Healing of chronic arterial and venous leg ulcers through systemic effects of electromagnetic fields [corrected

BACKGROUND: Mitogen-activated autologous peripheral blood mononuclear cells applied locally on the ulcer surface promote healing of chronic arterial and venous leg ulcers. In vitro, extremely low frequency electromagnetic fields (ELF) interact with peripheral blood mononuclear cells (PBMC) via Ca++ channels, activating signal transduction cascades, promoting cytokine synthesis, and changing cell proliferation patterns. METHODS: ELF frequencies were configured to interact in vitro with the proliferation patterns of PBMC obtained from normal human volunteers. These ELF were then applied peripherally as the sole treatment to 26 patients with 42 chronic leg ulcers of predominantly arterial or venous etiology unresponsive to previous medical and/or surgical treatments in a phase I before-after design. RESULTS: At admission, age of ulcers had a skewed distribution with a median of 639 days. Wound healing or deleterious effects began in all patients during the first 2 weeks after ELF exposure, permitting their previously unresponsive ulcers to function as internal controls. After ELF exposure, 69% of all lesions were cured or healed >50% in a period <4 months. Defective wound healing was observed in lesions associated with important arterial occlusion, uncontrolled arterial hypertension, severe lipodermatosclerosis, non-pitting edema, and obesity (body mass index >30). Lesions worsened in patients with autoimmune diseases. CONCLUSIONS: Systemic effects are hypothetically explained by ELF activation of PBMC and their subsequent transportation to the ulcer site via humoral route. This therapy is effective in selected patients with chronic arterial and venous leg ulcers.     

术前MRV联合多普勒超声在活动性下肢静脉性溃疡诊断及治疗中的作用

目的 探讨术前磁共振静脉造影(magnetic resonance venography, MRV)检查在活动性下肢静脉性溃疡诊断及治疗中的作用。方法 回顾性分析60例慢性下肢静脉性溃疡患者资料,根据术前进行MRV联合多普勒超声检查(35例)和单纯多普勒超声检查(25例),分别设定为A组和B组。患者行腔内激光治疗技术(endovenous laser ablation, EVLT)联合隐股静脉结扎术,应用Kaplan-Meier生存分析方法对两组患者术后6个月的溃疡愈合率及术后36个月的溃疡复发率进行统计学分析。结果 随访36个月,随访率93.33%。两组患者的性别、年龄、溃疡直径和溃疡持续时间差异无统计学意义。术后6个月,两组患者的累积溃疡愈合率差异没有统计学意义(88.6% vs 92%, P=0.642)。36个月的随访期中,A组累积溃疡复发率明显低于B组(5.7% vs 24%, P=0.037)。结论 术前MRV联合多普勒超声检查对活动性下肢静脉性溃疡的诊断和治疗具有重要的指导价值。     

Long-term mortality of ultrasound structure in patients with venous leg ulcers-healed from one week to twenty years

目的　观察静脉溃疡患者愈合后皮肤超声结构的变化 ,探讨创面愈合质量。方法　应用皮肤超声仪检测静脉溃疡病人愈合后瘢痕表皮及真皮的厚度 ,分析真皮中低回声区像素 (LEPs)。结果　与正常皮肤比较 ,静脉溃疡愈合后瘢痕的平均表皮厚度显著增加 (P <0 0 1) ,平均真皮厚度显著降低 (P <0 0 1) ,而真皮中LEPs的数量及分布均无明显变化。皮肤的回声参数与创面愈合时间、创面大小、创面存在时间及病人年龄均无显著相关性。结论　静脉溃疡患者创面愈合后 ,真皮中液体的数量及分布无显著改变 ,表明愈合后水肿得到有效控制     

Venous ulceration: factors influencing recurrence after standard surgical procedures

