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diabetic osteomyelitis

Ryohei Ono, Koji Uehara, Izumi Kitagawa
Emphysematous osteomyelitis is a rare but potentially fatal infection. It is caused by gas-forming organismsand is characterized by the presence of intraosseous gas. A 75-year-old woman with untreated diabetes mellitus presented with difficulty in moving and anorexia. Laboratory studies revealed inflammation, a urinary infection, and diabetic ketoacidosis. Klebsiella pneumoniae was detected in both urine and blood cultures. Computed tomography and magnetic resonance imaging revealed emphysematous lesions in the paravertebral soft tissue, spinal canal, and iliopsoas muscle, with intraosseous gas at L1 and L2...
March 9, 2018: Internal Medicine
Abhisekh Mohapatra, Jon C Henry, Efthimios D Avgerinos, Rabih A Chaer, Steven A Leers, Aureline Boitet, Michael J Singh, Eric S Hager
OBJECTIVE: Ischemic heel ulcerations are generally thought to carry a poor prognosis for limb salvage. We hypothesized that patients undergoing infrapopliteal revascularization for heel wounds, either bypass or endovascular intervention, would have lower wound healing rates and amputation-free survival than patients with forefoot wounds. METHODS: A retrospective chart review was performed of patients who presented between 2006 and 2013 to our institution with ischemic foot wounds and infrapopliteal arterial disease and underwent either pedal bypass or endovascular tibial artery intervention...
February 28, 2018: Annals of Vascular Surgery
Kristopher S Pfirman, Robel Haile
BACKGROUND Intracardiac abscesses are an unusual occurrence in developed countries. With the increase in use of implantable cardiac devices, the increase use of and advancements in antibiotics, and the longevity of patients with cardiac devices, one may expect an increase in such infections; however, case reports are rare. We are presenting a case in which hematogenous dissemination of methicillin-sensitive Staphylococcus aureus (MSSA) infection from a lower extremity diabetic ulcer propagated into an infected pacemaker lead and ultimately an intracardiac abscess of the right atrium...
March 1, 2018: American Journal of Case Reports
Elite Arnon-Sheleg, Zohar Keidar
Osteomyelitis in the diabetic foot can be difficult to diagnose and has serious consequences. Although 2-deoxy-2-[18F]-fluoro-D-glucose (FDG) positron emission tomography (PET) was traditionally used in oncology, it is emerging as a useful method in inflammatory and infectious entities. In this chapter, original research articles, meta-analyses, and reviews on the performance of FDG PET in diagnosing osteomyelitis in the diabetic foot will be discussed. In addition, PET available data in comparison to different imaging methods, different analysis methods, and impact of other co-existing conditions such as hyperglycemia, and long-term antibiotic treatment on the performance of FDG PET will be reviewed...
February 26, 2018: Current Pharmaceutical Design
Alfred O Ankrah, Hans C Klein, Philip H Elsinga
Diabetic foot infections (DFIs) are associated with increased morbidity, an economic burden on patients, their families and healthcare systems and increased mortality. Early diagnosis with prompt, appropriate and adequate treatment of the infected diabetic foot is crucial. The determination of DFIs, however, may be quite perplexing and invasive. Imaging is useful in the evaluation of certain cases of DFIs, especially in suspected instances with no overt clinical features, or in the diagnosis of osteomyelitis...
February 26, 2018: Current Pharmaceutical Design
Chiara Lauri, Andor W J M Glaudemans, Alberto Signore
BACKGROUND: Diagnosing diabetic foot infection is often difficult, despite several available diagnostic methods. Amongst these, several imaging modalities exist to evaluate the diabetic foot in case of a suspected osteomyelitis. Nuclear Medicine, in particular, offers a variety of radiopharmaceuticals and techniques. Nowadays the gold standard radionuclide procedure, when an osteomyelitis is suspected, is represented by the use of radiolabelled leukocytes with either 99mTc-HMPAO or 111In-oxine...
February 26, 2018: Current Pharmaceutical Design
Anna Polak, Cezary Kucio, Luther C Kloth, Malgorzata Paczula, Ewa Hordynska, Tomasz Ickowicz, Edward Blaszczak, Ewa Kucio, Krystian Oleszczyk, Krzysztof Ficek, Andrzej Franek
The use of electrical stimulation (ES) should be considered for treating nonhealing pressure ulcers (PUs), but optimal ES wound treatment protocols have yet to be established. A randomized, controlled, double-blind clinical study was conducted to evaluate the effects of cathodal and anodal high-voltage monophasic pulsed current (HVMPC) on periwound skin blood flow (PSBF) and size reduction of Stage 2 to Stage 4 PUs of at least 4 weeks' duration. Persons >18 years of age, hospitalized with neurological injuries, at high risk for PU development (Norton scale <14 points; Waterlow scale >15 points), and with at least 1 Stage 2 to Stage 4 PU were eligible to participate in the study...
