1/11. osteomyelitis associated with peripheral vascular disease secondary to diabetes mellitus.diabetes mellitus and arteriosclerotic vascular disease have been found to be the predisposing factors of osteomyelitis associated with peripheral vascular disease (10). A diabetic person is more susceptible to osteomyelitis because of the microangiopathy, peripheral neuropathy and decreased resistance to infection. In diabetes mellitus there can be microangiopathy which results from the proliferation of the endothelium of the intima and thickening of the basement membrane. This further contributes to a sluggish blood flow. In the patient with arteriosclerotic vascular disease, the lumens of the arterioles and arterioles are compromised by the atheromatous plaques. The anatomic structure of the blood supply to bone along with the pathologic membrane thickening, allows for slowing of blood. This slowing of blood flow causes micro-thrombi and enhances bacterial growth. In diabetes mellitus it has been shown that there is a decreased immunologic response which, along with the above, contributes to the sheltering and proliferation of bacteria in the small bones of the foot.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
2/11. Preoperative assessment of the peripheral vascular disease patient for free tissue transfers.lower extremity reconstruction or salvage in patients with severe peripheral vascular disease is a unique challenge, requiring knowledge of the vascular anatomy, including the location of intraluminal irregularities and stenoses. In a retrospective study that includes four case reports, the authors describe the impressive ability of the Duplex imaging system, to assist in the proper selection of recipient vessels and of those areas within the vessels most suitable for anastomoses.- - - - - - - - - - ranking = 0.71428571428571keywords = vascular disease (Clic here for more details about this article) |
3/11. Use of injectable collagen to treat chronic diabetic foot ulcers.A significant portion of the population suffer from diabetic foot ulcers. While conservative treatment is often successful, many diabetic patients with accompanying peripheral vascular disease and neuropathy are under constant medical care for chronic, recurring foot ulcers. A new injectable biomaterial, Keragen Implant, was evaluated on two patients with bilateral diabetic ulcers. The implanted lesions healed completely during the months following treatment. Control lesions treated by conventional means remained open and ulcerated.- - - - - - - - - - ranking = 0.14285714285714keywords = vascular disease (Clic here for more details about this article) |
4/11. Diabetic osteomyelitis: long-term attempts at salvage with eventual mortality.Long-term complications of diabetes mellitus with respect to the lower extremities are well known to the podiatric profession. The author presents a case of a diabetic with multisystem pathology who underwent several salvage procedures for osteomyelitis and later expired from cardiovascular disease. The multi-system nature of diabetes necessitates a team approach in management of the acutely ill diabetic patient.- - - - - - - - - - ranking = 0.14285714285714keywords = vascular disease (Clic here for more details about this article) |
5/11. Decubitus ulcers: when to suspect osteomyelitis.Six nursing home patients developed pressure sores of the foot and ankle, complicated by osteomyelitis of the underlying bone. All patients had advanced multi-infarct dementia with multiple contractures, and were bedridden, debilitated, and nutritionally deficient. All had arteriosclerotic heart and peripheral vascular disease, and other chronic illnesses. The pressure sores progressed rapidly and did not respond to medical and surgical therapy. Cultures yielded organisms usually associated with pressure sores. diagnosis of osteomyelitis was initially made by radiography and eventually confirmed surgically. patients with osteomyelitis of the metatarsal bones responded well to intravenous antibiotics and local amputation; all survived. The two patients with osteomyelitis of the calcaneal bone died after a short course. The diagnosis of osteomyelitis of the foot associated with pressure ulcers requires a high index of suspicion when a pressure sore does not respond to medical and surgical therapy in the appropriate clinical setting.- - - - - - - - - - ranking = 0.14285714285714keywords = vascular disease (Clic here for more details about this article) |