Ninety patients with chronic venous ulceration were investigated to determine the extent of the incompetence of the venous valves. They were then treated by established surgical methods to control reflux. All wore fitted compression stockings and were regularly followed up. Forty-two patients had valvular incompetence confined to the perforating and superficial veins. All their ulcers healed and only one developed a minor recurrence during the three year follow-up. Nineteen patients had additional but limited incompetence of the deep veins; all their ulcers healed, but three developed a recurrence. Twenty-nine patients had extensive deep vein valvular incompetence including incompetence of the popliteal valve; in 12 of these patients either the ulcer failed to heal or the patient developed a recurrent ulcer within 18 months. Thirty-two other patients developed further venous reflux from the opening of new channels, including the perforating veins of the foot, and required sclerosants or local ligation. It was concluded that established surgical techniques, thoroughly performed, were very effective for the treatment of chronic venous ulceration provided the popliteal valves were competent. When the popliteal valves were incompetent the recurrence rate was unacceptably high and additional methods, including vein valve transplants, excision of the ulcer with skin grafting and lumbar sympathectomy, were considered. Nine of 11 patients who received a vein valve transplant had falls in their ambulant venous pressures, improvement in the nutrition of their skin and healing of their recurrent ulcers.     

兰索拉唑和雷尼替丁治疗胃溃疡疗效对比研究

目的：对兰索拉唑和雷尼替丁治疗胃溃疡病近期和远期愈合率进行对比研究。方法：６１例经内镜证实的活动性胃溃疡病,随机分成兰索拉唑组和雷尼替丁组,先行６周治疗,兰索拉唑每日３０ｍｇ,雷尼替丁１５０ｍｇ,每日二次,对愈合的５０例进行１年期治疗,兰索拉唑每３天３０ｍｇ,雷尼替丁每天１５０ｍｇ。结果：兰索拉唑和雷尼替丁组６周溃疡愈合率分别为９３．５％（２９／３１例）和７０％（２１／３０例）,１年愈合率分别为９     

慢性静脉性溃疡的研究现状与诊治策略

讨论慢性静脉性溃疡的研究现状与诊治策略。慢性持续性静脉高压是引起静脉性溃疡的主要原因,白细胞激活在静脉性溃疡的形成中起重要作用。静脉性溃疡需与各种其他疾病溃疡相鉴别。静脉性溃疡的治疗包括保守或药物治疗和外科治疗。硬化剂注射、浅静脉手术、深静脉瓣膜重建手术、交通静脉结扎术及皮肤移植均有利于溃疡愈合。     

复方磺胺嘧啶锌凝胶在治疗下肢静脉性溃疡中的应用

目的 观察复方磺胺嘧啶锌凝胶治疗下肢静脉性溃疡的疗效.方法 选择2015年1月至2019年12月于我院就诊的下肢静脉性溃疡患者,包括尚未行手术治疗的门诊换药患者40例和手术治疗患者40例.采用随机数字表法将未手术患者随机分为未手术试验组(20例)及未手术对照组(20例),将手术治疗患者随机分为手术试验组(20例)及手术...     

灭Hp胶囊与新三联并用对溃疡愈合质量及溃疡复发的影响

目的　观察灭Hp胶囊与新三联并用对消化性溃疡的溃疡愈合质量及溃疡复发的影响。方法　 75例活动期消化性溃疡并Hp阳性患者随机分为 3组 :A组 (新三联组 ) :口服兰索拉唑 30mg (1次 /d) 克拉霉素 2 5 0mg(2次 /d) 阿莫西林 5 0 0mg (2次 /d) ,连用 10d ;B组 (灭Hp胶囊四联组 ) :口服新三联 灭Hp胶囊 6粒 (2次 /d) ,连用 2 8d;C组 (安慰剂组 ) :口服胃舒平 3片 (2次 /d) ,连用 2 8d。疗程结束后 4周复查胃镜 ,观察Hp根治和溃疡愈合情况 ,对溃疡愈合者行光镜及电镜检查 ,评价溃疡愈合质量 ,并停服所有药物 ,随访 5年。结果　A、B两组患者溃疡愈合率、Hp根治率分别为 10 0 0 %、 96 4 % ,88 0 %、 92 0 % ;与安慰剂组的溃疡愈合率 (2 0 0 % )、Hp根治率 (0 )间差别均有显著性意义 (P <0 0 0 5 )。A、B两组与C组的溃疡愈合质量间的差别亦有显著性意义 (P <0 0 5 )。A组和B组溃疡复发率分别为 4 0 %和 10 0 % ,明显低于安慰剂的溃疡复发率 (10 0 % ) ,溃疡复发者均溃疡愈合质量不佳。结论　灭Hp胶囊四联疗法不但具有与新三联相当的Hp根治率和溃疡愈合率 ,而且更有显著提高溃疡愈合质量、降低溃疡复发的作用     

