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

During the years 1972-1985, 50 patients with malignant external otitis (MEO) were seen in our department. All our patients complained of severe earache; they presented initially with an apparently simple external otitis, but failed to improve when the usual measures were adopted. They all presented with granulation tissue in the external ear canal, and five of our patients had multiple cranial nerve involvement. MEO is in effect a severe external otitis which, if untreated, proceeds towards an osteomyelitis of the skull base. MEO is more prevalent in the summer, when external otitis is rampant. In some years, a relatively large number of these patients appear; in others there are none. The reason for this is unknown. In Israel, the disease is more prevalent in Jews than in Arabs. Diabetes was present in 68 per cent of our patients-severe diabetes in 42 per cent, mild diabetes in 26 per cent but 32 per cent of our patients were diabetes-free. The only otological past history in our patients was of a recent traumatic insult to the external ear canal; this was the case in about 8 per cent of them. Today, the treatment of choice of this important disease is local debridement supplemented by appropriate antibiotic treatment for 6-8 weeks. This should include some semi-synthetic penicillin to which pseudomonas aeruginosa is sensitive, combined with an appropriate aminoglycoside. During the earlier years of our encounter with MEO, two of our 10 patients died of it; later on, when we learned better how to treat it, the mortality rate decreased.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Malignant external otitis. 310 45

The diagnostic criteria of malignant external otitis (MEO) have been reviewed. They were divided into two categories: obligatory and occasional. The obligatory criteria are: pain, edema, exudate, granulations, microabscess (when operated), positive bone scan or failure of local treatment often more than 1 week, and possibly pseudomonas in culture. The occasional criteria are diabetes, cranial nerve involvement, positive radiograph, debilitating condition and old age. All of the obligatory criteria must be present in order to establish the diagnosis. The presence of occasional criteria alone does not establish it. The importance of Tc99 scan in detecting osteomyelitis is stressed. When bone scan is not available, a trial of 1-3 weeks of local treatment is suggested. Failure to respond to such treatment may assist in making the diagnosis of MEO.
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PMID:The diagnostic criteria of malignant external otitis. 310 47

The delayed images of the four-phase 99mTc phosphonate bone scan are compared with the delayed images of the three-phase study in patients with diabetes mellitus and/or peripheral vascular disease and suspected osteomyelitis. Three-phase bone imaging includes an immediate postinjection radionuclide angiogram, a blood-pool image, and delayed static images to 7 hr. The four-phase study adds a 24-hr static image. The scan is positive for osteomyelitis if images show progressively increasing lesion to background activity ratios over time. The results of analyzing 21 three- and four-phase bone scans in 17 patients were correlated with clinical course, cultures, and/or x-rays, gallium scans, and CT scans. The accuracy of four-phase bone imaging for diagnosing osteomyelitis was 85%; for three phase, 80%. Sensitivity for four phase was 80%; specificity was 87%. Sensitivity for three phase was 100%; specificity was 73%. Since overall accuracy of the four-phase study is slightly better than three phase, in these patients with diabetes mellitus and/or peripheral vascular disease, the addition of a 24-hr image, creating a four-phase bone scan, is recommended.
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PMID:Value of a 24-hour image (four-phase bone scan) in assessing osteomyelitis in patients with peripheral vascular disease. 315 58

Twenty-eight consecutive patients with chronic refractory osteomyelitis uncomplicated by persistent segmental bone defect, fracture nonunion, septic arthritis, total joint arthroplasty, or major systemic disease (immune deficiency, malignancy, diabetes mellitus, malnutrition, or renal or hepatic failure) were treated from January, 1980 through December, 1985 to evaluate the potential benefits of hyperbaric oxygen therapy. Patients were classified by a staging system that took into account the bone involved; subchondral, periarticular bone involvement; extent of bone involvement; quality of soft tissue envelope and vascular supply; and general health status of the patient. Using this staging system, patients were assigned to either hyperbaric oxygen therapy or control status after their initial debridement. A regimen of hyperbaric oxygen therapy consisting of 100% oxygen, two atmospheres pressure, two hour duration, one dive per day, six dives per week was used in 14 of the 28 patients. Hyperbaric oxygen had no effect on length of hospitalization, rapidity of wound repair, initial clinical outcome, or recurrence of infection noted to date in this patient population.
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PMID:Treatment of chronic refractory osteomyelitis with adjunctive hyperbaric oxygen. 317 22

Long-term complications of diabetes mellitus with respect to the lower extremities are well known to the podiatric profession. The author presents a case of a diabetic with multisystem pathology who underwent several salvage procedures for osteomyelitis and later expired from cardiovascular disease. The multi-system nature of diabetes necessitates a team approach in management of the acutely ill diabetic patient.
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PMID:Diabetic osteomyelitis: long-term attempts at salvage with eventual mortality. 322 91

