Developing a leg ulcer management programme.
Compression therapy is an essential component in the treatment of venous leg ulcers. Comprehensive education and training and support of district nurses in leg ulcer management is essential.
Biomedical subjects
Publications and source records attributed to H Charles.
Compression therapy is an essential component in the treatment of venous leg ulcers. Comprehensive education and training and support of district nurses in leg ulcer management is essential.
The pain of leg ulceration can dominate patients' lives and can have serious psychological and social effects on patients' quality of life. A phenomenological approach was used in this study to obtain rich data on patients' experiences. A feeling of loss of control and lack of faith in the professionals treating the condition was found.
Chaperonins are ubiquitous proteins found in all prokaryotic and eukaryotic cells. They are overproduced in several parasitic bacteria and are implicated in at least 2 types of endocytobiosis: in amoebae and in aphids. This work puts in evidence that a protein named symbionin, which shows an immunological homology with the E. coli protein GroEL, is present in the symbiotic relationship of 3 species of Sitophilus (S. oryzae, S. granarius, and S. zeamais). This protein is neither found in the naturally asymbiotic specie S. linearis nor in the aposymbiotic strain of S. oryzae obtained in the laboratory. This symbionin is stored in a great quantity within endocytobiotes and its amino acid composition seems to corroborate its chaperonin resemblance rather than its possible function as one of the insect storage proteins already described in the literature.
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The CheR methyltransferase catalyzes the transfer of methyl groups from S-adenosylmethionine to specific glutamyl residues in bacterial chemoreceptor proteins. Studies with sulfhydryl reagents such as p-chloromercuribenzoate, N-ethylmaleimide, and 5,5'-dithiobis(2-nitrobenzoate) suggest that a cysteine residue is required for enzyme activity. The nucleotide sequence of the cheR gene predicts a 288-amino acid protein with cysteine residues at positions 31 and 229. To ascertain the role of these cysteine residues in the structure and function of the enzyme, oligonucleotide-directed mutagenesis was used to change each cysteine to serine. Whereas the Cys229-Ser mutation had essentially no effect on transferase activity, the Cys31-Ser mutation caused an 80% decrease in enzyme activity. The double mutant in which both cysteines were replaced by serines also had markedly reduced transferase activity. Preincubation of the wild type or Cys229-Ser proteins with either S-adenosylmethionine or beta-mercaptoethanol protected it from inhibition by sulfhydryl reagents, whereas prior incubation with the second substrate, the Tar receptor, gave partial protection. From these studies, Cys31 appears to be necessary for enzyme activity, and it seems to be located in the vicinity of the active site.
Twenty patients with presumed uveal melanoma underwent internal eye wall resection. It was the primary procedure in 13 patients who had tumours within 2 disc diameters of the optic nerve head and was combined with external resection in the remainder. Malignant melanoma was confirmed histologically in 15 patients; the diagnosis was a benign tumour in the other 5. The length of follow-up ranged from 2 to 37 (mean 19) months. In all cases the retina was completely attached at the time of last examination. The visual acuity ranged from 20/40 to hand movements; nine patients had an acuity of 20/400 or better. At the time of writing no metastatic disease or local recurrence had developed in any of the 15 patients in whom malignant melanoma was diagnosed.
We used a Nd:YAg laser fit with a fiberoptic cord and sapphire tip to drain subretinal fluid externally in patients with rhegmatogenous retinal detachment. The direct contact between the laser and the choroid allowed for controlled cutting and coagulation of the intervening choroidal vasculature. The drainage was successfully achieved with no complication.
A footplate of an anterior chamber lens that extruded through clear cornea was treated by severing the protruding haptic with the Nd:YAG laser and removing it surgically. During the procedure, the remainder of the implant was repositioned and vitreous traction was relieved by pars plana vitrectomy. This technique appeared less injurious to the eye than attempting to cut all four fibrosed haptics and remove the entire implant.
Pars plana vitrectomy can be combined with injection of fluorosilicone oil to treat complex retinal detachments. We describe three cases to illustrate the technique, which is adapted according to the type and location of the retinal breaks.
A 24-year-old woman was seen with painless, progressive, unilateral visual acuity loss, optic nerve swelling, and opticociliary shunt vessels. Results of a skull series and conventional tomography showed enlargement and erosion of the optic canal. In addition, computed tomography (CT) disclosed a thickened optic nerve consistent with optic nerve sheath meningioma. A preoperative diagnosis of granulomatous optic neuropathy was based on the presence of mild posterior uveitis, "snowball" opacities in the vitreous ("string of pearl" sign), and a slightly elevated angiotensin-converting enzyme level. A specimen from a biopsy by means of a craniotomy indicated granulomatous optic nerve involvement with chiasmal invasion. The systemic effects of steroids for six months resulted in a modest improvement of visual acuity and restoration of normal optic nerve structure on repeated CT.
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