February 2018: Ostomy/wound Management
Nese Saltoglu, Onder Ergonul, Necla Tulek, Mucahit Yemisen, Ayten Kadanali, Gul Karagoz, Ayse Batirel, Oznur Ak, Cagla Sonmezer, Haluk Eraksoy, Atahan Cagatay, Serkan Surme, Salih A Nemli, Tuna Demirdal, Omer Coskun, Derya Ozturk, Nurgul Ceran, Filiz Pehlivanoglu, Gonul Sengoz, Turan Aslan, Yasemin Akkoyunlu, Oral Oncul, Hakan Ay, Lutfiye Mulazımoglu, Buket Erturk, Fatma Yilmaz, Gulsen Yoruk, Nuray Uzun, Funda Simsek, Taner Yildirmak, Kadriye Kart Yaşar, Meral Sonmezoglu, Yasar Küçükardali, Nazan Tuna, Oguz Karabay, Nail Ozgunes, Fatma Sargın
OBJECTIVES: We described the clinical outcome of the diabetic patients who had foot infections with multidrug resistant organisms. METHODS: We included the patients with diabetic foot infections (DFI) from 19 centers, between May 2011 and December 2015. Infection was defined according to IDSA DFI guidelines. Patients with severe infection, complicated moderate infection were hospitalized. The patients were followed-up for 6 months after discharge. RESULTS: In total, 791 patients with DFI were included, 531(67%) was male, median age was 62 (19-90)...
February 21, 2018: International Journal of Infectious Diseases: IJID
Konstantinos Markakis, Alan Robert Faris, Hamed Sharaf, Barzo Faris, Sharon Rees, Frank L Bowling
Foot infections are common among diabetic patients with peripheral neuropathy and/or peripheral arterial disease, and it can be the pivotal event leading to a minor or major amputation of the lower extremity. Treatment of diabetic foot infections, especially deep-seated ones, remains challenging, in part because impaired blood perfusion and the presence of biofilms can impair the effectiveness of systemic antibiotics. The local application of antibiotics is an emerging field in the treatment of diabetic foot infections, with demonstrable advantages...
February 1, 2018: International Journal of Lower Extremity Wounds
Estelle Rougier, Antoine Braud, Xavier Argemi, Nicolas Lefebvre, Daniel Christmann, Yves Hansmann, Nawal Douiri
INTRODUCTION: Aerococccus urinae (AU) is a pathogen mainly identified in male urinary tract infections and responsible for bacteremia and endocarditis. To the best of our knowledge, there are only five patients with osteomyelitis due to AU described in the literature. All of them had urinary tract disease or systemic conditions such as diabetes, and two were associated with an endocarditis. CASE REPORT: We described the first case of isolated spondylodiscitis without general or local predisposing condition, excepted age > 65 years...
February 16, 2018: Infection
Karen L de Mesy Bentley, Ashlee MacDonald, Edward M Schwarz, Irvin Oh
CASE: A patient presenting with an infected diabetic foot ulcer and Staphylococcus aureus chronic osteomyelitis was studied to validate the clinical importance of bacterial colonization of osteocytic-canalicular networks, as we recently reported in a mouse model. We utilized transmission electron microscopy to describe the deformation of S. aureus, from round cocci to rod-shaped bacteria, in the submicron osteocytic-canalicular networks of amputated bone tissue. CONCLUSION: To our knowledge, this is the first evidence of S...
February 14, 2018: JBJS Case Connector
Rachel Khoo, Shirley Jansen
The diabetic heel ulcer (DHU) represents a reconstructive challenge to clinicians and the multidisciplinary team alike. It is traditionally viewed as a condition that is inherently difficult to treat due to the intrinsic anatomical vulnerabilities of the heel. In addition to this, several factors are associated with poorer end outcomes - namely, that of major amputation. These include peripheral vascular disease, infection/osteomyelitis and the size of the ulcer itself. In light of the significant morbidity, economic burden and mortality seen in this cohort of patients, this review aims to explore current treatment modalities that have been undertaken...
February 12, 2018: International Wound Journal
Anuradha Rao, Girish Gandikota
Metabolic perturbations in diabetes mellitus affect various organ systems and can lead to end-organ failure. Though most musculoskeletal (MSK) complications of diabetes mellitus are usually not life-threatening, they are often the cause of significant morbidity. While some of the MSK complications have a proven association with diabetes mellitus, others have been loosely associated because of their frequent coexistence, as are the rheumatologic complications. While many of these conditions are well-known, some are overlooked in routine clinical practice...
