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Wakatsuki M, Yamamoto K, Kawashima A, Sakurai A, Kurokawa M, Mizushima R, Okumura N, Yamada G, Nomoto H, Ohmagari N. Autopsy of tetanus with foot gangrene as portal of entry. J Infect Chemother 2024; 30:450-453. [PMID: 37944699 DOI: 10.1016/j.jiac.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/26/2023] [Accepted: 11/04/2023] [Indexed: 11/12/2023]
Abstract
Non-traumatic chronic skin lesions are the second most common cause of tetanus. Herein, we describe an 85-year-old woman who presented with a chronically infected skin lesion. She developed tetanus while in hospital and died of respiratory failure, after refusing mechanical ventilation. Routine immunization against tetanus began in Japan during 1968; hence many people born before 1968 are unvaccinated. Mortality due to tetanus is high and the proportion with protective antibodies is low in older adults. Therefore, we recommend tetanus vaccination for older persons in Japan who have chronic skin lesions and have never been vaccinated.
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Affiliation(s)
- Miyu Wakatsuki
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Kei Yamamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
| | - Akira Kawashima
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Ayana Sakurai
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Masami Kurokawa
- Clinical Laboratory, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Ryo Mizushima
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Nobumasa Okumura
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Gen Yamada
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Hidetoshi Nomoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
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Xie Y, Zhao H. Commentary on "Digital gangrene in systemic sclerosis patients: not only due to the microvascular disease''. Clin Rheumatol 2024; 43:1413. [PMID: 38376770 DOI: 10.1007/s10067-024-06908-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 02/21/2024]
Affiliation(s)
- Youjun Xie
- Department of Clinical Laboratory, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, 6 Taoyuan Road, Nanning, Guangxi, China
| | - Hongying Zhao
- Department of Clinical Laboratory, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, 6 Taoyuan Road, Nanning, Guangxi, China.
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Gebretsion MT, Mergiyaw YA, Shumargaw AT. Spleno-Sigmoid Knotting - An Unfamiliar Cause of Intestinal Obstruction. Am J Emerg Med 2024; 78:241.e1-241.e3. [PMID: 38402100 DOI: 10.1016/j.ajem.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/18/2024] [Indexed: 02/26/2024] Open
Abstract
INTRODUCTION Spleno-sigmoid knotting is the twisting of the spleen around the sigmoid colon, causing obstruction of the sigmoid colon. It is an uncommon cause of intestinal obstruction. To our knowledge, there has been no previous case report of spleno-sigmoid knotting before our case. CASE REPORT Here, we present the case of an 18-year-old female patient who visited the surgical emergency outpatient department with diffuse and progressive abdominal pain lasting for one and a half days. She also experienced obstipation and frequent episodes of vomiting of ingested matter. Upon initial evaluation, she exhibited tachycardia and tachypnea, and her abdomen was grossly distended with diffuse direct and rebound tenderness. Further investigation revealed significant leukocytosis with neutrophil predominance. Emergency laparotomy was performed with a possible diagnosis of generalized peritonitis secondary to gangrenous sigmoid volvulus, which revealed gangrenous spleno-sigmoid knotting. DISCUSSION Various types of intestinal knots have been reported, with ileo-sigmoid knots being the most common and ileo-ileal knots being the rarest. Wandering spleen is a rare congenital anomaly with a variable clinical presentation ranging from asymptomatic to mild abdominal pain or acute abdomen due to torsion or acute pancreatitis. It can also cause intestinal obstruction, which may be the initial presentation. CONCLUSION In patients presenting with acute abdominal pain and features of bowel obstruction, the possibility of spleno-sigmoid knotting should be considered, and early intervention should be instituted to prevent gangrenous progression and sepsis.
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Affiliation(s)
| | - Yimam Ali Mergiyaw
- Department of Surgery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Fitridge R, Chuter V, Mills J, Hinchliffe R, Azuma N, Behrendt CA, Boyko EJ, Conte MS, Humphries M, Kirksey L, McGinigle KC, Nikol S, Nordanstig J, Rowe V, Russell D, van den Berg JC, Venermo M, Schaper N. The intersocietal IWGDF, ESVS, SVS guidelines on peripheral artery disease in people with diabetes and a foot ulcer. Diabetes Metab Res Rev 2024; 40:e3686. [PMID: 37726988 DOI: 10.1002/dmrr.3686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Diabetes related foot complications have become a major cause of morbidity and are implicated in most major and minor amputations globally. Approximately 50% of people with diabetes and a foot ulcer have peripheral artery disease (PAD) and the presence of PAD significantly increases the risk of adverse limb and cardiovascular events. The International Working Group on the Diabetic Foot (IWGDF) has published evidence based guidelines on the management and prevention of diabetes related foot complications since 1999. This guideline is an update of the 2019 IWGDF guideline on the diagnosis, prognosis and management of peripheral artery disease in people with diabetes mellitus and a foot ulcer. For this guideline the IWGDF, the European Society for Vascular Surgery and the Society for Vascular Surgery decided to collaborate to develop a consistent suite of recommendations relevant to clinicians in all countries. This guideline is based on three new systematic reviews. Using the Grading of Recommendations, Assessment, Development, and Evaluation framework clinically relevant questions were formulated, and the literature was systematically reviewed. After assessing the certainty of the evidence, recommendations were formulated which were weighed against the balance of benefits and harms, patient values, feasibility, acceptability, equity, resources required, and when available, costs. Through this process five recommendations were developed for diagnosing PAD in a person with diabetes, with and without a foot ulcer or gangrene. Five recommendations were developed for prognosis relating to estimating likelihood of healing and amputation outcomes in a person with diabetes and a foot ulcer or gangrene. Fifteen recommendations were developed related to PAD treatment encompassing prioritisation of people for revascularisation, the choice of a procedure and post-surgical care. In addition, the Writing Committee has highlighted key research questions where current evidence is lacking. The Writing Committee believes that following these recommendations will help healthcare professionals to provide better care and will reduce the burden of diabetes related foot complications.
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Affiliation(s)
- Robert Fitridge
- Faculty of Health and Medical Sciences, University of Adelaide and Vascular and Endovascular Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Vivienne Chuter
- School of Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
| | | | - Robert Hinchliffe
- Bristol Centre for Surgical Research, University of Bristol, Bristol, UK
| | | | - Christian-Alexander Behrendt
- Department of Vascular and Endovascular Surgery, Asklepios Clinic Wandsbek, Asklepios Medical School, Hamburg, Germany
| | | | - Michael S Conte
- San Francisco Medical Centre, University of California, San Francisco, California, USA
| | | | | | | | - Sigrid Nikol
- Clinical and Interventional Angiology, Asklepios Klinik, St Georg, Hamburg, Germany
| | | | - Vincent Rowe
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | | | - Jos C van den Berg
- CENTRO VASCOLARE TICINO Ospedale Regionale di Lugano, sede Civico and Universitätsinstitut für Diagnostische, Interventionelle und Pädiatrische Radiologie Inselspital, Universitätsspital, Bern, Switzerland
| | - Maarit Venermo
- Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Nicolaas Schaper
- Division of Endocrinology, Department Internal Medicine, MUMC+, Maastricht, The Netherlands
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Taib AG, Kler A, Prayle M, Kanakalingam D, Fani M, Asaad P. Appendicolith appendicitis: should we be operating sooner? A retrospective cohort study. Ann R Coll Surg Engl 2024; 106:237-244. [PMID: 37609681 PMCID: PMC10904264 DOI: 10.1308/rcsann.2023.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 08/24/2023] Open
Abstract
INTRODUCTION Evidence suggests that delaying an appendicectomy for up to 24 hours does not increase the risk of complicated appendicitis. Appendicoliths are a risk factor for perforation. No study has explored the temporal relationship between appendicolith presence and time to perforation. In this retrospective cohort study, we hypothesise that the presence of an appendicolith confirmed on preoperative computerised tomography scan (pCT) leads to a shorter time to complicated appendicitis. METHODS We undertook a retrospective single-centre study of patients admitted between 2018 and 2020. Inclusion criteria included: age ≥18 years, appendicitis confirmed on histopathology following an operation and a pCT scan. Complicated appendicitis was defined intraoperatively as an appendicular abscess, gangrenous or perforated appendix. RESULTS Some 310 patients were included in the study. Forty-five per cent presented with complicated appendicitis (n = 138). Appendicoliths were present in 79 (25.5%) patients. Multivariate logistic regression identified an appendicolith as a significant risk factor for perforation (odds ratio 3.50, 95% confidence interval [CI] 1.16-10.59; p = 0.027). Within the first 12 hours of admission, patients with an appendicolith accounted for a significantly greater proportion of those with complicated appendicitis intraoperatively compared with those without (56.7% vs 43.3%, respectively; p = 0.003). Within 12 hours of admission, those with an appendicolith were 2.05 times more likely to suffer from complicated appendicitis than those without (95% CI 1.28-3.29). CONCLUSIONS Patients with an appendicolith appendicitis should be considered for an early appendicectomy. Future large-scale multicentre prospective studies are required to explore this further, perhaps informing future guidelines.
