The pattern of mucosal blood flow in normal human stomachs, and benign gastric ulcers was assesed with laser Doppler flowmetry and the relationship between a single determination of ulcer blood flow and the systemic level of growth factors was investigated. A significant ascending gradient in mucosal blood flow from the antrum to fundus was demonstrated. Different levels of cellular activity in the regions of the stomach may explain this gradient. In the gastric ulcers that healed on standard medical therapy mucosal blood flow was significantly increased in comparison to normal stomachs. In the ulcers that were refractory to standard medical therapy mucosal blood flow was significantly lower than in normal stomachs and healing ulcers. Higher systemic levels of the growth factor bFGF were demonstrated in healing ulcers compared to non-healing ulcers. Gastric mucosal blood flow can increase in response to the increased metabolic demands of healing, however impairment of this response may be an important factor preventing healing of benign gastric ulcers. It would appear that non-healing of gastric ulcers can be predicted at initial diagnosis by reduced peri-ulcer gastric mucosal blood flow and low blood levels of bFGF. / Thesis (M.Med.Sc.)-University of Natal, Durban, 1999.

A study was undertaken of the stressful life situations of 87 duodenal ulcer patients (50 Indian and 37 Black males) and a control group of 75 non-ulcer patients (43 Indian and 32 Black males). The majority of the control group were orthopaedic patients selected on the grounds that they were not hospitalised for a psychosomatic complaint. The group emerged, however, as highly stressed in relation to possible work and income loss, because of their injuries. The duodenal ulcer and non-ulcer groups were similar in many demographic details and in several stressful life situations. There was a significantly higher reporting of stress in family life, in the work situation and as a result of the illness itself, by duodenal ulcer patients compared with the controls. The initial hypothesis that there would be more areas perceived of as stressful in the case of duodenal ulcer patients than controls was confirmed in the study. A minor hypothesis that there would be cross-cultural differences in the perception of stress was also confirmed. The follow-up study of Indian duodenal ulcer patients demonstrated the development of an "illness career" consisting of a periodic response to stress with onset or recurrence of duodenal ulcer symptoms accompanied by changes in the individual's family system. Minuchin's (1978) concept of enmeshment or disengagement in family systems was found to be applicable to the duodenal ulcer patient. The symptom served to maintain family homeostasis by transforming family conflict into care and concern, or by legitamising the under-functioning of the sick person. The role of social work intervention in relation to duodenal ulcer disease was explored through the establishment of a medical social work programme at the Gastro-Intestinal Unit, King Edward VIII Hospital, Durban. It was shown that the psychosocial aspects of duodenal ulcer disease must receive attention, together with medical treatment, if comprehensive patient care is to be achieved. Intervention should emphasise self management of stress through behaviour modification and cognitive restructuring. Family therapy is essential in cases where the symptom has a function in the family system. Many systems are involved in the aetiology and treatment of duodenal ulcer disease. A general systems approach is therefore useful in promoting a holistic view of the person and the illness. / Thesis (Ph.D.)-University of Durban-Westville, 1983.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Bakgrund: Venösa bensår är ett växande problem som orsakar smärta, begränsad rörlighet och minskad livskvalitet. Genom att främja egenvård till patienter med venösa bensår kan sårläkning förbättras. Egenvård är en hälso- och sjukvårdsåtgärd som legitimerad yrkesutövare har bedömt att personen kan utöva själv eller med hjälp av någon annan. Sjuksköterskors nyckelroll är att främja och optimera följsamhet av egenvård. Patientdelaktighet leder till att målen med vård och behandling uppfylls bättre. Syfte: Syftet med denna studie var att belysa distriktssköterskors erfarenheter av att främja egenvård hos patienter med venösa bensår. Metod: Data analyserades genom kvalitativ innehållsanalys med en induktiv ansats. Tio intervjuer med distriktssköterskor genomfördes. Resultat: Ur analysen av datamaterialet framträdde fyra kategorier med elva underkategorier; Involvera patienten i behandlingen, Skapa samsyn till förändring, Samarbeta kring patienten och Beakta patientens bristande medverkan. Konklusion: Studiens resultat visade att egenvårdsråd främjas till patienter med venösa bensår men att distriktssköterskorna saknade gemensamma riktlinjer. Genom att distriktssköterskorna tar sig tid och främjar egenvård kan patienten få ökad insikt till varför egenvård behövs för att främja sårläkning. / Background: Leg ulcers are a growing problem causing pain, limited mobility and reduced quality of life. Through promotion of self-care for patients with venous leg ulcers, wound healing can be improved. Self-care is a health measure that qualified professionals can decide a person can exert him or herself or with assistance from others. Nurses’ key role is to foster and optimize adherence to self-care. Patient participation leads to better fulfillment of the goals for the care and treatment. Purpose: The purpose of this study was to elucidate the district nurses’ experiences of promoting self-care in patients with venous leg ulcers. Method: Data were analyzed using qualitative content analysis and an inductive approach. Ten interviews with district nurses were conducted. Results: Analysis of the data produced four categories with eleven sub-categories; Involve the patient in treatment, Create consensus for change, Collaborate with the patient and Observe the patient's lack of participation. Conclusion: Our results showed that self-care is promoting to patients with venous leg ulcers, but that the district nurses lacked common guidelines. The district nurses can by taking the time to promote self-care advice give the patient a greater understanding why self-care is needed to promote wound healing.

