糖尿病足的临床治疗体会

目的 探讨糖尿病足的治疗方法,提高糖尿病足的诊治水平,降低病死率及致残率.方法 30例糖尿病足患者给予糖尿病饮食,严格控制血糖,全身应用扩血管改善微循环药物及抗生素,局部清创换药手术植皮的综合治疗,并分析其临床疗效,总结治疗方法.结果 30例患者经系统治疗后,痊愈28例(93.3%),好转1例(3.3%),截肢1例(3.3%).结论 糖尿病足病情复杂,结合降糖、改善微循环、抗感染、局部创面清创换药处理(皮肤缺损大者手术植皮)为一体进行综合治疗有较好的疗效.     

The diabetic foot.

Modern thought regarding the pathogenesis, clinical features and management of the 'diabetic foot' is reviewed. The interplay of the triad of ischaemia, neuropathy and infection is emphasized throughout. Management is directed at maintaining or providing a pain-free, working foot.     

83例糖尿病足患者护理体会

目的:探讨糖尿病足患者的护理方法、特点。方法:回顾性分析我院内分泌科2009年8月～2011年8月收治的83例糖尿病足患者的临床资料和护理措施。结果:本组83例患者经临床治疗及护理后,痊愈64例(77.1%),好转12例(14.5%),总有效率(91.6%)。结论:对糖尿病足患者进行针对性治疗与护理相结合,可以减轻患者痛苦,有效减少了截肢的发生,对糖尿病足的防治具有重要意义。     

The diabetic foot

Lower extremity complications are common in patients with diabetes and include neuropathy, ulceration, infection, and peripheral arterial disease. Foot infections represent the single most common cause of hospitalization and lower extremity amputation in persons with diabetes. Foot ulceration as a result of diabetic peripheral sensory neuropathy, rigid osseous deformities and soft-tissue contractures, repetitive trauma from unprotected ambulation, and peripheral vascular disease can all lead to a limb- or life-threatening infection. Antibiotic therapy for diabetic soft-tissue and osseous infections is usually inadequate as an isolated form of therapy. The mainstay of treatment involves well-planned surgical procedures, including extensive and properly placed incisions to perform adequate drainage of abscesses and débridement of necrotic soft-tissue and osseous structures from which deep cultures are obtained for specific antibiotic coverage. Initial antibiotic therapy should provide broad-spectrum coverage, and when final culture results are available the regimen should be revised to organism-specific coverage. Detailed and timely evaluation of the vascularity of the limb is paramount, followed by timely vascular reconstruction involving various endovascular and open surgical procedures to restore pulsatile flow to the full extent of the limb.     

The diabetic foot

Amputation of the lower extremity is more frequent in diabetic patients than in the general population. Causative factors include foot deformities, neuropathy, dysvascularity, infection, and gangrene. A grading and treatment program is outlined for aid in treating the lesions that develop in these feet.     

The Boerhaave syndrome. Personal experience

Boerhaave syndrome is a rare disease with a mortality rate that varies from 10 to 40%. The typical clinical presentation (vomiting, pain, subcutaneuous emphysema) is relatively infrequent. In the case of atypical clinical presentation CT scan with contrast medium administered per os is fundamental for diagnosis. Though there is no general consensus on therapeutic strategies, prognosis is dependent on time interval between onset and diagnosis. We observed four patients with Boerhaave syndrome with an atypical presentation. The time lapse between acute event and diagnosis was less than 6 hours in two cases, 24 hours in one case and 72 hours in the last. All patients presented abdominal pain at admission, preceeded by vomiting in two cases. In all cases diagnosis was carried out by CT scan. All patients were treated surgically: in one case raffia alone was performed, in two cases raffia was associated with temporal bipolar oesophageal exclusion, one case went through oesophageal resection with delayed reconstruction of digestive continuity. One patient with severe COBP died from post-surgical sepsis. One fistula after cervical recanalisation and another after raffia of the oesophageal lesion were successfully treated with endoscopy. We suggest that an aggressive surgical approach is the best treatment for this rare and often severe disease.     

Personal experience.

