1001
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Armstrong DG, Lavery LA. Monitoring neuropathic ulcer healing with infrared dermal thermometry. J Foot Ankle Surg 1996; 35:335-8; discussion 372-3. [PMID: 8872757 DOI: 10.1016/s1067-2516(96)80083-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study is to prospectively evaluate skin temperatures at the site of neuropathic ulceration before, during, and after wound healing using the contralateral extremity as a physiologic control and to evaluate variables that may influence skin temperature gradients. We studied 17 male and 8 female diabetics with mean age and duration of diabetes of 52.4 +/- 11.6 years and 13.8 +/- 7.8 years with grade I (Meggitt-Wagner) plantar ulcers. All patients received weekly cast changes with wound and skin temperature assessments. After healing, all patients were fitted with prescription shoe gear. Temperatures on the ulcerated foot were higher than those on the contralateral foot on initial presentation (91.1 vs. 84.2 degrees F, t = 8.9, p < 0.0001, 95% Cl 5.3 to 8.5), but the same following healing. Patients with vibration perception thresholds greater than 45 V had wider skin temperature gradients than those with lesser degrees of sensory neuropathy (8.8 +/- 4.1 vs. 4.9 +/- 2.5 degrees F, p = 0.007). Additionally, subjects with toe brachial indices below 0.60 had greater skin temperature gradients at the site of ulceration than those with higher indices (9.4 +/- 4.0 vs. 5.8 +/- 3.4 degrees F, p = 0.01). There was not a significant difference in initial skin temperature gradients by duration of wound prior to treatment, duration of wound healing, sex, maximum plantar pressure, or hemoglobin A1C level.
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1002
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Armstrong DG, Lavery LA, Sariaya M, Ashry H. Leukocytosis is a poor indicator of acute osteomyelitis of the foot in diabetes mellitus. J Foot Ankle Surg 1996; 35:280-3. [PMID: 8872749 DOI: 10.1016/s1067-2516(96)80075-5] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this article is to describe the frequency of leukocytosis and elevated erythrocyte sedimentation rate in a series of diabetics with acute foot infections and osteomyelitis due to neuropathic foot ulcerations. The authors reviewed the admission records of 28 type II diabetic patients admitted to University Hospital in San Antonio, Texas between January 1, 1990 and December 30, 1992 with acute osteomyelitis of the foot secondary to neuropathic ulceration. The mean white blood cell count on admission for all subjects studied was calculated at 11.9 +/- 5.4 x 10(3) cells/mm3. Of all white blood cell counts collected for patients admitted with acute osteomyelitis of the foot, 54% were within normal limits. Erythrocyte sedimentation rate was elevated in 96% of patients. Oral temperature was normal in 82% of patients. The authors conclude that a normal white cell count should not deter one from taking appropriate action to mitigate the propagation of a potentially limb-threatening foot infection.
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1003
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Das I, Jayatunga AP, Symonds JM. Pyomyositis: an unusual infection due to staphylococcus aureus. JOURNAL OF THE ROYAL COLLEGE OF SURGEONS OF EDINBURGH 1996; 41:182-3. [PMID: 8763184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Pyomyositis is a primary pyogenic infection of skeletal muscle, leading to the formation of intramuscular abscesses. Although common in tropical climates, it is infrequent in temperate zones. We report a patient who developed the condition without travelling to tropical areas.
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1004
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Abstract
This case study shows how a Cam Walker when equipped with an arch filler can be another tool the physician may use to help heal diabetic ulcerations. Even after other methods of conservative care have failed, the Cam Walker with an arch filler has been shown to gradually decrease and heal diabetic ulcerations on the plantar aspect of the foot. It accomplishes this by decreasing the pressure on the ulcerative areas and by decreasing the velocity with which the foot strikes the ground.
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1005
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Lin SS, Lee TH, Wapner KL. Plantar forefoot ulceration with equinus deformity of the ankle in diabetic patients: the effect of tendo-Achilles lengthening and total contact casting. Orthopedics 1996; 19:465-75. [PMID: 8727341 DOI: 10.3928/0147-7447-19960501-18] [Citation(s) in RCA: 110] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Between 1993 and 1995, 93 neuropathic diabetes mellitus patients with foot ulcers underwent a total contact cast (TCC) protocol. A randomly chosen group of 21 patients (Group I) demonstrated ulcer healing in a mean time of 43.5 days. Despite 9 weeks of TCC, 15 patients (Group II) with forefoot ulcers failed to heal. Physical examination of Group I revealed plantarflexion/dorsiflexion range of motion of the ankle of 33.8 degrees / 1.9 degrees compared to 32.3 degrees / -10.5 degrees of Group II, demonstrating an ankle equinus deformity and limited joint motion. Group II patients underwent a correction of the equinus deformity with percutaneous tendo-Achilles lengthening (TAL), followed by a TCC. All but one ulcer (93.3%) healed within 39.4 days. Four (19.0%) ulcers recurred (at the same site) in Group I, compared to none in Group II at the latest follow up of 17.3 months. Surgical correction with percutaneous TAL and TCC results in healing of forefoot ulcer and helps prevent ulcer recurrence.
