高压氧治疗糖尿病足的临床疗效

目的　观察高压氧对糖尿病足的治疗作用。方法　将 36例确诊为糖尿病足的患者随机均分为常规治疗组和高压氧治疗组 ,结合血液流变学、下肢血管多普勒、肌电图检测评价疗效。结果　高压氧治疗后 ,血液粘度显著降低 (P <0 .0 1 ) ;肢体彩色多普勒超声显像显示 ,下肢血管血流明显加快 (P <0 .0 1 ) ;神经电生理异常均有不同程度改善 ;足部症状明显缓解。结论　高压氧治疗糖尿病足 ,有助于糖尿病足尽早康复 ,对提高患者生活质量有积极作用     

Factors influencing the outcome of treatment of foot lesions in Nigerian patients with diabetes mellitus

A prospective cross-sectional study of 84 foot lesions in 50 diabetic patients was done in a Nigerian teaching hospital over a three-year period (1982-1984) to assess factors that may influence the choice of treatment and treatment outcome. Age, gender, duration of diabetes, mode of treatment of diabetes and tobacco smoking did not influence whether or not a diabetic with a foot lesion will have major amputation, an unsatisfactory outcome of primary treatment, prolonged hospital stay or will die. Similarly, the presence of foot infections alone, microangiopathy (nephropathy, retinopathy), foot ischaemia alone or neuropathy alone had no relationship to poor prognostic indices. However, when these complications appeared in concert (neuropathy, ischaemia and infection) and when, at presentation, there was associated systemic disease (as shown by anaemia and leucocytosis), severe fasting hyperglycaemia, evident bone destruction and anaerobic superinfection, the outcome of treatment was adverse. In addition, hypertension and infection of the foot were related to need for major amputation. Poor long-term control did not influence prognosis adversely. We therefore suggest that the high morbidity seen with diabetic foot lesions could be reduced by optimizing glycaemic control, using combination antibiotic chemotherapy, vigorously correcting anaemia and encouraging early presentation of even mild lesions before underlying bone disease supervenes.     

早期高压氧治疗对急性创伤性脊髓损伤患者疗效的影响

【目的】探讨早期高压氧（HBO）治疗对急性创伤性脊髓损伤（SCI）患者疗效的影响。【方法】将86例急性脊髓损伤患者随机分为早期HBO组（A组）28例、晚期HBO组（B组）32例及对照组（C组）26例。C组采取常规处理（包括脱水剂、皮质激素、神经营养药物、胃黏膜保护药物、康复训练、针灸以及对症支持治疗等）,A组患者在此基础上于SCI发生12h以内辅以HBO治疗,B组患者在此基础上于SCI发生3d以后辅以HB0治疗,于治疗前及治疗3个月后分别采用美国脊髓损伤协会（ASIA）评分、改良Barthel指数（MBI）及功能独立性评定量表（FIM）对患者进行测评。【结果】三组患者ASIA感觉、运动功能评分及MBI、FIM分值均较治疗前显著改善（P〈0．01）,组间治疗后ASIA感觉功能评分比较有显著差异（P〈0．01）,治疗后ASIA运动功能评分比较有显著差异（P〈0．05）。治疗后各组间MBI及FIM分值比较有显著性差异（P〈0．01）。【结论】HBO能显著改善急性SCI患者脊髓功能、日常生活活动能力及独立能力,且越早开始治疗效果越好。     

Therapieoptionen der schmerzhaften diabetischen Polyneuropathie

Distal symmetrical polyneuropathy is the most frequent manifestation of diabetic neuropathy and crucially contributes to the development of diabetic foot and subsequent amputation in 70 to 80% of all cases. In 10 to 15% of affected patients considerable pain is present, in particular in early diabetic polyneuropathy. This review summarizes evidence based data on prevention, neuroregenerative, and symptomatic treatment of painful diabetic polyneuropathy. The most important clinical trials on treatment and prevention are presented. Conclusions from these clinical studies in particular detailed treatment recommendations including dosage and side effects are given. Combined treatments and escalating therapies for severe pain syndromes are discussed.     

