risk factors. Prevention of peripheral neuropathy through aggressive glycaemic control may be the most important primary control measure for foot infections. The tropical diabetic hand syndrome (TDHS) is being increasingly seen in diabetes patients in certain parts of Africa. The syndrome is acute, usually follows minor trauma to the hand, and is associated with a progressive synergistic form of gangrene. The major risk factors for TDHS are unknown but recent data suggest poor glycaemic control is associated with poor outcome. Treatment of TDHS requires aggressive surgery. Hence, preventive efforts for both foot and hand sepsis include aggressive glucose control, and education on hand and foot care and the importance of seeking medical attention promptly at the earliest onset of symptoms. Diabet. Med. 19, 895,899 (2002) [source] Confirmatory factor analysis and recommendations for improvement of the Autonomy-Preference-Index (API)HEALTH EXPECTATIONS, Issue 3 2010Daniela Simon PhD Dipl Psych Abstract Objective, Validation of the German version of the Autonomy-Preference-Index (API), a measure of patients' preferences for decision making and information seeking. Methods, Stepwise confirmatory factor analysis was conducted on a sample of patients (n = 1592) treated in primary care for depression (n = 186), surgical and internal medicine inpatients (n = 811) and patients with minor trauma treated in an emergency department (n = 595). An initial test of the model was done on calculation and validation halves of the sample. Both local and global indexes-of-fit suggested modifications to the scale. The scale was modified and re-tested in the calculation sample and confirmed in the validation sample. Subgroup analyses for age, gender and type of treatment setting were also performed. Results, The confirmatory analysis led to a modified version of the API with better local and global indexes-of-fit for samples of German-speaking patients. Two items of the sub-scale, ,preference for decision-making', and one item of the sub-scale, ,preference for information seeking', showed very low reliability scores and were deleted. Thus, several global indexes-of-fit clearly improved significantly. The modified scale was confirmed on the validation sample with acceptable to good indices of fit. Results of subgroup analyses indicated that no adaptations were necessary. Discussion and conclusions, This first confirmatory analysis for a German-speaking population showed that the API was improved by the removal of several items. There were theoretically plausible explanations for this improvement suggesting that the modifications might also be appropriate in English and other language versions. [source] Acellular dermal matrix allograft used to gain attached gingiva in a case of epidermolysis bullosaJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 11 2003Eralp Buduneli Abstract Background: Epidermolysis bullosa (EB) is an acquired disease or inherited as either autosomal dominant or recessive with an incidence of 1/50,000. The prominent clinical characteristic of the disease is the development of bullae or vesicles in mucosa or skin in response to minor trauma. Aim: A female patient with a dystrophic type of EB had been put in a maintenance regimen after completion of the initial phase of periodontal therapy and followed for 7 years. The purpose of this report is to document acellular dermal matrix allograft application to increase the width of the attached gingiva in this patient experiencing difficulty in chewing and performing plaque control due to the dramatic loss of attached gingiva after 7 years of supportive periodontal therapy. Methods: Under local anaesthesia and antibiotic coverage, the acellular dermal matrix allograft was applied in the anterior region of the upper jaw in order to increase the width of attached gingiva, thereby improving patient comfort. Results: The healing was uneventful and a significant gain in attached gingiva dimensions was observed 9 months after the periodontal surgery. The procedure avoided a second surgical site, provided satisfactory results from an aesthetic point of view, and improved patient comfort. Conclusion: Acellular dermal matrix allograft may be regarded as an alternative in the treatment of EB cases to increase the width of attached gingiva and facilitate maintenance of the dentition. Zusammenfassung Hintergrund: Die Epidermolysis bullosa (EB) ist eine erworbene oder eine autosomal dominant oder rezessiv vererbte Krankheit mit einer Incidenz von 1:50,000. Die hervorstechenden klinischen Symptome dieser Erkrankung sind die Entwicklung von Blasen oder Vesikeln in der Mukosa oder in der Haut auf geringste Traumen. Ziel: Eine Frau mit dem dystrophischen Typ von EB wurde in der Erhaltungsphase seit 7 Jahren geführt, nachdem die initiale Phase der parodontalen Therapie beendet worden war. Der Zweck dieser Studie ist die Dokumentation der Applikation eines azellulären Hautmatrixtransplantats für die Verbreiterung der fest angewachsenen Gingiva bei dieser Patientin, die nach 7 Jahren der erhaltenden parodontalen Therapie Probleme beim Kauen und bei der Durchführung der Plaquekontrolle durch einen starken Verlust an fest angewachsener Gingiva hatte. Methoden: Unter lokaler Anästhesie und antibiotischer Abschirmung wurde das azelluläre Hautmatrixtransplantat in die anteriore Region des Oberkiefers appliziert, um die Breite der fest angewachsenen Gingiva zu vergrößern und so das Befinden der Patientin zu verbessern. Ergebnisse: Die Heilung war komplikationslos, und ein signifikanter Gewinn an fest angewachsener Gingiva 9 Monate nach der parodontalen Operation wurde beobachtet. Die Methode vermied eine zweite chirurgische Region, erbrachte zufriedenstellende Ergebnisse aus ästhetischer Sicht und verbesserte das Befinden der Patientin. Schlussfolgerung: Das azelluläre Hautmatrixtransplantat kann als eine Alternative in der Behandlung von EB betrachtet werden, um die Breite der fest angewachsenen Gingiva