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1006
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Brower AC. Septic arthritis. Radiol Clin North Am 1996; 34:293-309, x. [PMID: 8633117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Diagnosis of septic joint can be a problem for both the clinician and the imager. The longer the delay in diagnosis of a septic arthritis, the greater the chance of significant complication. Many imaging modalities are available to the imager and each plays a definite role. In determining the modality of choice, one should choose what is most efficacious for the individual patient.
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1007
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Nicholas JJ, Smith WF, Andersson GB. Bacterial discitis caused by limb gangrene requiring below-knee amputation. Arch Phys Med Rehabil 1996; 77:301-4. [PMID: 8600876 DOI: 10.1016/s0003-9993(96)90116-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Two patients presented with disabling back pain and were unable to participate in physical therapy activities after being admitted to an acute rehabilitation center. Both patients had bacterial discitis of the lumbar spine that was apparently caused by infected ischemic limb tissue, ultimately removed at below-knee amputation. The literature describes many cases of bacterial discitis infected from many sources, but not from ischemic limb tissue requiring subsequent amputation. Many such cases may exist, however, and earlier recognition of this condition will enable appropriate treatment before vertebral destruction and/or neurological sequelae.
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1008
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Cooke E. Dealing with the diabetic foot. THE PRACTITIONER 1996; 240:112-4. [PMID: 8736199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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1009
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Cook TA, Rahim N, Simpson HC, Galland RB. Magnetic resonance imaging in the management of diabetic foot infection. Br J Surg 1996; 83:245-8. [PMID: 8689178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A prospective study was carried out of 22 patients admitted with 25 diabetic foot infections. All had cellulitis, 12 had discharging ulcers and eight had digital gangrene. In one case magnetic resonance imaging (MRI) was unhelpful owing to patient movement. Thirteen scans suggested deep-seated infection, including abscess (ten), osteomyelitis (seven) and ankle effusion (one). Overall, imaging provided a specificity of 77 per cent, a positive predictive value of 77 per cent, a sensitivity of 91 per cent and a negative predictive value of 91 per cent. MRI is valuable in determining the presence and extent of infection, which allows appropriate planning of surgical intervention.
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1010
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Garbalosa JC, Cavanagh PR, Wu G, Ulbrecht JS, Becker MB, Alexander IJ, Campbell JH. Foot function in diabetic patients after partial amputation. Foot Ankle Int 1996; 17:43-8. [PMID: 8821287 DOI: 10.1177/107110079601700110] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The function of partially amputated feet in 10 patients with diabetes mellitus was studied. First-step bilateral barefoot plantar pressure distribution and three-dimensional kinematic data were collected using a Novel EMED platform and three video cameras. Analysis of the plantar pressure data revealed a significantly greater mean peak plantar pressure in the feet with transmetatarsal amputation (TMA) than in the intact feet of the same patients. The heels of the amputated feet had significantly lower mean peak plantar pressures than all the forefoot regions. A significantly greater maximum dynamic dorsiflexion range of motion was seen in the intact compared with the TMA feet. However, no difference was noted in the static dorsiflexion range of motion between the two feet and there was, therefore, a trend for the TMA feet to use less of the available range of motion. Given the altered kinematics and elevated plantar pressures noted in this study, careful postsurgical footwear management of feet with TMA would appear to be essential if ulceration is to be prevented.
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1011
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Podpriatov SI, Bondar SI, Solovyts'kyĭ OV, Starykova RP. [The efficacy of the surgical treatment of diabetic foot]. KLINICHNA KHIRURHIIA 1996:26-8. [PMID: 9053253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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1012
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Johnson JE, Kennedy EJ, Shereff MJ, Patel NC, Collier BD. Prospective study of bone, indium-111-labeled white blood cell, and gallium-67 scanning for the evaluation of osteomyelitis in the diabetic foot. Foot Ankle Int 1996; 17:10-6. [PMID: 8821280 DOI: 10.1177/107110079601700103] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Twenty-two adult diabetic patients with clinical suspicion of foot and/or ankle infection were prospectively evaluated using radiography, technetium-99m methylene diphosphonate bone scanning (99mTc), indium-111-labeled leukocyte scanning (111In), and gallium-67 scanning (67Ga) to determine the presence of clinically suspected osteomyelitis. Biopsy for culture and histology was performed in 16 patients. The diagnosis of osteomyelitis was confirmed by biopsy in 12 patients. The remaining 10 patients had no evidence of osteomyelitis with long-term follow-up. 99mTc was shown to be of limited valued when used alone in these patients with peripheral neuropathy. 67Ga, either alone or in combination with 99mTc bone scanning, was of little diagnostic value and gave no additional information that was not available from 111In. The combination of three-phase 99mTc and 111In had the highest diagnostic efficacy (100% sensitivity, 80% specificity, and 91% accuracy), followed closely by 111In alone (100% sensitivity, 70% specificity, and 86% accuracy). We conclude that for adult diabetic patients with clinical suspicion of osteomyelitis but no radiographic findings of that disease, 111In alone is an appropriate nuclear medicine evaluation for ruling out infection if it is negative. However, if an area of 111In white blood cell uptake is present, a "simultaneous" 99mTc is often helpful in providing the anatomic correlation to differentiate osteomyelitis from infection that is limited to soft tissue.