Treatment of duodenal ulcer with carbenoxolone sodium: a double-masked endoscopic trial.

In a double-masked trial, 43 patients with an endoscopically confirmed, symptomatic duodenal ulcer were allocated at random to treatment with either carbenoxolone sodium or placebo, both provided in identical "positioned-release" capsules. The 40 patients who satisfactorily completed the trial were evenly distributed between the two treatment groups. The groups were well matched with regard to clinical features and initial ulcer size. Endoscopic review of ulcer healing after six weeks' treatment showed that 12 patients (60%) receiving carbenoxolone had healed ulcers, compared with five (25%) receiving placebo (P = 0.05). Symptomatic remission occurred by the fourth week in 17 patients (85%) receiving carbenoxolone, compared with six (30%) receiving placebo (P less than 0.001). The mean (geometric) serum carbenoxolone level in patients with healed ulcers was 31.11 microgram/mL compared with 17.75 microgram/mL in those with unhealed ulcers (P less than 0.005). Side effects of carbenoxolone therapy were observed, but they did not necessitate withdrawal of the drug and were readily controlled in every instance. These results confirm the therapeutic efficacy of carbenoxolone sodium in duodenal ulcer. In addition, a relationship between serum carbenoxolone levels and the occurrence of ulcer healing was observed.     

Pinch skin grafting or porcine dermis in venous ulcers: a randomised clinical trial

Chronic venous ulcers are common, and even with effective compression or elevation large ulcers may take months to heal. Pinch skin grafting may allow healing from epithelial islands throughout the surface area of the ulcer, and a prospective randomised trial was therefore conducted comparing this treatment with porcine dermis dressings. Most patients were treated as outpatients, 25 ulcers being randomised to treatment with pinch skin grafts and 28 to treatment with porcine dermis. Though the groups were well matched, the mean healing rate in the first week was 15 cm2 for pinch skin grafts compared with 3.5 cm2 with porcine dermis (p less than 0.02). By life table analysis 64% of ulcers treated by pinch grafts were healed at six weeks and 74% by 12 weeks compared with 29% and 46% of ulcers, respectively, treated with porcine dermis dressings (chi2 = 4.1; p less than 0.05). All ulcers that failed to heal within 12 weeks included an area posterior to the medial malleolus, where local compression may have been inadequate. Pinch skin grafting improves the rate of healing in large venous ulcers and is a simple technique that may be performed as an outpatient procedure under local anaesthesia.     

复方壳聚糖膜剂促进皮肤溃疡愈合的实验研究

目的:观察复方壳聚糖膜剂促进家兔皮肤溃疡愈合的作用.方法:每只白色家兔背部制备4个皮肤溃疡模型,共19只家兔,制备76个皮肤溃疡模型:随机分为1空白对照组,2重组人表皮生长因子组,3、4、5组分别为复方壳聚糖膜剂大、中、小剂量组.以治疗后不同时间的各组溃疡面积,溃疡容积和组织病理学检查为指标,观察复方壳聚糖膜剂外贴对溃疡愈合的影响.结果:在伤后14天内,复方壳聚糖膜剂外贴可使溃疡面积和容积缩小的速度及表皮完全覆盖率均高于空白对照组.结论:局部应用复方壳聚糖膜剂对家兔皮肤溃疡愈合有促进作用.     

