Cellulitis in Venous Leg Ulcers Treated with a Hydrocolloid Dressing

Objective:

To evaluate the development of cellulitis in patients with venous leg ulcers in relation to colonizing or infecting microorganisms and principles of ulcer dressing.

Design:

Patients were prospectively randomized to either a routine leg ulcer dressing principle or hydrocolloid dressing (HCD).

Setting:

Tertiary care university hospital.

Patients:

Fifty-seven consecutive patients followed for at least 6 months.

Main outcome measures:

Development of cellulitis related to isolation of microorganisms and the ulcer dressing principle.

Results:

Development of cellulitis was only correlated to the isolation of haemolytic streptococci, predominantly belonging to Lancefield group G (2 p < 0.01). Staphylococcus aureus and Pseudomonas aeruginosa did not contribute to the development of cellulitis. One infection per 198 days was found in patients treated with HCD compared with one infection per 290 days in patients treated with chlorhexidine ointment with a vehicle of carbowax polyethylene glycol (not statistically different).

Conclusions:

Hydrocolloid dressing treatment was safe. Cellulitis was caused by haemolytic streptococci.

Pain-related psychological distress, self-rated health and significance of neuropathic pain in Danish soldiers injured in Afghanistan

BACKGROUND

Pain and mental health concerns are prevalent among veterans. While the majority of research has focused on chronic pain as an entity, there has been little work directed towards investigating the role of neuropathic pain in relation to psychological comorbidity. As such, we hypothesised that participants with signs of neuropathic pain would report higher levels of psychological distress and diminished self-rated health compared to those without a neuropathic component.

METHODS

A retrospective review of standardised questionnaires (PainDETECT Questionnaire, Post-traumatic Stress Disorder Checklist-Civilian, the Hospital Anxiety and Depression Scale, and EuroQOL Visual Analogue Scale) administered to injured soldiers. The participants were classified into three groups according to the PainDETECT questionnaire: non-neuropathic pain, possible neuropathic pain and definite neuropathic pain.

RESULTS

Fifty-three participants were included. The Post-traumatic Stress Disorder Checklist-Civilian score was in median (interquartile range) 26 (22-31), the Hospital Anxiety and Depression Scale score was 4 (2-6.5) and 2 (1-5) for anxiety and depression respectively. Evidence of neuropathic pain correlated positively with the Post-traumatic Stress Disorder Checklist-Civilian score (rho = 0.469, P < 0.001) and Hospital Anxiety and Depression Scale subscale for anxiety score (rho = 0.357, P = 0.009), and inversely with the EuroQOL Visual Analogue Scale score (rho = -0.361, P = 0.008). In multivariate regression analyses, the associations remained when adjusting for socio-demographics and clinical characteristics.

CONCLUSIONS

The results from the present study suggest that neuropathic pain is related to increased psychological distress and deterioration in self-rated health in injured soldiers.

Vein surgery with or without skin grafting versus conservative treatment for leg ulcers. A randomized prospective study

In order for us to evaluate the efficiency of perforator vein surgery and skin grafting in leg ulcer patients, 47 patients were randomized into 3 treatment groups (group A: surgery for incompetent perforators, group B: surgery for incompetent perforators and ulcer excision followed by grafting, group C: control group). All the patients were treated with a compression bandage. When cellulitis was observed, a systemic antibiotic was given; eczema was treated with a steroid ointment. Fourty patients were evaluated regularly during one year after entry. There were no differences between the 3 treatment groups considering base-line characteristics, median ulcer size at entry and after one year. According to a review of the initial phlebograms, the occurrence of post-thrombotic changes in the deep veins were recorded in the majority of the legs. Our results suggest that ligation of incompetent perforators and skin grafting, as used in the present study, may not offer an additional advantage for venous ulcer patients with insufficiency of the deep veins when compared to conservative treatment. However, the removal of insufficient superficial veins was not studied.

["Mouse" in Baker's cyst]

Calcified bodies may arise in a joint due to trauma, arthropathy resulting in joint destruction or synovial osteochondromatosis. These calcified loose bodies may pass into a popliteal cyst though posterior joint-bursal communications, or can arise in a popliteal cyst de novo on account of chondrometaplasia. A case history illustrates the differential diagnostic considerations. X-ray combined with ultrasound investigation will exclude soft tissue tumors and vascular lesions.

Treatment of excoriations with a transparent hydrocolloid dressing: a prospective study

A transparent hydrocolloid dressing (THCD) was compared with a traditional paraffin gauze dressing (PGD) in the treatment of excoriations with special focus on patient acceptability. A series of 12 emergency ward patients with 16 traumatic excoriations were included in the study. There were 9 women and 3 men. Average age was 26 years (range 12-66 years). Seven wounds were dressed with THCD and nine with PGD. Patients treated with THCD felt less pain than those treated with PGD. A significantly higher number of patients treated with PGD than THCD complained of wound or bandage sticking to their clothes (P = 0.0007). No infection was seen. We conclude that THCD is suitable for dressing acute excoriations. And the level of comfort is better than in traditional treatment with PGD.