The effect of 2 wk of topical hyperbaric oxygen (THO) treatment on the healing of diabetic foot ulcers without associated gangrene was evaluated in a prospective, controlled, and randomized manner in 28 patients. There were 12 patients in the THO group (group 1) and 16 in the control group (group 2). Clinical management of the two patient groups was similar except for THO treatment in the group 1 patients. Clinical parameters, including age, sex, baseline fasting serum glucose levels, duration of diabetes mellitus, duration of foot ulcers, presence of peripheral neuropathy or arterial insufficiency, and evidence of osteomyelitis as determined by radiographs and/or radionuclide scans, were comparable in both groups of patients. No statistical differences (Student's t test) were seen in the number of microorganisms isolated from curettage cultures of the base of the ulcer at days 0, 7, and 14 of the study between groups 1 and 2. In contrast to previous studies, there was a paucity of anaerobic microorganisms isolated from these foot ulcers without associated gangrenous changes. Ulcer areas were estimated by multiplying the maximum width by the maximum length in millimeters at days 0, 7, and 14. Analysis of variance and Student's t test revealed progressive significant reductions in the ulcer areas in both groups when days 0, 7, and 14 were compared and in ulcer depths in both groups when days 0 and 14 were compared. However, such ulcer size changes did not differ statistically between the control and THO groups. A trend toward slower healing was observed in the THO group. Healing of diabetic foot ulcers was not accelerated by THO in this study.
Diabetes Care 1988 Feb
PMID:Randomized controlled trial of topical hyperbaric oxygen for treatment of diabetic foot ulcers. 328 61

The bacterial aetiology of osteomyelitis is best determined by bone biopsy under radiographic control. While Staphylococcus aureus is still the most common cause of osteomyelitis, Gram-negative bacteria occur more frequently than they did in the past. The prognosis of antibiotic treatment is made worse by chronic infection and by underlying conditions, such as diabetes mellitus or peripheral vascular disease. Treatment for six weeks with single broad-spectrum antimicrobial agents can give success rates similar to those obtained with combination therapy, including aminoglycosides, and with less toxicity. Newer diagnostic methods (radionuclide scans and radiographic techniques) and treatment options (antibiotic-containing acrylic beads and microvascular grafts) may offer improved management if used discriminatingly.
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PMID:Osteomyelitis: options for diagnosis and management. 329 Jan 80

Sonographic characteristics and percutaneous catheter drainage of thigh abscesses in 18 patients are described. Most of these patients had underlying diseases including osteomyelitis, trauma, diabetes mellitus, rheumatoid arthritis, leukemia, lymphoma, sepsis, bleeding dyscrasia, and autoimmune disease. Previous procedures on these thigh collections included seven operations and 12 nondiagnostic ward aspirations. All collections were shown by sonography to be either anterior or anterolateral. Two cases referred for drainage were posteromedial; sonography showed these to be mycotic pseudoaneurysms. The abscesses were either anechoic or hypoechoic, and occasionally had debris and septations. Abscesses associated with underlying osteomyelitis abutted the femur; those related to other causes generally were more superficial within muscle or fascial layers. Sonographically guided catheter drainage successfully cured all patients, even those in whom ward aspiration or formal surgery had been unsuccessful. Sonography is a simple and inexpensive method of imaging and guiding the drainage of thigh abscesses. Percutaneous catheter drainage is the treatment of choice in cases in which simple emergency room or ward incision and drainage are inadequate.
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PMID:Sonography of thigh abscess: detection, diagnosis, and drainage. 330 56

Osteomyelitis is becoming a more common infection. This increase has been associated with an increase in the number of orthopaedic surgical procedures and with severe bone trauma. The etiology of osteomyelitis is also changing, with more gram-negative and more polymicrobial infections due to both gram-positive and gram-negative pathogens. Underlying diseases such as diabetes mellitus, peripheral vascular and sickle cell disease are associated with a poor cure rate when treated with antibiotics. The emergence of resistant strains of bacteria during the long-term treatment necessary for osteomyelitis has been documented, and continues to be a concern, as are the other side effects.
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PMID:Overview of osteomyelitis. 333 35

Controversy has surrounded the role of local hypothermia as a preoperative treatment in amputations of the lower extremity. A study was undertaken to determine the effectiveness of amputation under cryoanesthesia in decreasing postoperative morbidity and mortality in below-knee (BK) amputations. Of 154 BK amputations, only 91 with unreconstructable vascular disease, gangrene, or both, were included in this study. Group I consisted of 48 patients (mean age 63.9 years) who had undergone a routine BK amputation; group II consisted of 43 patients (mean age 65.7 years) who were acutely ill and too unstable to undergo a major surgical procedure. Group II patients were treated by amputation while under cryoanesthesia before any definitive operative intervention. The patients in group II were significantly (p less than 0.05) more ill preoperatively than those in group I. Group II patients had a higher prevalence of previous myocardial infarction, previous stroke, diabetes mellitus, osteomyelitis, and wet gangrene. Seventy percent of the patients in group II had three or more risk factors vs. 46% in group I. Early postoperative mortality rates did not differ significantly between groups (group I, 8%; group II, 9%); the average length of hospital stay for group I patients was 24.2 days compared with 17.7 days in group II. Group II patients sustained slightly more postoperative complications. Amputation under cryoanesthesia appears to be of value in reducing postoperative morbidity and mortality and length of hospital stay in the acutely ill patient with unreconstructable vascular disease, gangrene, or both.
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PMID:Below-knee physiologic cryoanesthesia in the critically ill patient. 334 56


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