Recombinant bovine basic fibroblast growth factor accelerates wound healing in patients with burns, donor sites and chronic dermal ulcers

Objective To evaluate the effect of recombinant bovine basic fibroblast growth factor(rbFGF) on accelerating healing of burn wounds, donor sites and chronic dermal ulcers in multicenters. Methods One thousand and twenty-four patients with burns, donor sites and chronic dermal ulcers were recruited for this prospective and multicenter clinical trial and another 641 patients with the similar wounds were used as controls. All patients were divided into three groups: burn group, donor site group, and chronic dermal ulcer group. In the burn group, 654 patients with superficial second-degree burns( superficial Ⅱ(0)) or deep second-degree burns( deep Ⅱ(0)) were treated topically with either recombinant bovine basic fibroblast growth factor (rbFGF plus vehicle, rbFGF 150 AU/cm(2)/day, 330 patients) or placebo (vehicle without rbFGF, 324 patients). In the donor site group, 509 patients were treated with rbFGF and 317 patients with placebo in a similar way as described elsewhere. In the chronic dermal ulcer group, 185 patients were treated with rbFGF and the controls were themselves. Photography, histological evaluation and clinical examination were used to evaluate the results of wound healing. Results All of superficial second-degree burns, deep second-degree burns and the donor sites treated with recombinant bovine basic fibroblast growth factor had an accelerated rate of granulation tissue formation and epidermal regeneration as compared with that in the controls. Superficial second-degree burns and deep second-degree burns treated with recombinant bovine basic fibroblast growth factor healed in 9.89±2.45 and 17.04±4.56 days, respectively, whereas the average healing time in those receiving placebo was 12.35±2.74 and 21.21±4.88 days. The donor sites treated with rbFGF or placebo healed in 10.68±4.55 and 14.74±6.46 days, respectively. All chronic dermal ulcers except 12 patients treated with rbFGF healed within 6 weeks. Histological evaluation of punch-biopsy specimens from the burn wounds, donor sites and chronic dermal ulcers seven days after treatment supported the impression of accelerated wound healing after rbFGF treatment. Conclusions rbFGF is effective in shortening the wound healing time and improving the wound healing quality. Accelerating wound healing is of clinical benefit in reducing the length of hospitalization, costs and emotional burden of the patient.     

Comparison of ranitidine and cimetidine in duodenal ulcer healing

A single-blind trial in 50 outpatients was aimed at comparing the effectiveness of ranitidine (150 mg twice a day) and cimetidine (200 mg three times a day and 400 mg at night) in the healing of endoscopically proven duodenal ulcer. Patients were reassessed after two weeks of therapy, and then after four weeks immediately before repeat endoscopy. If the ulcer had not healed, treatment was continued for a further two weeks when patient assessment and endoscopy were repeated. By four weeks, ulcers had healed in 72% of patients receiving ranitidine and in 64% of those receiving cimetidine (P = 0.76). At six weeks, the healing rate was 92% in both groups. Symptomatic improvement was similar with both drugs. It is concluded that ranitidine and cimetidine are equally effective in healing duodenal ulcer.     

大鼠实验性胃溃疡自愈过程中HDC和H+,K+-ATP酶的表达

目的探讨胃黏膜内组氨酸脱羧酶（histidine decarboxylase,HDC）和H^＋,K^＋-ATP酶的表达与大鼠实验性胃溃疡自愈过程的关系。方法制备大鼠乙酸性胃体溃疡模型,采用逆转录聚合酶链反应和Western blot技术,观察溃疡自愈过程中大鼠胃黏膜内HDC和H^＋,K^＋-ATP酶mRNA及蛋白表达的动态变化。结果制模术后1d大鼠胃体出现明显溃疡,3d溃疡最为明显,12d溃疡基本愈合。HDC和H^＋,K^＋-ATP酶mRNA表达在制模术后1d即开始降低,术后9d恢复正常。HDC和H^＋,K^＋-ATP酶蛋白表达在制模术后也出现降低,术后6d达到最低,术后12d基本恢复正常。结论在胃溃疡自愈过程中,胃黏膜内HDC和H^＋,K^＋-ATP酶mRNA和蛋白表达下调,其作用是抑制胃酸分泌以促进溃疡愈合。     

