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Diabetic major amputation

Petros Yiannoullou, Angela Summers, Shu C Goh, Catherine Fullwood, Hussein Khambalia, Zia Moinuddin, Iestyn M Shapey, Josephine Naish, Christopher Miller, Titus Augustine, Martin K Rutter, David van Dellen
OBJECTIVE: People with type 1 diabetes and kidney failure have an increased risk for major adverse cardiovascular events (MACE). Simultaneous pancreas and kidney transplantation (SPKT) improves survival, but the long-term risk for MACE is uncertain. RESEARCH DESIGN AND METHODS: We assessed the frequency and risk factors for MACE (defined as fatal cardiovascular disease and nonfatal myocardial infarction or stroke) and related nonfatal MACE to allograft failure in SPKT recipients with type 1 diabetes who underwent transplantation between 2001 and 2015 in the U...
February 14, 2019: Diabetes Care
H R Smith, C Conyard, J Loveridge, R Gunnarsson
BACKGROUND: Tooth knuckle injuries can be expensive to treat and may necessitate amputation in some cases. Several limitations exist in the literature regarding our knowledge around the factors predicting amputation and the need for multiple debridements in treating this injury. METHODS: A historic cohort study of 321 patients treated for tooth knuckle injuries was undertaken. Twenty-one demographic, clinical and laboratory variables were collected. Two outcome measurements were collected - the need for amputation and the need for more than one surgical debridement...
March 2019: Journal of Hand Surgery Asian-Pacific Volume
Ibrahim Al-Zakwani, Ekram Al-Siyabi, Najib Alrawahi, Arif AlMulla, Abdullah Alnaeemi, Abdulla Shehab, Mohammed Zubaid
OBJECTIVE: To evaluate the association between peripheral artery disease (PAD) and major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS) in the Arabian Gulf. METHODS: Data was analyzed from 4044 consecutive patients diagnosed with ACS admitted to 29 hospitals in four Arabian Gulf countries from January 2012 to January 2013. PAD was defined as any of the following: claudication, amputation for arterial vascular insufficiency, vascular reconstruction, bypass surgery, or percutaneous intervention in the extremities, documented aortic aneurysm or ankle brachial index of < 0...
February 10, 2019: Medical Principles and Practice: International Journal of the Kuwait University, Health Science Centre
Linda Wennberg, Sarah Widgren, Rimma Axelsson, Kurt Gerok-Andersson, Börje Åkerlund
AIM: To investigate at a national level the multidisciplinary team (MDT) care of patients with diabetes mellitus and foot complications. METHODS: A questionnaire was sent to all 75 Swedish hospitals with emergency departments, which were grouped according to size. RESULTS: The response rate was 92 %, 58/69 of the hospitals have a foot team. Most teams have access to an internal medicine specialist/diabetologist, podiatrist and orthotist. Fewer teams reported access to an orthopaedic surgeon and infectious diseases specialist and only half to a vascular surgeon...
February 7, 2019: Diabetes Research and Clinical Practice
Gaurav M Parmar, Zdenek Novak, Emily Spangler, Mark Patterson, Marc A Passman, Adam W Beck, Benjamin J Pearce
BACKGROUND: Statin use is recommended in all patients with peripheral arterial disease (PAD) owing to its morbidity and mortality benefits. However, the effect of statin use on limb salvage in patients with PAD after intervention is unclear. We examined the effect of statin use on limb salvage and survival among patients with PAD undergoing surgical or endovascular intervention. METHODS: A total of 488 patients with PAD were identified who underwent surgical (n = 297) or endovascular (n = 191) intervention between 2009 and 2010...
February 1, 2019: Journal of Vascular Surgery
Tze-Woei Tan, Chia-Ding Shih, Kirsten C Concha-Moore, Muhanad M Diri, Bo Hu, David Marrero, Wei Zhou, David G Armstrong
OBJECTIVE: The purpose of this study was to evaluate the disparities in the outcomes of White, African American (AA) and non-AA minority (Hispanics and Native Americans (NA)), patients admitted in the hospitals with diabetic foot infections (DFIs). RESEARCH DESIGN AND METHODS: The HCUP-Nationwide Inpatient Sample (2002 to 2015) was queried to identify patients who were admitted to the hospital for management of DFI using ICD-9 codes. Outcomes evaluated included minor and major amputations, open or endovascular revascularization, and hospital length of stay (LOS)...
2019: PloS One
Adolfo Andrade-Cetto, Elda Carola Cruz, Christian Alan Cabello-Hernández, René Cárdenas-Vázquez
Type 2 diabetes (T2D) is a major health problem worldwide. In this condition, the organism can produce insulin but becomes resistant to it; thus the insulin is ineffective. High blood glucose levels are a result of insulin resistance and insulin deficiency; they produce diabetes-associated complications such as kidney failure, blindness, cardiovascular disease, and lower-limb amputation. In Guatemala, there were over 752.700 cases of the disease in 2017 with prevalence of 8.4 (IDF, 2017). The use of plants for medicinal purposes has been practiced in the country since pre-Hispanic times...
