Valutazione clinica e strumentale dell'attività terapeutica di un vasoprotettore contenente vitamina PP,vitamina C ed estratti fitoterapici titolati in escina,bromelina,antocianosidi nella cura delle ulcere

Background. Chronic leg ulcers due to venous insufficiency represent a significant burden for the national sanitary system. Although the role of venous hypertension as a key pathogenetic factor of this lesion is clear, several microcirculatory mechanisms involved in the tissue repair process remain to be clarified. The purpose of this study was to evaluate the efficacy and tolerability of a vasoactive drug for the treatment of varicose leg ulcers. Methods. The study was a prospective randomized trial lasting eight weeks. Twenty patients matched for sex, age, wound dimensions and with clinical and instrumental evidence of chronic venous insufficiency were enrolled in this study. Patients attended a weekly consultation at the outpatients clinic for chronic leg ulcers of the Department of Dermatology at the University of Pisa and they were randomized into two groups according to treatment: G1 (n=10) vasoactive drug, occlusive dressing, elastic bandage, G2 (n=10) occlusive dressing, elastic bandage. During the study, subjective parameters were evaluated: intensity of pain, paresthesia, heaviness and objective parameters: intensity of oedema, wound area, transcutaneous tissue gas monitoring (O2 - CO2). Results. At the end of the study a marked reduction of subjective symptoms such as pain and paresthesia was observed with an increase of oxygen tissue perfusion in the G1 group compared to the G2 group. No significant differences were observed in the two groups about the remaining parameters investigated. Conclusions. The drug investigated in this study showed a good tolerability and efficacy in weakening the clinical symptoms related to venous insufficiency. The positive effect of the vasoactive drug on transcutaneous oxygen tension confirms a direct action on the microcirculatory system, which could positively modulate the tissue repair process

Lo sbrigliamento delle ulcere cutanee

The aim of this study is to review different methods of debridement in chronic wounds and to identify the evidence of debriding agents in wound healing. Debridement is an essential part of the tissue repair process and is defined as the removal of devitalized tissue from the wound bed. The accumulation of this tissue is regarded to prevent or delay granulation and epithelialization. Debridement techniques are divided into mechanical and non-mechanical methods on the basis of the physical peculiarities of the means employed and into selective and non-selective methods regarding the preservation or not of vital tissue from the wound bed. Advantages and disadvantages of each procedure are taken in to account to select the best form of debridement for each type of chronic wound. Surgical debridement is the most aggressive form and the more rapid compared to other techniques. It is essential to prevent infection and to remove dry thick eschars mainly in pressure ulcers. Autolytic debridement is the most easy and well tolerated from the patient and it is obtained through the use of occlusive dressings. Other forms of debridement such as the larva-therapy were used in the past and today have been reconsidered as useful and safe methods. The enzymatic and wet to dry debridements are the most common methods in our country and this is mainly due to the availability of these products. Chronic wounds are often contaminated with devitalized tissue and foreign material, which represent a barrier to cells migration and a source of infection. Selection of the debridement technique must consider the patient compliance, the wound size, the amount of exudate and the skill of the operator

Pattern VEP alterations in psoriatic patients may indicate a sub clinic optic neuritis

We examined 44 subject (Group A) of both sexes (27 males and 17 females) aging between 16 and 80 (average: 45 +/- 16.6), divided into age bands, affected by mild-medium psoriasis with PASI (psoriasis area and severity index) between 1.2 and 48.6 (average: 11.2 +/- 9.7) without any other disease and we performed pattern transient VEP (Visual Evoked Potential) at the frequencies usually Used in clinical experience (73', 36' 18' check size). For a good statistic comparison we choose 55 healthy subjects (group B) divided into a L,,e hands oil which we performed the same test. Comparison of VEP parameters between psoriatic and healthy subjects. showed in group A 10 normal (22.7%) and 34 pathological (77.3%). In the latter group there are 16 subjects who show only a P100 reduced amplitude (36.3%), 3 with only increased latency (6.8%), 15 with alterations of both values (34%). The achieved data show that more than 3/4 of group A subjects have VEP alterations as index of the presence of a sub clinic optic neuritis With a probably toxic autoimmune origin due to the action of TNF alpha, of IgG, of ECP or of other cytokines (IL6, IL7, etc) that are increased in the blood of this patients. The electro physiologic monitoring of optic nerve seems to represent a good routine test to evaluate the global conditions of psoriatic patients