大鼠乙酸性胃溃疡自愈过程中HDC和H+、K+-ATP酶的表达

目的探讨胃黏膜内组氨酸脱羧酶(HDC)和H ,K -ATP酶的表达与大鼠乙酸性胃溃疡自愈过程的关系。方法制备大鼠乙酸性胃体溃疡模型,采用逆转录聚合酶链反应和免疫组化法,观察溃疡自愈过程中大鼠胃黏膜内HDC和H ,K -ATP酶mRNA及蛋白表达的动态变化。结果制模术后1d大鼠胃体出现明显溃疡,3d溃疡最为明显,12d溃疡基本愈合。胃黏膜内HDC和H ,K -ATP酶mRNA表达在制模术后1d即开始降低,术后9d恢复正常。胃黏膜内HDC和H ,K -ATP酶阳性细胞率及胞质平均灰度值在制模术后也出现降低,术后6d达到最低,术后12d基本恢复正常。结论在胃溃疡自愈过程中,胃黏膜内HDC和H ,K -ATP酶表达下调,其作用是抑制胃酸分泌以促进溃疡愈合。     

Controlled trial of Iodosorb in chronic venous ulcers

Cadexomer iodine (Iodosorb) is a hydrophilic starch powder containing iodine, which is a suitable dressing for granulating wounds such as venous ulcers. A total of 61 outpatients with chronic venous ulcers participated in a randomised optional crossover trial using cadexomer iodine or a standard dressing for their ulcers. The trial lasted for 24 weeks or until the ulcer had healed. Two patients withdrew during the course of the trial. Both treatments were highly effective, but the epithelium of ulcers dressed with cadexomer iodine grew again significantly faster (p less than 0.001). At the midpoint of the trial (12th week) 13 of 30 patients receiving standard treatment were changed to cadexomer iodine, while only three of 29 receiving cadexomer iodine changed to the standard dressing (p less than 0.02). In most cases ulcers were dressed and rebandaged daily by the patients themselves after instruction and supervision. This may be better than having dressings and bandages applied by professionals less regularly.     

哌吡氮平和甲氰咪胍治疗十二指肠溃疡近期疗效的比较

本文对哌吡氮平与甲氰咪胍治疗十二指肠溃疡的近期疗效进行了比较。经4周治疗后,溃疡愈合率在哌吡氮平组为74.2％,甲氰咪胍组为68.2％,经统计学处理,两组疗效无明显差异(P>0.05)。本组观察结果认为哌吡氮平与甲氰咪胍对十二指肠溃疡均有良好的疗效,副作用较小。     

Effect of Helicobacter pylori eradication on peptic ulcer healing.

In a prospective study designed to assess the effect of Helicobacter pylori eradication on peptic ulcer healing, 85 consecutive patients with H. pylori-positive peptic ulcer disease were treated with a triple therapy regimen consisting of colloidal bismuth subcitrate 120 mg four times daily for 28 days, with metronidazole 400 mg three times daily and tetracycline 500 mg three times daily for the first seven days of treatment. H. pylori status was assessed by CLO test and histology at least four weeks after completing therapy. Of 75 patients (88%) H. pylori-negative after therapy, 69 (92%) had healed ulcers compared with only five of 10 patients (50%) who remained H. pylori-positive (p = 0.003). Cigarette smoking had no significant effect on ulcer healing. Our results suggest that H. pylori eradication may accelerate ulcer healing and provide further evidence that an effective helicobactericidal regimen is the treatment of choice in H. pylori-positive peptic ulcer.     

Effect of biofeedback-assisted relaxation training on foot ulcer healing

A prospective, randomized study was conducted to determine the effect of biofeedback-assisted relaxation training on foot ulcer healing. For patients with chronic nonhealing foot ulcers, medical care was combined with a standardized biofeedback-assisted relaxation training program in the experimental group. The intervention was designed to increase peripheral perfusion, thereby promoting healing. A total of 32 patients with chronic nonhealing ulcers participated in the study. In the experimental group, 14 out of 16 ulcers (87.5%) healed, as compared with 7 out of 16 ulcers (43.8%) in the control group.