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1013
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van der Meer JW, Koopmans PP, Lutterman JA. Antibiotic therapy in diabetic foot infection. Diabet Med 1996; 13 Suppl 1:S48-51. [PMID: 8741830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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1014
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Crerand S, Dolan M, Laing P, Bird M, Smith ML, Klenerman L. Diagnosis of osteomyelitis in neuropathic foot ulcers. THE JOURNAL OF BONE AND JOINT SURGERY. BRITISH VOLUME 1996; 78:51-5. [PMID: 8898126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We reviewed all patients with a clinically infected foot ulcer attending a specialised neuropathic foot clinic. Neuropathy was confirmed by the inability to feel a 5.07 Semmes-Weinstein hair, areflexia and impaired vibration sense, as measured by a biothesiometer. Of 40 patients who attended the clinic over a two-year period, six with ischaemic ulcers were excluded. The remaining 34 had plain radiographs of the foot followed by a 99mTc-MDP bone scan. If the latter was positive, an 111In-labelled WBC scan was performed with planar and/or tomographic dual-isotope studies where appropriate. Bone and WBC scans were performed in 31 patients. In ten, isotope imaging showed infection localised to the soft tissues only and conservative treatment was successful in them all. Eighteen patients were treated surgically with excision of the involved bone, which was sent for culture and histological examination. Dual-isotope scans had a sensitivity of 93% and a specificity of 83%. 99mTc-MDP bone scans with the appropriate In-labelled WBC scans can reliably determine the site and extent of osteomyelitis in the neuropathic diabetic foot.
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1015
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Dorigo B, Cameli AM, Trapani M, Raspanti D, Torri M, Mosconi G. Efficacy of femoral intra-arterial administration of teicoplanin in gram-positive diabetic foot infections. Angiology 1995; 46:1115-22. [PMID: 7495317 DOI: 10.1177/000331979504601207] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In this study the efficacy and safety femoral intra-arterial administration of teicoplanin in the treatment of diabetic foot infections caused by gram-positive bacteria were evaluated. Twenty-five hospitalized diabetic patients with foot ulcers or with foot ulcers and metatarsophalangeal osteomyelitis were included in the study. In the ulcers Staphylococcus aureus was present alone in 16 patients and was associated with Pseudomonas aeruginosa in 2 patients, with Candida albicans in 2, and with coagulase-negative Staphylococcus in 1 patient. In 4 patients other gram-positive bacteria were isolated. All isolated strains were resistant to various antibiotics tested. Teicoplanin, 200 mg, was administered once a day by femoral intra-arterial injection for an average period of 14.72 +/- 7.16 days (range ten to thirty-six days). Six patients were treated with an additional antibiotic intramuscularly or intravenously because of a mixed infection. At the end of the therapy microbiological assessment confirmed that gram-positive infection was eliminated in all patients. Clinical outcome demonstrated that healing occurred in 18 patients (72%) and improvement in 7 patients (28%). No adverse drug reactions were observed during the treatment. The results demonstrate that femoral intra-arterial administration of teicoplanin was highly effective in skin- and bone-infected lesions in the diabetic foot. This method may represent a further advantage in management of this severe diabetic complication.
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1016
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Stuesse DC, Robinson JH, Durzinsky DS. A late sternal wound infection caused by hematogenous spread of bacteria. Chest 1995; 108:1742-3. [PMID: 7497792 DOI: 10.1378/chest.108.6.1742] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
A 56-year-old man presented with a sternotomy wound infection 6 months after coronary artery bypass grafting. The organism responsible was group B beta-hemolytic Streptococcus. This organism was simultaneously cultured from an infected diabetic ulcer on the patient's foot as well as from a total knee prosthesis. The Streptococcus apparently spread hematogenously to the sternum, an extremely rare cause of sternotomy wound infection.
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1017
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Lee BY, Guerra J, Civelek B. Compartment syndrome in the diabetic foot. ADVANCES IN WOUND CARE : THE JOURNAL FOR PREVENTION AND HEALING 1995; 8:36, 38, 41-2 passim. [PMID: 8696576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The compartment syndrome is a well-described clinical entity that results from increased pressure within a myofascial compartment. The infection in a diabetic foot usually presents in the whole compartment and can spread to a neighboring compartment. The association of infection and increased compartment pressure in the diabetic foot makes its treatment a formidable challenge. Fasciotomies of the feet when indicated may accelerate infection control and wound healing in the diabetic foot. The presence of a compartment syndrome in the diabetic foot is seldom recognized. Awareness of this problem is mandatory for physicians dealing with diabetic feet.
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1018
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Armstrong DG, Liswood PJ, Todd WF. 1995 William J. Stickel Bronze Award. Prevalence of mixed infections in the diabetic pedal wound. A retrospective review of 112 infections. J Am Podiatr Med Assoc 1995; 85:533-7. [PMID: 7473085 DOI: 10.7547/87507315-85-10-533] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This retrospective study reviewed the culture results of 112 admissions to a multidisciplinary diabetic foot care team with a primary diagnosis of infected diabetic pedal ulceration. An average of 1.5 +/- 0.9 species per patient (P < 0.0001) were isolated. Eighty-nine percent of wounds cultured grew two or fewer organisms. Anaerobic species were isolated in only 5% of all cultures. Of these isolates, the distinction between anaerobic colonization and true anaerobic infection is made. Results suggest that aggressive early hospitalization, coupled with aggressive intraoperative debridement, may yield less microbiologically complex infections that may be controlled with less expensive narrow spectrum antibiotic therapy. Diagnosis of the infected pedal ulceration of a patient with diabetes is a clinical one. If this diagnosis is combined with appropriate surgical intervention, microbiologic correlation, and antimicrobial therapy, the result may be a less complex hospital course and improved outcome.
