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Diabetic major amputation

Melissa Anne Wright, Daniel Steffens, Ravi Lee Huilgol
BACKGROUND: The prevalence of peripheral arterial disease (PAD) in Australia is currently poorly characterized. The risk factor profile for PAD is changing with the population ageing, diabetes increasing and smoking rates declining. The management of PAD is also evolving, with advances in medical management and endovascular technique. The trends in PAD prevalence and surgical management have implications for preventative medicine, the Australian health system and vascular surgery. We report and analyse trends in PAD surgical intervention performed between 2001 and 2015...
October 15, 2018: ANZ Journal of Surgery
Rienk Dekker, Yoanna V Hristova, Juha M Hijmans, Jan H B Geertzen
BACKGROUND: Major lower-limb amputation (LLA) predisposes patients post-operatively to a significant decline in daily-life functioning. The physical condition of amputee patients prior to surgery is significantly deteriorated due to chronic peripheral vascular disease (PVD) and diabetes, which accounts for the majority of LLAs in the adult population. A common strategy called pre-rehabilitation has been used in multiple patient populations to prepare the patient for undergoing a surgical event and to improve post-operative patient outcomes...
2018: PloS One
Abdulaziz Alhomaidi Al Odhayani, Salwa Al Sayed Tayel, Faisal Al-Madi
Diabetic foot is a serious complication that causes lower extremity amputations. The aim of this study was to identify the patient's awareness about risk factors for diabetic foot disease and to explore the knowledge and foot care practices among diabetic patients in a Saudi population. This cross-sectional study was conducted in King Khalid University Hospital (KKUH), King Abdulaziz University Hospital (KAUH), King Fahad Medical City, National Guard Hospital, Military Hospital, and Prince Salman Hospital capital city of Saudi Arabia...
November 2017: Saudi Journal of Biological Sciences
Randolph Fish, Elizabeth Kutter, Daniel Bryan, Gordon Wheat, Sarah Kuhl
Infections involving diabetic foot ulcers (DFU) are a major public health problem and have a substantial negative impact on patient outcomes. Osteomyelitis in an ulcerated foot substantially increases the difficulty of successful treatment. While literature suggests that osteomyelitis in selected patients can sometimes be treated conservatively, with no, or minimal removal of bone, we do not yet have clear treatment guidelines and the standard treatment failure fallback remains amputation. The authors report on the successful treatment, with a long term follow up, of a 63 YO diabetic female with distal phalangeal osteomyelitis using bacteriophage, a form of treatment offering the potential for improved outcomes in this era of escalating antibiotic resistance and the increasingly recognized harms associated with antibiotic therapy...
October 2, 2018: Antibiotics
S Cheddie, C G Manneh, B Pillay
BACKGROUND: Primary amputation (stump closure) for diabetic foot sepsis is perceived to have a higher re-amputation rate due to stump sepsis. A guillotine amputation with elective stump closure is widely practised due to the lower risk of stump sepsis and re-amputation. AIMS: To provide an epidemiological analysis of the spectrum of disease and outcomes of primary amputation for diabetic foot sepsis in a regional rural hospital. METHODS: A prospective cohort study of 100 patients who underwent surgery for diabetic foot sepsis over a 5-year period was undertaken at Madadeni Provincial Hospital, in northern KwaZulu-Natal...
September 2018: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
Iris Baumgartner, Lars Norgren, F Gerry R Fowkes, Hillary Mulder, Manesh R Patel, Jeffrey S Berger, W Schuyler Jones, Frank W Rockhold, Brian G Katona, Kenneth Mahaffey, William R Hiatt
BACKGROUND: Lower extremity revascularization (LER) is a common treatment in patients with peripheral artery disease (PAD), but long-term outcomes are poorly defined. OBJECTIVES: The aim was to analyze LER in the EUCLID (Examining Use of tiCagreLor In paD) trial to determine predictors and cardiovascular outcomes. METHODS: Patients were grouped according to whether they received a post-randomization LER (n = 1,738) or not (n = 12,147)...
October 2, 2018: Journal of the American College of Cardiology
Meinhard Wlaschek, Karmveer Singh, Anca Sindrilaru, Diana Crisan, Karin Scharffetter-Kochanek
Chronic wounds pose a stern challenge to health care systems with growing incidence especially in the aged population. In the presence of increased iron concentrations, recruitment of monocytes from the circulation and activation towards ROS and RNS releasing M1 macrophages together with the persistence of senescent fibroblasts at the wound site are significantly enhanced. This unrestrained activation of pro-inflammatory macrophages and senescent fibroblasts has increasingly been acknowledged as main driver causing non-healing wounds...