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Affiliation(s)
| | | | - M Prayle
- Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, UK
| | - D Kanakalingam
- Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, UK
| | - M Fani
- Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, UK
| | - P Asaad
- Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, UK
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Chuter V, Schaper N, Hinchliffe R, Mills J, Azuma N, Behrendt CA, Boyko EJ, Conte MS, Humphries M, Kirksey L, McGinigle KC, Nikol S, Nordanstig J, Rowe V, David R, van den Berg JC, Venermo M, Fitridge R. Performance of non-invasive bedside vascular testing in the prediction of wound healing or amputation among people with foot ulcers in diabetes: A systematic review. Diabetes Metab Res Rev 2024; 40:e3701. [PMID: 37493206 DOI: 10.1002/dmrr.3701] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION The presence of peripheral artery disease (PAD) confers a significantly increased risk of failure to heal and major lower limb amputation for people with diabetes-related foot ulcer (DFU). Determining performance of non-invasive bedside tests for predicting likely DFU outcomes is therefore key to effective risk stratification of patients with DFU and PAD to guide management decisions. The aim of this systematic review was to determine the performance of non-invasive bedside tests for PAD to predict DFU healing, healing post-minor amputation, or need for minor or major amputation in people with diabetes and DFU or gangrene. METHODS A database search of Medline and Embase was conducted from 1980 to 30 November 2022. Prospective studies that evaluated non-invasive bedside tests in patients with diabetes, with and without PAD and foot ulceration or gangrene to predict the outcomes of DFU healing, minor amputation, and major amputation with or without revascularisation, were eligible. Included studies were required to have a minimum 6-month follow-up period and report adequate data to calculate the positive likelihood ratio (PLR) and negative likelihood ratio for the outcomes of DFU healing, and minor and major amputation. Methodological quality was assessed using the Quality in Prognosis Studies tool. RESULTS From 14,820 abstracts screened 28 prognostic studies met the inclusion criteria. The prognostic tests evaluated by the studies included: ankle-brachial index (ABI) in 9 studies; ankle pressures in 10 studies, toe-brachial index in 4 studies, toe pressure in 9 studies, transcutaneous oxygen pressure (TcPO2 ) in 7 studies, skin perfusion pressure in 5 studies, continuous wave Doppler (pedal waveforms) in 2 studies, pedal pulses in 3 studies, and ankle peak systolic velocity in 1 study. Study quality was variable. Common reasons for studies having a moderate or high risk of bias were poorly described study participation, attrition rates, and inadequate adjustment for confounders. In people with DFU, toe pressure ≥30 mmHg, TcPO2 ≥25 mmHg, and skin perfusion pressure of ≥40 mmHg were associated with a moderate to large increase in pretest probability of healing in people with DFU. Toe pressure ≥30 mmHg was associated with a moderate increase in healing post-minor amputation. An ABI using a threshold of ≥0.9 did not increase the pretest probability of DFU healing, whereas an ABI <0.5 was associated with a moderate increase in pretest probability of non-healing. Few studies investigated amputation outcomes. An ABI <0.4 demonstrated the largest increase in pretest probability of a major amputation (PLR ≥10). CONCLUSIONS Prognostic capacity of bedside testing for DFU healing and amputation is variable. A toe pressure ≥30 mmHg, TcPO2 ≥25 mmHg, and skin perfusion pressure of ≥40 mmHg are associated with a moderate to large increase in pretest probability of healing in people with DFU. There are little data available evaluating the prognostic capacity of bedside testing for healing after minor amputation or for major amputation in people with DFU. Current evidence suggests that an ABI <0.4 may be associated with a large increase in risk of major amputation. The findings of this systematic review need to be interpreted in the context of limitations of available evidence, including varying rates of revascularisation, lack of post-revascularisation bedside testing, and heterogenous subpopulations.
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Affiliation(s)
- Vivienne Chuter
- School of Health Sciences, Western Sydney University, Campbelltown, Sydney, Australia
| | - Nicolaas Schaper
- Division of Endocrinology, Department of Internal Medicine, MUMC+, Maastricht, The Netherlands
| | - Robert Hinchliffe
- Bristol Centre for Surgical Research, University of Bristol, Bristol, UK
| | | | | | - Christian-Alexander Behrendt
- Department of Vascular and Endovascular Surgery, Asklepios Clinic Wandsbek, Asklepios Medical School, Hamburg, Germany
| | | | - Michael S Conte
- San Francisco (UCSF) Medical Centre, University of California, San Francisco, California, USA
| | | | | | | | - Sigrid Nikol
- Clinical and Interventional Angiology, Asklepios Klinik, St. Georg, Hamburg, Germany
| | | | - Vincent Rowe
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | | | - Jos C van den Berg
- CENTRO VASCOLARE TICINO Ospedale Regionale di Lugano, sede Civico and Universitätsinstitut für Diagnostische, Interventionelle und Pädiatrische Radiologie Inselspital, Universitätsspital, Bern, Switzerland
| | - Maarit Venermo
- Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Robert Fitridge
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Vascular and Endovascular Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Tay WJ, Teh DJW, Qin Y, Lam WWC. The Curious Case of the Missing Limb on FDG PET Imaging. Clin Nucl Med 2024; 49:185-187. [PMID: 38170911 DOI: 10.1097/rlu.0000000000004999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
ABSTRACT A 58-year-old woman with poorly controlled diabetes, peripheral vascular disease, and end-stage renal disease requiring hemodialysis was referred for 18 F-FDG PET/CT to evaluate for source of sepsis. She had history of prior left forefoot and right second toe amputation, as well as left lower-limb dry gangrene for which she declined surgical management. We present a case of a nonamputated lower limb demonstrating regions of absolute photopenia, consistent with dry gangrene.
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Affiliation(s)
- Wan Jiun Tay
- From the Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital
| | - Daniel Jing Wen Teh
- Department of Diagnostic and Interventional Radiology, Tan Tock Seng Hospital
| | - Yan Qin
- Department of Internal Medicine, Singapore General Hospital, Singapore
| | - Winnie Wing-Chuen Lam
- From the Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital
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El Farhaoui H, Elmoudane A, Sallem D, Irzi M, Barki A. Superinfected Penile Cancer Complicated by Genital Gangrene: Management and Role of Gangrene Biopsy. Urology 2024; 183:e310-e311. [PMID: 37832830 DOI: 10.1016/j.urology.2023.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/05/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023]
Affiliation(s)
- Hammou El Farhaoui
- Faculté de médicine et de pharmacie Oujda, Université Mohammed premier, Oujda, Morocco; Department of Urology, Centre Hospitalier Universitaire Mohammed VI, Oujda, Morocco.
| | - Anouar Elmoudane
- Faculté de médicine et de pharmacie Oujda, Université Mohammed premier, Oujda, Morocco; Department of Urology, Centre Hospitalier Universitaire Mohammed VI, Oujda, Morocco
| | - Debe Sallem
- Faculté de médicine et de pharmacie Oujda, Université Mohammed premier, Oujda, Morocco; Department of Urology, Centre Hospitalier Universitaire Mohammed VI, Oujda, Morocco
| | - Mohammed Irzi
- Faculté de médicine et de pharmacie Oujda, Université Mohammed premier, Oujda, Morocco; Department of Urology, Centre Hospitalier Universitaire Mohammed VI, Oujda, Morocco
| | - Ali Barki
- Faculté de médicine et de pharmacie Oujda, Université Mohammed premier, Oujda, Morocco; Department of Urology, Centre Hospitalier Universitaire Mohammed VI, Oujda, Morocco
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Keita M, Coulibaly SK, Diarra A, Sanogo SD. [Cellulitis of male external genitalia in Mali]. Med Trop Sante Int 2023; 3:mtsi.v3i4.2023.428. [PMID: 38390011 PMCID: PMC10879899 DOI: 10.48327/mtsi.v3i4.2023.428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/24/2023] [Indexed: 02/24/2024]
Abstract
The observation presented is that of cellulitis of the external genitalia (Fournier's gangrene) in an elderly diabetic male hospitalized in Kati in Mali. The speed of progression and severity of this syndrome are detailed.
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Affiliation(s)
| | - Sanou Khô Coulibaly
- Faculté de médecine et dodontostomatologie, Université des sciences, des techniques et des technologies de Bamako (USTTB), Mali
| | - Abdoulaye Diarra
- Faculté de médecine et dodontostomatologie, Université des sciences, des techniques et des technologies de Bamako (USTTB), Mali
- CHU de Kati, Mali
| | - Sanra Déborah Sanogo
- Faculté de médecine et dodontostomatologie, Université des sciences, des techniques et des technologies de Bamako (USTTB), Mali
- CHU du Point G, Bamako, Mali
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Hu J, Zeng Q, Chen X, Luo W, Tang Z, Mei M, Zhao W, Du Z, Liu Z, Li Q, Cheng Q, Yang S. Primary aldosteronism and lower-extremity arterial disease: a two-sample Mendelian randomization study. Cardiovasc Diabetol 2023; 22:352. [PMID: 38124109 PMCID: PMC10734059 DOI: 10.1186/s12933-023-02086-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND AND AIMS Primary aldosteronism (PA) is an adrenal disorder of autonomous aldosterone secretion which promotes arterial injury. We aimed to explore whether PA is causally associated with lower-extremity arterial disease (LEAD). METHODS We included 39,713 patients with diabetes and 419,312 participants without diabetes from UK Biobank. We derived a polygenic risk score (PRS) for PA based on previous genome-wide association studies (GWAS). Outcomes included LEAD and LEAD related gangrene or amputation. We conducted a two-sample Mendelian randomization analysis for PA and outcomes to explore their potential causal relationship. RESULTS In whole population, individuals with a higher PA PRS had an increased risk of LEAD. Among patients with diabetes, compared to the subjects in the first tertile of PA PRS, subjects in the third tertile showed a 1.24-fold higher risk of LEAD (OR 1.24, 95% CI 1.03-1.49) and a 2.09-fold higher risk of gangrene (OR 2.09, 95% CI 1.27-3.44), and 1.72-fold higher risk of amputation (OR 1.72, 95% CI 1.10-2.67). Among subjects without diabetes, there was no significant association between PA PRS and LEAD, gangrene or amputation. Two-sample Mendelian randomization analysis indicated that genetically predictors of PA was significantly associated with higher risks of LEAD and gangrene (inverse variance weighted OR 1.20 [95% CI 1.08-1.34]) for LEAD, 1.48 [95% CI 1.28-1.70] for gangrene), with no evidence of significant heterogeneity or directional pleiotropy. CONCLUSIONS Primary aldosteronism is genetically and causally associated with higher risks of LEAD and gangrene, especially among patients with diabetes. Targeting on the autonomous aldosterone secretion may prevent LEAD progression.
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Affiliation(s)
- Jinbo Hu
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi St, Chongqing, 400016, China
| | - Qinglian Zeng
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi St, Chongqing, 400016, China
| | - Xiangjun Chen
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi St, Chongqing, 400016, China
| | - Wenjin Luo
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi St, Chongqing, 400016, China
| | - Ziwei Tang
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi St, Chongqing, 400016, China
| | - Mei Mei
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi St, Chongqing, 400016, China
| | - Wenrui Zhao
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi St, Chongqing, 400016, China
| | - Zhipeng Du
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi St, Chongqing, 400016, China
| | - Zhiping Liu
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi St, Chongqing, 400016, China
| | - Qifu Li
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi St, Chongqing, 400016, China.
| | - Qingfeng Cheng
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi St, Chongqing, 400016, China.
| | - Shumin Yang
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi St, Chongqing, 400016, China.
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Fernández Vecilla D, Roche Matheus MP, Calvo Muro FE, Iglesias Hidalgo G, Díaz de Tuesta Del Arco JL. Identification of curved Gram-negative rods by MALDI-TOF mass spectrometer in a patient with Fournier ́s gangrene. A bacteremia caused by Desulfovibrio desulfuricans and Escherichia coli. Rev Esp Quimioter 2023; 36:629-631. [PMID: 37767548 DOI: 10.37201/req/026.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Affiliation(s)
- D Fernández Vecilla
- Domingo Fernández Vecilla, Clinical Microbiology and Parasitology. Hospital Universitario de Basurto. Avenida Montevideo nº18, Gurtubay pavilion, 3rd floor. Postal code: 48013, Bilbao (Basque country). Spain.