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1019
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Nardone DA. Probing to bone in infected pedal ulcers. JAMA 1995; 274:869-70. [PMID: 7674490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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1020
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Záhumenský E, Rybka J, Adamíková A. [New aspects of pharmacologic and general prophylactic care of the diabetic foot]. VNITRNI LEKARSTVI 1995; 41:531-4. [PMID: 7483335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Ischaemia, neuropathies and infections are predisposing factors for the development of ulceration of the diabetic foot. Diabetics have evidently a disposition for affections of the peripheral circulation and impaired regulation of the microcirculation as a result of autonomic neuropathy. The lower the driving pressure (in critical ischaemia), the more important are rheological factors and drugs which can influence them. These preparations include e.g. Trental (pentoxiphilline), Prostavasin (prostaglandin E1), Vessel due F (sulodexide). In advanced stages of ischaemic extremities oedema is a very adverse factor. Non-cardiac oedema can be very effectively handled by manual lymphatic drainage combined with intermittent one-segment pneumatic compression which was successfully used by the authors in ulcerations of the diabetic foot. One of the main general protective measures is adequate care of the foot and protective footwear for diabetics. After 3.5 years' use of protective footwear the authors recorded, consistent with data in the literature, a 50% reduction of relapses of ulcerations (and amputations). By examination on an EMED II apparatus abnormally high local pressures on the sole of risk patients can be detected and at the some time the protective effect of materials used for protective insoles can be tested. Active pharmacological and generally protective care of diabetic foot leads to a reduced number of amputations, in particular supracondylar ones by 50 or more per cent.
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1021
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Apelqvist J, Ragnarson-Tennvall G, Larsson J, Persson U. Long-term costs for foot ulcers in diabetic patients in a multidisciplinary setting. Foot Ankle Int 1995; 16:388-94. [PMID: 7550950 DOI: 10.1177/107110079501600702] [Citation(s) in RCA: 122] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The purpose of this study was to analyze long-term costs for foot ulcers in diabetic patients. Patients were treated and followed prospectively by a foot care team. A retrospective economic analysis was performed of costs for 274 patients during 3 years from healing of an initial foot ulcer, with or without amputation. Costs were estimated for inpatient care, outpatient care, home care, and social service. The cost calculations include costs due to complications and disability related to the initial ulcer, costs related to recurrence of ulcer, and costs for prevention of new ulcers. Expected total present value cost per patient during 3 years of observation was $26,700 (U.S. dollars) for primary healed patients with critical ischemia and $16,100 for primary healed patients without critical ischemia. For patients who healed with an amputation, the corresponding costs were $43,100 after a minor amputation and $63,100 after a major amputation. When estimating the costs for diabetic foot ulcers, it is not sufficient to calculate short-term costs. Long-term costs are high, mainly due to the need for increased home care and social service, but also due to costs for recurrent ulcers and new amputations.
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1022
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Johnson S, Lebahn F, Peterson LR, Gerding DN. Use of an anaerobic collection and transport swab device to recover anaerobic bacteria from infected foot ulcers in diabetics. Clin Infect Dis 1995; 20 Suppl 2:S289-90. [PMID: 7548577 DOI: 10.1093/clinids/20.supplement_2.s289] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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1023
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Abstract
The prevalence of anaerobic bacteria in cultures of specimens from foot infections in diabetic patients is dependent upon the method of obtaining the specimen, the care with which it is transported anaerobically, and the sophistication of the laboratory methods. The rate at which anaerobes are isolated with use of the best methods ranges from 74% to 95% of patients, but it is only 41% to 53% in clinical studies of patients with limb-threatening infection. The mean number of bacterial isolates from an infected foot ranges from 4.1 to 5.8, of which 1.2 to 2.6 isolates are anaerobic. Most anaerobic isolates are gram-positive, and Peptostreptococcus species are most common. Bacteroides species are the most common anaerobic gram-negative isolates. Treatment covering anaerobic bacteria is included in most empirical regimens, but the use of agents that are modestly active against anaerobic organisms (i.e., fluoroquinolones or trimethoprim-sulfamethoxazole) has also been successful. Surgical debridement and drainage are essential adjuncts to antimicrobial therapy and may assist in the control of anaerobic infection. Questions regarding management of such infections parallel those regarding management of polymicrobial intraabdominal infections, but to date, studies of the former have been much less sophisticated than those of the latter.
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1024
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Schon LC, Marks RM. The management of neuroarthropathic fracture-dislocations in the diabetic patient. Orthop Clin North Am 1995; 26:375-92. [PMID: 7724199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Appropriate management for the diabetic patient with a fracture or sprain depends on recognition of "at-risk" factors. For patients with stable, minimally displaced injuries, conservative modalities (prolonged immobilization and non-weight-bearing) are sufficient. For patients with unstable or displaced fracture-dislocations, and whose general condition does not contraindicate surgery, open reduction and internal fixation, at times combined with external fixation, is recommended. Initial aggressive management can avoid or minimize the disastrous sequelae of a destructive neuroarthropathic process and can effect a biomechanically sound plantigrade, braceable, and shoeable lower extremity.