2019: Evidence-based Complementary and Alternative Medicine: ECAM
Bridget Kool, Maybelline Ipil, Judith McCool
Diabetes Mellitus (DM) is the leading cause of morbidity and mortality in the Republic of the Marshall Islands (RMI), a small Pacific nation located in Micronesia (population 53,184). Although generally preventable, diabetic foot disease is among the most frequently reported complication of DM globally and in the RMI. Over 25% of people with DM globally will have at least one DM-related foot ulcer, which may require surgical intervention. The purpose of this study is to determine the incidence of DM-related foot surgeries at the Leroij Atama Zedkaia Majuro Hospital, the main tertiary referral centre for the RMI, and where 90% of all DM-related foot surgeries in the country are conducted...
January 2019: Hawai'i Journal of Medicine & Public Health: a Journal of Asia Pacific Medicine & Public Health
Tae-Yul Lee, Ki-Bum Kim, Seung-Kyu Han, Seong-Ho Jeong, Eun-Sang Dhong
BACKGROUND: Xerosis, defined as abnormal skin dryness and scaling, is a common disorder in patients with diabetes. The skin may crack and develop fissures, potentially allowing bacterial entry and increasing vulnerability to ulceration and infection. Therefore, maintaining adequate skin hydration may be crucial for diabetic wound healing. However, no clinical study has addressed this issue. This study aimed to determine and compare the effect of the skin hydration level on diabetic wound healing with that of the tissue oxygenation level, which is recognized as the most reliable parameter in predicting diabetic wound healing...
January 21, 2019: Plastic and Reconstructive Surgery
Gem Kennedy, K McGarry, G Bradley, D W Harkin
Background: Major lower limb amputation remains a common treatment for patients with peripheral vascular disease (PVD) in whom other measures have failed. It has been associated with high morbidity and mortality, including risks from venous thromboembolism (VTE). Methods: A two-year retrospective cohort study was conducted involving 79 patients who underwent major lower limb amputation (below- or above-knee amputation) between January 2014 and December 2015 in a single tertiary referral centre...
January 2019: Ulster Medical Journal
Se-Young Kim, Tae Hoon Kim, Jun-Young Choi, Yu-Jin Kwon, Dong Hui Choi, Ki Chun Kim, Min Ji Kim, Ho Kyung Hwang, Kyung-Bok Lee
Purpose: Diabetic foot wound (DFW) is known as a major contributor of nontraumatic lower extremity amputation. We aimed to evaluate overall amputation rates and risk factors for amputation in patients with DFW. Materials and Methods: From January 2014 to December 2017, 141 patients with DFW were enrolled. We determined rates and risk factors of major amputation in DFW and in DFW with peripheral arterial occlusive disease (PAOD). In addition, we investigated rates and predictors for amputation in diabetic foot ulcer (DFU)...
December 2018: Vascular Specialist International
Abdulrahman Ibrahim Mufti Alsadiqi, Ahmed Hussein Subki, Rami Hussam Abushanab, Mohammed Rashid Ocheltree, Hattan Ahmed Bajahmom, Yosef Ibrahim Mufti Alsadiqi, Wesam Awad Alhejily
Background: Peripheral artery disease (PAD) is a major health problem in Saudi Arabia with considerable implications for morbidity and mortality. Many risk factors have been established for developing PAD, but the prevalence of these risk factors is variable from one country to another. Aim: To identify the risk factors for PAD and study their prevalence in Jeddah, Saudi Arabia. Methods: A retrospective chart review study was conducted in a tertiary center in Jeddah from July 2012 to September 2015...
2019: International Journal of General Medicine
Reiner A Wimmer, Alexandra Leopoldi, Martin Aichinger, Nikolaus Wick, Brigitte Hantusch, Maria Novatchkova, Jasmin Taubenschmid, Monika Hämmerle, Christopher Esk, Joshua A Bagley, Dominik Lindenhofer, Guibin Chen, Manfred Boehm, Chukwuma A Agu, Fengtang Yang, Beiyuan Fu, Johannes Zuber, Juergen A Knoblich, Dontscho Kerjaschki, Josef M Penninger
The increasing prevalence of diabetes has resulted in a global epidemic1 . Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and amputation of lower limbs. These are often caused by changes in blood vessels, such as the expansion of the basement membrane and a loss of vascular cells2-4 . Diabetes also impairs the functions of endothelial cells5 and disturbs the communication between endothelial cells and pericytes6 . How dysfunction of endothelial cells and/or pericytes leads to diabetic vasculopathy remains largely unknown...
