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

Spontaneous, nontraumatic clostridial myonecrosis is a rare infection with an insidious onset and usually fatal outcome. Spontaneous clostridial myonecrosis has a frequent association with colon carcinoma, leukemia, diabetes mellitus, and drug-induced immunosuppression. We present the case of a 73-year-old diabetic man who died of spontaneous Clostridium septicum myonecrosis, who had presented with fulminant gangrene of the right thigh. Clostridium septicum was cultured from the quadriceps muscle postmortem. At autopsy, in addition to the gangrene, there was a Duke's A adenocarcinoma of the cecum, which had not been diagnosed during life. When spontaneous nontraumatic clostridial myonecrosis is diagnosed at autopsy, investigation should include through exam and the obtaining of past medical history in order to elucidate predisposing factors.
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PMID:Spontaneous clostridial myonecrosis. 140 68

From January 1985 through January 1990, 244 patients (168 males, 76 females, mean age: 69 +/- 14 years) received epidural spinal cord stimulation for the treatment of advanced, nonreconstructable, peripheral vascular disease of the lower limbs due to atherosclerosis in 180 patients, atherosclerosis and/or diabetes in 49, and thromboangiitis obliterans in 15 patients: previous surgery included 101 bypass-grafts in 70 patients, 51% of which below the knee, and 117 sympathectomies in 113 patients as the last resource in face of distal peripheral vascular disease of the lower limbs. Mean ankle-to brachial systolic pressure ratio was .31 +/- .34 on symptomatic limbs; due to pain and advanced disease, walking capacity was assessed in only 151 patients, either on treadmill in 25, or in a metered corridor in 126; angiogram of the lower limbs was performed in every patient unless one not older than three months was readily available; pain at rest was assessed after an analogical scale; partial transcutaneous oxygen tension was measured on the dorsum of the fore-foot of 77 symptomatic limbs (mean: 13.35 +/- 14 mmHg). According to clinical and functional evaluation, 18 patients had exertional ischemia (group I), 87 had permanent ischemia with pain at rest and no tissue loss (group II), and 139 had chronic tissue loss (group III), including 93 ischemic ulcers (mean surface: 3.7 cm2, mean duration: 3.5 months) in 88 patients, 27 limited gangrene, and 24 previous limited non-healing distal amputation. After temporary spinal cord stimulation at T12-L1 level (mean duration: 9 +/- 4 days) with a percutaneous quadripolar electrode lead had allowed for selection of responders, 212 patients received an implantable neurostimulator.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Electric stimulation of the spinal cord in arterial diseases of the legs. A multicenter study of 244 patients]. 143 7

Upper extremity ischemia related to the construction of a chronic angioaccess is a serious and occasionally devastating complication. Fourteen patients with end-stage renal disease (mean age 58 +/- 18 years, 13 with diabetes, 10 female) had ischemia after construction of an angioaccess. Twelve patients had a polytetrafluoroethylene brachioaxillary bridge arteriovenous fistula (BAVF), one patient had a radiocephalic arteriovenous fistula (AVF) and one patient had a brachiocephalic AVF. All patients had severe ischemia and five of them had established gangrenous changes. Symptoms appeared immediately after construction of the access in 10 patients. The remaining four patients had late onset of ischemia. The technique used for revascularization in all of these patients consisted of ligating the artery just distal to the takeoff of the AVF or BAVF and establishing an arterial bypass from a point proximal to the AVF or BAVF inflow to a point distal to the ligature. Bypass grafts consisted of saphenous vein in 13 cases and polytetrafluoroethylene in one case. Thirteen patients had a complete recovery, including healing of gangrenous lesions. One patient with severe gangrene of the hand at the time of revascularization required forearm amputation 13 months later because of progressive occlusive arterial disease. All AVFs were patent at 1 year. The 1-year patency rate for the BAVFs was 81.7%. All arterial bypasses were patent at 1 year. It is concluded that this technique offers consistent and durable hemodynamic and clinical improvement in arms affected by access-induced ischemia, with minimal morbidity, and does not affect the longevity of the angioaccess.
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PMID:Treatment of angioaccess-induced ischemia by revascularization. 146 Jul 12