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1025
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Eckman MH, Greenfield S, Mackey WC, Wong JB, Kaplan S, Sullivan L, Dukes K, Pauker SG. Foot infections in diabetic patients. Decision and cost-effectiveness analyses. JAMA 1995; 273:712-20. [PMID: 7853629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To examine the cost-effectiveness of approaches to the diagnosis and treatment of patients with type II (non-insulin-dependent) diabetes mellitus (NIDDM) who have foot infections and suspected osteomyelitis. DESIGN Decision and cost-effectiveness analyses were performed using a Markov model. We examined the prevalence of osteomyelitis, the major complications and efficacies of long-term antibiotic therapy and surgery, and the performance characteristics of four diagnostic tests (roentgenography, technetium Tc 99m bone scanning, indium in 111-labeled white blood cell scanning, and magnetic resonance imaging). Data were drawn from the English-language literature using MEDLINE searches and bibliographies from selected articles. SETTING Primary care. PATIENTS Patients with NIDDM who had foot infections and suspected osteomyelitis but no signs of systemic toxicity. INTERVENTIONS Following hospitalization for surgical débridement and intravenous antibiotic therapy: (1) treatment for presumed soft-tissue infection, (2) culture-guided empiric treatment for presumed osteomyelitis, (3) 71 combinations of diagnostic tests preceding antibiotic therapy for osteomyelitis, (4) 71 combinations of tests preceding amputation, and (5) immediate amputation. MAIN OUTCOME MEASURES Quality-adjusted life expectancy, average costs. RESULTS Culture-guided empiric treatment for osteomyelitis with 10 weeks of oral antibiotic therapy has similar effectiveness to testing followed by a long course of antibiotic therapy if any test result is positive. However, empiric treatment is the least expensive strategy. CONCLUSIONS Noninvasive testing adds significant expense to the treatment of patients with NIDDM in whom pedal osteomyelitis is suspected, and such testing may result in little improvement in health outcomes. In patients without systemic toxicity, a 10-week course of culture-guided oral antibiotic therapy following surgical débridement may be as effective as and less costly than other approaches.
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1026
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Kunz KR, Barrus DM, Nixon BP. Fatal pontine hemorrhage after podiatric surgery. A case report. J Am Podiatr Med Assoc 1995; 85:158-61. [PMID: 7776206 DOI: 10.7547/87507315-85-3-158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The authors present a case of massive fatal pontine hemorrhage as a complication of hypertension in a patient treated for an infected diabetic ulcer. The podiatric physician must be aware of the risks associated with concomitant medical problems such as hypertension and ensure that proper therapeutic measures are taken to avoid the potential for catastrophic complications.
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1027
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Abstract
A guide to the design principles of specialist shoes for patients with diabetes
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1028
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Grayson ML, Gibbons GW, Balogh K, Levin E, Karchmer AW. Probing to bone in infected pedal ulcers. A clinical sign of underlying osteomyelitis in diabetic patients. JAMA 1995. [PMID: 7853630 DOI: 10.1001/jama.1995.03520330051036] [Citation(s) in RCA: 326] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess a bedside technique for diagnosing osteomyelitis. DESIGN We prospectively assessed infected pedal ulcers for detectable bone by probing with a sterile, blunt, stainless steel probe. We then examined the relationship between detection of bone and the presence or absence of osteomyelitis that was defined histopathologically and/or clinically. SETTING A tertiary care center. PATIENTS Seventy-five hospitalized diabetic patients with a total of 76 infected foot ulcers were studied. RESULTS Osteomyelitis was diagnosed in 50 instances (66%) and was excluded in 26 instances. Bone was detected by probing in 33 of 50 ulcers with contiguous osteomyelitis; in contrast, bone was probed in only four of 26 ulcers without contiguous osteomyelitis (P < .001). Bone detected on probing was visible in only three instances. Palpating bone on probing the pedal ulcer had a sensitivity of 66% for osteomyelitis, a specificity of 85%, a positive predictive value of 89%, and a negative predictive value of 56%. CONCLUSIONS Palpation of bone in the depths of infected pedal ulcers in patients with diabetes is strongly correlated with the presence of underlying osteomyelitis. If bone is palpated on probing, specialized roentgenographic and radionuclide tests to diagnose osteomyelitis are unnecessary. Probing for bone should be included in the initial assessment of all diabetic patients with infected pedal ulcers.
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1029
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Larsson J, Agardh CD, Apelqvist J, Stenström A. Clinical characteristics in relation to final amputation level in diabetic patients with foot ulcers: a prospective study of healing below or above the ankle in 187 patients. Foot Ankle Int 1995; 16:69-74. [PMID: 7767449 DOI: 10.1177/107110079501600203] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The aim of this study was to describe the clinical characteristics in relation to final amputation level in diabetic patients with foot ulcers. In a prospective series, 187 consecutively presenting patients were investigated. From admission until final outcome, the patients were treated by a multidisciplinary team both as in- and out-patients. All the patients had one or more signs of neuropathy and 171 had evidence of peripheral vascular disease. Healing with an amputation below the ankle occurred in 74 patients, 88 patients healed with an amputation above the ankle, and 25 patients died unhealed. Amputation above the ankle was associated with high age, living in an institution, a limited walking capacity, cerebrovascular disease, congestive heart failure, and a low hemoglobin level. Amputation below the ankle was associated with diabetes diagnosis before 30 years of age and diabetes duration. In conclusion, older age, history of cerebrovascular disease and low hemoglobin level are associated with above ankle amputation level in diabetic patients with foot ulcers. However, level selection cannot be based upon these factors only, since some patients at high age, with cerebrovascular disease or with a low hemoglobin value, healed with an amputation below the ankle. None of these factors per se should be taken as a cause to choose a primary amputation above the ankle, unless amputation is supported by the total clinical picture, including local characteristics, such as type and localization of ulcer, and signs of peripheral vascular disease. More attention should be paid to biological than to chronological age.