September 24, 2018: Free Radical Biology & Medicine
Behrouz Fard, Pieter U Dijkstra, Roy E Stewart, Jan H B Geertzen
OBJECTIVE: To analyze the incidence rates of dysvascular major lower extremity amputations (LEA) in Northern Netherlands in 2012-2013 compared to previous cohorts in 1991-1992 and 2003-2004. DESIGN: Retrospective cohort study. PARTICIPANTS: Adults (N = 343) with first ever dysvascular LEA at ankle disarticulation or more proximal levels. The median age (interquartile range) was 74.2 years (64.5-81.9), 64% were male and 55% had been diagnosed with diabetes mellitus (DM)...
2018: PloS One
Marvin Heyboer, Joseph Byrne, Paula Pons, Elena Wolner, Sarah Seargent, Susan M Wojcik
Introduction: Hyperbaric oxygen (HBO2) therapy is used to promote healing in select problem wounds. Transcutaneous oxygen measurement (TCOM) can be used to predict the response of these wounds to HBO2, with in-chamber TCOM values shown to be the most predictive. We evaluated the use of in-chamber TCOM values to determine optimal treatment pressure. Methods: A retrospective review was completed of patients undergoing HBO2 therapy for a lower-extremity wound and who had in-chamber TCOM...
July 2018: Undersea & Hyperbaric Medicine: Journal of the Undersea and Hyperbaric Medical Society, Inc
Ria Arnold, Tim J Pianta, Bruce A Pussell, Zoltan Endre, Matthew C Kiernan, Arun V Krishnan
In Australia approximately 1.7million adults have evidence of chronic kidney disease (CKD). This complex disease can result in a multitude of complications, including hyperkalaemia which common and well recognised. . The advent of new therapeutics aimed at lowering serum potassium have raised the possibility of optimising potassium control to enable greater use of renin-angiotensin-aldosterone system inhibitors in the management of CKD. Recent studies suggest that hyperkalaemia also has implications for peripheral neuropathy in CKD, a complication that substantially contributes to patient morbidity...
September 19, 2018: Internal Medicine Journal
Shaima Alothman, Aqeel Alenazi, L Russ Waitman, Joseph LeMaster, Patricia Kluding
AIMS: The purpose of the study was to identify the frequency of a prior diagnosis of neuropathy, peripheral vascular disease (PVD), and foot ulceration in patients with diabetes who subsequently underwent lower extremity amputation (LEA). METHODS: We performed a retrospective electronic review of de-identified charts from a tertiary medical health center of patients who had the diagnosis codes of diabetes and the procedure codes of LEA. For this query, neuropathy, PVD, and foot ulcer diagnosis codes were selected as the variables of interest...
2018: Journal of Allied Health
Johannes Pollmanns, Maria Weyermann, Max Geraedts, Saskia E Drösler
BACKGROUND: Hospitalizations and lower limb amputations related to diabetes mellitus (DM) are considered to be potentially avoidable. Appropriate outpatient care of diabetes prevents complications. Rates on potentially avoidable hospitalizations for diabetes are core indicators of the German diabetes surveillance program. International comparisons showed high hospitalization rates in Germany for both indicators. OBJECTIVES: The objective of this analysis is to describe time trends on hospitalizations and inpatient lower limb amputations (major amputations) for DM...
September 6, 2018: Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
Tuna Demirdal, Pinar Sen
AIMS: The aim of the study was to evaluate the value of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and lymphocyte to monocyte ratio (LMR) in predicting peripheral arterial disease, peripheral neuropathy, osteomyelitis and need for amputation in diabetic foot infection (DFI). METHODS: A total of 280 patients were analyzed retrospectively. The NLR, PLR and LMR were evaluated statistically in DFI. RESULTS: A total of 280 patients were enrolled in the study...
September 1, 2018: Diabetes Research and Clinical Practice
Arash Peivandi Yazdi, Alireza Bameshki, Maryam Salehi, Gholamhosein Kazemzadeh, Majid Sharifian Razavi, Shaghayegh Rahmani, Seyed Isaac Hashemy
Background: Anesthesia is performed in two major methods including regional and general.The aim of this study was to compare the effect of anesthesia method (spinal and general) on oxidative stress in diabetic patients underwent diabetic amputation surgery. Methods: In this randomized control trial, 40 patients with diabetic foot who were candidate for foot amputation surgery at our academic hospital in 2013, were selected and divided into two groups based on anesthesia method...