zu vergrößern und zur Möglichkeit der Erhaltung der Dentition beizutragen. Résumé La bullose épidermolysie (EB) est une maladie contractée ou héritée qui peut être aussi bien autosomale dominante que récessive avec une fréquence de 1/50,000. La caractéristique clinique importante de la maladie est le développement de bulles ou de vésicules au niveau de la muqueuse ou de la peau comme réponse à un traumatisme mineur. Une femme avec un type dystrophique de EB a été placée dans un régime de maintenance après la fin de la phase initiale du traitement parodontal et suivie durant sept années. Le but de ce rapport est de documenter le placement d'un allographe de la matrice dermique acellulaire visant à augmenter la largeur de la gencive attachée chez cette patiente qui avait des problèmes aux niveaux masticatoire et du contrôle de la plaque dentaire vu la perte dramatique de la gencive attachée après sept années de maintenance parodontale. Sous anesthésie locale et sous couverture antibiotique, l'allographe de la matrice dermique acellulaire a été placé dans la région antérieure de la mâchoire supérieure pour augmenter la largeur de la gencive attachée afin d'améliorer le confort de la patiente. La guérison s'est déroulée sans problème et un gain significatif de gencive attachée a été observé neuf mois après la chirurgie parodontale. Ce processus chirurgical élimine la nécessité d'avoir un site donneur, apporte des résultats satisfaisants du point de vue esthétique et améliore le confort du patient. L'allographe de la matrice dermique acellulaire peut donc être considéré comme une alternative dans le traitement des cas de EB afin d'augmenter la largeur de la gencive attachée et faciliter le maintien de la dentition. [source] Partial percutaneous discectomy for treatment of thoracolumbar disc protrusion: retrospective study of 331 dogsJOURNAL OF SMALL ANIMAL PRACTICE, Issue 10 2005S. Kinzel Objectives: To determine retrospectively the prognosis and outcome for dogs diagnosed with thoracolumbar intervertebral disc disease treated with partial percutaneous discectomy (PPD). Methods: Three hundred and thirty-one dogs presenting with symptoms of thoracolumbar intervertebral disc disease from 1998 to 2003 were treated with PPD. Diagnosis and location of intervertebral disc disease was confirmed by clinical examination, radiography, myelography and magnetic resonance imaging. PPD was performed via fluoroscopy-guided removal of a 5 mm bore cylinder out of the central intervertebral space. Results: Clinical success after surgery was achieved in 159 (88·8 per cent) grade II to IV patients and 58 (38·2 per cent) grade V patients. The mean (sd) time from percutaneous discectomy to first improvement was 8·3 (13·2) days. Clinical Significance: The PPD approach to the thoracolumbar spine involves minor trauma (yielding rapid recovery) and less pain, and produces results comparable with open fenestration. Consequently, this simple minimal invasive technique can be recommended as an alternative to the technique of fenestration and can be easily performed in addition to open surgical decompression techniques or prophylactically. However, it is not a replacement for surgical treatment in dogs with thoracolumbar disc disease that require removal of disc fragments causing spinal cord or nerve root compression. [source] Seasonal occurrence of impetigo: a retrospective 8-year review (1996,2003)CLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 5 2005A. Loffeld Summary Impetigo, a common skin infection, has shown seasonal variation in African, Australian and Indian studies. We investigated seasonal variation of impetigo in a UK paediatric population. A total of 1552 children with impetigo were seen in the Accident and Emergency (A&E) department between 1996 and 2003. The number of impetigo cases was always higher in late summer than in winter, and furthermore, increased year on year. These changes could not be accounted for by variation in total patient numbers seen in A&E, and suggest a correlation between impetigo frequency and climatic temperature. Possible reasons for these findings include exposed skin due to loose clothing in the summer leading to more skin-to-skin contact and minor trauma. [source] Paediatric utilization of a general emergency department in a developing countryACTA PAEDIATRICA, Issue 8 2003AY Goh Aim: Knowledge of the spectrum and frequencies of paediatric emergencies presenting to an emergency department (ED) of individual developing countries is vital in optimizing the quality of care delivered locally. Methods: A prospective 6 wk review of all paediatric (< 18y) attendees to an urban ED was done, with patient age, presenting complaints, diagnoses, time of arrival and disposition recorded. Results: Complete data were available on 1172 patients, with an age range of 4 d to 18 y (mean ± SD 6.9 ± 5.6 y); 43% were aged ,4 y. The main presenting complaints were injuries (26.9%), fever (24%) and breathing difficulties (16.6%). The most common diagnosis was minor trauma (24.2%), with soft-tissue injuries predominating (80.6%). The other diagnoses were asthma (12.6%), upper respiratory infections (12.1%), other infections (12.1%) and gastroenteritis (11.8%). Equal proportions of patients were seen throughout the day. 25% of patients were admitted. Young age (<1 y); presence of past medical history, general practitioner referrals, diagnosis of bronchiolitis and pneumonia were significantly associated with risk of admission. Conclusion: A wide spectrum of paediatric illnesses was seen in the ED, with an overrepresentation of young children. This supports the decision to have either a separate paediatric ED or paediatric residents on the staff. The training curricula should emphasize the management of paediatric trauma, infections and asthma. Alternatively, developing guidelines for the five most common presenting complaints would account for 82% of all attendees and could be directed towards all staff on the ED. [source] | ||||||||||