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1030
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Thordarson DB, Perry JR, Patzakis MJ. Tetanus complicating a polymicrobial diabetic foot infection: case presentation and review of current treatment. Foot Ankle Int 1995; 16:97-9. [PMID: 7767456 DOI: 10.1177/107110079501600210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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1031
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Braun-Mauger A, Aubry F. [A diabetic foot]. Rev Med Interne 1995; 16:163. [PMID: 7709108 DOI: 10.1016/0248-8663(96)80683-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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1032
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Gohdes D, Rith-Najarian S. Foot disease in diabetes. N Engl J Med 1995; 332:269-70. [PMID: 7808499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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1033
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Griffith J, Davies AM, Close CF, Nattrass M. Organized chaos? Computed tomographic evaluation of the neuropathic diabetic foot. Br J Radiol 1995; 68:27-33. [PMID: 7881879 DOI: 10.1259/0007-1285-68-805-27] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Accurate radiographic evaluation of diabetic neuroarthropathy is increasingly difficult as the disease becomes more florid. 22 patients with a known diabetic neuroarthropathy of one or both feet were prospectively examined by computed tomography (CT) in the axial and coronal planes. Bilateral changes of a neuroarthropathy were present in 75% of cases. Distinct patterns of disease were seen and categorized into five types in order of increasing severity. Changes at the medial tarsometatarsal joints and adjacent intercuneiform joints were seen in all affected feet. More extensive disease involved the medial arch more commonly than the lateral. Fractures of the tarsal bones were found in 32% of cases and were associated with neuroarthropathic changes in adjacent joints. Calcaneal fractures were seen in four feet. A Lisfranc fracture-dislocation was present in 41% of cases and a bilateral in only 21%. A single CT examination of the foot, while an accurate method of demonstrating the extent of the disease, is an insensitive indicator of disease activity.
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1034
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Mayrovitz HN, Larsen PB. Standard and near-surface laser-Doppler perfusion in foot dorsum skin of diabetic and nondiabetic subjects with and without coexisting peripheral arterial disease. Microvasc Res 1994; 48:338-48. [PMID: 7731398 DOI: 10.1006/mvre.1994.1060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Appropriate assessment of microvascular function is now recognized as an important adjunct to the diagnostic workup and medical follow-up for a variety of conditions. Laser Doppler fluxmetry (LDF)-derived rbc perfusion (Q) and the volume (V) and velocity (U) components are useful in this regard but the fact that the sampled volume includes both nutritional and nonnutritional components may limit its specificity and range of usefulness. It was reasoned that if the depth of penetration could be reduced without significantly altering essential optical transmission features, then the detected signal would better represent the nutritional component. A 0.68-mm-thick Delrin spacer was fabricated and used to compare LDF values with (WITH) and without (WITHOUT) its use on the foot dorsum of 71 limbs of 44 diabetic (DM) and nondiabetic (NO-DM) subjects with lower extremity arterial disease (LEAD, n = 39) and without disease (NORM, n = 32). Overall LDF values WITH as compared to WITHOUT had a slightly greater U (1.01 vs 0.89 mm/sec, P < 0.01) and much lower V (0.06 vs 0.63%, P < 0.001) and Q (0.25 vs 1.88 ml/min/100 g, P < 0.001). In NO-DM subjects, WITH detected a lower Q in limbs with LEAD (0.14 vs 0.27, P < 0.05) but WITHOUT did not (1.48 vs 1.47, ns). In DM subjects, WITH measured a significantly lower U in LEAD limbs (1.05 vs 1.22 mm/sec, P < 0.05), which was not detected WITHOUT. Without the spacer, NORM limb LDF values were all greater in DM vs NO-DM subjects. With spacer use, only the DM velocity component was significantly greater. Use of a modified LDF procedure has shown both utility and promise as a method for evaluation of skin microcirculation and appears to offer some potential benefits as compared with the currently used standard method. Previously undocumented differences between LEAD and NORM limbs in DM and NO-DM patients as herein reported represent initial findings using a 0.68-mm spacer.
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1035
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Brenner MA. Tracking the diabetic foot: adjunctive treatment with collagen material. ADVANCES IN WOUND CARE : THE JOURNAL FOR PREVENTION AND HEALING 1994; 7:44, 46, 48-52. [PMID: 7795864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Many people with diabetes mellitus have foot lesions that can lead to amputation if they do not receive excellent care. Coordinating patient care with other specialists, using new treatment technology, educating the patient, and including the patient as a significant part of the team are all required for effective patient care. The use of a new, technologically advanced product, Kollagen, is illustrated in two case studies. Collagen plays a significant part in almost every function of the body. Previously, the broad use of collagen was stifled because of cost. Recent advances have made it possible to develop cost-effective gels, powders, pouches, and thin dressings.