There are many terms used to describe pressure ulcers: pressure sores, decubitus ulcers, bedsores, and pressure necrosis or ischaemic ulcers. Essentially they all describe damage to the patient's skin and underlying tissue. The nursing literature abounds with information about the risk, grading, prevention and treatment of pressure ulcers. These ulcers are a problem in hospital and long term care facilities, and are a major cause of morbidity. In the hospital setting they contribute to an extended length of stay and by doing so 'block' the bed for use by another patient. The ulcers are difficult to treat, are an ongoing cause for pain and discomfort for the patient and can be a strain on hospital finances. Pressure ulcers are not unique to modern times, as they have been discovered on the remains of an Egyptian mummified body (Armstrong & Bortz 2001). This would suggest that the problem dates back to the Pharoahs, and has continued to be a challenging problem throughout the centuries (Bridel 1992). The escalating costs of treating these ulcers today, has brought about an emphasis on the risk factors, prevention and the appropriate interventions, rather than an acceptance of these ulcers as a tolerable ondition (Bridel 1992). In the operating room, nurses are faced with unique challenges when caring for their patients. This is due to difficulty in caring for patients under the influence of the anaesthesia required for surgery, long periods of forced immobility and the inability of the patient to perceive pain and discomfort from the pressure of the hard surface of the operating room table. These problems are increased by nurses' inability to gain access to the patient because of the sterile drapes required to cover the patient for surgery. Armstrong and Bortz (2001) present information from one study in which it is stated that surgical patients have 90% greater chance of developing pressure ulcers than medical patients. One reason for this may be due to the limited information available in regard to the most effective support surface to place on top of the operating room table. This gap in information is problematic for operating room nurses as it limits their ability to select the most effective item of equipment, and determine if the chosen equipment reduces pressure on tissue intra- operatively. The most effective operating room table mattress used and the skills and knowledge of the operating room nurse about the aetiology and prevention of pressure ulcer prevention, are important aspects of nursing care and can influence patient outcomes. The potential for complications to occur may be dependent on single or combined factors such as the patient's age, disease processes, nutritional status and mobility. Preparatory and supportive nursing interventions for surgical procedures based on best available evidence, nursing experience and patient preference, can reduce the incidence of pressure ulcer development in the perioperative environment. This doctoral portfolio contains four separate sections related and linked together by a common theme - pressure ulcer prevention in the perioperative environment. This first section of the portfolio situates the topic and provides a brief overview of the portfolio. The second section is a critical review of the literature pertaining to the most commonly used operating room table mattresses, and the effectiveness of these mattresses in the prevention of pressure ulcer development. This review highlighted a lack of quality research in this area, and while many evaluations have been undertaken to determine the effectiveness of perating room table mattresses, the results are contradictory concerning the patients, exposures and interventions. Because of issues related to the methodological quality of published research in this area a systematic review using meta- analysis was not possible rather a critical review of the research literature is used. The third section of the portfolio reports on a hermeneutic ethnography of the perceived skills and knowledge of nurses in the prevention of pressure ulcer development in the perioperative environment. This study was designed to determine if pressure ulcer prevention forms an aspect of the everyday practice of perioperative nurses. This review has highlighted the need for operating room nurses to review practices when caring for patients in the perioperative environment particularly in respect of pressure ulcer prevention. The fourth and final section of the portfolio summarises the research and provides recommendations for nursing practice and further research in the area of pressure ulcer prevention in the perioperative environment. / Thesis (D.Nurs.)--Department of Clinical Nursing, 2004.