February 22, 2018: British Journal of Radiology
Xin-Xing Fan, Yang Shen, Wen-Long Xie
OBJECTIVE: To investigate the risk factors of wound complications after closed calcaneal fracture operation using a lateral extensive L-shaped incision and to explore the effective interventions to reduce the complications after incision. METHODS: Retrospective analysis of clinical data of 285 patients(315 calcaneal fractures) who underwent open reduction and internal fixation by using the lateral extensive L-shaped incision from January 2011 to January 2015. Eighteen factors which might cause the complications of calcaneal incision were compared by univariate analysis, and multiple Logistic regression analysis was performed for factors with statistically significances...
April 25, 2017: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
Martina Sollini, Chiara Lauri, Roberto Boni, Elena Lazzeri, Paola Anna Erba, Alberto Signore
There is an increased need to find non-invasive tools for early diagnosis and follow-up of infections. Nuclear medicine techniques may be used to diagnose, localize and evaluate the severity and the extent of infections before the occurrence of anatomical abnormalities. This review focuses on different approaches based on radiolabelled cells, peptides and antibodies or [18F]FDG to image infective diseases in agreement with what is being jointly evaluated by the European Association of Nuclear Medicine (EANM)...
January 9, 2018: Current Pharmaceutical Design
Katriina Heikkila, David C Mitchell, Ian M Loftus, Amundeep S Johal, Sam Waton, David A Cromwell
Background -The availability and diversity of lower limb revascularisation procedures have increased in England in the past decade. We investigated whether these developments in care have translated to improvements in patient pathways and outcomes. Methods -Individual-patient records from Hospital Episode Statistics (HES) were used to identify 103 934 patients who underwent endovascular (angioplasty) or surgical (endarterectomy, profundaplasty or bypass) lower limb revascularisation for infrainguinal peripheral artery disease (PAD) in England between January 2006 and December 2015...
January 9, 2018: Circulation
Cristiana M Toscano, Tatiana H Sugita, Michelle Q M Rosa, Hermelinda C Pedrosa, Roger Dos S Rosa, Luciana R Bahia
The aim of this study was to estimate the annual costs for the treatment of diabetic foot disease (DFD) in Brazil. We conducted a cost-of-illness study of DFD in 2014, while considering the Brazilian Public Healthcare System (SUS) perspective. Direct medical costs of outpatient management and inpatient care were considered. For outpatient costs, a panel of experts was convened from which utilization of healthcare services for the management of DFD was obtained. When considering the range of syndromes included in the DFD spectrum, we developed four well-defined hypothetical DFD cases: (1) peripheral neuropathy without ulcer, (2) non-infected foot ulcer, (3) infected foot ulcer, and (4) clinical management of amputated patients...
January 8, 2018: International Journal of Environmental Research and Public Health
Roger V Ortines, Haiyun Liu, Lily I Cheng, Taylor S Cohen, Heather Lawlor, Abhishek Gami, Yu Wang, Carly A Dillen, Nathan K Archer, Robert J Miller, Alyssa G Ashbaugh, Bret L Pinsker, Mark C Marchitto, Christine Tkaczyk, C Kendall Stover, Bret R Sellman, Lloyd S Miller
Staphylococcus aureus wound infections delay healing and result in invasive complications such as osteomyelitis, especially in the setting of diabetic foot ulcers. In preclinical animal models of S. aureus skin infection, antibody neutralization of α-toxin (AT), a S. aureus secreted pore-forming cytolytic toxin, reduces disease severity by inhibiting skin necrosis and restoring effective host immune responses. However, whether therapeutic neutralization of α-toxin is effective against S. aureus-infected wounds is unclear...
January 8, 2018: Antimicrobial Agents and Chemotherapy
Crystal L Ramanujam, David Han, Thomas Zgonis
The primary aim of our study was to compare the preoperative diagnostic accuracy of plain radiographic findings with the accuracy of magnetic resonance imaging (MRI) findings for diabetic foot osteomyelitis in hospitalized patients who underwent first-time partial foot amputations with confirmed histopathological specimens positive for osteomyelitis. Second, it was desired to determine whether certain variables within the initial clinical presentation and preoperative laboratory findings were associated with more accurate diagnosis of diabetic foot osteomyelitis in this study population...
December 1, 2017: Foot & Ankle Specialist
Efstathios Drampalos, Hasan Raza Mohammad, Chris Kosmidis, Moez Balal, Jason Wong, Anand Pillai
BACKGROUND: Chronic osteomyelitis necessities appropriate infected bone and soft tissue excision. The authors describe the Silo surgical technique for the treatment of calcaneal osteomyelitis using a new antibiotic-loaded absorbable calcium sulphate/hydroxyapatite biocomposite. METHODS: The Silo method involves debridement of the dead bone and local delivery of antibiotic in drilled tunnels using the biocomposite. It is combined with multiple sampling and culture-specific systemic antibiotic treatment guided by a multidisciplinary team...
November 23, 2017: Foot
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