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Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The diabetic foot can be classified into the neuropathic foot, characterized by the neuropathic ulcer, the Charcot joint and neuropathic oedema associated with a good circulation, in which neuropathy predominates, and the ischaemic foot in which atherosclerosis is the dominant factor leading to a reduction in blood flow with absent pulses. In the neuropathic foot, blood flow is increased, the vessels are still and dilated as a result of medial wall calcification and there is evidence for arteriovenous shunting. The neuropathic ulcer characteristically develops on the plantar surface following inflammatory autolysis and haematoma formation under neglected callosities. Chiropody is therefore the mainstay of treatment and recurrence is prevented by redistribution of weight bearing forces by moulded insoles in special footwear. Charcot osteoarthropathy is often preceded by fracture which is a further complication of diabetic neuropathy and which precipitates the rapid bone and joint destruction of the Charcot joint. Neuropathic oedema responds to ephedrine with a reduction in peripheral flow and an increase in urinary sodium excretion. The ischaemic foot is characterized by rest pain, ulceration and gangrene. Medical management can be successful in up to 72%, the remainder needing arteriography to assess suitability for arterial reconstruction or angioplasty. In the diabetic leg, atherosclerosis is predominant in the branches of the popliteal artery making arterial reconstruction difficult. Optimum care of the diabetic foot is provided in a diabetic foot clinic where the skills of chiropodist, shoe-fitter and nurse receive full support from physician and surgeon. Many lesions of the diabetic foot are avoidable and thus patient education is the cornerstone of prevention.
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PMID:The diabetic foot: pathophysiology and treatment. 353 4

From 1977 to 1984, 87 above- and below-knee amputations were done on 77 patients for ischemic ulcerations and gangrene of the lower extremities. The overall three-month mortality was 14% and was mainly related to generalized atherosclerosis. Patients having infections with gas formations were more likely to be diabetic (80% vs 15%, P less than .01), have clinical sepsis and a higher preoperative WBC (19,000 vs 12,600/cu mm, P less than .01), and have a higher mortality (40% vs 12%, P less than .05) than those with infections due to non-gas-forming organisms. Mixed bacterial flora were cultured from most wounds. We conclude that infections with gas formation may be due to either clostridial or nonclostridial organisms, mortality is higher if gas accumulates and if the patient is diabetic, gas is more likely to accumulate in infected extremities of diabetic patients, and the combination of gas formation and diabetes is highly lethal.
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PMID:Infections of the lower extremities due to gas-forming and non-gas-forming organisms. 378 84

The incidence of macrovascular morbidity and mortality in diabetics is high. At the end of a five-year observation period in the Schwabing Study 138 (26.5%) out of 542 reexamined diabetics suffered from a cardiovascular death, gangrene or myocardial infarction. Univariate and multiple logistic analysis revealed age, systolic blood pressure, and serum triglycerides as significant predictors. Duration of diabetes was only significant in type I-diabetics. Sex differences exist. In conclusion, a basis for preventive measures of major macrovascular complications in diabetes is given. Atherosclerosis represents the major cause of morbidity and mortality in the diabetic patient. Particularly overt and borderline diabetics are afflicted who constitute 10-15% of the population in the western industrial countries. Due to high incidence and rapid progression of atherosclerosis in diabetes mellitus cardiovascular diseases and their causes can be studied in these patients at best. An excess morbidity in diabetics due to cardiovascular disease has been noted in several epidemiologic studies, although the number of patients are rather small in some studies. In the Bedford Study, for instance, 111 overt diabetics, in the Framingham Study less than 250 diabetic were included. Furthermore, subjects were examined at a relatively young age (35-55 years) where only a low incidence of vascular diseases at diagnosed by noninvasive methods can be expected. Accordingly, inconsistant data have been obtained. The Schwabing Study for Macrovascular Disease in Diabetes Mellitus is a longitudinal study of more than 600 diabetic outpatients by all ages. The results of 5-year incidence of major macrovascular complications and its relationship to a number of cardiovascular risk factors will be given in this communication.
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PMID:Five-year incidence of major macrovascular complications in diabetes mellitus. 386 79

Widespread muscle alterations in the form of partial or full muscle fiber replacement by the fibrofatty tissue within the borders of the fascial sheath with the retention of the volume and topography of the muscles are observed in the obliterating atherosclerosis of the lower limbs arteries. These alterations are connected with a slowly progressing degenerative process due to chronic ischemia. The limb with a fibrofatty replacement (FFR) of the muscles is more resistant to the gangrene resulting from acute occlusion of the main arteries. The FFR should be correctly interpreted and considered when acute arterial occlusion of the lower limbs is diagnosed.
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PMID:[Fibrofatty changes in the muscles in arterial occlusions of the extremities]. 405 97