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12
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Shinde RV, Anne SA, Firdos AP, Muralidhar V. Twisted aggressive angiomyxoma of the vulva presenting as an emergency with severe pain and impending gangrene. BMJ Case Rep 2023; 16:e257870. [PMID: 37996144 PMCID: PMC10668135 DOI: 10.1136/bcr-2023-257870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Affiliation(s)
- Ranoji V Shinde
- Obstetrics and Gynaecology, Chettinad Academy of Research and Education, Kanchipuram, Tamil Nadu, India
| | - Shreya A Anne
- Obstetrics and Gynaecology, Chettinad Academy of Research and Education, Kanchipuram, Tamil Nadu, India
| | - Alhaj P Firdos
- Obstetrics and Gynaecology, Chettinad Academy of Research and Education, Kanchipuram, Tamil Nadu, India
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Agarwal N, Ashutosh, Sharma A, Gupta A. A prospective study on skin and soft tissue infections: a fact-finding mission from a tertiary centre in north India. J Wound Care 2023; 32:S4-S13. [PMID: 37907364 DOI: 10.12968/jowc.2023.32.sup11.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
OBJECTIVE Despite the high prevalence and poor outcome of skin and soft tissue infections (SSTIs), very few studies from India have dealt with the subject. We planned a prospective study of inpatients with SSTIs to study the aetiology, clinical presentation (severity) and outcome of patients with SSTIs in our facility. METHOD Patients with SSTIs involving >5% body surface area (BSA) and/or systemic signs were admitted to the surgery department of a teaching tertiary level hospital in Delhi, India, and were clinically classified into cellulitis, necrotising soft tissue infections (NSTIs), pyomyositis, and abscess. Demographic and clinical variables such as: age; sex; occupation; history of trauma/insect or animal bites; duration of illness; presenting symptoms and signs; comorbid conditions; predisposing factors such as lymphoedema or venous disease; hospital course; treatment instituted; complications; hospital outcome; presence of crepitus, bullae, gangrene, muscle necrosis and compartment syndrome were recorded. The chief outcome parameters were death and length of hospital stay; others, such as abscess drainage, the need for plastic surgical procedures and amputations were also noted. RESULTS Out of 250 patients enrolled in the study, 145 (58%) had NSTIs, 64 (26%) had abscesses, 15 (6%) had cellulitis and 26 (10%) had pyomyositis. Mortality was observed with NSTIs (27/145, 19%) and with pyomyositis (3/26, 11.5%). Factors affecting mortality by univariate analysis in the NSTI group were: abnormal pulse; hypotension; tachypnea; bullae; increased blood urea and serum creatinine; inotrope or ventilator support (all with p<0.001); local tenderness, gangrene, dialysis support and BSA (9.33±6.44 versus 5.12±3.62; p<0.05 for the last four). No factor was found to be significant on multivariate analysis. Variables associated with hospital stay >12 days were immunocompromise, pus discharge, ulceration or gangrene, and after interventions such as blood transfusion, drainage or skin grafting. CONCLUSION High prevalence of NSTI and pyomyositis with high mortality was observed in our SSTI patients, often in immunocompetent young individuals. Epidemiological studies focused on virulent strains of Staphylococcus aureus may be required to identify the cause, since Staphylococcal toxins have been implicated in other infections.
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Affiliation(s)
- Nitin Agarwal
- Formerly at Department of Surgery, University College of Medical Sciences (UCMS) and Guru Tegh Bahadur Hospital (GTBH), Delhi, India
- Department of Surgery and Transplant, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital (RMLH), Delhi, India
| | - Ashutosh
- Formerly at Department of Surgery, University College of Medical Sciences (UCMS) and Guru Tegh Bahadur Hospital (GTBH), Delhi, India
| | - Ashish Sharma
- Formerly at Department of Surgery, University College of Medical Sciences (UCMS) and Guru Tegh Bahadur Hospital (GTBH), Delhi, India
| | - Arun Gupta
- Formerly at Department of Surgery, University College of Medical Sciences (UCMS) and Guru Tegh Bahadur Hospital (GTBH), Delhi, India
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Ansert E, Najjar J, Snyder RJ. A Preliminary Look at the Macrovascular System for Transmetatarsal Amputation Success. Adv Skin Wound Care 2023; 36:610-615. [PMID: 37861666 DOI: 10.1097/asw.0000000000000057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Transmetatarsal amputation (TMA) is a commonly used level of amputation that preserves most of the foot's function and independence. However, many TMAs fail, and patients go onto higher amputations. The primary endpoint of this study is to determine if source artery occlusions are correlated with TMA flap failure. METHODS A total of 82 patients with TMAs were retrospectively reviewed for healing rates between 2009 and 2019 at a single center. Forty-five of the patients had an angiogram, which was analyzed for source artery and overall TMA failure. Of the initial 82 patients, a cohort of 12 had documentation of specific flap failure and an angiogram performed. This cohort of 12 patients was used for correlation of flap failure with source artery occlusion. RESULTS Overall, the TMA healing rate was 45.28%. No correlation was noted between a specific source artery occlusion and overall TMA failure. However, a moderate positive correlation was seen with dorsalis pedis artery and peroneal artery occlusions and dorsal flap failure. No correlation was seen with the posterior tibial artery and plantar flap failure. A moderate negative correlation was seen with peroneal artery occlusion and plantar flap failure. CONCLUSIONS The authors concluded that retrograde flow through the angiosome principle is what allowed for successful outcomes in TMAs. Physicians are urged to carefully plan, dissect, and preserve these vessels to help prevent TMA flap failure, especially in patients with vascular risk or disease.
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Affiliation(s)
- Elizabeth Ansert
- Elizabeth Ansert, DPM, MBA, MA, is Podiatric Resident, Saint Vincent Hospital, Worcester, Massachusetts, USA. John Najjar, MD, is Vascular Surgeon, Reliant Medical Group, Worcester, Massachusetts. Robert J. Snyder, DPM, MBA, MSc, CWSP, is Dean, Podiatric Medical School, Barry University School of Podiatric Medicine, Miami, Florida. Acknowledgment: The authors thank the vascular surgeons involved in data collection. The authors have disclosed no financial relationships related to this article. Submitted October 30, 2022; accepted in revised form January 9, 2023
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Stone M, Dimofte C, Strong D, Pulvers K, Crespo NC, Leas EC, Pierce JP. Evaluating US smokers' willingness to pay for different cigarette packaging designs before and after real-world exposure in a randomised trial. Tob Control 2023; 32:689-695. [PMID: 35232793 DOI: 10.1136/tobaccocontrol-2021-057071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/20/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Removal of tobacco industry branding from cigarette packs may reduce their appeal. Adding graphic warning labels (GWLs) should enhance this effect. We investigate whether willingness to pay for various packaging designs changes after 3 months' use of: (1) US branded packs without GWLs (US), (2) non-branded packs without GWLs (Blank), and (3) rotating non-branded packs with GWLs (gangrene; throat cancer; neonatal baby) covering >75% of pack (GWL). METHODS Californian adult daily smokers not planning to quit (n=287; 56% female; mean age=39.6) completed a discrete choice purchase task before and after 3 months' experience using one of three packaging options. Conjoint analysis and pre-post modelling evaluated the change in importance of pack attributes and willingness to pay for US, Blank or GWL (blindness; teeth; gangrene) pack designs. RESULTS Price determined ~70% of purchase choices, while pack design determined ~22%. Irrespective of intervention arm, US packaging generated appeal valuations compared with Blank packaging, while GWLs consistently provoked strong aversive valuations at baseline and follow-up. Compared with the US pack arm, using GWL packs for 3 months decreased willingness to pay for US packaging (β=-$0.38, 95% CI -0.76 to 0.00). Wear-out effects were detected in the discount needed to willingly purchase the gangrene-GWL pack (β=$0.49, 95% CI 0.16 to 0.82) and Blank pack (β=$0.42, 95% CI 0.09 to 0.74) but not for GWLs (blindness, teeth) not used in trial. CONCLUSION Compared with US branded packs, the negative valuation of non-branded GWL packs attenuates with even 3 months' use but does not generalise to non-used GWLs. This suggests that GWLs should be regularly refreshed. The appeal valuation of industry imagery suggests that the US plan to retain such imagery on packs may ameliorate the effect of GWLs.
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Affiliation(s)
- Matthew Stone
- Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Claudiu Dimofte
- Marketing, San Diego State University, San Diego, California, USA
| | - David Strong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
- Cancer Prevention and Control Program, University of California San Diego Moores Cancer Center, La Jolla, California, USA
| | - Kim Pulvers
- Psychology, California State University San Marcos, San Marcos, California, USA
| | - Noe C Crespo
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Eric C Leas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
- Cancer Prevention and Control Program, University of California San Diego Moores Cancer Center, La Jolla, California, USA
| | - John P Pierce
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
- Cancer Prevention and Control Program, University of California San Diego Moores Cancer Center, La Jolla, California, USA
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Yu Y, Chen Y, Yang F, Song Q. Black necrosis of the glans penis associated with calciphylaxis: A case report. Medicine (Baltimore) 2023; 102:e35609. [PMID: 37861559 PMCID: PMC10589551 DOI: 10.1097/md.0000000000035609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 09/21/2023] [Indexed: 10/21/2023] Open
Abstract
RATIONALE Calciphylaxis, known as calcific uremic arteriolopathy, is a rare cause of dry gangrene. Despite an increase in the clinical recognition of demographic characteristics and risk factors associated with calciphylaxis, it remains a poorly understood disease with high mortality. PATIENT CONCERNS AND DIAGNOSES We present a 45-year-old man, who was diagnosed with calciphylaxis disease, with a history of diabetes mellitus, end-stage renal disease and cirrhosis with a half-month evolution of painful dry gangrene on his glans penis and scrotum. The patient also presented with gangrene of fingers. INTERVENTIONS AND OUTCOMES The patient and his family opted for palliative care. However, he died eventually. LESSONS This case contributed to the current understanding of calciphylaxis. Since no standard treatment is available and the prognosis remained poor, early, and accurate diagnosis of calciphylaxis is important. We here report the current case and provide data for the diagnosis and treatment of this kind of disease.
