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Diabetic major amputation

Stavros Spiliopoulos, Panagiotis M Kitrou, Elias N Brountzos
Patients with below-the-knee arterial disease are primarily individuals suffering from critical limb ischemia (CLI), while a large percentage of these patients are also suffering from diabetes or chronic renal failure or both. Available data from randomized controlled trials and their meta-analysis demonstrated that the use of infrapopliteal drug-eluting stents (DES), in short- to medium- length lesions, obtains significantly better results compared to plain balloon angioplasty and bare metal stenting with regards to vascular restenosis, target lesion revascularization, wound healing and amputations...
November 26, 2018: World Journal of Cardiology
Milad S Bitar, Joelle Nader, Waleed Al-Ali, Ashraf Al Madhoun, Hossein Arefanian, Fahd Al-Mulla
Sarcopenia, a loss of muscle mass and functionality, constitutes a major contributor to disability in diabetes. Hydrogen sulfide (H2 S) dynamics and muscle mass regulatory signaling were studied in GK rats, a model for type 2 diabetes (T2D). GK rats exhibited a number of features that are consistent with sarcopenia and T2D including loss of muscle mass and strength, in addition to glucose intolerance, insulin resistance, and impaired β -cell responsiveness to glucose. Mechanistically, activation levels of Akt, a key modulator of protein balance, were decreased in T2D...
2018: Oxidative Medicine and Cellular Longevity
Masayuki Kaneko, Mamoru Narukawa
BACKGROUND AND OBJECTIVE: Empagliflozin and canagliflozin decreased the risk of major adverse cardiovascular events (MACE) compared with placebo in randomized clinical trials which were conducted to evaluate their cardiovascular risks. However, canagliflozin increased the risks of amputation and bone fracture, and the reasons for these observed differences remain unclear. The objective of this study was to evaluate the safety risks, specifically the risks of amputation and bone fracture, associated with sodium-glucose cotransporter 2 (SGLT2) inhibitors by using the difference in restricted mean survival time (RMST), an alternative measure to the hazard ratio...
November 30, 2018: Clinical Drug Investigation
Sanne M Schreuder, M Nieuwdorp, Marc J W Koelemay, Shandra Bipat, Jim A Reekers
Objective: There is evidence from the literature that dysfunctionality of the sympathetic nervous system of the foot with subsequent loss of local autoregulation could be a predictor of early amputation in patients with diabetes with a neuroischemic ulcer. To confirm this we tested the functionality of the sympathetic nervous system in the foot in a consecutive group of 31 patients with diabetes with critical limb ischemia and non-healing neuroischemic ulcer. Research design and methods: Prospective cohort with retrospective analysis after 12 months of routinely acquired clinical data...
2018: BMJ Open Diabetes Research & Care
Vikas Kotha, Elliot Walter, Gregory Stimac, Paul Kim
In the environment of diabetes and peripheral vascular disease (PVD), there is a high risk of incisional complications following amputation, including seroma, hematoma, infection, and dehiscence. Incisional negative-pressure wound therapy (iNPWT) is a novel application of negative-pressure wound therapy (NPWT) that may be able to mitigate these complications and reduce the need for revisional surgery (including higher-level major lower-extremity amputations). It may also facilitate an increased rate of healing and earlier return to function...
November 23, 2018: Surgical Technology International
Anna Z Fashandi, J Hunter Mehaffey, Robert B Hawkins, Irving L Kron, Gilbert R Upchurch, William P Robinson
OBJECTIVE: Major adverse limb events (MALEs) and major adverse cardiovascular events (MACEs) at 30 days provide standardized metrics for comparison and have been adopted by the Society for Vascular Surgery's objective performance goals for critical limb ischemia. However, MALEs and MACEs have not been widely adopted within the claudication population, and the comparative outcomes after lower extremity bypass (LEB) and infrainguinal endovascular intervention (IEI) remain unclear. The purpose of this study was to compare MALEs and MACEs after LEB and IEI in a contemporary national cohort and to determine predictors of MALEs and MACEs after revascularization for claudication...
December 2018: Journal of Vascular Surgery
Daniel Baumfeld, Tiago Baumfeld, Benjamim Macedo, Roberto Zambelli, Fernando Lopes, Caio Nery
Objective: There are no specific criteria that define the level of amputation in diabetic patients. The objective of this study was to assess the influence of clinical and laboratory parameters in determining the level of amputation and the wound healing time. Methods: One hundred and thirty-nine diabetic patients were retrospectively assessed. They underwent surgical procedures due to infection and/or ischemic necrosis. Type of surgery, antibiotic use, laboratory parameters and length of hospital stay were evaluated in this study...