The objective of this study was to determine the impact of renal transplantation and hemodialysis treatment on outcome of elderly diabetic patients with end-stage renal disease (ESRD) among other factors related to survival. Results of treatment of ESRD in 78 patients with non-insulin-dependent diabetes mellitus (type 2) showed a survival rate of 58% at 1 year and 14% at 5 years, independent of treatment modality. Patients who received a renal allograft had a higher survival rate as compared with patients on hemodialysis treatment (5-year survival, 59% v 2%; P < 0.005). Diabetic patients with a history of myocardial infarction, stroke, or peripheral gangrene before onset of renal replacement therapy had a worse prognosis in comparison to patients without vascular complications (5-year survival, 2% v 21%; P < 0.05). Analysis of patients who survived less than 6 months and more than 24 months was performed. Long-term survivors were slightly younger, had diabetes for a shorter period, and showed a better metabolic control of diabetes mellitus. Sixteen long-term survivors received a renal allograft. In contrast, only three short-term survivors were transplanted. Furthermore, short-term survivors also had a greater than 70% incidence of severe vascular complications before renal replacement therapy. A history of myocardial infarction, stroke, or peripheral gangrene is an independent predictor of decreased survival, irrespective of whether the patients were transplanted or maintained on chronic hemodialysis treatment. In contrast, renal transplantation improved survival of elderly diabetic patients without vascular complications and should be the treatment of choice in this specific group of patients.
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PMID:Renal replacement therapy in type 2 diabetic patients: 10 years' experience. 146 83

In recent years, our operative approach to ulceration and gangrene in the diabetic foot has changed markedly. We now investigate all such patients for ischemia, even in the presence of neuropathy and localized infection. This strategy is based on a rejection of the concept of a microvascular occlusive lesion, an improved understanding of the pattern of atherosclerotic occlusion, an emphasis on arteriographic delineation of the foot arteries, and increasing success with extreme distal arterial reconstruction, especially vein bypass grafts to the dorsalis pedis artery. From 1984 through 1990, 2883 procedures were performed at our institution on patients with diabetes mellitus. There was a statistically significant decrease in every category of amputation, which correlated precisely with the increasing rate of dorsalis pedis artery bypass. Our indications for surgery, in-hospital mortality, and the bypass-associated amputation rate did not change.
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PMID:Trends in the care of the diabetic foot. Expanded role of arterial reconstruction. 157 32

In a subset of patients requiring lower extremity revascularization, the popliteal artery may be used for inflow, thereby minimizing dissection and the length of vein required for bypass. This retrospective study was done to define the risks and benefits of arterial reconstruction in a population of patients having popliteal-to-distal bypass procedures. Between 1986 and 1990, 32 surgical procedures were performed on 29 patients. The patient's ages ranged from 46 to 86 years, with a mean age of 68 years. Twenty-four of 29 (83%) were men and 19 of the 29 (66%) had diabetes. Most patients had multiple indications for surgical intervention, and these included rest pain (54%), nonhealing ulcers (64%), and gangrene (29%). Arterial bypass with use of the popliteal artery for the proximal anastomosis was performed with in situ saphenous vein (50%), reversed saphenous vein (41%), and orthograde autologous vein (9%). Distal anastomoses were to the posterior tibial artery in 11 bypasses (33%), the peroneal artery in 10 (30%), the anterior tibial artery in two (6%), and the dorsal pedal artery in 10 (30%). Two deaths occurred in the perioperative period for an operative mortality rate of 6.9%. With use of life-table analysis, the cumulative graft patency rate was 97% at 1 year, 97% at 2 years, and 63.5% at 4 years. The overall cumulative limb salvage rate was 90.1% at 1 year, 90.1% at 2 years, and 78.8% at 4 years.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Popliteal-to-distal bypass for limb-threatening ischemia. 157 30