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Affiliation(s)
- Youwei Yu
- Department of Emergency Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Yangxi Chen
- Department of Emergency Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Fan Yang
- Department of Emergency Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Qitai Song
- Department of Emergency Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
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Zhang H, Huang C, Bai J, Wang J. Effect of diabetic foot ulcers and other risk factors on the prevalence of lower extremity amputation: A meta-analysis. Int Wound J 2023; 20:3035-3047. [PMID: 37095728 PMCID: PMC10502264 DOI: 10.1111/iwj.14179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 04/26/2023] Open
Abstract
A meta-analysis study was conducted to measure the consequence of diabetic foot ulcers (DFUs) and other risk factors (RFs) on the prevalence of lower extremity amputation (LEA). A comprehensive literature inspection till February 2023 was applied and 2765 interrelated studies were reviewed. Of the 32 chosen studies enclosed, 9934 subjects were in the chosen studies' starting point, and 2906 of them were with LEA. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to compute the value of the effect of DFUs and other RFs on the prevalence of LEA by the continuous and dichotomous approaches and a fixed or random effect model. Male gender (OR, 1.30; 95% CI, 1.17-1.44, P < .001), smoking (OR, 1.24; 95% CI, 1.01-1.53, P = .04), previous foot ulcer (OR, 2.69; 95% CI, 1.93-3.74, P < .001), osteomyelitis (OR, 3.87; 95% CI, 2.28-6.57, P < .001), gangrene (OR, 14.45; 95% CI, 7.03-29.72, P < .001), hypertension (OR, 1.17; 95% CI, 1.03-1.33, P = .01), and white blood cells count (WBCC) (MD, 2.05; 95% CI, 1.37-2.74, P < .001) were significantly shown to be an RF in LEA in subjects with DFUs. Age (MD, 0.81; 95% CI, -0.75 to 2.37, P = .31), body mass index (MD, -0.55; 95% CI, -1.15 to 0.05, P = .07), diabetes mellitus type (OR, 0.99; 95% CI, 0.63-1.56, P = .96), and glycated haemoglobin (MD, 0.33; 95% CI, -0.15 to 0.81, P = .17) were not shown to be an RF in LEA in subjects with DFUs. Male gender, smoking, previous foot ulcer, osteomyelitis, gangrene, hypertension, and WBCC were significantly shown to be an RF in LEA in subjects with DFUs. However, age and diabetes mellitus type were not shown to be RF in LEA in subjects with DFUs. However, caused of the small sample sizes of several chosen studies for this meta-analysis, care must be exercised when dealing with its values.
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Affiliation(s)
- Huiling Zhang
- Department of Endocrinology and MetabologyLiaocheng People's HospitalShandongChina
| | - Chuanwang Huang
- Department of Orthopedic SurgeryLiaocheng People's HospitalShandongChina
| | - Jie Bai
- Department of Endocrinology and MetabologyLiaocheng People's HospitalShandongChina
| | - Jing Wang
- Department of Endocrinology and MetabologyLiaocheng People's HospitalShandongChina
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Wang XB, Wang ML, Chu YJ, Zhou PP, Zhang XY, Zou J, Zuo LH, Shi YY, Kang J, Li B, Cheng WB, Sun Z, Zhang XJ, Du SZ. Integrated pharmacokinetics and pharmacometabolomics to reveal the synergistic mechanism of a multicomponent Chinese patent medicine, Mailuo Shutong pills against thromboangiitis obliterans. Phytomedicine 2023; 112:154709. [PMID: 36774843 DOI: 10.1016/j.phymed.2023.154709] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/23/2023] [Accepted: 02/05/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Mailuo Shutong Pills (MLST) have displayed pharmacological activity against thromboangiitis obliterans (TAO). However, the active ingredients and therapeutic mechanism of MLST against TAO remained to be further clarified. PURPOSE The aim of this study was to explore the active components of MLST and their synergistic mechanism against TAO by integrating pharmacokinetics (PK) and pharmacometabolomics (PM). METHODS TAO model rats were established by sodium laurate solution. Firstly, the efficacy of MLST was evaluated by gangrene score, blood flow velocity, and hematoxylin-eosin (H&E) staining. Secondly, PK research was conducted on bioavailable components to characterize their dynamic behaviors under TAO. Thirdly, multiple plasma and urine metabolic biomarkers for sodium laurate-induced TAO rats were found by untargeted metabolomics, and then variations in TAO-altered metabolites following MLST treatment were analyzed utilizing multivariate and bioinformatic analysis. Additionally, metabolic pathway analysis was performed using MetaboAnalyst. Finally, the dynamic link between absorbed MLST-compounds and TAO-associated endogenous metabolites was established by correlation analysis. RESULTS MLST significantly alleviated gangrene symptoms by improving the infiltration of inflammatory cells and blood supply in TAO rats. Significant differences in metabolic profiles were found in 17 differential metabolites in plasma and 24 in urine between Sham and TAO rats. The 10 bioavailable MLST-compounds, such as chlorogenic acid and paeoniflorin, showed positive or negative correlations with various TAO-altered metabolites related to glutamate metabolism, histidine metabolism, arachidonic acid metabolism and so on. CONCLUSION This study originally investigated the dynamic interaction between MLST and the biosystem, providing unique insight for disclosing the active components of MLST and their synergistic mechanisms against TAO, which also shed light on new therapeutic targets for TAO and treatment.
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Affiliation(s)
- Xiao-Bao Wang
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Jianshe East Road 1, Zhengzhou 450052, China; Henan Engineering Research Center of Clinical Mass Spectrometry for Precision Medicine, Zhengzhou Key Laboratory of Clinical Mass Spectrometry, Jianshe East Road 1, Zhengzhou 450052, China
| | - Meng-Li Wang
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Jianshe East Road 1, Zhengzhou 450052, China; Henan Engineering Research Center of Clinical Mass Spectrometry for Precision Medicine, Zhengzhou Key Laboratory of Clinical Mass Spectrometry, Jianshe East Road 1, Zhengzhou 450052, China
| | - Yao-Juan Chu
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Jianshe East Road 1, Zhengzhou 450052, China; Henan Engineering Research Center of Clinical Mass Spectrometry for Precision Medicine, Zhengzhou Key Laboratory of Clinical Mass Spectrometry, Jianshe East Road 1, Zhengzhou 450052, China
| | - Pei-Pei Zhou
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Jianshe East Road 1, Zhengzhou 450052, China; Henan Engineering Research Center of Clinical Mass Spectrometry for Precision Medicine, Zhengzhou Key Laboratory of Clinical Mass Spectrometry, Jianshe East Road 1, Zhengzhou 450052, China
| | - Xiang-Yu Zhang
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Jianshe East Road 1, Zhengzhou 450052, China; Henan Engineering Research Center of Clinical Mass Spectrometry for Precision Medicine, Zhengzhou Key Laboratory of Clinical Mass Spectrometry, Jianshe East Road 1, Zhengzhou 450052, China
| | - Jing Zou
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Jianshe East Road 1, Zhengzhou 450052, China; Henan Engineering Research Center of Clinical Mass Spectrometry for Precision Medicine, Zhengzhou Key Laboratory of Clinical Mass Spectrometry, Jianshe East Road 1, Zhengzhou 450052, China
| | - Li-Hua Zuo
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Jianshe East Road 1, Zhengzhou 450052, China; Henan Engineering Research Center of Clinical Mass Spectrometry for Precision Medicine, Zhengzhou Key Laboratory of Clinical Mass Spectrometry, Jianshe East Road 1, Zhengzhou 450052, China
| | - Ying-Ying Shi
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Jianshe East Road 1, Zhengzhou 450052, China; Henan Engineering Research Center of Clinical Mass Spectrometry for Precision Medicine, Zhengzhou Key Laboratory of Clinical Mass Spectrometry, Jianshe East Road 1, Zhengzhou 450052, China
| | - Jian Kang
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Jianshe East Road 1, Zhengzhou 450052, China; Henan Engineering Research Center of Clinical Mass Spectrometry for Precision Medicine, Zhengzhou Key Laboratory of Clinical Mass Spectrometry, Jianshe East Road 1, Zhengzhou 450052, China
| | - Bing Li
- State Key Laboratory of Common Technology of Traditional Chinese Medicine and Pharmaceuticals, Lunan Pharmaceutical Group Co., Ltd., Linyi, China
| | - Wen-Bo Cheng
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Zhi Sun
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Jianshe East Road 1, Zhengzhou 450052, China; Henan Engineering Research Center of Clinical Mass Spectrometry for Precision Medicine, Zhengzhou Key Laboratory of Clinical Mass Spectrometry, Jianshe East Road 1, Zhengzhou 450052, China.
| | - Xiao-Jian Zhang
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Jianshe East Road 1, Zhengzhou 450052, China; Henan Engineering Research Center of Clinical Mass Spectrometry for Precision Medicine, Zhengzhou Key Laboratory of Clinical Mass Spectrometry, Jianshe East Road 1, Zhengzhou 450052, China.
| | - Shu-Zhang Du
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Jianshe East Road 1, Zhengzhou 450052, China; Henan Engineering Research Center of Clinical Mass Spectrometry for Precision Medicine, Zhengzhou Key Laboratory of Clinical Mass Spectrometry, Jianshe East Road 1, Zhengzhou 450052, China.
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Su HY, Yang CY, Ou HT, Chen SG, Chen JC, Ho HJ, Kuo S. Cost-effectiveness of Novel Macrophage-Regulating Treatment for Wound Healing in Patients With Diabetic Foot Ulcers From the Taiwan Health Care Sector Perspective. JAMA Netw Open 2023; 6:e2250639. [PMID: 36633847 PMCID: PMC9856772 DOI: 10.1001/jamanetworkopen.2022.50639] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
IMPORTANCE Diabetic foot ulcers (DFUs) and subsequent amputation incur enormous health and economic burdens to patients, health care systems, and societies. As a novel macrophage-regulating drug, ON101 is a breakthrough treatment for DFUs, which demonstrated significant complete wound healing effects in a phase 3 randomized clinical trial, but its economic value remains unknown. OBJECTIVE To assess the cost-effectiveness of an ON101 cream added on to general wound care (GWC; ie, conventional treatments for DFUs, which comprised initial and regular foot examinations, ulcer management, comorbidity control, patient education, and multidisciplinary care) vs GWC alone for DFUs from the Taiwan health care sector perspective. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation used a hypothetical cohort of patients with diabetes, with characteristics mirroring those of the participants in the ON101 trial. A Markov state-transition simulation model was constructed to estimate costs and health outcomes associated with the ON101 with GWC and GWC alone strategies over a 5-year time horizon, discounting costs and effectiveness at 3% annually. Costs were in 2021 US dollars. Data were sourced from the ON101 trial and supplemented from published literature. Deterministic and probabilistic sensitivity analyses were performed to assess the uncertainty of input parameters and study generalizability. The analysis was designed and conducted from September 1, 2020, to January 31, 2022. EXPOSURES ON101 with GWC vs GWC alone. MAIN OUTCOMES AND MEASURES DFU-related complications, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. RESULTS Patients in the hypothetical cohort had a mean age of 57 years and an uninfected DFU of 1 to 25 cm2 that was present for 4 or more weeks with a Wagner grade of 1 or 2. Over 5 years, the ON101 with GWC group vs the GWC alone group experienced more healing events, stayed for a longer time in the healing state, and had fewer infected DFUs, gangrene, and amputations (eg, 2787 additional healing events and 2766 fewer infected DFU, 72 fewer amputation, and 7 fewer gangrene events in the ON101 with GWC group vs GWC alone group). The ON101 with GWC strategy vs GWC alone yielded an additional 0.038 QALYs at an incremental cost of $571, resulting in $14 922/QALY gained. Economic results were most sensitive to healing efficacy, drug cost, and health utility of the healing state. Cost-saving results were observed in patient subgroups with poor glycemic control, larger ulcer sizes, longer ulcer durations, and current smoking. The ON101 with GWC strategy was considered cost-effective in 60% to 82% of model iterations against willingness-to-pay thresholds of $32 787/QALY gained to $98 361/QALY gained. CONCLUSIONS AND RELEVANCE In this economic evaluation study using a simulated patient cohort, the ON101 with GWC strategy represented good value compared with GWC alone for patients with DFUs from the Taiwan health care sector perspective and may be prioritized for those with high risks for disease progression of DFUs.
