Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diabetic foot is one of challenging diseases in vascular surgery. This is based on uncontrolled diabetes mellitus and its true character is the neuropathic gangrene due to microangiopathy. Diabetic foot, however, is sometimes accompanied by peripheral arterial occlusive disease, which true status is macroangiopathy. Therefore, the strategy for diabetic foot is as follows;the first step is the infection control by minor amputation and/or drainage, the second step is the assessment of the limb ischemia, and the final is the complete vascular reconstruction. To salvage these diabetic feet, it is important that doctors, who concern to diabetics, understand these strategies and also that they have a settled opinion for the diabetic foot.
 ...
PMID:[Surgical management of the diabetic foot]. 1577

Diabetic foot ulceration is a serious complication of diabetes mellitus; it is the cause of more than half of nontraumatic lower limb amputations. Diabetic foot ulcers are the major cause of hospital admission for diabetic patients. Treatment costs are high. There have been advances in managing diabetic foot ulceration with the development of new dressings, growth factors, skin substitutes, and other novel approaches to stimulating wound healing. The management of vascular disease in the patient with diabetes mellitus is an essential and important consideration. However, the need for a multidisciplinary team to provide good foot care to diabetic patients is still vital for the prevention and treatment of diabetic foot ulceration.
 ...
PMID:Changing perspectives in diabetic foot ulcer management. 1586 21

Diabetic foot ulceration represents a major medical, social and economic problem all over the world. While more than 5% of diabetic patients have a history of foot ulceration, the cumulative lifetime incidence may be as high as 15%. Ethnic differences exist in both ulcer and amputation incidences. Foot ulceration results from the interaction of several contributory factors, the most important of which is neuropathy. The use of the total-contact cast is demonstrated in the treatment of plantar neuropathic ulcers. Histological evidence suggests that pressure relief results in chronic foot ulcers changing their morphological appearance by displaying some features of an acute wound. Thus, repetitive stresses on the insensate foot appear to play a major role in maintaining ulcer chronicity. It is hoped that research activity in foot disease will ultimately result in fewer ulcers and less amputation in diabetes.
 ...
PMID:Pathogenesis of foot ulcers and the need for offloading. 1591 13

Most patients are older, but increasing numbers of young patients also develop diabetic foot ulcer (DFU). A third of the patients are under 50 years of age. The prevalence in the Western countries is 4-10% and the incidence 2-6%. Only 10-60% of patients are healed after the first three months and the recurrence rate is 44%, 61%, and 70% after one, two and three years, respectively. DFU results in extensive treatment costs, and the hospital treatment cost of DFU counts towards 25-30% of the total hospital expenses of treatment of patients suffering of diabetes. Recent progress in the treatment of patients with DFU has reduced the number of low-extremity amputation (LEA) cases. These improvements have been achieved through an increasing understanding of the importance of the multifactorial background of DFU, and that there should be a multidisciplinary organized structure behind the treatment of DFU. This used to be a topic of interest, but especially focused on the international Consensus on the Diabetic Foot from 1999. Our understanding of the importance of surgery in DFU has increased over the last 30 years. A simple classification based on presents or absents of neuropathy, open wound or infection has been suggested. Treatment is dependable of the type and classification group of the wound. Various surgical correction techniques are available. The team approach and collaboration between all healthcare professionals is required to facilitate good quality holistic care. Recognition of the talent and creativity of all employees in the multidisciplinary team will increase the chance of success in establishment of the concept. This article is based on a presentation focusing on the surgical and organisational aspects in thr treatment of DFU.
 ...
PMID:Management of the diabetic foot: surgical and organisational aspects. 1591 14

Diabetic foot skin close to an ulcer shows only a few infiltrating cells compared to nondiabetic inflamed tissues. Diabetes is characterized by thickened basement membrane of the blood arterioles and capillaries. This may affect the transcapillary transport of immune humoral factors and cells to the extravascular space. We analyzed by immunohistochemistry the phenotype and expression pattern of adhesion molecules on leukocyte, dermal fibroblast, and endothelial cells in diabetic foot ulcers. Although there was accumulation of granulocytes on the surface and superficial layers of the granulation tissue, rare perivascular granulocyte infiltrates in the dermis were seen. Moreover, lack of macrophage and CD3+ T cell infiltrates was observed. In contrast, there was increased intensity of CD1a staining of Langerhans cells in the epidermis and papillary dermis (p < 0.05). Fibroblasts revealed increased presence in the ulcer margins compared with normal skin (p < 0.05). Skin endothelial cells expressed stronger von Willebrand factor and E-selectin compared with normal skin (p < 0.05). Our study provides evidence that increased expression of endothelial cell adhesion molecules responsible for immunocyte extravasation is not associated with increased inflammatory cell infiltration of the ulcerated diabetic foot tissue. We suggest that the healing process of diabetic foot ulcers may be hampered by mechanisms decreasing accumulation of leukocytes. This implies that pharmacological or biological stimulation of leukocyte extravasation into the ulcer tissue should be tried.
 ...
PMID:Low recruitment of immune cells with increased expression of endothelial adhesion molecules in margins of the chronic diabetic foot ulcers. 1595 43