不同时间窗高压氧治疗对脊髓损伤患者疗效的影响

目的 观察不同时间窗高压氧治疗对脊髓损伤(SCI)患者疗效的影响.方法 共选取284例SCI患者,将其随机分为高压氧治疗组(HBO组)及对照组.2组均给予常规处理(包括脱水剂、神经营养药物、康复训练、针灸以及对症支持治疗等),HBO组患者在此基础上于不同时间窗(SCI发生8 h以内、8 h～1 d、1 d～1周、1周以上)分别辅以HBO治疗.于治疗前、治疗3个月后分别采用美国脊髓损伤协会(ASIA)评分及Barthel指数对患者脊髓功能及日常生活活动(ADL)能力进行评定.结果 在SCI发生8 h内开始治疗,2组患者脊髓感觉、运动功能及ADL能力均较治疗前显著改善(P＜0.01),2组间疗效差异无统计学意义(P＞0.05);在SCI发病24 h内或1周内开始治疗,2组患者脊髓功能、ADL能力亦较治疗前获得一定程度改善(P＜0.05),但均明显不及发病8 h内开始治疗的患者(P＜0.05);且此时HBO组疗效显著优于对照组(P＜0.05);在SCI发病1周后开始治疗,发现2组患者脊髓功能及ADL能力均无明显改善(P＞0.05).结论 于SCI发病早期(＜8 h)辅以HBO治疗,能显著改善患者脊髓功能及ADL能力,其疗效明显优于其它时间窗治疗.     

Brown Recluse Spider Envenomation: A Prospective Trial of Hyperbaric Oxygen Therapy

Objectives : Loxosceles reclusa (brown recluse) spider bites can produce severe skin lesions that may necessitate extensive surgical repair. This study delineated the effects of hyperbaric oxygen (HBO) therapy on these lesions by performing a prospective controlled animal study. Methods : After approval by the Institutional Animal Care and Use Committee, 41 New Zealand white rabbits received 64 intradermal injections of 73 μL of raw venom extract mixed with physiologic buffered saline (Dulbecco's solution). Control injections were made with buffer. The animals were divided into 5 groups: 1) venom and no HBO; 2) venom and 1 immediate HBO treatment (100% O₂); 3) venom and immediate HBO with 10 treatments (100% O₂); 4) venom and then delayed (48 hr) HBO therapy with 10 treatments (100% O₂); and 5) venom and immediate hyperbaric treatment with normal inspired Po₂ for 10 treatments (8.4% O₂). Three animals in group 2 also received a control sodium citrate buffer injection. HBO treatments were at 2.5 atm absolute (ATA) for 90 minutes twice daily. Daily measurements were made of the lesion diameter, and skin blood flow using a laser Doppler probe. Results : There was no significant effect of HBO on blood flow at the wound center or 1–2 cm from the wound center. Standard HBO significantly decreased wound diameter at 10 days (p < 0.0001; ANOVA), whereas hyperbaric treatment with normoxic gas had no effect. Histologic preparations from 2 animals in each group revealed that there were more polymorphonuclear leukocytes in the dermis of all the HBO-treated animals when compared with the venom-alone and sodium-citrate controls. Conclusion : HBO treatment within 48 hours of a simulated bite from L. reclusa reduces skin necrosis and results in a significantly smaller wound in this model. The mechanism appears unrelated to augmented local blood flow between treatments.     

不同时间窗高压氧治疗对脊髓损伤患者疗效的影响

目的 观察不同时间窗高压氧治疗对脊髓损伤(SCI)患者疗效的影响.方法 共选取284例SCI患者,将其随机分为高压氧治疗组(HBO组)及对照组.2组均给予常规处理(包括脱水剂、神经营养药物、康复训练、针灸以及对症支持治疗等),HBO组患者在此基础上于不同时间窗(SCI发生8 h以内、8 h～1 d、1 d～1周、1周以上)分别辅以HBO治疗.于治疗前、治疗3个月后分别采用美国脊髓损伤协会(ASIA)评分及Barthel指数对患者脊髓功能及日常生活活动(ADL)能力进行评定.结果 在SCI发生8 h内开始治疗,2组患者脊髓感觉、运动功能及ADL能力均较治疗前显著改善(P＜0.01),2组间疗效差异无统计学意义(P＞0.05);在SCI发病24 h内或1周内开始治疗,2组患者脊髓功能、ADL能力亦较治疗前获得一定程度改善(P＜0.05),但均明显不及发病8 h内开始治疗的患者(P＜0.05);且此时HBO组疗效显著优于对照组(P＜0.05);在SCI发病1周后开始治疗,发现2组患者脊髓功能及ADL能力均无明显改善(P＞0.05).结论 于SCI发病早期(＜8 h)辅以HBO治疗,能显著改善患者脊髓功能及ADL能力,其疗效明显优于其它时间窗治疗.     