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Affiliation(s)
- Hsuan-Yu Su
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chen-Yi Yang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Huang-Tz Ou
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shyi-Gen Chen
- Department of Medical Science, Oneness Biotech Co, Ltd, Taipei, Taiwan
- Department of Surgery, Tri-Service General Hospital, Taipei, Taiwan
| | - Jui-Ching Chen
- Department of Medical Science, Oneness Biotech Co, Ltd, Taipei, Taiwan
| | - Hui-Ju Ho
- Department of Clinical Research, Oneness Biotech Co, Ltd, Taipei, Taiwan
| | - Shihchen Kuo
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
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Hrubovčák J, Tulinský U, Ihnát P, Jelínek P, Slívová I, Mitták M, Roman J, Stránský J. Is abdominal pain after an injury just an injury? Case report of rare aspiration pneumonia with lung gangrene and peritoneal response in a 5-year-old child. Cas Lek Cesk 2023; 162:160-163. [PMID: 37734942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Although pneumonia presents a relatively common diagnosis, it does not always present with classic clinical symptoms, nor does it follow a regular course without complications. The presented case describes a rare case of aspiration necrotizing pneumonia, which despite intensive therapy, progressed to lung gangrene and required a lung lobectomy. Another peculiarity is that the correct diagnosis was established only after the onset of abdominal pain, surprisingly by a trauma surgeon. This case emphasizes the necessity of a thorough general examination and draws attention to a rare, but conservatively intractable necrotizing pneumonia complicated by lung gangrene.
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Osonoi S, Hamaura K, Murakami H. A diabetic patient with finger gangrene. Eur J Intern Med 2022; 103:100-101. [PMID: 35606289 DOI: 10.1016/j.ejim.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/09/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Sho Osonoi
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan; Department of Diabetes and Endocrinology, Mutsu General Hospital, Aomori 035-0071, Japan.
| | - Kiho Hamaura
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan
| | - Hiroshi Murakami
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan; Department of Diabetes and Endocrinology, Mutsu General Hospital, Aomori 035-0071, Japan
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Patel S, Smiley A, Feingold C, Khandehroo B, Kajmolli A, Latifi R. Chances of Mortality Are 3.5-Times Greater in Elderly Patients with Umbilical Hernia Than in Adult Patients: An Analysis of 21,242 Patients. Int J Environ Res Public Health 2022; 19:10402. [PMID: 36012037 PMCID: PMC9408293 DOI: 10.3390/ijerph191610402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
The goal of this study was to identify risk factors that are associated with mortality in adult and elderly patients who were hospitalized for umbilical hernia. A total of 14,752 adult patients (ages 18−64 years) and 6490 elderly patients (ages 65+), who were admitted emergently for umbilical hernia, were included in this retrospective cohort study. The data were gathered from the National Inpatient Sample (NIS) 2005−2014 database. Predictors of mortality were identified via a multivariable logistic regression, in patients who underwent surgery and those who did not for adult and elderly age groups. The mean (SD) ages for adult males and females were 48.95 (9.61) and 46.59 (11.35) years, respectively. The mean (SD) ages for elderly males and females were 73.62 (6.83) and 77.31 (7.98) years, respectively. The overall mortality was low (113 or 0.8%) in the adult group and in the elderly group (179 or 2.8%). In adult patients who underwent operation, age (OR = 1.066, 95% CI: 1.040−1.093, p < 0.001) and gangrene (OR = 5.635, 95% CI: 2.288−13.874, p < 0.001) were the main risk factors associated with mortality. Within the same population, female sex was found to be a protective factor (OR = 0.547, 95% CI: 0.351−0.854, p = 0.008). Of the total adult sample, 43% used private insurance, while only 18% of patients in the deceased population used private insurance. Conversely, within the entire adult population, only about 48% of patients used Medicare, Medicaid, or self-pay, while these patients made up 75% of the deceased group. In the elderly surgical group, the main risk factors significantly associated with mortality were frailty (OR = 1.284, 95% CI: 1.105−1.491, p = 0.001), gangrene (OR = 13.914, 95% CI: 5.074−38.154, p < 0.001), and age (OR = 1.034, 95% CI: 1.011−1.057, p = 0.003). In the adult non-operation group, hospital length of stay (HLOS) was a significant risk factor associated with mortality (OR = 1.077, 95% CI: 1.004−1.155, p = 0.038). In the elderly non-operation group, obstruction was the main risk factor (OR = 4.534, 95% CI: 1.387−14.819, p = 0.012). Elderly patients experienced a 3.5-fold higher mortality than adult patients who were emergently admitted with umbilical hernia. Increasing age was a significant risk factor of mortality within all patient populations. In the adult surgical group, gangrene, Medicare, Medicaid, and self-pay were significant risk factors of mortality and female sex was a significant protective factor. In the adult non-surgical group, HLOS was the main risk factor of mortality. In the elderly population, frailty and gangrene were the main risk factors of mortality within the surgical group, and obstruction was the main risk factor for the non-surgical group.
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Affiliation(s)
- Saral Patel
- Westchester Medical Center, School of Medicine, New York Medical College, Valhalla, NY 10595, USA
| | - Abbas Smiley
- Westchester Medical Center, School of Medicine, New York Medical College, Valhalla, NY 10595, USA
| | - Cailan Feingold
- Westchester Medical Center, School of Medicine, New York Medical College, Valhalla, NY 10595, USA
| | - Bardia Khandehroo
- Westchester Medical Center, School of Medicine, New York Medical College, Valhalla, NY 10595, USA
| | - Agon Kajmolli
- Westchester Medical Center, School of Medicine, New York Medical College, Valhalla, NY 10595, USA
| | - Rifat Latifi
- Minister of Health, Republic of Kosova, Adjunct Professor of Surgery, University of Arizona, Tucson, AZ 10000, USA
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Tisch Mendes J, Klein RJ. The value of a biopsy in chronic ulcers: a case series. Wounds 2022; 34:119-123. [PMID: 35452409 DOI: 10.25270/wnds/2022.119123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Chronic wounds affect millions of individuals in the United States. Chronic wounds of the lower extremity and foot are commonly associated with vascular insufficiency, diabetes, pressure, and neuropathy. Nonhealing wounds are at risk of severe complications, including infection, gangrene, amputation, and malignant transformation. Primary cutaneous malignancies may masquerade as nonhealing ulcers; thus, it can be challenging to differentiate between the malignant transformation of a chronic wound and a primary cutaneous malignancy with ulceration. A biopsy can be a safe, valuable tool in investigating underlying pathology in chronic wounds. Early biopsy diagnosis of malignant transformation can prevent diagnostic and treatment delays. Presented is a review of biopsy and its need and timing to identify malignant transformation in chronic wounds. The authors present 3 patient cases in which biopsies confirmed presence of malignancy in chronic ulcers.
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Affiliation(s)
- Jocelyn Tisch Mendes
- University of South Carolina School of Medicine Greenville, Greenville, South Carolina
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24
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Samuel SV, George TK, Gopinathan VR, Abraham OC. Community-acquired fungal pyelonephritis with renal infarction and gangrene of the colon: an uncommon diagnosis. BMJ Case Rep 2022; 15:e241685. [PMID: 35131766 PMCID: PMC8823032 DOI: 10.1136/bcr-2021-241685] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2021] [Indexed: 12/26/2022] Open
Abstract
A 54-year-old male farmer with a history of long-standing uncontrolled type 2 diabetes mellitus (HbA1c 10.8) presented with a 3-week history of fever, intermittent vomiting, malaise and left flank pain for which he was treated with broad-spectrum antibiotics and oral antifungals for Candida isolated from urine culture. CT of the abdomen revealed predominant involvement of the left kidney and retroperitoneal structures. Nephrectomy was performed due to worsening abdominal pain and features of bowel perforation found on imaging. Pus culture from the necrotic kidney grew aseptate fungal hyphae, and the histopathological examination was suggestive of zygomycosis. He received amphotericin B postoperatively, but his condition deteriorated and he succumbed to nosocomial gram-negative septicaemia.
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Affiliation(s)
- Stephen Varghese Samuel
- Geriatric Medicine, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Tarun K George
- Internal Medicine, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | | | - O C Abraham
- Internal Medicine, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
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25
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Novais Lima P, Cruz Silva J, Gonçalves A, Fonseca M. VENOUS GANGRENE: REMINDING A VASCULAR CATASTROPHE. Port J Card Thorac Vasc Surg 2022; 28:73. [PMID: 35334167 DOI: 10.48729/pjctvs.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Indexed: 06/14/2023]
Abstract
A 85 year-old, female patient, with an active colon neoplasm, was diagnosed with extensive ilio-femoro-popliteal deep vein thrombosis. She presented with severe oedema of the left lower limb and a cyanotic foot. Pedal pulses were palpable. Despite immediate anticoagulation, the patient expired at 72h.