July 2018: Archives of Bone and Joint Surgery
Thenmalar Vadiveloo, William Jeffcoate, Peter T Donnan, Helen C Colhoun, Stuart McGurnaghan, Sarah Wild, Rory McCrimmon, Graham P Leese
AIMS/HYPOTHESIS: Our aim was to investigate amputation-free survival in people at high risk for foot ulceration in diabetes ('high-risk foot'), and to compare different subcategories of high-risk foot. METHODS: Overall, 17,353 people with diabetes and high-risk foot from January 2008 to December 2011 were identified from the Scotland-wide diabetes register (Scottish Care Information-Diabetes: N = 247,278). Participants were followed-up for up to 2 years from baseline and were categorised into three groups: (1) those with no previous ulcer, (2) those with an active ulcer or (3) those with a healed previous ulcer...
August 31, 2018: Diabetologia
Yasser Mostafa Hafez, Omnia Safwat El-Deeb, Marwa Mohamed Atef
BACKGROUND: Diabetic foot ulceration (DFU) is a serious diabetic complication that can progress to amputation and since SIRT1 regulates glucose metabolism, inflammation, and oxidative stress which are the major contributors in diabetic complications, So we aimed to discuss its role as an epigenetic biomarker in DFU and highlight its link to oxidative stress and inflammatory cytokines. METHOD: 60 DM patients were enrolled in the study, 30 without DFU and 30 with DFU in addition to 15 healthy subjects (control group)...
November 2018: Diabetes & Metabolic Syndrome
Lynn Ang, Nathan Cowdin, Kara Mizokami-Stout, Rodica Pop-Busui
IN BRIEF Distal symmetric polyneuropathy (DSPN) and diabetic autonomic neuropathies, particularly cardiovascular autonomic neuropathy (CAN), are prevalent diabetes complications with high morbidity, mortality, and amputation risks. The diagnosis of DSPN is principally a clinical one based on the presence of typical symptoms combined with symmetrical, distal-to-proximal stocking-glove sensory loss. CAN is an independent risk factor for cardiovascular mortality, arrhythmia, silent ischemia, major cardiovascular events, and myocardial dysfunction...
August 2018: Diabetes Spectrum: a Publication of the American Diabetes Association
Awalou Mohaman Djibril, Edem Komi Mossi, Agbeko Kodjo Djagadou, Abago Balaka, Toyi Tchamdja, Razak Moukaila
Background: Diabetic foot is a common and severe complication of diabetes. This study aimed to determine the epidemiological, diagnostic, therapeutic and evolutionary features of diabetic foot at a Hospital in Lomé (Togo). Methods: We conducted a retrospective, descriptive study from 1 January 2011 to 31 December 2015 (5 years) at the Medico-surgical Clinic, University Hospital Sylvanus Olympio in Lomé All patients hospitalized for diabetic foot during the study period were enrolled...
2018: Pan African Medical Journal
Mousab Yousef Al-Ayed, Mutasem Ababneh, Asirvatham Alwin Robert, Ahmed Salman, Abdulghani Al Saeed, Mohamed Abdulaziz Al Dawish
BACKGROUND AND AIMS: Considering that diabetic foot ulceration is one of the major health issues globally, we aimed to evaluate the risk factors associated with foot ulcers in patients with type 2 diabetes mellitus (T2DM). METHODS: A total of 81 T2DM patients (age range: 40-80 years) registered at the Diabetes Treatment Center, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia between April and September 2015 were included in this cross-sectional study after purposive selection and assigning of patient numbers...
August 16, 2018: Current Diabetes Reviews
Ming Ngan Aloysius Tan, Zhiwen Joseph Lo, Soon Hong Lee, Rui Ming Teo, Wei Leong Glenn Tan, Sadhana Chandrasekar
Objective : To evaluate outcomes after transmetatarsal amputation (TMA) in peripheral arterial disease (PAD) limb salvage in an Asian population and identify risk factors associated with TMA failure. Methodology : A retrospective review of 147 patients with PAD, who had undergone TMA between 2008 and 2014, was carried out. Univariate and multivariate analysis were used to identify predictors of TMA failure. Kaplan-Meier survival analysis was used to calculate major amputation and all-cause mortality rates. Results : The mean age was 66 years...
June 25, 2018: Annals of Vascular Diseases
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