2018: Acta Ortopedica Brasileira
Pablo Aqueveque, Rodrigo Osorio, Francisco Pastene, Francisco Saavedra, Esteban Pino
Diabetic foot is a pathology associated with diabetic neuropathy, where the vast majority of diabetic foot infections terminate in surgical intervention; from debridement to amputation of the involved limb. Commonly, diabetic foot infections come from ulceration produced by high-pressure areas under the foot. For this reason, researchers have been working on a continuous measurement system to detect the high-pressure areas in-shoe in a low cost way. This paper presents the design and implementation of a continuous monitoring device to measure the pressure in-shoe...
July 2018: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Mehdi Khalfallah, Esma Leila Gouta, Wejih Dougaz, Hichem Jerraya, Imene Samaali, Ramzi Nouira, Ibtissem Bouasker, Chadli Dziri
BACKGROUND: Major amputation of the lower limb is defined by a leg or thigh amputation. The aim of our work was identifying predictive factors for lower limb major amputation in patients with diabetes admitted on for foot lesions through using an administrative data base. METHODS: It was a retrospective study ranging from June 1st, 2008 to December 31st, 2011, which included all the patients admitted on for an infected diabetic foot to the surgery unit B of Charles Nicolle hospital in Tunis...
May 2018: La Tunisie Médicale
Nawaf J Shatnawi, Nabil A Al-Zoubi, Hasan Hawamdeh, Yousef S Khader, Abd El-Karim Omari, Muhammad R Khammash
Purpose: The aim of this study was to present the redefined clinical spectra of diabetic foot syndrome (RCS-DFS) and determine whether the RCS-DFS can be used to predict amputations. Patients and methods: This is a retrospective study of type 2 diabetic patients referred with DFS for management at King Abdullah University Hospital (KAUH) between January 2014 and December 2015. Data collection form and diabetic foot (DF) characteristic chart were used to document the following: demographic data, diabetes-related parameters, DF characteristics, surgical interventions and amputations...
2018: Vascular Health and Risk Management
Linda S Geiss, Yanfeng Li, Israel Hora, Ann Albright, Deborah Rolka, Edward W Gregg
OBJECTIVES: To determine whether declining trends in lower extremity amputations have continued into the current decade. RESEARCH DESIGN AND METHODS: We calculated hospitalization rates for nontraumatic lower extremity amputation (NLEA) for the years 2000-2015 using nationally representative, serial cross-sectional data from the Nationwide Inpatient Sample on NLEA procedures and from the National Health Interview Survey for estimates of the populations with and without diabetes...
November 8, 2018: Diabetes Care
Haleh Ghavami, Moloud Radfar, Soraya Soheily, Shams Aldin Shamsi, Hamid Reza Khalkhali
OBJECTIVES: Diabetic peripheral neuropathy (DPN) is the most common and troublesome complication of diabetes leading to great morbidity and resulting in a huge economic burden for diabetes care. Over half of people with diabetes develop neuropathy. Also, DPN is a major cause of reduced quality of life due to pain, sensory loss, gait instability, fall-related injury, and foot ulceration and amputation. The aim of this study was evaluating the effects of lifestyle interventions on diabetic neuropathy severity in diabetes type 2 outpatients...
October 2018: Aǧrı: Ağrı (Algoloji) Derneği'nin Yayın Organıdır, the Journal of the Turkish Society of Algology
Mohammad Alasaad, Anwar Zaitoun, Suzan Szpunar, Thomas Lalonde, Howard S Rosman, Rajendra H Mehta, Hiroshi Yamasaki, Hussein Othman
BACKGROUND: Race-related differences in clinical features, presentation, treatment and outcomes of patients with various cardiovascular diseases have been reported in previous studies. However, the long-term outcomes in black versus white patients with popliteal and/or infra-popliteal peripheral arterial disease (PAD) undergoing percutaneous peripheral vascular interventions (PVI) are not well known. METHODS AND RESULTS: We retrospectively evaluated long-term outcomes in 696 patients (263 blacks and 433 whites) who underwent PVI for popliteal and/or infra-popliteal PAD at our institution between 2007 and 2012...
October 11, 2018: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Cristina Neagu, Alexandra Buzea, Alexandra Agache, Dragoş Georgescu, Traian Pătraşcu
Introduction: Diabetes mellitus is one of the chronic diseases that showed a steady increase in the number of patients in the last decades. After the diagnosis of diabetes mellitus, evolution towards limb amputation goes, step by step, through neuropathy, leg ulcers and infection appearance. The existence of diabetic arteriopathy prevents ulcer's healing due to the limb's ischemic status. By restoring arterial flow in the lower extremity, we solve the most important cause for diabetic foot ulcers, namely ischemia...