Hyperbaric oxygenation accelerates the healing rate of nonischemic chronic diabetic foot ulcers: a prospective randomized study

OBJECTIVE: To study the effect of systemic hyperbaric oxygenation (HBO) therapy on the healing course of nonischemic chronic diabetic foot ulcers. RESEARCH DESIGN AND METHODS: From 1999 to 2000, 28 patients (average age 60.2 +/- 9.7 years, diabetes duration 18.2 +/- 6.6 years), of whom 87% had type 2 diabetes, demonstrating chronic Wagner grades I-III foot ulcers without clinical symptoms of arteriopathy, were studied. They were randomized to undergo HBO because their ulcers did not improve over 3 months of full standard treatment. All the patients demonstrated signs of neuropathy. HBO was applied twice a day, 5 days a week for 2 weeks; each session lasted 90 min at 2.5 ATA (absolute temperature air). The main parameter studied was the size of the foot ulcer measured on tracing graphs with a computer. It was evaluated before HBO and at day 15 and 30 after the baseline. RESULTS: HBO was well tolerated in all but one patient (barotraumatic otitis). The transcutaneous oxygen pressure (TcPO(2)) measured on the dorsum of the feet of the patients was 45.6 +/- 18.1 mmHg (room air). During HBO, the TcPO(2) measured around the ulcer increased significantly from 21.9 +/- 12.1 to 454.2 +/- 128.1 mmHg (P < 0.001). At day 15 (i.e., after completion of HBO), the size of ulcers decreased significantly in the HBO group (41.8 +/- 25.5 vs. 21.7 +/- 16.9% in the control group [P = 0.037]). Such a difference could no longer be observed at day 30 (48.1 +/- 30.3 vs. 41.7 +/- 27.3%). Four weeks later, complete healing was observed in two patients having undergone HBO and none in the control group. CONCLUSIONS: In addition to standard multidisciplinary management, HBO doubles the mean healing rate of nonischemic chronic foot ulcers in selected diabetic patients. The time dependence of the effect of HBO warrants further investigations.     

高压氧辅助治疗鼻咽癌放射治疗致放射性脑病的临床研究

目的探讨高压氧对放射治疗（放疗）所致放射性脑病的鼻咽癌患者的治疗价值。方法将47例因放疗导致放射性脑病的鼻咽癌患者分为高压氧（HBO）治疗组和对照组，HBO治疗组采用药物＋高压氧治疗，对照组采用单纯药物治疗。治疗前、后比较2组患者的临床症状、病灶体积和日常生活活动（ADL）能力，并采用Х^2检验和t检验进行统计学分析。结果HBO治疗组临床总有效率达70．0％，而对照组为35．3％，2组比较差异有统计学意义（P〈0．01）。治疗后，HBO治疗组病灶体积较治疗前明显缩小（P〈0．01）；2组治疗后病灶体积比较，HBO治疗组明显小于对照组（P〈0．05）。2组治疗前、后ADL能力比较，差异均有统计学意义（P〈0．05）。结论高压氧结合药物是治疗鼻咽癌放射治疗所致放射性脑病行之有效的手段之一。     

高压氧对脑挫裂伤患者认知功能和日常生活活动能力的影响

[目的]探讨高压氧(HBO)治疗对脑挫裂伤患者认知功能和日常生活活动能力(ADL)的影响.[方法]96例脑挫裂伤患者随机分为对照组和观察组各48例.两组患者均接受常规治疗,治疗组在此基础上接受HBO治疗.治疗前及3个月后分别使用蒙特利尔评估量表(MoCA)和Barthel指数对两组患者进行认知功能和日常生活活动能力评定.[结果]治疗前两组患者MoCA及Barthel指数分值比较无显著性差异( P ＞0.05),治疗3个月后观察组MoCA及Barthel指数分值均增加,与治疗前和对照组同期比较均有显著差异( P <0.01或 P <0.05).[结论]HBO能有效改善脑挫裂伤患者的认知功能,提高ADL.     

