1/37. Thermal biofeedback for claudication in diabetes: a literature review and case study.temperature biofeedback (TBFB) is designed to alter cutaneous temperature in treated extremities by providing information corresponding to minor temperature fluctuations in the context of therapeutic structure and reinforcement. Toe TBFB may improve vascular flow and walking tolerance in patients with peripheral vascular disease. This case study documents improved walking in a diabetes patient with lower extremity complications, and suggests TBFB might increase lower extremity temperature and blood flow volume pulse in uncomplicated diabetes. ankle-brachial index (ABI) and walking function were assessed in a 60-year-old woman with type 2 diabetes and intermittent claudication, before and after five sessions of TBFB applied to the ventral surface of the great toe. Toe temperature increased during feedback phases but not during baseline phases. Improvements were seen in ankle-brachial index, walking distance, walking speed, and stair climbing. This case indicates the need for extended and controlled study of TBFB for improved vascular and ambulatory function in diabetic claudication.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
2/37. Use of topical recombinant human platelet-derived growth factor-BB (becaplermin) in healing of chronic mixed arteriovenous lower extremity diabetic ulcers.lower extremity ulcers cause significant morbidity and mortality in patients with diabetes. The primary factors that contribute to the development of this type of ulcer are peripheral neuropathy and peripheral vascular disease, which are often accompanied by infection. lower extremity diabetic ulcers are chronic and difficult to treat, in part due to underlying pathologic conditions in individuals with diabetes that can contribute to impaired wound healing. This article reports the author's experience with treatment of chronic lower extremity ulcers of mixed etiologies with recombinant human platelet-derived growth factor--BB [rhPDGF-BB, REGRANEX (becaplermin) Gel 0.01%] in a patient with multiple risk factors including long-standing insulin-dependent type 2 diabetes.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
3/37. Nontraumatic clostridial myonecrosis.We describe three cases of nontraumatic clostridial myonecrosis seen at the Victorian Institute of forensic medicine. Nontraumatic clostridial myonecrosis is an uncommon and often fatal condition that requires immediate institution of appropriate medical and surgical therapy. It is most commonly caused by clostridium perfringens and clostridium septicum and is associated with gastrointestinal and hematologic malignancies, diabetes mellitus, and peripheral vascular disease. The clinical features include a rapidly evolving acute illness with severe pain, marked tachycardia, and brawny discoloration of the skin with bullae formation and crepitus, followed by hypotension and acute renal failure. Features at autopsy include reddish brown skin discoloration with bullae formation and necrotic skeletal muscle. Radiographs may be of use prior to the postmortem in detecting gas within the soft tissues. Gram stain and microbiologic culture are important in establishing a definitive diagnosis; although the major factors in suggesting the diagnosis are the recognition of the typical clinical history and macroscopic autopsy findings.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
4/37. Treatment of severe proliferative retinopathy and diabetic maculopathy.Strict blood glucose control, early detection and surveillance of diabetic retinopathy by means of validated screening programmes, and judicious use of laser photocoagulation can greatly reduce the risk of visual loss in diabetes. Some patients however, have aggressive neovascular disease resistant to laser treatment, or present at a late stage with advanced fibroproliferative disease, and may progress rapidly to blindness. In the elderly with Type 2 disease, diabetic maculopathy is more common and requires a different therapeutic approach. The present article describes two diabetic patients and discusses the management of patients with severe proliferative retinopathy or diabetic maculopathy.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
5/37. blindness following a diabetic foot infection: a variant to the 'eye-foot syndrome'?AIMS: The 'eye-foot syndrome' was initially described by Walsh et al. to highlight the important association of foot lesions in patients with diabetic retinopathy. We present a case of a 58-year-old patient with Type 2 diabetes mellitus who developed blindness following endogenous staphylococcal endophthalmitis from an infected foot ulcer. RESULTS: Our case describes the link between the eye and the foot but is somewhat different to the association as described by Walsh et al. Endogenous endophthalmitis is rare with diabetic patients being especially at risk, and we report the first case of endogenous staphylococcal endophthalmitis related to a diabetic foot lesion. CONCLUSIONS: Our case illustrates several important issues in the management of diabetic patients admitted to hospital with infection; the need to thoroughly examine the feet to ascertain any foot lesions and any underlying peripheral vascular disease or peripheral neuropathy, to treat aggressively any infected foot lesions to prevent serious complications of septicaemia and to consider rare conditions like endogenous endophthalmitis in any diabetic patient presenting with acute visual impairment and septicaemia.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
6/37. skin tags and the atherogenic lipid profile.This report details four patients who had skin tags, mainly on their torso, neck, and axillae, and who also displayed an abnormal lipid profile. All showed an increased serum triglyceride (fasting > 1.70 mmol/litre) and a decreased high density lipoprotein (HDL) cholesterol (< 1.1 mmol/litre in women and 1.0 mmol/litre for men) concentration. The displayed lipid profile is also known as the atherogenic profile and is associated with insulin resistance, type 2 diabetes mellitus, and an increased risk of cardiovascular disease. Two of the patients had impaired glucose tolerance and one had type 2 diabetes mellitus. Three of the individuals had coronary artery disease. skin tags might be a useful clinical sign that could alert clinicians to screen such individuals for abnormal lipids, type 2 diabetes mellitus, and cardiovascular disease.- - - - - - - - - - ranking = 2keywords = vascular disease (Clic here for more details about this article) |