Thesis (doctoral)--Ludwig-Maximilians Universität zu München, 1994. / Includes bibliographical references.

Thesis (M.Tech.: Homoeopathy)-Dept. of Homoeopathy, Durban University of Technology, 2006 xxxiii, 112 leaves : ill. / The purpose of this double-blind placebo-controlled study was to evaluate the relative and combined efficacy of the homoeopathic similimum, taken orally, and the topical application of a lotion made from the homoeopathic mother tinctures of Hypericum perforatum and Calendula officinalis in the treatment of venous leg ulcers. Venous hypertension in the lower limb, occurring from a variety of causes, leads to microcirculatory abnormalities which may permit the formation of a chronic ulcer (Zimmet, 1998). Venous leg ulcers are a cause of much debility, social isolation, depression, fears of loss of employment and income (Royal College of Nursing Institute, 1998). The mainstay of treatment at present is compression bandaging to reduce the venous pressure in the lower limb. Eighty percent of venous leg ulcers will heal within eight to twelve weeks with compression bandaging (Thomas, 1997). Homoeopathy is a system of medicine based on natural laws of healing, and recognizes the biophysical energy of an individual (also known as the vital force) as that which provides the normal protective defence mechanisms of the body, and is disturbed in disease, producing symptoms on the physical, mental and emotional levels (Vithoulkas, 1980). Many plants are known to have wound-healing properties (Curtis and Fraser, 2003). Calendula officinalis and Hypericum perforatum were considered the best plants in a homoeopathic lotion to be used on chronic venous leg ulcers, as they cover all the common problems associated with this type of wound, providing pain relief and anti-microbial activity (Lawless, 1995). In this study, homoeopathic mother tinctures of the herbs were used to make the lotion for topical application to the wounds.

Made available in DSpace on 2015-05-14T12:59:29Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 2252279 bytes, checksum: ea5b5b6231d4ef81bdae276ac8546529 (MD5) Previous issue date: 2011-02-24 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Xylopia langsdorffiana A. St.-Hil. & Tul., species belonging to the Annonaceae family, popularly known as "pimenteira da terra" was selected for the study on the basis of the chemotaxonomic criteria, because many chemical compounds with pharmacological activities have been isolated. Among these, the diterpenes are highlighted, considered as important biomarkers of the species from genus Xylopia. The crude ethanol extract (EEtOH) and the hexane phase (FaHex) were obtained from the leaves of this species and were used to evaluate the toxicity, gastroprotective and healing activities in animal models. In acute toxicity test, the single dose of 2000 mg/kg of EEtOH administered p.o. caused signs of hyperactivity and irritability, increase in food consumption and body weight in female mice, while for male mice was observed only increase in water consumption. During the study, no deaths and no macroscopic changes were observed in the organs of the mice. For the evaluation of gastroprotective activity were used the models to induce ulcers by HCl/ethanol, ethanol (in rats), stress (immobilization and cold), nonsteroidal anti-inflammatory drug (NSAID) piroxicam in mice and contention of the gastric juice. In the HCl/ethanol-induced ulcer model the EEtOH-Xl (62,5 125, 250 and 500 mg/kg, p.o.) reduced the ulcerative lesion index (ULI) in 29, 38, 52 and 60 %, respectively. It was also observed in the ethanol-induced ulcer model that the EEtOH-Xl and FaHex-Xl (62,5 125, 250 and 500 mg/kg, p.o.) inhibited the ULI in 37, 41, 64, 83 and 23, 51, 81, 84 %, respectively. In the stress-induced ulcer model the EEtOH-Xl