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1036
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Pashkova VS, Filippova LA, Bobrovskikh MP, Lavrenov AL. [Secondary glycogenosis (Mauriac's syndrome) in a young man with diabetes mellitus]. Arkh Patol 1994; 56:79-80. [PMID: 7695499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A rare observation of secondary glycogenesis in a male of 31 with a long history of irregularly treated diabetes mellitus is described. The diagnosis was established after death and was confirmed histologically, histochemically and electron microscopically.
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1037
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Abstract
The stepwise approach to the treatment of painful diabetic peripheral neuropathy allows the practitioner to use a broad spectrum of therapeutic modalities and physiologic approaches to this complicated clinical problem. The authors review the etiology and clinical presentation of diabetic neuropathy. Available therapeutic alternatives are discussed and an original stepwise algorithm is presented. Pharmacologic profiles of the most commonly used drugs are also described.
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1038
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Larsson J, Agardh CD, Apelqvist J, Stenström A. Local signs and symptoms in relation to final amputation level in diabetic patients. A prospective study of 187 patients with foot ulcers. ACTA ORTHOPAEDICA SCANDINAVICA 1994; 65:387-93. [PMID: 7976281 DOI: 10.3109/17453679408995476] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Local signs and symptoms were evaluated in 187 consecutively presenting diabetic patients undergoing amputation for foot ulcers. From admission until final outcome the patients were treated by the same multidisciplinary team both as in- and out-patients. At the time of amputation, the types of lesions were superficial/deep ulcer (n 17), ulcer with deep infection, but without gangrene (n 40), and gangrene with or without infection (n 130). Healing after a minor amputation (below the ankle) occurred in 74 patients, while 88 patients healed after a major amputation (above the ankle), and 25 patients died before healing had occurred. Deep infection and presence of popliteal or pedal pulses were associated with healing after minor amputation and so were ulcers on the small toes, metatarsal head area and midfoot. Pain, progressive gangrene, intermittent claudication, and decubital and multiple ulcers were related to healing after major amputation. In a logistic regression analysis, pain, progressive gangrene and intermittent claudication remained. However, none of these factors excluded healing of a minor amputation and thus selection of amputation level in diabetic patients with foot ulcers cannot be based upon these factors exclusively.
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1039
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Brower AC. What is the preferred method for diagnosing osteomyelitis in the foot of a patient with diabetes? AJR Am J Roentgenol 1994; 163:471-2. [PMID: 8037056 DOI: 10.2214/ajr.163.2.8037056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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1040
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Yazaki M, Tokuda T, Matsuda M, Shindo M, Yanagisawa N. [A case of transverse myelopathy caused by pyogenic vertebral osteomyelitis having extended from a pedal ulcer]. Rinsho Shinkeigaku 1994; 34:371-6. [PMID: 8026133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A 64-year-old man who had suffered from diabetes mellitus and a recurrent intractable ulcer of the foot developed subacute transverse myelopathy with severe inflammatory reactions. Magnetic resonance imaging (MRI) revealed destructive lesions in both upper thoracic and lumbar spines. In plain X-ray film, although intervertebral spaces of the lumbar spines were apparently normal on the supine position, they became narrow spaces on the sitting position. The aspiration biopsy from the intervertebral spaces of the lumbar spines showed non-specific necrotic tissues. These findings suggested that the destruction of the intervertebral disks also occurred simultaneously. According to the clinical course and radiological studies, we diagnosed this patient as pyogenic osteomyelitis, and performed the antibiotics therapy. Although he showed no change in his signs and symptoms due to transverse myelopathy, radiological studies exhibited an improvement of both the lumbar and thoracic lesions. In addition, MRI studies in the lumbar lesions revealed low intensity signals on both T1 and T2 weighted images before the antibiotics therapy. It was suggested that lumbar lesions were older than the thoracic lesions. Serial studies including bone X-ray film and MRI were not only useful for the diagnosis of pyogenic osteomyelitis but also for an evaluation of the lesions.
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1041
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Levine SE, Neagle CE, Esterhai JL, Wright DG, Dalinka MK. Magnetic resonance imaging for the diagnosis of osteomyelitis in the diabetic patient with a foot ulcer. Foot Ankle Int 1994; 15:151-6. [PMID: 7951944 DOI: 10.1177/107110079401500311] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Twenty-seven diabetic patients (12 males and 15 females) with clinically suspected osteomyelitis complicating soft tissue infection of the foot underwent 29 magnetic resonance imaging studies of the suspected lesion. Of these patients, 26 had plain film radiographs, 11 had technetium bone scanning, and 12 had indium-labeled leukocyte scintigraphy performed within 2 weeks of the magnetic resonance imaging. Definitive diagnosis of the presence or absence of osteomyelitis was obtained on the basis of surgical findings, histological evidence, or resolution with nonoperative therapy. Magnetic resonance imaging was 90% accurate (sensitivity 77%, specificity 100%) in the diagnosis of osteomyelitis in this patient population. Technetium bone scan was 45% accurate (sensitivity 100%, specificity 25%); indium-labeled leukocyte scintigraphy was 50% accurate (80% sensitivity, 29% specificity); and plain film roentgenography was 73% accurate (60% sensitivity, 81% specificity). Magnetic resonance imaging is a powerful, noninvasive tool for determining the presence or absence of osteomyelitis in the patient with a diabetic foot ulcer.