Macrovascular and microvascular complications of diabetes may be associated with different environmental factors. To investigate this further, a prevalence study of 503 Mexican type II diabetic subjects was carried out while their patterns of nutrition were constrained by government food subsidies. Average daily dietary intakes were 1866 kcal; 46.5% as carbohydrate, 13.7 mmol cholesterol, 8.7 g fiber, and a polyunsaturated/saturated fat ratio of 0.98. With respect to macrovascular disease, 49.3% of patients had evidence of peripheral vascular disease, and 21.6% myocardial ischemia, 6.0% angina, 10.8% EKG evidence of ischemia, 4.8% EKG evidence of myocardial infarction. Only 1.2% (six patients) had a clear history of completed stroke, and all were hypertensive. Six patients had also undergone amputations for diabetic gangrene. Tabulation of the means of clinical characteristics according to presence or absence of myocardial ischemia showed that higher cholesterol, calorie, and fat intake, higher mean blood pressure, higher serum cholesterol, and serum triglyceride levels were found in those with myocardial ischemia. Patients with peripheral vascular disease were more commonly smokers. Stepwise logistic regression revealed significant positive associations between myocardial ischemia and dietary cholesterol, serum cholesterol, and mean blood pressure. In contrast, the presence of peripheral vascular disease was significantly related only to smoking and retinopathy. There were no associations between macrovascular complications and duration of diabetes in the multivariate analysis, and they occurred with equal frequency in men and women. Prospective studies of atherosclerosis in maturity-onset diabetes should assess and seek to modify dietary cholesterol, serum cholesterol, and hypertension.
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PMID:Association of differing dietary, metabolic, and clinical risk factors with macrovascular complications of diabetes: a prevalence study of 503 Mexican type II diabetic subjects. I. 609 28

Cholesterol embolism after left heart catheterisation by the femoral approach was diagnosed in seven men (mean age 59.6 years) out of a total of 4587 catheterisations. Diabetes was present in four patients, systemic hypertension in three, and signs of extensive atherosclerosis in six; five patients were taking anticoagulant drugs. Acute pain in the legs or abdomen occurred in six patients, two of whom had abdominal angina; renal failure was present in six patients, cutaneous manifestations in five, and a cholesterol embolus was seen in the retina in one. Six out of six patients had an appreciable increase in the erythrocyte sedimentation rate and five out of five had eosinophilia within a week of catheterisation. Renal failure was progressive in five patients, one of whom required haemodialysis. Three patients required amputation of the toes because of gangrene. Four patients died within four and a half months of catheterisation from causes not directly related to cholesterol embolism. At necropsy cholesterol emboli were found in all four patients. Cholesterol embolism is a rare but serious complication of left heart catheterisation.
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PMID:Cholesterol embolism as a complication of left heart catheterisation. Report of seven cases. 646 20

In the 1940s major amputation in paraplegic and tetraplegic patients was performed mainly for the complications of pressure sores. With the increased understanding of paraplegia, life expectancy has greatly improved, with the consequence that the chief indication for amputation is now gangrene due to atherosclerosis. The special problems of the spinal-cord-paralysed amputee are reviewed.
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PMID:Major amputation in paraplegic and tetraplegic patients. 652 77

This review examines the pathology, clinical effects and physiological disturbances produced by vascular disease and autonomic neuropathy in the lower limb in diabetic subjects. Atherosclerosis is a major factor in causing foot lesions in diabetics. The distribution of the disease frequently makes vascular reconstructive surgery difficult or impossible but an aggressive approach to reconstruction is justified because the results of major amputations are bad. Arterial calcification probably has no significant effect on the blood supply to the foot. There is some evidence that disease of arteries in the foot may be associated with the development of ulcers or gangrene. Disease of the arterioles and capillaries is frequent, but there is little evidence that this microangiopathy causes lesions. Autonomic neuropathy affecting the limb is also common, and although there are several mechanisms by which this might predispose to ulcers or gangrene, there is little evidence of such a direct relationship. In a patient presenting with ulceration or gangrene of the foot it is often impossible to determine the relative roles of vascular disease, affecting large or small vessels, and neuropathy, either somatic or autonomic, in the development of the lesion. Further progress depends on the development of more direct methods for assessing microvascular and autonomic nervous function.
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PMID:Vascular disease and vascular function in the lower limb in diabetes. 652 89

The occurrence of lower limb gangrene due to atherosclerosis is reported in 14 spinal cord paralysed patients. A further three patients became paraplegic and developed lower limb gangrene following aortic surgery for atherosclerotic complications. The clinical features are described and the difficulty in diagnosing ischaemia in the paralysed limb is emphasised. The incidence and prognosis following amputation are similar to those in the general population and there is no evidence from this series that paraplegia and tetraplegia predispose to atherosclerosis.
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PMID:Amputation for peripheral vascular disease in the paraplegic and tetraplegic. 664 3

We studied the clinical features of 262 consecutive patients who had 289 limb amputations in the University Department of Orthopaedics, Singapore General Hospital from January, 1978 to June, 1980. Of these, 171 (59.2%) were done for diabetic complications, 43 (14.9%) for trauma and 27 (9.3%) for atherosclerosis. The mean age of the three groups were 65 +/- 10 (S.D.), 32 +/- 17, and 75 +/- 8 years respectively. The indications for amputation in diabetics were gangrene (36%), ulcer (25%), infection (14%), gangrene and ulcer (11%), gangrene and infection (8.2%), and ulcer and infection (6%). The majority of diabetics were treated with oral agents (80.2%) and diet (6.4%), with 13.4% on insulin. Most patients had their diabetes for less than ten years-38.6% less than five years and 30.7% six-ten years. The mean known duration of the lesion was 1.13 +/- 1.42 months, with 38.7% less than one week. To determine the prevalence of peripheral vascular disease in diabetics admitted for amputation, the ankle/arm systolic BP ratio at rest and post-exercise were determined. In the affected leg, 16/19 patients had decreased ankle/arm systolic BP ratio. In another study, 23/26 diabetic amputees had decreased ankle/arm systolic BP ratio in the remaining leg. These data suggest that diabetes is the most common indication for amputation in this study. Most of these patients are Type II diabetics and have peripheral vascular disease.
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PMID:Diabetic amputees in Singapore. 668 May 34


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