7/37. Glitazones and the potential improvement of lipid profiles in diabetes patients at high risk for cardiovascular disease.Most deaths and hospitalizations in patients with diabetes are related to atherosclerotic vascular disease. An asymptomatic patient with type 2 diabetes has a cardiovascular risk comparable to that of a patient without diabetes who has a history of a myocardial infarction. The american heart association classifies diabetes as a coronary heart disease risk equivalent. Thus, it is important in patients with diabetes to aim for systolic blood pressures less than 130 mm Hg, using an angiotensin-converting enzyme inhibitor-based regimen. The target hemoglobin A1C (HbA1C) for those patients is < 7%. New oral insulin-sensitizing medications, known as thiazolidinediones or glitazones, are useful to improve glycemic control. Most patients with diabetes require 2 or more oral agents to achieve optimal glucose control. Glitazones generally lower HbA1C by 1% to 2%. They also raise high-density lipoprotein cholesterol levels and lower triglycerides. Thus, they may potentially improve low-density lipoprotein (LDL) particle sizes by converting small, dense LDL particles into larger, less atherogenic ones. Current data concerning the lipid effects of pioglitazone and rosiglitazone are reviewed in this article.- - - - - - - - - - ranking = 5keywords = vascular disease (Clic here for more details about this article) |
8/37. The clinical implications of insulin resistance.insulin resistance is a prime risk factor associated with atherosclerosis and thrombosis. Other risk factors include dyslipidemia, obesity, and hypertension. The constellation of those factors, which is known as the cardiovascular dysmetabolic syndrome, increases the risk of macrovascular disease. insulin resistance may contribute directly to cardiovascular disease and may also act as a precursor of diabetes, which is also associated with an increased risk of macrovascular disease. insulin resistance can be difficult to assess clinically, but it is invariably present in patients with type 2 diabetes, impaired fasting glucose, or impaired glucose tolerance. Treatment of insulin resistance includes diet, exercise, smoking cessation, strict control of hypertension, aggressive treatment of lipid abnormalities, and keeping the hemoglobin A1c level below 7%. New oral agents improve glycemic control for those with diabetes or insulin resistance, but their role in reducing the risk of macrovascular disease is undetermined.- - - - - - - - - - ranking = 4keywords = vascular disease (Clic here for more details about this article) |
9/37. Endothelial dysfunction in type 2 diabetes mellitus subjects with peripheral artery disease.We strived to characterize the endothelial function status in type 2 diabetic patients with peripheral artery disease which was detected by ankle-brachial index by utilizing high frequency ultrasounds. Predictors of endothelial dysfunction were investigated. We chose 23 type 2 diabetic patients had ankle-brachial index <0.97 (0.15-0.95; mean=0.74 /-0.20), 31 diabetic patients had ankle-brachial index >/=1.0 and 28 non-diabetic subjects for study. Older age, a longer duration of diabetes, higher systolic blood pressure, higher prevalence of history of hypertension were observed in patients with peripheral vascular disease. Type 2 diabetic patients showed impaired flow-mediated dilatation than non-diabetic and it showed more impaired in patients with peripheral vascular disease. Nitroglyerin-induced dilatation showed a trend of impairment in patients with peripheral vascular disease but did not reach statistical significance. Age (r=-0.259, P=0.019), baseline brachial artery diameter (r=-0.321, P=0.003), ankle-brachial index (r=0.259, P=0.002) and hypertension history (P=0.01) were significantly associated with flow-mediated dilatation. However, after adjusting for age, only baseline diameter and ankle-brachial index were independent predictors of flow-mediated dilatation. In conclusion, we demonstrated flow-mediated dilatation was impaired in type 2 diabetic patients and it was further impaired in patients with peripheral vascular disease. nitroglycerin-induced dilatation showed a trend of impairment but did not reach statistical significance.- - - - - - - - - - ranking = 4keywords = vascular disease (Clic here for more details about this article) |
10/37. Comprehensive management of patients with type 2 diabetes: establishing priorities of care.Type 2 diabetes is a complex metabolic disorder characterized by elevated blood glucose levels and a marked increase in the risk of cardiovascular disease (CVD). The increased CVD risk is caused by a unique cluster of metabolic abnormalities, including dyslipidemia, hypertension, insulin resistance, and hyperglycemia. To reduce the risk of cardiovascular complications in patients with type 2 diabetes, comprehensive management of risk factors is essential. Aggressive treatment of dyslipidemia and hypertension is known to benefit patients with type 2 diabetes. In addition, intensive glycemic control and targeted treatment of insulin resistance can further reduce the enormous burden of CVD in this high-risk population. Increasing evidence suggests that insulin resistance is one of the earliest markers of risk for both CVD and diabetes, and it is known that insulin resistance alone can significantly increase the risk of CVD. Type 2 diabetes and insulin resistance are both associated with disordered lipid metabolism, manifest in elevated triglyceride levels, low levels of high-density lipoprotein cholesterol, and small, dense low-density lipoprotein cholesterol particles. patients with type 2 diabetes and insulin resistance have an increased risk of hypertension, which further contributes to their CVD risk. Each of these factors can also contribute to the risk of microvascular disease. To ensure that patients with type 2 diabetes receive comprehensive, high-quality care, specific standards have been developed. These standards can help providers establish clear treatment targets, identify specific priorities of care, and use therapies of known efficacy to reduce the risk of complications. This review summarizes the current standards of care for patients with type 2 diabetes, with an emphasis on treatments that reduce the cardiovascular risk factors. Using a case study approach, it reviews the essential components of diabetes care and proposes a rational approach to these complex cases--an approach that should result in consistent, high-quality care.- - - - - - - - - - ranking = 2keywords = vascular disease (Clic here for more details about this article) |
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