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Affiliation(s)
- Pedro Novais Lima
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de Coimbra, Portugal
| | - Joana Cruz Silva
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de Coimbra, Portugal
| | - Anabela Gonçalves
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de Coimbra, Portugal
| | - Manuel Fonseca
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de Coimbra, Portugal
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26
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Fukue R, Gono T, Hayashi H, Terasaki Y, Kuwana M. Rapidly Progressive Multiple Digital Gangrene and Diffuse Alveolar Damage in a Patient With Antisynthetase Antibody and Gastric Cancer. J Clin Rheumatol 2021; 27:S585-S589. [PMID: 30585991 DOI: 10.1097/rhu.0000000000000974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Kanno K, Cho Y, Fujii S, Ami Y, Nishizeki O, Sonoda M, Ishimura M, Fujiwara N. Ecthyma Gangrenosum in an Infant with Interleukin-1 Receptor-Associated Kinase 4 Deficiency. J Pediatr 2021; 239:241-242. [PMID: 34400209 DOI: 10.1016/j.jpeds.2021.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/09/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Koji Kanno
- Division of Pediatric Critical Care Medicine, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center; Department of Clinical Research and Quality Management, University of the Ryukyus Graduate School of Medicine, Okinawa, Japan
| | - Yoshiaki Cho
- Division of Pediatric Infectious Diseases, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Okinawa, Japan
| | - Shuichi Fujii
- Division of Pediatric Critical Care Medicine, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Okinawa, Japan
| | - Yuki Ami
- Division of Pediatric Critical Care Medicine, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Okinawa, Japan
| | - Osamu Nishizeki
- Department of Plastic and Reconstructive Surgery, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Okinawa, Japan
| | - Motoshi Sonoda
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masataka Ishimura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naoki Fujiwara
- Division of Pediatric Critical Care Medicine, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Okinawa, Japan
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28
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Weissler EH, Clare RM, Lokhnygina Y, Buse JB, Goodman SG, Katona B, Iqbal N, Pagidipati NJ, Sattar N, Holman RR, Hernandez AF, Mentz RJ, Patel MR, Jones WS. Predicting major adverse limb events in individuals with type 2 diabetes: Insights from the EXSCEL trial. Diabet Med 2021; 38:e14552. [PMID: 33690915 PMCID: PMC8429063 DOI: 10.1111/dme.14552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/01/2021] [Accepted: 03/09/2021] [Indexed: 02/06/2023]
Abstract
AIMS Although models exist to predict amputation among people with type 2 diabetes with foot ulceration or infection, we aimed to develop a prediction model for a broader range of major adverse limb events (MALE)-including gangrene, revascularization and amputation-among individuals with type 2 diabetes. METHODS In a post-hoc analysis of data from the Exenatide Study of Cardiovascular Event Lowering (EXSCEL) trial, we compared participants who experienced MALE with those who did not. A multivariable model was constructed and translated into a risk score. RESULTS Among the 14,752 participants with type 2 diabetes in EXSCEL, 3.6% experienced MALE. Characteristics associated with increased risk of MALE were peripheral artery disease (PAD) (HRadj 4.83, 95% CI: 3.94-5.92), prior foot ulcer (HRadj 2.16, 95% CI: 1.63-2.87), prior amputation (HRadj 2.00, 95% CI: 1.53-2.64), current smoking (HRadj 2.00, 95% CI: 1.54-2.61), insulin use (HRadj 1.86, 95% CI: 1.52-2.27), coronary artery disease (HRadj 1.67, 95% CI: 1.38-2.03) and male sex (HRadj 1.64, 95% CI: 1.31-2.06). Cerebrovascular disease, former smoking, age, glycated haemoglobin, race and neuropathy were also associated significantly with MALE after adjustment. A risk score ranging from 6 to 96 points was constructed, with a C-statistic of 0.822 (95% CI: 0.803-0.841). CONCLUSIONS The majority of MALE occurred among participants with PAD, but participants without a history of PAD also experienced MALE. A risk score with good performance was generated. Although it requires validation in an external dataset, this risk score may be valuable in identifying patients requiring more intensive care and closer follow-up.
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Affiliation(s)
- E. Hope Weissler
- Division of Vascular Surgery, Duke University School of Medicine, Durham, NC
| | - Robert M. Clare
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Yuliya Lokhnygina
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - John B. Buse
- Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Shaun G. Goodman
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, and St. Michael's Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brian Katona
- BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD USA
| | - Nayyar Iqbal
- BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD USA
| | - Neha J. Pagidipati
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Rury R. Holman
- Diabetes Trials Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Adrian F. Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Robert J. Mentz
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - Manesh R. Patel
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Division of Cardiology, Duke University School of Medicine, Durham, NC
| | - W. Schuyler Jones
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Division of Cardiology, Duke University School of Medicine, Durham, NC
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29
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Choi SW, Shin YH, Kim JK. Five-year mortality rate for patients with diabetic hand gangrene who undergo upper extremity amputation. Acta Orthop Traumatol Turc 2021; 55:344-348. [PMID: 34464311 DOI: 10.5152/j.aott.2021.21100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to describe the characteristics of patientsundergoing upper extremity amputation (UEA) for diabetic hand gangrene with aspecial focus on mortality and to determine the risk factors for thedevelopment of hand gangrene in diabetic patients. METHODS The medical records of patients who underwent lower extremity amputation (LEA) or UEA because of diabetic gangrene between January 2005 and December 2012 were retrospectively reviewed. Patients were then assigned to one of two groups: the UEA group (n = 15, 9 male; mean age = 62 ± 12.4) and the LEA group (n = 280, 196 male; mean age = 64.6 ± 10.9). A Kaplan-Meier analysis was performed to compare the five-year survival rates between the two groups. A multivariable logistic analysis including demographic characteristics, laboratory data, and dialysis status was conducted to identify the risk factors for diabetic hand gangrene. RESULTS The five-year mortality rate in the UEA group (86.7%, 13 of 15 patients) was significantly higher than that in the LEA group (51.8%, 145 of 280 patients, P < 0.001). Dialysis status was determined as a risk factor associated with the development of diabetic hand gangrene (OR, 4.05; 95% CI, 1.23-13.29; P = 0.021). CONCLUSION Evidence from this study has revealed that that amputation for diabetichand gangrene is associated with a high rate of mortality. Among diabeticpatients, the five-year survival rate of patients who underwent amputation fordiabetic hand gangrene was only 13.3%. LEVEL OF EVIDENCE Level IV, Prognostic Study.
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Affiliation(s)
- Shin Woo Choi
- Department of Orthopedic Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Young Ho Shin
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Kwang Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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30
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Hassan R, Johari M, Nijhar JS, Sharifah BSA, Low LL, Amri N. Emergency Laparotomy in a COVID-19 patient with acute abdomen. Med J Malaysia 2021; 76:254-257. [PMID: 33742640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We describe here the first laparotomy involving a COVID-19 patient in Malaysia. A 60-year-old man screened positive for SARS-CoV-2 in March 2020 and developed acute abdomen in the ward in Hospital Sultanah Bahiyah, Kedah. He underwent laparotomy and cholecystectomy for gangrenous cholecystitis. All personnel adhered to infectious control precautions, donning full personal protective equipment (PPE) throughout the surgery. Post-operatively, due to raised septic parameters, he was carefully diagnosed with and treated empirically for superimposed bacterial sepsis instead of cytokine release syndrome, with confirmed blood culture of Klebsiella pneumoniae. Patient was discharged well later. None of the staff involved in his care developed COVID-19 infection.
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Affiliation(s)
- R Hassan
- Hospital Sultanah Bahiyah, Department of Surgery, Alor Setar, Kedah, Malaysia.
| | - M Johari
- Hospital Sultanah Bahiyah, Department of Surgery, Alor Setar, Kedah, Malaysia
| | - J S Nijhar
- Hospital Sultanah Bahiyah, Department of Surgery, Alor Setar, Kedah, Malaysia
| | - B S A Sharifah
- Hospital Sultanah Bahiyah, Department of Medicine, Infectious Disease Unit, Alor Setar, Kedah, Malaysia
| | - L L Low
- Hospital Sultanah Bahiyah, Department of Medicine, Infectious Disease Unit, Alor Setar, Kedah, Malaysia
| | - N Amri
- Hospital Sultanah Bahiyah, Department of Surgery, Alor Setar, Kedah, Malaysia
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31
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Affiliation(s)
- T S Thomas
- From the Department of Internal Medicine, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg 2041, South Africa
| | - N Goolam Mahyoodeen
- From the Department of Internal Medicine, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg 2041, South Africa
- Department of Endocrinology, Chris Hani Baragwanath Hospital, 26 Chris Hani Road, Diepkloof, Johannesburg 1864, South Africa
| | - K Huddle
- From the Department of Internal Medicine, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg 2041, South Africa
- Department of Endocrinology, Chris Hani Baragwanath Hospital, 26 Chris Hani Road, Diepkloof, Johannesburg 1864, South Africa
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32
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Kabir T, Ngaserin S, Koh FH, Huang J, Ong BC, Chew MH. The COVID-19 conundrum: SARS-CoV-2 is not present in bile. Br J Surg 2020; 107:e381. [PMID: 32779750 PMCID: PMC7404877 DOI: 10.1002/bjs.11820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 12/17/2022]
Affiliation(s)
- T Kabir
- Division of Surgery, Sengkang General Hospital, Singapore
| | - S Ngaserin
- Division of Surgery, Sengkang General Hospital, Singapore
| | - F H Koh
- Division of Surgery, Sengkang General Hospital, Singapore
| | - J Huang
- Department of Pathology, Sengkang General Hospital, Singapore
| | - B C Ong
- Department of Anaesthesiology, Chairman Medical Board, Sengkang General Hospital, Singapore
| | - M H Chew
- Division of Surgery, Sengkang General Hospital, Singapore
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33
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Hu Y, Su X, Chen X. Rapidly progressive gangrene on the scrotum. Eur J Intern Med 2020; 75:97-98. [PMID: 32115326 DOI: 10.1016/j.ejim.2020.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 02/15/2020] [Indexed: 11/23/2022]
Affiliation(s)
- Yayu Hu
- Department of Dermatology, Taizhou Municipal Hospital, No. 381, Zhongshan East Road, Jiaojiang District, Taizhou, Zhejiang 318000, China.
| | - Xiangchuan Su
- Department of Dermatology, Taizhou Municipal Hospital, No. 381, Zhongshan East Road, Jiaojiang District, Taizhou, Zhejiang 318000, China
| | - Xiangen Chen
- Department of Dermatology, Taizhou Municipal Hospital, No. 381, Zhongshan East Road, Jiaojiang District, Taizhou, Zhejiang 318000, China
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34
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Lomonosov KM, Zaborova VA. Disabling complications of primary syphilis in a 34-year-old woman living with HIV. Int J STD AIDS 2020; 31:274-275. [PMID: 32024443 DOI: 10.1177/0956462419888312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 34-year-old woman managed at the department of skin and venereal diseases was diagnosised with primary syphilis (with gangrenisation and phagedenisation of the hard chancre) and HIV co-infection. In the nasolabial triangle area there was a large ulcerated defect of an irregular configuration and with dense crusts of brown-black colour, transiting to the nasal septum. The complete scarring of the chancre was observed on the 17th day. Complications of syphilis can have physical, psychological and social consequences and even lead to disability.