January 16, 2019: Nature
Rodrigo Bruno Biagioni, George Dias Brandão, Luisa Ciucci Biagioni, Felipe Nasser, Marcelo Calil Burihan, José Carlos Ingrund
OBJECTIVE: The outcomes of endovascular treatment of femoropopliteal atherosclerotic lesions have been improving recently. Although open repair is indicated for class D femoropopliteal lesions based on the TransAtlantic Inter-Society Consensus II (TASC II) document, in some cases, it is reasonable to use the endovascular approach for these lesions. The aim of this study was to retrospectively analyze the technical aspects and outcomes of treating TASC II D femoropopliteal disease with endovascular approaches...
January 2, 2019: Journal of Vascular Surgery
Philip Home
Three further cardiovascular (CV) outcome studies of glucose-lowering drugs (linagliptin, albiglutide and dapagliflozin) have recently been published, adding to the twelve earlier within-class studies. The linagliptin study (CARMELINA) recruited people with renal disease as well as prior CV events and confirms the overall CV safety (and other safety) of the dipeptidylpeptidase-4 (DPP4) inhibitors, with no heart failure risk associated with this agent. However, taken together with the findings from two previous studies of DPP4 inhibitors (sitagliptin and saxagliptin), the three DPP4 inhibitor CV outcome trials (CVOTs) have highlighted a safety signal regarding risk of pancreatitis...
January 3, 2019: Diabetologia
Tea Nguyen, Edgardo R Rodriguez-Collazo
The purpose of this study was to demonstrate use of a distally based peroneus brevis muscle flap in high-risk patients with diabetes and peripheral vascular disease for limb salvage of nonhealing heel ulcerations. Seventeen patients were referred for a below-knee amputation because of nonhealing heel ulcerations and peripheral vascular disease. As a last resort, 17 distally based peroneus brevis muscle flaps were elevated in 17 patients with full-thickness heel ulcerations measuring an average defect size of 14...
December 21, 2018: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Abhisekh Mohapatra, Aureline Boitet, Othman Malak, Jon C Henry, Efthimios D Avgerinos, Michel S Makaroun, Eric S Hager, Rabih A Chaer
OBJECTIVE: The peroneal artery is a well-established target for bypass in patients with critical limb ischemia (CLI). The objective of this study was to evaluate the outcomes of peroneal artery revascularization in terms of wound healing and limb salvage in patients with CLI. METHODS: Patients presenting between 2006 and 2013 with CLI (Rutherford 4-6) and isolated peroneal runoff were included in the study. They were divided into patients who underwent bypass to the peroneal artery and those who underwent endovascular peroneal artery intervention...
January 2019: Journal of Vascular Surgery
Anand Dayama, Nikolaos Tsilimparis, Stephen Kolakowski, Nathaniel M Matolo, Misty D Humphries
BACKGROUND: Chronic limb-threatening ischemia (CLTI), defined as ischemic rest pain or tissue loss secondary to arterial insufficiency, is caused by multilevel arterial disease with frequent, severe infrageniculate disease. The rise in CLTI is in part the result of increasing worldwide prevalence of diabetes, renal insufficiency, and advanced aging of the population. The aim of this study was to compare a bypass-first with an endovascular-first revascularization strategy in patients with CLTI due to infrageniculate arterial disease...
January 2019: Journal of Vascular Surgery
Tasmania Del Pino-Sedeño, María M Trujillo-Martín, Isabel Andia, Javier Aragón-Sánchez, Estefanía Herrera-Ramos, Francisco J Iruzubieta Barragán, Pedro Serrano-Aguilar
Foot ulcer is a major complication of diabetes mellitus and often precedes leg amputation. Among the different methods to achieve ulcer healing, the use of platelet-rich plasma, which is rich in multiple growth factors and cytokines and may have similarities to the natural wound healing process, is gaining in popularity. A systematic review with meta-analyses was performed to evaluate the safety and clinical effectiveness of platelet-rich plasma for the treatment of diabetic foot ulcers compared to standard treatment or any other alternative therapy...
December 21, 2018: Wound Repair and Regeneration
Nicolas W Shammas, Pradeep Chandra, Marianne Brodmann, Barry Weinstock, Gino Sedillo, Ian Cawich, Antonio Micari, Arthur Lee, Chris Metzger, Luis Mariano Palena, John Rundback
BACKGROUND: B-Laser™ is a novel atherectomy device that uses a solid-state third harmonic pulsed Nd:YAG laser with an output of 355 nm. Early data showed that the B-Laser™ is safe in treating a broad range of infrainguinal arterial lesions. We present the results of the EX-PAD-03 U.S. pivotal trial of the EXIMO B-Laser™. METHODS: EX-PAD-03 is a prospective, single-arm, multi-center, international, open-label, clinical study. The study enrolled patients in the United States and Europe...
November 29, 2018: Cardiovascular Revascularization Medicine: Including Molecular Interventions
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