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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Information on the incidence and nature of the causative organisms in the infected tissues of patients with diabetic gangrene is scanty. Studies in which material for culture was obtained from the presenting lesion reveal multiple organisms in host isolates. No data are available regarding the bacterial flora of the deep infected tissue itself, uncontaminated by surface organisms. In this investigation 58 specimens from 52 patients were obtained utilizing aerobic and anaerobic culture techniques. In the surgical theater, material was obtained from the infected deep tissues using careful aseptic dissection techniques. All patients had been on antibiotic therapy from 2 to 10 days before the study. An average of 2.3 organisms per specimen was found. The predominant organisms were Proteus sp., Enterococcus, Staphylococcus aureus, and other enterobacteriacae in that order. Anaerobes were isolated in 27 per cent of cases, but never as the only organism. Prior antibiotic therapy did not eradicate infection in infected diabetic gangrene.
Diabetes Care
PMID:Microbiology of deep tissue in diabetic gangrene. 72 Jan 82

One hundred and thirty-two newly diagnosed Asian diabetic patients (39 Malay, 30 Chinese and 63 Indians) have been studied in Kuala Lumpur. The highest proportion of diabetic patients were Indian and the lowest were Chinese. Vascular complications were equally common in Asian diabetic patients as in Europeans; coronary heart disease was relatively more common in Indians and cerebral vascular disease in Chinese. Twenty percent of all Asian diabetic patients requiring admission to hospital also had coronary heart disease, 9% had cerebral vascular disease and 8% had gangrene or ulceration of the feet. In Kuala Lumpur, diabetes is a very important risk factor for coronary heart disease: 17% of all patients admitted to the General Hospital with coronary heart disease were already diabetic.
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PMID:Diabetes and its vascular complications in Malaysia. 74 78

Ten patients with pregangrenous and gangrenous changes of the toes in the presence of normal peripheral pulses are described. In the absence of diabetes this is an uncommon condition and is only rarely reported upon in the literature. Four patients had non occlusive arteriosclerotic changes in large arteries; three suffered from thrombocytosis and one from polycythemia vera; one patient had a monoclonal gamopathy and one was exposed to cold three months before the onset of gangrene. None of these patients smoked regularly. Severe pain usually preceded the gangrene. The process did not progress proximally in any patients, and in those who underwent toe amputations the healing was uneventful. Vasodilators and low-molecular dextran were not effective. Lumbar sympathectomy was performed in three patients, also with no effect on the course of the disease. Treatment of hematological disorders gave relief in three patients. Proximal arteriosclerotic changes should be corrected if possible to eliminate a source of emboli. In two patients anti-platelet aggregation agents provided relief. Toe amputation should be conservative and performed when definite demarcation appears between necrotic and viable tissue. This condition has a benign prognosis.
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PMID:Gangrene of toes with normal peripheral pulses. 84 22

In a prospective, randomized study a comparison was made of the results of primary below-knee amputation for ischaemic gangrene carried out by two methods: In 47 cases by the transverse technique with a long posterior musculo-cutaneous flap and in 41 cases by the sagittal technique using equally large medial and lateral musculo-cutaneous flaps--in both instances followed by 2 weeks in a half-open plaster cast with extended knee. The sex ratio and age distribution were the same in both groups. Minor differences in the vascular condition between the groups, assessed by the duration of rest pain, pulsation findings, extent of gangrene, and frequency of diabetes, wholly or partially equalized each other. The course of healing was the same in both groups, primary healing being attained in 38 per cent and 41 per cent, respectively (0.70 less than P less than 0.80). There was also no difference between the results as regards limb fitting, ambulation, occupational, or social status. It is concluded that the choice between the two methods can be based merely upon surgical skill and the ischaemic changes in the lower leg.
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PMID:Below-knee amputation for ischaemic gangrene. Prospective, randomized comparison of a transverse and a sagittal operative technique. 92 Jan 24

Seventy patients with cutaneous erythema of the feet with or without necrosis were the subjects of this investigation. Sixty-five of them had open diabetes. The glucose tolerance of the remaining five patients was altered in a diabetic direction. Twenty-seven of the 70 patients had roentgenologically demonstrable destruction in the bones of the feet. These 70 patients were compared with 61 diabetic control patients of corresponding age and duration of diabetes but without these skin lesions of the feet. Only four of the 61 control patients had destruction in the bones of the feet and all these destructions were small. Precipitating factors were identified in general for the skin lesions, the most common being cardiac decompensation. A higher frequency of precipitating factors was seen in patients with skeletal destructions than in those without. The skeletal destructions and cutaneous necrosis are supposed to be equivalent lesions, localized to different tissues in the feet. When patients presenting skin lesions of the feet in the form of distal gangrene were compared with those who had cutaneous erythema and necrosis of the feet, but no distal gangrene, no differences were found with respect to age, duration of diabetes, occurrence of precipitating factors and the occurrence of skeletal destruction. Cutaneous erythema without necrosis is understood to be incipient diabetic gangrene.
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PMID:Skeletal lesions of the feet in diabetics and their relationship to cutaneous erythema with or without necrosis on the feet. 97 Feb 23