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Affiliation(s)
- K M Lomonosov
- Institute of clinical medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - V A Zaborova
- Institute of clinical medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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35
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Rehman ZU, Farooq R. Outcome of traumatic inferior vena caval injuries: A case series. J PAK MED ASSOC 2020; 70(Suppl 1):S99-S101. [PMID: 31981344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Inferior vena caval (IVC) injuries are uncommon and challenging. The objective of the study is to evaluate outcomes of patients operated for inferior vena caval injuries at a university hospital. This is a retrospective case series of all adult patients aged >18 years who had been operated for traumatic IVC injuries at a university hospital between Jan 1998 to December 2018. During the study period, 9 patients with IVC injuries were operated with mean age of 26±10.3 years and all were males. Five (55.5%) patients had penetrating injuries while 4 (44.4%) had blunt trauma. Four (44.4%) patients had infra-renal while 5(66.7%) had suprarenal segment injuries with 4 (44.4%) patients undergoing primary repair of the injury. The most injured associated organ was liver 5 (55.6%). Thirty-days operative mortality was 66.7%.
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MESH Headings
- Abdominal Injuries/complications
- Accidents, Traffic/mortality
- Adolescent
- Adult
- Colon, Ascending/injuries
- Gangrene
- Hospitals, University
- Humans
- Intestines/pathology
- Kidney/injuries
- Ligation
- Liver/injuries
- Male
- Mortality
- Multiple Trauma
- Retrospective Studies
- Vascular Surgical Procedures
- Vascular System Injuries/mortality
- Vascular System Injuries/surgery
- Vena Cava, Inferior/injuries
- Venous Thrombosis
- Wounds, Gunshot/mortality
- Wounds, Gunshot/surgery
- Wounds, Nonpenetrating/complications
- Wounds, Nonpenetrating/mortality
- Wounds, Nonpenetrating/surgery
- Wounds, Penetrating/complications
- Wounds, Penetrating/mortality
- Wounds, Penetrating/surgery
- Young Adult
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Affiliation(s)
- Zia Ur Rehman
- Department of Surgery, Aga Khan University Hospital, Karachi
| | - Rimsha Farooq
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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36
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Kanikovskyi OE, Osadchyі AV, Androsov SI, Tomashevsky AV, Yarmak OA, Bakhnivskyi VS. Therapeutic tactics in the deep forms of rectal abscesses complicated by fournie gangrene. Wiad Lek 2020; 73:293-297. [PMID: 32248162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The aim: To conduct an analysis of the complex treatment of severe forms of rectal abscesses complicated by NF. PATIENTS AND METHODS Materials and methods: The results of treatment in 471 patients with deep forms of RA was performed. In 38(8%) the spread of the process and rotten-necrotic affection of the perineal fascia. Patients were treated at the surgical clinic of the medical faculty №2, VNPMMU, and Vinnytsya Clinical Emergency Hospital in the period from 2010-2018. RESULTS Results: Total lethality 8(1,7%). Mortality in GF was 8(19,5%). It is worth noting the reduction of the treatment duration against the background of the modern technologies usage in the period from 2016 to 12 days in relation to the total figure of 15 days. CONCLUSION Conclusions: Early surgical treatment, adequate necrectomy, fasciotomy and antibacterial therapy stop the necrotic process. The active aspiration reduces the timing of wound cleansing and further ensures the accelerated implementation of reconstructive surgical interventions.
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Affiliation(s)
| | | | | | | | - Oleh A Yarmak
- National Pirogov Memorial Medical University, Vinnytsia, Ukraine
| | - Valentyn S Bakhnivskyi
- Cracow University Of Economics, Cracow, Poland, Stefan Żeromski Hospital In Cracow, Poland
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37
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Agarwal P, Gautam A, Bansal M, Jose R, Upadhyay S. Malignant Melanoma Masquerading as Diabetic Gangrene. J Assoc Physicians India 2019; 67:78-79. [PMID: 31571461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | | | | | - Rosmy Jose
- Post Graduate Resident, Department of Medicine, SNMC, Agra, Uttar Pradesh
| | - Shalini Upadhyay
- Post Graduate Resident, Department of Medicine, SNMC, Agra, Uttar Pradesh
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Bianucci R, Abenavoli L, Charlier P, Lippi D, Appenzeller O, Perciaccante A. A great legal scholar of the 18th century with liver cirrhosis and septicemia. Med Hypotheses 2019; 127:88-89. [PMID: 31088655 DOI: 10.1016/j.mehy.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/28/2019] [Accepted: 04/08/2019] [Indexed: 11/30/2022]
Affiliation(s)
- R Bianucci
- Legal Medicine Section, Department of Public Health and Paediatric Sciences, University of Turin, Italy; Warwick Medical School, Microbiology and Infection Division, University of Warwick, United Kingdom; UMR 7268, Laboratoire d'Anthropologie bio-culturelle, Droit, Etique & Santé (Adés), Faculté de Médecine de Marseille, France.
| | - L Abenavoli
- Department of Health Sciences, University Magna Graecia of Catanzaro, Italy
| | - P Charlier
- Section of Medical and Forensic Anthropology (UVSQ DANTE Laboratory EA 4498), Montigny-Le-Bretonneux, France; Direction Département de la Recherche et de l'Enseignement Musée du Quai Branly - Jacques Chirac, Paris, France
| | - D Lippi
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - O Appenzeller
- New Mexico Health Enhancement and Marathon Clinics Research Foundation, 361 Big Horn Ridge Dr. NE, Albuquerque, NM, USA; New Mexico Museum of Natural History and Science, 1801 Mountain Road NW. Albuquerque, NM, USA
| | - A Perciaccante
- Department of Medicine, San Giovanni di Dio Hospital, Gorizia, Italy
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Liu C, You JX, Chen YX, Zhu WF, Wang Y, Lv PP, Zhao F, Li HY, Li L. Effect of Induced Membrane Formation Followed by Polymethylmethacrylate Implantation on Diabetic Foot Ulcer Healing When Revascularization Is Not Feasible. J Diabetes Res 2019; 2019:2429136. [PMID: 31828156 PMCID: PMC6885796 DOI: 10.1155/2019/2429136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/22/2019] [Indexed: 01/04/2023] Open
Abstract
No study has investigated the role of induced membrane (IM) formation in treating diabetic foot ulcer (DFU). This retrospective study was aimed (1) at evaluating the potential role of a two-staged surgical approach, comprising polymethylmethacrylate (PMMA) implantation and IM formation, in the treatment of DFU and (2) at comparing the results of those with routine wound debridement in patients with DFUs and nonrevascularized peripheral arterial disease (PAD). Fifty patients with infected DFUs who were not candidates for vascular interventions were enrolled between February 2016 and April 2018 and assigned to the PMMA group (n = 28) and conventional group (n = 22). The healing rate, major amputation rate, duration of healing, frequency of debridement procedures, patient survival rate, and reulceration of DFUs were determined. The Mann-Whitney U test, independent sample t-test, and χ 2 or Fisher exact test were used in statistical analysis. Overall clinical outcomes were statistically different between the groups (Z = -2.495, P = 0.013). In the PMMA group, 16 patients (57.1%) with intact IM formation achieved ulceration healing at 13.1 ± 3.7 weeks with a mean number of debridements of 1.3 ± 0.4, which were significantly different compared to those values in 5 patients of the conventional group (22.7%, P = 0.014; healing duration: 26.4 ± 7.8 weeks, P = 0.016; mean number of debridements: 3.6 ± 0.5, P ≤ 0.001). At a mean 16.8 ± 4.3-month follow-up, patient survival rates were 92.9% and 68.2% in the PMMA and conventional groups, respectively (P = 0.032). The major amputation rate and reulceration of DFUs were similar between the groups. The two-staged surgical approach is an available, effective modality for improving healing of DFUs. This study provides preliminary information of IM formation followed by PMMA implantation in the management of DFUs in PAD when revascularization is not feasible.
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Affiliation(s)
- Chao Liu
- Department of Orthopedics, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, #3 E. Qingchun Rd, Hangzhou 310016, China
| | - Jia-Xing You
- Department of Orthopedics, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, #3 E. Qingchun Rd, Hangzhou 310016, China
| | - Yi-Xin Chen
- Department of Endocrinology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, #3 E. Qingchun Rd, Hangzhou 310016, China
| | - Wei-Fen Zhu
- Department of Endocrinology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, #3 E. Qingchun Rd, Hangzhou 310016, China
| | - Ying Wang
- Wound and Ostomy Care Clinic, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, #3 E. Qingchun Rd, Hangzhou 310016, China
| | - Pan-Pan Lv
- Department of Ultrasound, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, #3 E. Qingchun Rd, Hangzhou 310016, China
| | - Feng Zhao
- Department of Clinical Laboratory, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, #3 E. Qingchun Rd, Hangzhou 310016, China
| | - Hong-Ye Li
- Department of Orthopedics, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, #3 E. Qingchun Rd, Hangzhou 310016, China
| | - Lin Li
- Department of Endocrinology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, #3 E. Qingchun Rd, Hangzhou 310016, China
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Bobircă F, Bobircă A, Bordianu A, Jauca C, Georgescu D, Radu R, Pătraşcu T. Current Surgical Approach in the Pathology of the Arteriopathic Predominant Diabetic Foot. Chirurgia (Bucur) 2018; 113:625-633. [PMID: 30383989 DOI: 10.21614/chirurgia.113.5.625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2018] [Indexed: 11/23/2022]
Abstract
Introduction: The diabetic foot is a complex pathologic entity characterized by the totality of modifications appearing on the foot during the evolution of the diabetic disease. This survey aims to elaborate an algorithm of treatment for patients with arteriopathic predominant diabetic foot lesions, with the purpose of reducing the number of debilitating interventions and improving the quality of life. Material and Method: There were analysed a number of 188 patients admitted to the Surgery Clinic I of the Dr.I.Cantacuzino Clinical Hospital, in the year 2017, suffering from arteriopathic predominant diabetic foot lesions, based on several inclusion/exclusion criteria. Results: According to the type of foot lesion, most patients had the diagnosis of wet gangrene of the toe/toes (51.06%), followed by ischaemic gangrene of the toe/toes (40.4%); the surgical interventions performed on these types of lesions in 73.9% of the cases consisted of minor amputations (transmetatarsal amputation of the toe/toes/foot). Conclusions: The treatment algorithm developed as a result of this survey represents a feasible treatment solution for the pathology of the arteriopathic predominant diabetic foot and failure to comply with this treatment may lead to treatment errors in a sense in which disproportional surgery can be performed in correlation with an inexact diagnosis.
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Safa R, Berbari I, Hage S, Dagher GA. Atypical presentation of gangrenous cholecystitis: A case series. Am J Emerg Med 2018; 36:2135.e1-2135.e5. [PMID: 30146394 DOI: 10.1016/j.ajem.2018.08.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 01/05/2023] Open
Abstract
Gangrenous cholecystitis (GC) is a serious complication of acute cholecystitis that has been associated with increased morbidity. Patient with GC can present with a wide variety of non-specific clinical, laboratory, and imaging characteristics, making the diagnosis challenging. This disease requires emergent treatment, which is why a quick and reliable diagnosis is essential for the wellbeing of the patient. The authors herein present a case of GC in a patient whose initial complaint was intractable hiccups, and provide a thorough review of the literature of cases of GC with atypical presentations.