高压氧对糖尿病患者周围神经传导速度的影响

目的观察高压氧(HBO)对糖尿病患者周围神经传导速度(NCV)的影响。方法糖尿病患者112例分为2组,对照组56例采用糖尿病饮食、降血糖、能量合剂、促代谢药物等治疗,HBO组56例在上述治疗的基础上加用HBO治疗。采用多人高压氧舱,在舱内停留100min,压力0.25MPa,戴面罩吸入纯氧60min,中间休息10min,每日1次,10d为1个疗程,共4个疗程,疗程间隔4～6d。分别于治疗前、治疗2个月后测定正中神经、尺神经、腓总神经、腓肠神经的NCV并进行比较。结果治疗后HBO组各运动神经传导速度(MNCV)、正中神经感觉神经传导速度(SNCV)显著加快(P＜0.01);对照组仅正中神经MNCV显著加快(P＜0.01),组间比较差异有显著性。HBO治疗后无周围神经症状者NCV均显著加快(P＜0.01或0.05);有周围神经症状者仅正中神经MNCV和SNCV、腓总神经、尺神经MNCV显著加快(P＜0.01或0.05)。结论HBO能有效地改善糖尿病患者的NCV,治疗越早,改善越显著。     

Can diabetic neuropathy be prevented by angiotensin-converting enzyme inhibitors?

The incidence of diabetes and its complications is increasing to staggering proportions. Presently the WHO estimates an overall prevalence of 130 million, but by 2025 there will be 300 million individuals with diabetes mellitus. The incidence of diabetic neuropathy approaches 50% in most diabetic populations; there is no treatment, and its consequences in the form of foot ulceration and amputation are financially punishing for health care providers. Attempts to develop treatments have faltered for want of an understanding of the aetiology of diabetic neuropathy. As a consequence, 1999 saw the demise of two further compounds: recombinant growth factor by Roche-Genentech and the aldose reductase inhibitor zopolrestat, by Pfizer, both had reached phase III clinical trials. They joined an impressive list of at least 30 other compounds which have reached phase III clinical trials and failed to establish efficacy. The need to establish a viable treatment for human diabetic neuropathy is absolutely paramount. To provide a rational answer as to whether angiotensin-converting enzyme (ACE) inhibitors can prevent human diabetic neuropathy, two major issues need addressing: 1) Does vascular dysfunction cause human diabetic neuropathy? 2) Can ACE inhibitors ameliorate diabetic vascular dysfunction and hence neuropathy? Epidemiological studies support a strong association between neuropathy, retinopathy and nephropathy. Microangiopathy is deemed as the root cause of both nephropathy, and retinopathy and mounting evidence provides support for a vascular basis of diabetic neuropathy. ACE inhibitors appear to correct many of the abnormalities associated with the vascular dysfunction found in diabetes. Thus effective ACE inhibition impacts very positively on cardiovascular outcomes in patients with ischaemic heart disease, particularly in diabetic patients. ACE inhibition also prevents the development and progression of incipient and established diabetic nephropathy and delays progression of background retinopathy. Quinapril improves measures of diabetic autonomic neuropathy. Our recent study has demonstrated a significant improvement in peripheral neuropathy following 12 months of treatment with the ACE inhibitor trandolapril.     

高压氧治疗糖尿病足的临床价值分析

目的探讨高压氧对糖尿病足的治疗价值。方法糖尿病足患者58例,高压氧组(HBO)31例,药物治疗基础上加高压氧治疗1 h/d,共30 d;对照组27例,给予传统药物治疗。观察两组患者治疗前及治疗2个月后患者超敏C反应蛋白(hs-CRP)、纤维蛋白原(FIB)、下肢血流峰值的变化,并且判断两组治疗2个月后疗效。结果两组患者治疗前,超敏C反应蛋白、纤维蛋白原、下肢血流速度差异均无显著性(P>0.05);治疗2个月后,HBO组患者超敏C反应蛋白、纤维蛋白原均低于治疗前及对照组治疗后(P<0.01),下肢动脉血流速度高于治疗前及对照组治疗后(P<0.01)。治疗2个月后,对照组总有效率为70.37%(19/27),高压氧组总有效率为83.87%(26/31),两组比较差异有统计学意义(P<0.01)。结论高压氧组对糖尿病足的治疗效果明显优于单用药物治疗,是一种安全有效的治疗方法。     