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1042
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Ballard WT, Cooper RR. An environmental hazard to the diabetic foot. A case report. THE IOWA ORTHOPAEDIC JOURNAL 1994; 14:171-3. [PMID: 7719772 PMCID: PMC2329026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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1043
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Got I, Voche P, Merle M, Drouin P. [Medical and surgical management of septic diabetic foot]. DIABETE & METABOLISME 1994; 20:53-59. [PMID: 8056136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Infected wounds in diabetic patients are still frequent and the main cause of amputations. The experience of 180 patients admitted for foot lesions between june 1988 and september 1993 shows us the importance of combined medical and chirurgical cares. Non invasive vascular evaluation is reliable and often sufficient for preoperative vascular assessment. Total excision of infected and necrotic tissues is essential for the control of septic conditions. Conservative surgery can be considered a possibility as atypic amputations and adapted footwear may allow quick recovery and early walking. Resigned attitudes and pejorative outlooks are out-of-date, when faced with a diabetic foot problem. Optimal metabolic control and full preoperative assessment guide surgical possibilities.
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1044
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Jacobson R, Krahenbuhl JL, Patout C, Axelrod C. Public health applications of Hansen's disease research and treatment. Public Health Rep 1994; 109:818-20. [PMID: 7800793 PMCID: PMC1403586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Because of the similarities in causative agents of Hansen's disease and tuberculosis, Hansen's disease research is now being used in the identification, treatment, and prevention of tuberculosis. Numerous studies are under way to screen and develop new drugs to combat the threat of multiple drug-resistant tuberculosis. Additional studies focus on factors to reduce the transmission of tuberculosis and on the development of techniques for early diagnosis and identification of drug resistance. Advances in Hansen's disease research and treatment also are being applied to the prevention of ulcers and amputations in diabetics and others without protective sensation in their feet. The Lower Extremity Amputation Prevention Program, developed at the Gillis W. Long Hansen's Disease Center in Carville, LA, is a multidisciplinary approach that includes screening, risk assessment, and the development of a treatment plan with an emphasis on patient involvement. Expected to prevent up to 90 percent of diabetes-related amputations, the program is being implemented in Jackson, MS, in a community-based diabetic foot program and will be replicated throughout the United States.
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1045
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Milgram JW. Osteomyelitis in the foot and ankle associated with diabetes mellitus. Clin Orthop Relat Res 1993:50-7. [PMID: 8222449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Osteomyelitis in a foot or ankle is a common complication in patients with diabetes mellitus. Although acute osteomyelitis can be a surgical emergency, this presentation is uncommon. Chronic bone infection in most patients is associated with either vascular impairment or neuropathic skin breakdown or both. Neuropathic joints and stress fractures have to be differentiated from radiographic abnormalities caused by infection.
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1046
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Garrison MW, Campbell RK. Identifying and treating common and uncommon infections in the patient with diabetes. DIABETES EDUCATOR 1993; 19:522-9; quiz 530-1. [PMID: 8156867 DOI: 10.1177/014572179301900609] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Patients with diabetes represent a unique group of individuals who appear more prone than others to developing infections. Several mechanisms have been proposed to explain the association between diabetes and infections. However, few conclusive studies exist and considerable debate continues regarding evidence for this predisposition. Despite this lack of documented proof, many health care practitioners acknowledge that a number of infections are overrepresented in patients with diabetes. Some of these infections appear to occur exclusively in patients with diabetes, especially patients who are poorly controlled. The presenting clinical features, causative organisms, and preferred treatment approaches will be discussed in this article for a variety of common and uncommon infections observed in patients with diabetes. In addition, the proposed predisposing factors will be addressed briefly.
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1047
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Fahal AH, Suliman SH, Sharfi AR, el Mahadi EM. Acute idiopathic scrotal oedema in association with diabetic septic foot. Diabetes Res Clin Pract 1993; 21:197-200. [PMID: 8269822 DOI: 10.1016/0168-8227(93)90069-h] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Acute idiopathic scrotal oedema was observed in three adult diabetic patients with septic foot following life saving above knee guillotine amputation. This is a previously unreported association as far as we know and no clue to the pathogenesis could be obtained.
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1048
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Genyk SN, Grushetskiĭ NN. [The surgical aspects of suppurative necrotic processes in the foot area in diabetes mellitus]. VESTNIK KHIRURGII IMENI I. I. GREKOVA 1993; 150:87-9. [PMID: 8091601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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1049
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Fox IM, Zeiger L. Tc-99m-HMPAO leukocyte scintigraphy for the diagnosis of osteomyelitis in diabetic foot infections. J Foot Ankle Surg 1993; 32:591-4. [PMID: 8130789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The diagnosis of osteomyelitis in the presence of soft tissue infection and neuropathic bone changes is often difficult in the diabetic foot. Previous attempts at scintigraphic diagnosis included Tc-99m methylene diphosphonate, Gallium-67 citrate and Indium-111 autologous leukocytes (WBCs). A new agent recently available, Technetium-99m-HMPAO labeled white blood cells, shows promise as a scintigraphic agent superior to other agents for this purpose. The authors discuss this agent and present a case report as a preliminary study.
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