The care of decubitus ulcers pressure sores.

Despite a large volume of literature particularly directed toward treatment, pressure sores (including decubitus ulcers) remain a difficult problem, especially in the nursing home environment. The treatment of pressure sores is somewhat controversial and quite diversified. Selection of a successful therapeutic modality must be preceded by correct evaluation, i.e., whether the sore is superficial or deep, open or closed. The treatment of superficial sores is conservative and directed toward cleanliness, relief of pressure, and exposure to air. Surgical debridement may be indicated. Proteolytic enzymes often are employed as adjunctive therapy, although there are some major drawbacks to their use. The plethora of therapeutic agents suggested for the treatment of deep pressure sores probably is related to the difficulties in achieving success. Surgical debridement is indicated, and proteolytic enzymes are widely used. Possible interactions. and factors leading to the inactivation of these enzymes are discussed, as is the use of various solutions, ointments, gold leaf, oxygen, dry heat, and other adjunctive devices. Of paramount importance in the management of pressure sores is the maintenance of cleanliness and dryness.     

Drug resistant malaria, with special reference to Thailand.

Drug resistance of malaria parasites is a major problem confronting efforts to treat and control malaria. Starting with chloroquine, the emergence of resistance to other drugs has led to multi-drug resistance patterns that pose increasing threats for the future. This report reviews work carried out over the past decades at the Hospital for Tropical Diseases, Bangkok, which monitors patients from many areas, including the Thai-Cambodian border, which harbors the world's most severe multi-drug resistant Plasmodium falciparum.     

Collagenase in the treatment of dermal and decubitus ulcers.

The current management of decubitus ulcers, factors in wound healing and the role of enzymes in treatment are discussed. The therapeutic benefits of collagenase (Santyl) ointment in 21 patients are described, supplemented by serial color photographs. Statistical evidence is provided for the conclusion that collagenase ointment is an excellent adjunct to therapy.     

A randomized trial of cadexomer iodine in decubitus ulcers

Thirty-four patients with decubitus ulcers were studied in a randomized trial to compare topical cadexomer iodine with the standard decubitus ulcer treatments used in the participating hospitals. There was a significant reduction of ulcer area with both treatments within three weeks; however, eight of 16 patients treated with cadexomer iodine had a reduction of ulcer area of more than 50 per cent, compared with one of 18 patients treated with the standard treatment (P less than 0.01). Twenty-seven patients continued the same treatment for five more weeks, during which time six in the cadexomer iodine group healed, compared with one in the standard treatment group (P less than 0.05). Cadexomer iodine was superior to the standard treatment in removing pus and debris from the ulcer surface and in reducing pain at the ulcer site. It was found to be easy both to apply and to remove from the ulcers and did not stain skin or clothing. Transient smarting during the first hour after application was reported by three patients, and one patient complained of skin irritation. The results show that cadexomer iodine applied daily has a debriding effect on decubitus ulcers and accelerates healing.     

Design of exercise test, with special reference to heart patients.

Estimation of exercise tolerance in patients with heart disease and significant symptoms can usually not be expressed in terms of maximal oxygen uptake or power at a fixed heart rate calculated from a 'steady state' exercise test. The exercise tolerance can be expressed only by the maximal power developed, when limited by symptoms. For this purpose the level of tolerance is better assessed by a test with small increments and short duration of each work load. In clinical practice this type of almost continuous increase in load was found to be particularly useful in patients with ischaemic heart disease. Comparative studies showed that the work per heart beat at equal loads is significantly higher in the test with continuous increase in load than in the test with steps of 6 minutes duration, both in normal subjects and in heart patients. The difference, however, is small (7%) and for practical purposes these tests have equal validity as a measure of the circulatory capacity.     

Design of exercise test, with special reference to heart patients.

Estimation of exercise tolerance in patients with heart disease and significant symptoms can usually not be expressed in terms of maximal oxygen uptake or power at a fixed heart rate calculated from a 'steady state' exercise test. The exercise tolerance can be expressed only by the maximal power developed, when limited by symptoms. For this purpose the level of tolerance is better assessed by a test with small increments and short duration of each work load. In clinical practice this type of almost continuous increase in load was found to be particularly useful in patients with ischaemic heart disease. Comparative studies showed that the work per heart beat at equal loads is significantly higher in the test with continuous increase in load than in the test with steps of 6 minutes duration, both in normal subjects and in heart patients. The difference, however, is small (7%) and for practical purposes these tests have equal validity as a measure of the circulatory capacity.