脐血单个核细胞移植治疗糖尿病足23例

背景:以自体骨髓、外周血间充质干细胞移植治疗糖尿病足,对缺血性病变及周围神经损伤所致临床症状有改善作用。目的:观察脐血单个核细胞移植治疗糖尿病足病缺血及神经损伤的疗效。对象:选取2006/2010住院行脐血单个核细胞移植治疗的糖尿病足病患者23例,脐血单个核细胞稀释后双下肢肌肉内注射,每点1~3mL,间隔约3cm。单个肢体移植1.23×108~1.06×109个,共计38条肢体。结果与结论:移植后踝肱指数升降不一,移植后6个月疼痛评分及冷感评分明显改善,间歇性跛行及皮肤温度、经皮氧分压治疗后3,6个月比较差异均有显著性意义;对神经病变损伤自觉症状评分、临床检查评分、振动觉阀值移植后6个月与移植前比较差异有显著性意义。腓浅神经、胫神经感觉神经传导速度,腓总神经、胫神经运动神经传导速度,在移植后3个月与移植前比较,差异无显著性意义(P>0.05),移植6个月与移植前相比较有升高,差异有显著性意义(P<0.05)。可见脐血单个核细胞可以改善糖尿病缺血性病变及周围神经病变的临床症状及客观指标。     

Factors Influencing the Outcome of Treatment of Foot Lesions in Nigerian Patients with Diabetes Mellitus

A prospective cross-sectional study of 84 foot lesions in 50diabetic patients was done in a Nigerian teaching hospital overa three-year period (1982–1984) to assess factors thatmay influence the choice of treatment and treatment outcome.Age, gender, duration of diabetes, mode of treatment of diabetesand tobacco smoking did not influence whether or not a diabeticwith a foot lesion will have major amputation, an unsatisfactoryoutcome of primary treatment, prolonged hospital stay or willdie. Similarly, the presence of foot Infections alone, microangiopathy(nephropathy, retinopathy), foot ischaemla alone or neuropathyalone had no relationship to poor prognostic indices. However,when these complications appeared in concert (neuropatby, ischaemiaand infection) and when, at presentation, there was associatedsystemic disease (as shown by anaemia and leucocytosis), severefasting hyperglycaemia, evident bone destruction and anaerobicsuperinfection, the outcome of treatment was adverse. In addition,hypertension and infection of the foot were related to needfor major amputation. Poor long- term control did not influenceprognosis adversely. We therefore suggest that the high morbidityseen with diabetic foot lesions could be reduced by optimizingglycaemic control, using combination antibiotic chemotherapy,vigorously correcting anaemia and encouraging early presentationof even mild lesions before underlying bone disease supervenes.     

Fundamentals of hyperbaric oxygen therapy.

Hyperbaric oxygen therapy (HBO) is an adjunctive treatment used for wound healing. HBO treatments are given by increasing the atmospheric pressure in a chamber while the patient is breathing 100% oxygen. Many orthopaedic disease entities can benefit from HBO therapy. For the orthopaedic nurse to recognize potential HBO patients, a basic understanding of HBO therapy is necessary. Knowledge of diseases that can be treated with HBO, the side effects of HBO, and educating a patient for HBO therapy are all important aspects of hyperbaric therapy.     

Enhancement of glucose toxicity by hyperbaric oxygen exposure in diabetic rats

The side effects of hyperbaric oxygen (HBO) treatment, such as oxidative stress and oxygen toxicity, have long been of interest. However, there are no comprehensive studies evaluating such toxic effects in diabetes mellitus (DM). The purpose of this study was to determine the effects of HBO on glucose homeostasis and histological changes in pancreatic beta-cells of experimentally induced diabetic rats. A total of 24 male Wistar rats were randomly divided into 4 groups: 1) Control group, no diabetic induction without HBO treatment; 2) HBO group, exposed to 100% oxygen at 2.8 ATA (atmosphere absolute) for 2 h once daily, for 7 days; 3) DM group, diabetes induced by streptozotocin (STZ) injection; and 4) DM + HBO group, received both STZ injection and HBO exposure. HBO treatment, with clinically recommended pressures and duration of therapy, was started on day 5 after STZ injection, when the blood glucose levels were significantly increased. After the last HBO treatment, the pancreatic tissues were immunostained to measure the areas of insulin immunoreactive beta-cells in the islets of Langerhans. The blood glucose increased significantly following exposure to HBO, with the highest levels achieved in rats, which had been treated with both HBO and diabetic induction. The area populated with insulin immunoreactive beta-cells decreased significantly following diabetic induction and/or HBO exposure, with the smallest area in DM + HBO group. Thus, HBO exposure enhanced the cytotoxic effect of STZ in the beta-cells of the pancreas. HBO should be cautiously employed in diabetic patients.     