The surgical treatment of foot wounds in patients with diabetes is an art and a science. I summarize the surgical management presentation of The Diabetic Foot Wound Symposium at the 2004 Musculoskeletal Infectious Disease Society meeting in Pittsburgh, PA. The science of surgical management of the diabetic foot wound is seen in the accurate diagnosis of its severity. This is accomplished by a simple to use five assessment wound score that grades wound base appearance, size, depth, bio-burden and perfusion each from 0 (worse) to 2 (best) using objective criteria. The resultant 0 to 10 score quantifies the severity and provides a guideline for what treatments should be done. The art of surgically treating foot wounds in patients with diabetes is exemplified in doing minimally invasive surgeries in the office or their more complex counterparts in the operating room. The surgeries are classified into five types: debridements, correction of deformities, wound closures, partial amputations, and miscellaneous procedures including nail care and Charcot arthropathy treatment. The information presented in this paper reflects my 25 years of experience caring for problem foot wounds in patients with diabetes.
 ...
PMID:Surgical treatment of problem foot wounds in patients with diabetes. 1620 45

Foot ulcers are a common, serious, and costly complication of diabetes, preceding 84% of lower extremity amputations in diabetic patients and increasing the risk of death by 2.4-fold over diabetic patients without ulcers. Health-related quality of life (HRQOL) is worse among individuals with diabetes than individuals without diabetes, and complications of diabetes, including foot ulcers, have a major negative effect on HRQOL. Diabetic foot ulcers are associated with reduced mobility and deficits related to activities of daily living that adversely affect HRQOL. Qualitative studies have confirmed clinical observations that diabetic foot ulcers have a huge negative psychological and social effect, including reduction in social activities, increased family tensions for patients and their caregivers (spouses or partners), limited employment, and financial hardship. Quantitative studies confirm the findings of qualitative studies that diabetic foot ulcers exert a negative effect on physical functioning, psychological status, and social situation. Recent advances include the development and validation of disease-specific HRQOL surveys for diabetic patients with foot ulcers. Disease-specific surveys may improve the evaluation of HRQOL as a function of ulcer healing, the effect of different treatment methods on HRQOL, and the relationship between treatment-specific HRQOL, patient compliance, and treatment efficacy.
 ...
PMID:Health-related quality of life in diabetic patients with foot ulcers: literature review. 1630 2

The International Diabetes Federation (IDF) has proclaimed 2005 to be the "Year of the Diabetic Foot." Together with the International Working Group on the Diabetic Foot, the IDF has launched a year-long campaign to raise awareness of the diabetic foot worldwide. In this article, both organizations are briefly described, an overview of the aims of the global awareness campaign is given, and the activities to promote World Diabetes Day in 2005 are outlined. Attention is also paid to present and future developments to improve the standards of diabetic foot care worldwide.
 ...
PMID:2005: The International Diabetes Federation focuses on the diabetic foot. 1631 94

Diabetes mellitus affects approximately 171 million individuals worldwide. The costs of the adult form of diabetic mellitus account for up to 6% of total health care expenditures in industrialized countries. About 25% of these diabetics develop disabling and most painful foot complications accounting for about 17% of the direct lifetime costs. Diabetic foot prevention programs have been recently introduced in some Austrian federal states to meet the diabetic health targets of the Austrian Health Plan and the St. Vincent Declaration. We developed a new age-group specific Markov model combined with a Monte Carlo simulation model to help policymakers analyze the cost-effectiveness of such programs compared to the status quo in terms of incremental costs per quality-adjusted life years gained (QALY). The Markov model revealed that diabetic foot prevention programs were cost saving when targeted at patients at high risk and mainly cost-effective when targeted at patients with mild symptoms. The Monte Carlo simulation showed that only large scope prevention programs would fulfill the specified reductions in the number of diabetic foot complications as defined in the Austrian Health Plan and the St. Vincent Declaration. Our results clearly indicate the enormous impact of diabetic foot prevention programs.
 ...
PMID:Model-based evaluation of diabetic foot prevention strategies in Austria. 1637 9

Diabetic foot disease causes more amputations than any other lower limb disease. Management of the diabetic foot requires a thorough knowledge of the risk factors for ulceration and amputation, the most common of which are neuropathy, ischaemia and infection. Amputations are not inevitable, however; early detection and appropriate treatment of ulcers can prevent up to 85% of amputations. This has been demonstrated in the formation of multidisciplinary diabetic foot clinics, which have been shown to reduce the number of amputations across the world. Adherence to a systematic regime of organization, education, screening and intervention can improve communication between patients, GPs, community nursing and diabetes sub-specialists to facilitate appropriate treatment and prevention of complications. The case discussed here demonstrates how inadequate and disjointed management through lack of communication, education and knowledge of diabetic foot disease can lead to complications requiring amputation and debridement.
 ...
PMID:Amputation and the diabetic foot: learning from a case study. 1641 26


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>