and FaHex-Xl (62,5, 125, 250 and 500 mg/kg, p.o.) decreased the ULI for 47, 50, 52, 48 and 32, 43, 56, 75 %, respectively. Similar results were evidenced in NSAID-induced lesion model, which percentages of protection were 31, 70, 71, 72 % (EEtOH-Xl) and 42, 58, 61 % to FaHex-Xl doses of 125, 250 e 500 mg/kg. In the contention of the gastric juice (pyloric ligation) the EEtOH-Xl (500 mg/kg) and FaHex-Xl (250 mg/kg) showed gastric protection with the administration both orally (p.o.) (54 and 28 %) and intraduodenally (i.d.) (36 and 45%), respectively. In this model, the EEtOH (500 mg/kg) and FaHex (250 mg/kg) in both routes of administration did not alter the parameters of gastric juice (pH, [H+] and gastric volume). In the elucidating the mechanisms of cytoprotective activity of Xylopia langsdorffiana the FaHex-Xl (250 mg/kg) did not increase the production of mucus to the mucosa; the EEtOH-Xl (500 mg/kg) and FaHex-Xl (250 mg/kg) administered orally induced gastroprotection dependent on sulfhydryl groups and nitric oxide. In the acetic acid-induced ulcer model, the treatment with EEtOH-Xl (500 mg/kg, p.o.) and FaHex-Xl (250 mg/kg, p.o.) resulted in 51 and 36% of ulcer healing, respectively. In this model, during the 14 days of treatment, it was observed that the extract increased the water and food intake and the hexane phase reduced the biochemical parameters AST and uric acid. These data indicate that X. langsdorffiana has gastroprotective and healing activity, with partial participation of sulfhydryl groups and nitric oxide and possibly the involvement of growth factors and angiogenesis in the healing process induced by the chemical constituents, particularly diterpenes, present in the vegetal samples tested. / Xylopia langsdorffiana A. St.-Hil. & Tul., espécie pertencente a família Annonaceae, conhecida, popularmente, como ―pimenteira-da-terra‖, foi selecionada para o estudo com base em critérios quimiotaxonômicos, uma vez que muitos compostos químicos detentores de atividades farmacológicas têm sido isolados seja do gênero ou da própria espécie. Dentre esses, destacam-se os diterpenos, considerados biomarcadores das espécies do gênero Xylopia. A partir das folhas dessa espécie foram obtidos o extrato etanólico bruto (EEtOH) e a fase hexânica (FaHex) utilizados na avaliação da toxicidade e das atividades gastroprotetora e cicatrizante, em modelos animais. No ensaio de toxicidade aguda, a dose única de 2000 mg/kg do EEtOH administrada via oral (v.o.), provocou sinais de irritabilidade e hiperatividade, aumento no consumo de ração e peso corpóreo dos camundongos fêmeas, enquanto que para os camundongos machos ocorreu apenas aumento no consumo de água. Não foram registradas mortes e nem alterações macroscópicas nos órgãos dos camundongos. Para a avaliação da atividade gastroprotetora foram utilizados os modelos de indução de úlcera pelos agentes lesivos HCl/etanol, etanol, estresse (imobilização e frio), antiinflamatório não-esteroidal (AINE piroxicam) e por contensão do suco gástrico. No modelo HCl/etanol, o EEtOH-Xl (62,5 125, 250 e 500 mg/kg, v.o.) reduziu o índice de lesão ulcerativa (ILU) em 29, 38, 52 e 60 %, respectivamente. No modelo de etanol, o EEtOH-Xl e a FaHex-Xl (62,5 125, 250 e 500 mg/kg, v.o.) inibiram o ILU em 37, 41, 64, 83 e 23, 51, 81, 84 %, respectivamente. Com relação ao modelo de estresse o EEtOH-Xl e a FaHex-Xl (62,5, 125, 250 e 500 mg/kg, v.o.) diminuíram o ILU em cerca de 47, 50, 52, 48 e 32, 43, 56 e 75 %, respectivamente. Resultado semelhante foi evidenciado para o modelo de AINE, cujas porcentagens de proteção foram 31, 70, 71, 72 % (EEtOH-Xl) e 42, 58, 61 % (FaHex-Xl nas doses de 125, 250 e 500 mg/kg). Nas úlceras induzidas por contensão do suco gástrico (ligadura de piloro) o EEtOH-Xl (500 mg/kg) e a FaHex-Xl (250 mg/kg) induziram proteção