When sufficient vein for a completely autogenous femorotibial artery bypass is not available, composite sequential grafting by using vein combined with polytetrafluoroethylene material is a surgical option. This study reviews what is currently the largest collection of these grafts and focuses on technical aspects and long-term patency characteristics. During a 7-year period 67 composite sequential bypasses were used to manage rest pain (38), ulcer (18), or gangrene (11) in 62 patients (mean age, 66 years). Fifty-two percent were men, and 51% had diabetes. This method was used as a primary reconstruction in 30, a second bypass in 16, and in 21 it was used after multiple other failed bypasses. Femoral to above-knee popliteal (44) and below-knee popliteal (23) 6 mm polytetrafluoroethylene grafts were placed. Then extensions of greater saphenous (57) or lesser saphenous (10) vein were anastomosed to the anterior tibial (19), posterior tibial (26), or peroneal (22) arteries. Fifty-three percent were maintained on long-term warfarin (Coumadin) anticoagulation, and 33% were maintained on aspirin. No deaths occurred in the perioperative period. Bypass patency was ascertained by a Doppler pressure and waveform analysis, with mean follow-up of patency or to the time of graft failure of 33 months (1 to 91 months). Three-year patient survival was 72%. Cumulative life-table primary patency of 72% (1-year), 64% (2-year), and 48% (3-year) was calculated. Two grafts are functioning 7 years after placement. Limb salvage was 84% at 2 years and 70% at 4 years. At the time of failure, five grafts retained a patent venous bypass segment, which allowed prompt reconstruction of the proximal portion. In a comparison of grafts with early failure and those with long-term patency, the SVS/ISCVS runoff score, vein diameter, tibial artery diameter, and coagulation status were similar. However, patients with the popliteal anastomosis above the knee had 2-year patency of 72% compared with 46% for those with below-knee anastomoses. This technique, when possible, appears preferable to an all prosthetic tibial bypass.
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PMID:Long-term evaluation of composite sequential bypass for limb-threatening ischemia. 143 71

Neuropathy, mechanical stress, and macrovascular disease are involved in the pathogenesis of diabetic foot ulceration. Implicit in the development of gangrene and ulceration is the recognition that these factors interact with the microcirculation, resulting in the failure of skin capillary flow to meet nutritive requirements. There is little evidence to associate structural microangiopathy with foot microcirculatory failure. Significant functional abnormalities of the microcirculation have been defined. In accord with the haemodynamic hypothesis early hyperaemia and capillary hypertension promote more sinister late functional abnormalities with increasing duration of diabetes. These late functional abnormalities include loss of autoregulation and reduced hyperaemic responses which interact with loss of neurogenic flow regulation, disturbed endothelial function, and abnormal rheology to produce the familiar clinical picture of the diabetic foot. Ischaemia secondary to multi-segment arterial disease induces additional abnormalities of microcirculatory function which are superimposed on the pre-existing diabetic microvascular structural and functional microangiopathy.
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PMID:Aetiology of diabetic foot ulceration: a role for the microcirculation? 160 Jul 1

Osteomyelitis of the foot is a well-known complication of diabetes mellitus. In this study, the validity of 111In-labeled human nonspecific immunoglobulin G (IgG) scintigraphy was studied in 16 diabetic patients with foot ulcers, gangrene or painful Charcot joints. In all patients, plain radiographs, conventional bone scan images and 111In-IgG images were recorded. The results were verified by histologic examination of surgical specimens in patients who did not respond to antibiotic treatment within 2-3 wk (10 lesions) or long-term clinical follow-up of at least 6-mo (16 lesions). On the bone scans, all seven osteomyelitic foci were detected. However, 19 additional foci not due to osteomyelitis were seen. The absence of true-negative bone scans in this study resulted in a specificity of 0%. On the plain radiographs, four of seven osteomyelitis foci were detected; for 111In-IgG scintigraphy, six of seven (sensitivity 57% and 86%, respectively). Plain radiographs correctly ruled out osteomyelitis in 15 of 19 lesions, 111In-IgG scintigraphy in 16 of 19 (specificity 79% and 84%, respectively). All imaging procedures gave false-positive results in penetrating ulcers over the calcaneus in two patients and in one patient with a Charcot joint, most likely due to recent fractures. A false-negative 111In-IgG study was observed in a patient with severe arterial angiopathy. Accurate estimation of probable osteomyelitis was not possible from the results of soft-tissue cultures, since in only 6 of 12 positive cultures, osteomyelitic foci could be proven. Indium-111-IgG scintigraphy can contribute to adequate evaluation of osteomyelitis in diabetic foot complications because it improves specificity when compared to bone scan and radiographic findings and improves sensitivity in comparison to plain radiographs.
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PMID:Evaluation of infectious diabetic foot complications with indium-111-labeled human nonspecific immunoglobulin G. 161 74

People with diabetes are liable to suffer potentially disastrous foot problems, including gangrene with subsequent amputation. This article describes the risk factors, management, and ulcer-prevention methods which are essential knowledge for nurses working with this patient group.
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PMID:Foot problems in people with diabetes. 162 15


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