Three attacks of infective endocarditis with consequent emergency surgery to the aortic and mitral valves leave their mark. These are the impressions of a physician at the receiving end of his medical environment, an experience which entailed 4 periods of hospitalisation in 2 hospitals.     

Management of the diabetic foot.

If the diabetic foot fails to respond adequately to a short period of basic primary treatment surgery must be considered. The main factor determining its nature and extent is the severity of large-vessel disease. If investigation shows this to be of minor significance local surgery is usually successful. In the presence of definite large-vessel disease, however, major amputation is usually necessary, though arterial reconstruction with local distal amputation may occasionally be feasible. The factors to be taken into consideration in the choice of treatment are discussed.     

The multiple tumor syndrome. Personal experience

The multiple tumor syndrome is an unusual pathologic condition, which consists in association of multiple malignancies in the same patient. Seven cases are discussed: two women, five men, aged 32-70 years. The period between the two neoplasias was 2-23 years (in 6 cases). In one case the two malignancies appeared concomitantly. The hematological malignancies were: multiple myeloma: 2 cases; chronic granulocytic leukemia: 2 cases; chronic lymphatic leukemia: 3 cases. In four cases, the solid tumor followed the hematological malignancy at variable periods (2 and 4 years). In other two cases, the solid tumors preceded the hematological malignancy with 2 years, 23 years respectively. The solid tumors were genital cancers, malignant melanoma, spino-cellular carcinoma, thyroid cancer, hemangiosarcoma. In a single case the second tumor was a hematological malignancy too (NHL-diffuse lymphocytic lymphoma). Possible implications of previous therapy and environmental factors are discussed.     

The infected diabetic foot

Infections in the diabetic foot are regularly the consequence of neuropathic, ischemic, or combined neuropathic-ischemic ulcerations which cause substantial morbidity including a high rate of major amputations. Diabetic foot infections are responsible for substantially high costs of diabetic treatment and induce an increased rate of mortality. An early diagnosis on the basis of clinical presentation, laboratory results, and radiologic imaging together with an adequate classification of the severity of infection represents the key for a successful intervention strategy. Severe infections in diabetic feet have a poorer prognosis than mild or moderate infections. A guideline which includes a multifaceted approach to infection control by débridement, antibiotic therapy, and revascularization before definitive reconstruction of the defect may aid in reducing the risk of amputation and improving the quality of life and mobility of the patient. This can be realized by multidisciplinary cooperation. Additional preventive measures such as osseous and soft tissue reconstructions during the infection-free period to establish a plantigrade and ulcer-free foot together with education and routine follow-up controls provide the basis for a long-term reduction of ulcer and infection recurrence with progressive deterioration of the prognosis.     

Types of foot problems seen by Australian podiatrists

BackgroundUnderstanding frequency of foot problems can assist health care planners with resource deployment to new and emerging services such as paediatric podiatry and focus future research on the most salient foot conditions.MethodsA review of 2187 patient consultations during a three month period was conducted. Patient medical and podiatric history was coded using industry standards. All patients were recruited for convenience from a metropolitan university podiatry clinic.Results392 new patients were identified with mean age 40.6 years old (range 1–95), with 65% being female. Arthritic diseases, asthma, hypertension and allergies were the most common medical conditions reported. The frequency of new consultations in younger people (n = 102; 27%) exceeded those of the elderly (n = 75; 20%). Conversely, the elderly were nearly three times more prevalent in this cohort (n = 910; 43%) compared to younger people (n = 332; 16%).ConclusionThis study illustrates the diverse nature of pathology seen by podiatrists. Knowledge that skin lesions are highly prevalent is of relevance to health departments, given the aging nature of most populations. Moreover there appears to be a growing trend in the number of young people who present for care, however government funded access to these services are limited.     

Riedel's thyroiditis. Personal experience

The Riedel's thyroiditis, also called "wood's thyroiditis", is a rare chronic "inflammatory" disease of unknown etiology, relatively frequent in female >45-50 years, characterized by a fibrotic process that pervades thyroid and neighbouring structures (vessels, muscles, oesophagus, trachea upper- mediastinum). The authors discuss about three cases of Riedel's thyroiditis and report the outcome after total thyroidectomy in two cases and sub-total resection in the other one.