gástrica com a administração tanto por via oral (v.o.) (54 e 34 %) quanto por via intraduodenal (i.d.) (36 e 45 %), respectivamente. Ainda nesse modelo, o EEtOH (500 mg/kg) e a FaHex (250 mg/kg) em ambas as vias de administração (v.o e i.d.) não alteraram os parâmetros do suco gástrico (pH, [H+] e volume gástrico). Na elucidação dos mecanismos de ação da atividade citoprotetora de Xylopia langsdorffiana, a FaHex-Xl (250 mg/kg) não aumentou a produção de muco aderido à mucosa; o EEtOH-Xl (500 mg/kg) e a FaHex-Xl (250 mg/kg) administrados oralmente, induziram gastroproteção dependente dos grupamentos sulfidrilas e da via do óxido nítrico. Já no modelo de úlcera induzida por ácido acético, os tratamentos com o EEtOH-Xl (500 mg/kg, v.o.) e a FaHex-Xl (250 mg/kg, v.o.) resultaram em 51 e 36 % de cicatrização das úlceras, respectivamente. Neste modelo, durante os 14 dias de tratamento, o EEtOH-Xl promoveu aumento na ingesta de água e ração enquanto que a FaHex-Xl reduziu os parâmetros bioquímicos AST e ácido úrico. Estes dados indicam que X. langsdorffiana possui atividade gastroprotetora e cicatrizante, com a participação parcial dos grupamentos sulfidrilas e da via do óxido nítrico, e, possivelmente, há o envolvimento de fatores de crescimento e angiogênese no processo de cicatrização induzido pelos seus constituintes químicos, em especial os diterpenos.

A fototerapia laser (FTL) tem sido usada clinicamente para auxiliar na cicatrização de inúmeras doenças bucais, especialmente no tratamento de lesões ulceradas. Os mecanismos celulares através dos quais o laser é capaz de promover a bioestimulação não são completamente compreendidos. Dessa forma, o objetivo do presente estudo foi avaliar in vitro o efeito da FTL no comportamento de queratinócitos bucais no processo de cicatrização. Células epiteliais bucais (NOK-SI) foram cultivadas sob duas condições nutricionais: suplementadas com 10% de soro fetal bovino (FBS) e sob déficit nutricional (2% FBS) seguido de irradiação com laser de diodo InGaAlP (660nm, 40mW, 4 e 20J/cm2, 4 e 20s), através da técnica pontual e em contato. Foram realizados ensaio de viabilidade celular (MTT), migração celular (cicatrização) e análise proteica (Western Blotting e Fluorescência). Os resultados obtidos indicaram que a FTL influencia diretamente a migração epitelial evidenciado pelo fechamento acelerado das feridas irradiadas e polarização do citoesqueleto celular (F-actina). Conclui-se que os efeitos clínicos da FTL estão associados, entre outros fatores, ao aumento da migração epitelial. / Laser phototherapy (LPT) has been used clinically to accelerate wound healing in a variety of oral diseases. The cell mechanisms by which LPT can promote biostimulation have not yet been fully elucidated. Epithelial cells play an important role in the reparative process since it proliferation and migration from the wound margin is crucial for restore epithelial continuity. It is unclear whether LPT has an effect on epithelial cell migration. Based on this, the aim of this study was to investigate the effect of LPT in oral wound healing process using oral keratinocytes. Oral keratinocytes were maintained under two nutritional conditions supplemented with 10% of fetal bovine serum (FBS) and in nutritional deficit (2% FBS). Laser irradiation was delivered with InGaAlP laser (660nm, 40mW, 4 e 20J/cm2, 4 e 20s). Irradiations were performed in contact, using the punctual irradiation mode. The following tests were performed cell viability, cell migration and protein analysis. Results obtained suggest that LPT influences epithelial migration and cytoskeleton polarization. Interestingly, LPT effect under epithelial cell migration occurs independently of cell viability. In conclusion, clinical LPT effects are associated with an increase in epithelial cell migration.