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Affiliation(s)
- Rawan Safa
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Iskandar Berbari
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sandrine Hage
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Gilbert Abou Dagher
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Abstract
RATIONALE Methamphetamine (METH) abuse is increasing rapidly all over the world and becoming a significant public health concern in China. However, abdominal complications secondary to METH abuse are usually overlooked. We describe an unusual case of gangrenous cholecystitis and small intestinal ischemia due to METH abuse. PATIENT CONCERNS In this report, a 44-year-old male patient with abdominal pain and hematochezia has a history of crystal meth abuse. DIAGNOSIS The patient was diagnosed as septic shock, paralytic ileus, gangrenous cholecystitis, and small intestinal ischemia due to METH abuse based on computed tomography (CT) scan, endoscopy examination, laparotomy, and pathology. INTERVENTIONS Antishock treatment, broad-spectrum antibiotics, and exploratory laparotomy were given. OUTCOMES The patient survived. Six months later, he tolerated oral intake and stopped using crystal METH. LESSONS Visceral ischemia should be considered if an adult patient with a history of METH abuse is accompanied by abdominal pain and hematochezia.
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Affiliation(s)
- Xiaojing Zou
- Department of Critical Care Medicine
- Institute of Anesthesiology and Critical Care Medicine, Union Hospital
| | - Haiyan Huang
- Department of Critical Care Medicine
- Institute of Anesthesiology and Critical Care Medicine, Union Hospital
| | - Le Yang
- Department of Emergency Internal Medicine, Tongji Hospital
| | - Hong Liu
- Department of Critical Care Medicine
- Institute of Anesthesiology and Critical Care Medicine, Union Hospital
| | | | - Qin Xia
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Shiying Yuan
- Department of Critical Care Medicine
- Institute of Anesthesiology and Critical Care Medicine, Union Hospital
| | - Shanglong Yao
- Department of Critical Care Medicine
- Institute of Anesthesiology and Critical Care Medicine, Union Hospital
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Hashimoto T, Satoh T, Yokozeki H. Toe Gangrene Associated with Macroangiopathy in Systemic Sclerosis: A Case Series on the Unreliability of the Ankle-brachial Pressure Index. Acta Derm Venereol 2018; 98:532-533. [PMID: 29379977 DOI: 10.2340/00015555-2897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Takashi Hashimoto
- Department of Dermatology, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Japan
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Affiliation(s)
- A S Adamson
- Department of Surgery, Royal Postgraduate Medical School, Hammersmith Hospital, London
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Affiliation(s)
- C Buckley
- Department of Dermatology, Royal Free Hospital, Hampstead, London
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Abstract
RATIONALE We present 4 cases of symmetrical peripheral gangrene (SPG) associated with use of inotropic agent to elevate blood pressure. SPG is a relatively rare phenomenon characterized by symmetrical distal ischemic damage that leads to gangrene of 2 or more sites in the absence of large blood vessel obstruction, where vasoconstriction rather than thrombosis is implicated as the underlying pathophysiology. We present 4 SPG cases of the multiple limbs amputation, associated with inevitable use of inotropic agents. PATIENT CONCERNS Inotropic agents including dopamine and norepinephrine are used frequently in the treatment of hypotension, and its effectiveness in treating shock is firmly established. However, it can be caused peripheral gangrene by prolonged administration of high dose inotropics, inducing the constant contraction of the peripheral blood vessels. DIAGNOSIS These 4 patients had different clinical histories and background factors, but each experienced sepsis. The level of amputation is determined by the line of demarcation in concert with considerations of the biomechanics of stump stability, weight bearing, and ambulation. INTERVENTIONS After recovering of general conditions and completion of demarcation, these 4 patients underwent the amputation of multiple limbs.(bilateral amputations of upper extremities or bilateral amputations of lower extremities). OUTCOMES In each patient, there was no additional amputation caused by extension of SPG, and the rehabilitation with appropriate orthosis was performed. Treatment of underlying disease were continued too. LESSONS It is important to alert the possibility of amputations, according to the use of inevitable inotropics. We recommended the careful use of the inotropic agents to the physicians in treating septic shock.
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Affiliation(s)
- Ki Jin Jung
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan-si
| | - Jae-Hwi Nho
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Yongsan-gu, Seoul, South Korea
| | - Hyeung-Kyu Cho
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Yongsan-gu, Seoul, South Korea
| | - Sijohn Hong
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan-si
| | - Sung Hun Won
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Yongsan-gu, Seoul, South Korea
| | - Dong-Il Chun
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Yongsan-gu, Seoul, South Korea
| | - Byungsung Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Yongsan-gu, Seoul, South Korea
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Affiliation(s)
- J Ramus
- Wycombe General Hospital, High Wycombe HP11 2TT, UK.
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Akamatsu D, Fujishima F, Goto H, Hashimoto M, Tsuchida K, Kawamura K, Tajima Y, Umetsu M, Suzuki S, Kamei T. Histological Analysis of a New Route after Subintimal Crural Angioplasty. Ann Vasc Surg 2017. [PMID: 28647629 DOI: 10.1016/j.avsg.2017.06.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Subintimal angioplasty is an alternative approach in treating critical limb ischemia with crural artery disease. However, route or location of the newly created channel is not understood. CASE PRESENTATION A 68-year-old man was referred to our hospital with ischemic gangrene of the right big toe. We performed endovascular treatment because he was a poor candidate for bypass surgery. The posterior tibial artery was treated using subintimal angioplasty, although it resulted in early occlusion. We decided that he was not able to receive any further limb salvage treatment and performed amputation below the knee 7 days after treatment. The specimen from the origin of posterior tibial artery to plantar artery bifurcation was resected and the formalin-fixed vessel was cut into 39 segments. Histological analysis showed that the newly formed lumen was comparatively well dilated and created in the media by tearing internal elastic lamina in almost the whole of its length. The severely poor runoff vessels below the ankle were thought to be a main cause of early occlusion. CONCLUSIONS The newly formed lumen by subintimal crural angioplasty could be well dilated and created in the media.
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Affiliation(s)
- Daijirou Akamatsu
- Department of Surgery, Vascular Surgery, Tohoku University, Sendai, Japan.
| | | | - Hitoshi Goto
- Department of Surgery, Vascular Surgery, Tohoku University, Sendai, Japan
| | - Munetaka Hashimoto
- Department of Surgery, Vascular Surgery, Tohoku University, Sendai, Japan
| | - Ken Tsuchida
- Department of Surgery, Vascular Surgery, Tohoku University, Sendai, Japan
| | | | - Yuta Tajima
- Department of Surgery, Vascular Surgery, Tohoku University, Sendai, Japan
| | - Michihisa Umetsu
- Department of Surgery, Vascular Surgery, Tohoku University, Sendai, Japan
| | - Syunya Suzuki
- Department of Surgery, Vascular Surgery, Tohoku University, Sendai, Japan
| | - Takashi Kamei
- Department of Surgery, Vascular Surgery, Tohoku University, Sendai, Japan
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Kılıç MÖ, Güldoğan CE, Balamir İ, Tez M. Ischemia-modified albumin as a predictor of the severity of acute appendicitis. Am J Emerg Med 2016; 35:92-95. [PMID: 27769665 DOI: 10.1016/j.ajem.2016.10.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/04/2016] [Accepted: 10/04/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The early prediction of gangrenous/perforated appendicitis is of great importance for the surgical planning, further treatments, and predicting the course of disease. Ischemia-modified albumin (IMA) was previously reported as a biomarker of various ischemia-based diseases. Our aim is to determine the predictive value of serum IMA in the severity of acute appendicitis. METHODS Sixty-two patients who underwent urgent appendectomy were included in the study. Plasma level of IMA was measured after diagnosis and before treatment. All patients were classified as noncomplicated (acute) appendicitis and complicated (gangrenous/perforated) appendicitis according to histopathological findings, and comparisons were made between the groups. RESULTS The data of 62 patients with a mean age of 30.1 years were statistically evaluated. The pathological diagnoses were acute appendicitis in 33 (53.2%), and gangrenous/perforated appendicitis in 29 (46.8%) patients. There were significant differences in computed tomography (CT) findings (P = .031) and IMA (P = .012) levels between the groups. A strong positive correlation between IMA levels and CT findings was also found (Spearman ρ = +0.688, P = .003). CONCLUSIONS The IMA can be considered as a novel and useful marker to distinguish gangrenous/perforated appendicitis from noncomplicated appendicitis. The correlation of IMA with CT findings also enhances the predictive value of IMA.
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Affiliation(s)
- Murat Özgür Kılıç
- Department of General Surgery, Numune Training and Research Hospital, Ankara, Turkey.
| | - Cem Emir Güldoğan
- Department of General Surgery, Numune Training and Research Hospital, Ankara, Turkey
| | - İlhan Balamir
- Department of Biochemistry, Numune Training and Research Hospital, Ankara, Turkey
| | - Mesut Tez
- Department of General Surgery, Numune Training and Research Hospital, Ankara, Turkey
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Kernbach-Wighton G, Amberg R, Madeal B. Malrotation syndrome resulting in fatal ileus in children. Arch Kriminol 2016; 238:128-135. [PMID: 29870176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND This report deals with two deaths of children involving intestinal volvulus, i. e. a pathological knotting and twisting of the mesenterial root on the basis of congenital malrotation followed by obstruction and extensive ischaenia. CASE REPORTS (1) A 10-year-old girl (premature, 25th week) with severe disability, amaurosis and epilepsy was admitted to hospital due to general agitation and a bloated abdomen without peristaltic sounds, but died some hours later. Autopsy revealed a volvulus of 2/3 of the small intestine based on congenital malrotation with additional clamping of the intestine underneath adhesions (previous appendectomy). The abdominal cavity showed beginning peritonitis as the cause of death. (2) A 2-month-old premature male baby (surviving twin, 29th week) with a persisting ductus arteriosus was hospitalised for four weeks after failed vascular surgery due to acute general deterioration. Radiological diagnostics using a contrast medium revealed a vascular anomaly (right-sided aortic arch). Around 10 hours later, the infant developed an acute abdomen with ileus symptoms. Emergency surgery showed infarction of the entire small intestine due to an anti-clockwise 180⁰-volvulus, with death occurring 24h later. Further examination showed a malrotation as anomaly. Apparently, the volvulus had been caused by extensive use of contrast medium resulting in increased intestinal mobility.
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