脐血单个核细胞移植治疗糖尿病足23例

背景：以自体骨髓、外周血间充质干细胞移植治疗糖尿病足,对缺血性病变及周围神经损伤所致临床症状有改善作用。目的：观察脐血单个核细胞移植治疗糖尿病足病缺血及神经损伤的疗效。对象：选取2006/2010住院行脐血单个核细胞移植治疗的糖尿病足病患者23例,脐血单个核细胞稀释后双下肢肌肉内注射,每点1~3mL,间隔约3cm。单个肢体移植1.23×108~1.06×109个,共计38条肢体。结果与结论：移植后踝肱指数升降不一,移植后6个月疼痛评分及冷感评分明显改善,间歇性跛行及皮肤温度、经皮氧分压治疗后3,6个月比较差异均有显著性意义;对神经病变损伤自觉症状评分、临床检查评分、振动觉阀值移植后6个月与移植前比较差异有显著性意义。腓浅神经、胫神经感觉神经传导速度,腓总神经、胫神经运动神经传导速度,在移植后3个月与移植前比较,差异无显著性意义（P〉0.05）,移植6个月与移植前相比较有升高,差异有显著性意义（P〈0.05）。可见脐血单个核细胞可以改善糖尿病缺血性病变及周围神经病变的临床症状及客观指标。     

高压氧治疗对阿尔茨海默病患者认知功能及血清Humanin水平的影响

目的探讨高压氧(HBO)治疗对阿尔茨海默病(AD)患者认知功能及血清Humanin水平的影响。 方法选取2015年6月至2017年6月在泰安市中心医院神经内科住院的轻中度AD患者,共72例,采用随机数字表法随机分为对照组和HBO治疗组,每组各36例。对照组给予常规治疗,HBO治疗组在对照组的基础上给予HBO治疗,两组疗程均为2个月。比较两组患者治疗前后简易精神量表(MMSE)评分、蒙特利尔认知量表(MoCA)评分及血清Humanin水平变化情况。 结果治疗前,对照组MMSE评分、MoCA评分及血清Humanin水平分别为(15.35±2.12)分,(17.08±2.73)分,(147.2±39.6)ng/L;HBO治疗组MMSE评分、MoCA评分及血清Humanin水平分别为(15.29±2.43)分,(17.16±2.61)分,(141.8±41.3)ng/L,两组比较均差异无统计学意义(t＝0.11, －0.13, 0.57;均P>0.05);治疗2个月后,对照组MMSE评分、MoCA评分及血清Humanin水平分别为(18.57±3.59)分,(20.46±3.07)分,(180.9±48.1)ng/L,低于HBO治疗组[(20.68±2.97)分,(22.74±3.28)分,(216.5±52.9)ng/L],差异具有统计学意义(t＝－2.72, －3.05, －2.99;均P<0.01);血清Humanin水平与MMSE评分、MoCA评分均呈正相关(r＝0.628,0.691;均P<0.05)。 结论HBO可改善AD患者的认知功能,其作用机制可能与升高血清Humanin的水平有关。     

A foot care program for diabetic unilateral lower-limb amputees

OBJECTIVE: To assess the efficacy of a specialist foot care program designed to prevent a second amputation and to assess peripheral vascular disease (PVD) and peripheral neuropathy in diabetic unilateral lower-limb amputees. RESEARCH DESIGN AND METHODS: Investigations were carried out in 143 diabetic lower-limb unilateral amputees referred to a subregional rehabilitation center for prosthetic care from a catchment area of approximately 3 million people. Peripheral vascular and nerve assessment, education, and podiatry were provided for each patient. RESULTS: For the patients referred to the foot care program, there were no baseline differences between the patients who proceeded to a bilateral amputation (n = 22) and those who remained as unilateral amputees (n = 121) in their level of foot care knowledge and mean neuropathy scores. Mean ankle-brachial pressure index was significantly lower for the bilateral amputees (0.75 +/- 0.04) compared with the unilateral amputees (0.90 +/- 0.03, mean +/- SEM, P < 0.05), but there was no difference in the level of oxygen in the skin. However, the level of carbon dioxide was significantly lower in patients with bilateral amputation (24.21 +/- 2.16 vs. 31.20 +/- 0.85 mmHg, P < 0.03). Overall, the establishment of a specialist foot care program made no impact on contralateral limb amputation (22 of 143, 15.4%) compared with matched patients without the program (21 of 148, 14%) over a 2-year outcome period for each patient. CONCLUSIONS: PVD is more closely associated with diabetic bilateral amputation than neuropathy or level of foot care knowledge. Preventative foot care programs for diabetic unilateral amputees should therefore place greater emphasis on peripheral vascular assessment to identify patients at risk and on the development of timely intervention strategies.