2018: Chirurgia
Petronel Mustăţea, Cătălin Bugă, Horia Doran, Octavian Mihalache, Florin Teodor Bobîrcă, Dragoş Eugen Georgescu, Alexandra Agache, Cristina Jauca, Andra Bîrligea, Ovidiu Chiriac, Vlad Marin, Traian Pătraşcu
Background: the patient with diabetes has an increased susceptibility to infections, with negative evolutionary potential leading to increased morbidity and mortality compared to the general population. The cause is the alteration of immune defense mechanisms, the hyperglycemic environment leading to alteration of neutrophil function, suppression of the antioxidant system and humoral activity, systemic micro and macroangiopathy, neuropathy, depression of antibacterial activity of the genitourinary and digestive tract...
2018: Chirurgia
Anca Bordianu, Florin Bobircă, Traian Pătraşcu
Background: According to the World Health Organization, cases of diabetes have risen from 108 million in 1980 to 422 million in 2014, with a more rapid rising in middle- and low-income countries. Diabetes causes yearly approximately 1.6 million deaths, and is a major cause of heart attacks, stroke, kidney failure, blindness and lower limb amputation. This article provides information on the treatment of a frequent complication related to diabetes, namely toe/ partial foot amputation. Broad, deep operative defects of the diabetic foot represent a reconstructive challenge...
2018: Chirurgia
Dragoş Eugen Georgescu, Petronel Mustăţea, Octavian Mihalache, Florin Bobircă, Alexandra Agache, Teodor Florin Georgescu, Ovidiu Chiriac, Vlad Marin, Horia Doran, Traian Pătraşcu
Background: Diabetic foot complications result from the association between peripheral vascular disease, neuropathy and a precarious healing process. Peripheral neuropathy observed in diabetics affects all components of the nervous system, contributing to the occurrence of leg ulcers, musculoskeletal changes, resulting in severe deformities. The clinical manifestation of these complications ranges from simple lesions to complex entities threatening the loss of pelvic limb or even life (1,2). Methods: In our surgery department, a significant number of patients with diabetic foot lesions are hospitalized and treated annually, 40% having clinical manifestations of diabetic neuropathy associated...
2018: Chirurgia
Noemi Galas, Ingrid Becker, Tomasz Ficon, Maik Sakrauski, Rita Reichert, Wael Ahmad, Spyridon Mylonas, Jan Brunkwall, Payman Majd
BACKGROUND: Peripheral arterial disease (PAD) is one of the major manifestations of general atherosclerosis and strongly associated with increased cardiovascular morbidity and mortality. Because only few epidemiologic studies are available concerning the prevalence of PAD in inhabitants ≥ 80 years of age, we screened inhabitants of nursing care homes in Germany for PAD and cardiovascular diseases and to assess the one year mortality. PATIENTS AND METHODS: We conducted a prospective cohort study, screening inhabitants of 42 nursing homes for PAD...
October 30, 2018: VASA. Zeitschrift Für Gefässkrankheiten
LaTonya J Hickson, Andrew D Rule, Bjorg Thorsteinsdottir, Raymond C Shields, Ivan E Porter, Mark D Fleming, Daniel S Ubl, Cynthia S Crowson, Kristine T Hanson, Bassem T Elhassan, Rajnish Mehrotra, Shipra Arya, Robert C Albright, Amy W Williams, Elizabeth B Habermann
OBJECTIVE: Patients receiving dialysis are at increased risk for lower extremity amputations (LEAs) and postoperative morbidity. Limited studies have examined differences in 30-day outcomes of mortality and health care use after amputation or the preoperative factors that relate to worsened outcomes in dialysis patients. Our objective was to examine dialysis dependency and other preoperative factors associated with readmission or death after LEA. METHODS: A retrospective cohort study was conducted of dialysis-dependent and nondialysis patients undergoing major LEA in the 2012 to 2013 American College of Surgeons National Surgical Quality Improvement Program...
November 2018: Journal of Vascular Surgery
Maja Olsson, Krister Järbrink, Ushashree Divakar, Ram Bajpai, Zee Upton, Artur Schmidtchen, Josip Car
Chronic wounds are a health problem that have devastating consequences for patients and contribute major costs to healthcare systems and societies. To understand the magnitude of this health issue, a systematic review was undertaken. Searches were conducted in MEDLINE, EMBASE, EBM Reviews and Cochrane library, CINAHL, EBSCO, PsycINFO, and Global Health databases for articles published between 2000 and 2015. Included publications had to target adults (≥18 years of age), state wound chronicity (≥3 weeks) and/or label the wounds as chronic, complex, hard-to-heal, or having led to an amputation...
October 26, 2018: Wound Repair and Regeneration
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