Submitted by LEONARDO APARECIDO TEIXEIRA BENTIN null (alt_leonardo@hotmail.com) on 2016-01-06T19:40:47Z No. of bitstreams: 1 Dissertação de Mestrado - Leonardo Aparecido Teixeira Bentin.pdf: 2077277 bytes, checksum: 91ac29c40909388a064b37399d1d3c5a (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2016-01-08T12:34:47Z (GMT) No. of bitstreams: 1 bentin_lat_me_araca.pdf: 2077277 bytes, checksum: 91ac29c40909388a064b37399d1d3c5a (MD5) / Made available in DSpace on 2016-01-08T12:34:47Z (GMT). No. of bitstreams: 1 bentin_lat_me_araca.pdf: 2077277 bytes, checksum: 91ac29c40909388a064b37399d1d3c5a (MD5) Previous issue date: 2016-01-05 / As úlceras abomasais atingem bovinos de todas as idades e raças em todos os sistemas de produção, gerando perdas econômicas. A úlcera resulta da isquemia, atraindo leucócitos e macrófagos, estimulando fibroblastos, células endoteliais e epiteliais. A proteína do grupo de alta mobilidade 1 (HMGB1) liga-se a diferentes receptores de superfície celular, incluindo Toll-like-2 (TLR-2) e -4 (TLR-4), produzindo citocinas. A presença da HMGB1 causa aumento dos níveis do fator de crescimento endotelial vascular (VEGF), um regulador fundamental da angiogênese. Assim, investigou-se a participação da HMGB1, TLR-2, TLR-4 e VEGF em úlceras abomasais em bovinos de corte. Um total de 150 abomasos de bovinos de corte foi examinado em um abatedouro; 17 amostras da região cárdica foram colhidas. Os tecidos extraídos foram classificados em grupo normal (sem ulceração de mucosa); ulceração de grau 1 (erosões não perfuradas com lesões mínimas da mucosa) e ulceração de grau 2 (erosões não perfuradas combinadas com sangramento moderado da mucosa) e confirmado pela histopatologia. A expressão dos genes nas amostras normais ou ulceradas no abomaso foi avaliada pela RT qPCR. Os dados foram submetidos à ANOVA seguido por teste de Bonferroni ao nível de p<0,05. Não houve diferença de expressão de HMGB1, de TLR-4 e de VEGF entre os dois tipos de úlceras em relação aos abomasos normais. Úlceras de grau 2 tiveram expressão de TLR-2 superior a úlceras de grau 1. O aumento da expressão de TLR-2 pode estar associado à manutenção da cicatrização, promovendo a resposta inflamatória, evidenciado pela presença de infiltrado inflamatório mononuclear e neutrófilos. / Abomasal ulcers affect cattle of all ages and breeds in all production systems, leading to economic losses. The ulcer resulting from tissue ischemia, attracting leukocytes and macrophages, stimulates fibroblasts, endothelial and epithelial cells. The protein of high mobility group 1 (HMGB1) binds to different cell surface receptors, including Toll-like-2 (TLR-2) and 4 (TLR-4) resulting in cytokine production. The presence of HMGB1 causes increased levels of vascular endothelial growth factor (VEGF), a key regulator of angiogenesis. Thus, it was investigated whether HMGB1, TLR-2, TLR-4 and VEGF play a role in abomasal ulcers in beef cattle. A total of 150 abomasums from beef cattle were examined in a slaughterhouse; 17 samples were collected from the cardiac region. The extracted tissues were divided into normal group (without ulceration of the mucosa); type 1 ulcers (unperforated erosions with minimal mucosal injury) and type 2 ulcers (unperforated erosions combined with moderate bleeding of the mucosa) and confirmed by histopathology. Gene expression was evaluated by RT qPCR in samples of normal or ulcerated abomasums. Data were analyzed by ANOVA followed by Bonferroni test at p <0.05. No difference in expression of HMGB1, TLR-4 and VEGF was detected between the two types of ulcers when compared to normal abomasums. TLR-2 expression was higher in type 2 ulcers than in type 1 ulcers. Increased TLR-2 expression might be associated with the maintenance of abomasal healing, promoting the inflammatory response, as evidenced by the presence of mononuclear cell infiltration and neutrophils.