In many cases of digital gangrene, limited amputation to preserve the majority of the foot is possible. In the absence of invasive infection, forefoot perfusion pressure is the single most important factor in determining outcome of minor amputation. At ankle pressures of less than 35 mm. Hg, salvage of the foot appears to be futile. The presence or absence of diabetes mellitus has no noticeable effect on the result of amputation. Ankle systolic pressure measurement cannot supplant but should supplement clinical judgement in selecting surgical treatment for gangrene.
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PMID:Forefoot perfusion pressure and minor amputation for gangrene. 100 20

Results of 208 minor amputations were analyzed in 179 patients who had no food pulses. Wound healing was assessed at 3 months in relation to diabetes and previous vascular surgery. The results suggest that simple removal of the toe or toes is not advisable unless the blood supply to the foot can be improved by vascular reconstruction or sympathectomy, or both. Transmetatarsal amputation should be considered more often as a conservative amputation for gangrene of the toes. The absence of a palpable posterior tibial pulse is a contraindication to the Syme's amputation.
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PMID:Results of minor foot amputations for ischemia of the lower extremity in diabetics and nondiabetics. 109 47

In the course of 24 months, 164 nontraumatic vascular amputees were accepted for prosthetic rehabilitation; 120 (73%) were diabetic and 44 (27%) non-diabetic. Subjects were divided into two groups, the first consisting of 114 with spontaneous foot infection or gangrene and the second of 50, of whom 44 were diabetic and six had peripheral arterial disease on its own. Sixty-five per cent of all amputees had fewer than nine years of formal education and 46% were in the low-income bracket, but no significant relationship was found between mechanism of self-injury and level of education and income. All patients in the second group were able to detail ways in which they had injured their feet. The relationship between the mechanism of self-injury and the presence of diabetes mellitus was found to be highly significant. By instructing in better self-care it may be possible to prevent or at least postpone amputation in these patients.
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PMID:Self-injury resulting in amputation among vascular patients: a retrospective epidemiological study. 135 Sep 33

Percutaneous transluminal balloon angioplasty (PTA) was performed in 17 tibial arteries with an average cross-sectional area stenosis of 92% (range 75-99%) in 13 patients (14 limbs) for limb salvage. In 4 of 14 lower extremities, PTA of femoropopliteal arteries was also performed. Technical success with 50% or less residual stenosis was achieved in all 17 tibial vessels. At approximately 2 months after PTA, clinical improvement had occurred in 10 of 14 limbs; no patient was made worse. Most recent follow-up (mean 19 months, range 8-34 months) revealed continued satisfactory clinical success with no further vascular intervention in 9 of these 10 limbs (one patient died). Short segmental stenoses, residual stenoses less than 40% following PTA, and absence of diabetes or gangrene appear to be predictors of favorable clinical outcomes. Our results suggest that PTA of focal tibial stenosis is an effective and safe treatment modality in properly selected patients and that wider use of PTA may be justified.
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PMID:Percutaneous transluminal angioplasty of tibial arteries for limb salvage. 139 56

From 1986 through to 1990 a total of 483 consecutive in situ infra-inguinal vein bypass procedures were performed in 444 patients, of whom 112 (25%) were diabetics (57 insulin dependent diabetes mellitus and 55 non-insulin-dependent diabetes mellitus). Based on a prospective vascular data registry this material was analysed to determine the influence of diabetes on the outcome. Preoperative risk factors were equally distributed among diabetic and non-diabetic patients, except for smoking habits (diabetics: 48%; non-diabetics: 64%, p = 0.002) and cardiac disease (diabetics: 45%; non-diabetics: 29%, p = 0.005). Indication for surgery was gangrene or ulceration in 57% of diabetics, as opposed to 36% in non-diabetic patients (p = 0.0002). A femoro-popliteal bypass was performed in 18% of patients, whereas 82% received an infrapopliteal procedure, of which 42% were to the distal third of the calf or foot. Diabetic patients had a significantly lower distal anastomosis than non-diabetic patients (p = 0.0001). The overall 3-year primary and secondary patency rates were 58 and 64%, respectively, with no differences between non-diabetics, non-insulin-dependent diabetics and insulin-dependent diabetics. Neither did limb survival differ among the three groups. However, the rate of minor amputations was significantly higher in insulin-dependent compared with non-insulin-dependent diabetics, who in turn had a higher rate than non-diabetic patients (p less than 0.00001). A markedly decreased survival rate was found in diabetics (p less than 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:In situ saphenous vein bypass surgery in diabetic patients. 139 49


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