6/11. Nosocomial septicemia with CDC group IV c-2, an unusual gram-negative bacillus.A 55-year-old man with severe peripheral vascular disease developed nosocomial septicemia which was caused by the gram-negative bacterium CDC group IV c-2, presumably from a plantar abscess on the left foot. Recovery followed amputation of the infected extremity and antibiotic therapy. This is the first reported case of nosocomial acquisition of this organism.- - - - - - - - - - ranking = 0.14285714285714keywords = vascular disease (Clic here for more details about this article) |
7/11. Chronic leg ulcers and Klinefelter's syndrome.Venous and arterial leg ulcers have been reported in patients with Klinefelter's syndrome. We report a case of Klinefelter's syndrome associated with chronic leg and foot ulcers and thrombophlebitis. Both venous and arterial vascular disease seems to be associated with Klinefelter's syndrome and should be considered in men presenting with chronic leg and foot ulcers.- - - - - - - - - - ranking = 0.14285714285714keywords = vascular disease (Clic here for more details about this article) |
8/11. Treatment of advanced vascular disease with intra-arterial thrombolytic therapy followed by arterial dilatation.A patient with severe arterial insufficiency was successfully treated with a combination of intra-arterial low-dose streptokinase and percutaneous transluminal dilatation. The judicious use of a combination of these two techniques may extend the application of each technique and allow salvage of some severely ischemic extremities.- - - - - - - - - - ranking = 0.57142857142857keywords = vascular disease (Clic here for more details about this article) |
9/11. Diabetic neuroarthropathy in the foot: patient characteristics and patterns of radiographic change.The diagnosis of diabetic neuroarthropathy of the foot can be difficult. A series of 96 patients (116 extremities) who had diabetes and peripheral neuropathy with bone and joint changes was reviewed. Typically, the patients were middle-aged or older, were taking insulin, and had had diabetes for more than 10 years. Retinopathy, nephropathy, and peripheral vascular disease were often present. There were abnormalities of vibratory sensation (94%) and of the gastrosoleus reflex (88%). The finding of specific radiographic abnormalities assisted but did not reliably differentiate neuropathy from infection. Three patterns of radiographic changes were noted: (1) at the metatarsophalangeal and interphalangeal joints, usually with underlying ulceration; (2) at the tarsometatarsal joints; and (3) in the anterior pillar-medial column of the foot, with talus, talonavicular, navicular, or naviculocuneiform destruction. Ulceration and infection in patients with patterns (2) and (3) were rare. When correlated, the demographic features, mode of presentation, physical signs, specific radiographic abnormalities, and patterns of change were distinctive and allowed the diagnosis of this complication of diabetes to be readily made.- - - - - - - - - - ranking = 0.14285714285714keywords = vascular disease (Clic here for more details about this article) |
10/11. Microsurgical management of extremity wounds in diabetics with peripheral vascular disease.Plastic surgeons are frequently called upon to evaluate wounds in diabetic patients with compromised vascular inflow. Although a few authors have reported success in coverage of such wounds with microsurgical techniques, enthusiasm for this procedure has remained low due to concerns about flap viability, occlusion of flow to the distal limb, and the usually poor systemic status of such patients. We report here on our experience with 19 diabetic patients with peripheral vascular disease and a nonhealing wound of the lower extremity treated over the last 4 years with microvascular tissue transfer. Two patients (10.5 percent) suffered anastomotic difficulties and there was one flap loss (5 percent). Major morbidity rates were acceptable, with only one perioperative death (5 percent) and three cases of nonfatal major systemic difficulties in the immediate postoperative period (16 percent). Despite the importation of well-vascularized tissue, local morbidity at the recipient site was seen in nine patients (47 percent). The overall limb salvage rate was 72 percent during the period of follow-up, which averaged 22 months. Despite this loss of five limbs, all but three of the patients eventually returned to ambulation. The overall death rate in our series was only 2/19 (10.5 percent) over the period of follow-up. Although further work needs to be done in this difficult group of patients to ascertain the long-term benefit (especially relative to the cost/benefit ratio), we feel that this series confirms the safety and short-term efficacy of microsurgical treatment of such individuals.- - - - - - - - - - ranking = 0.71428571428571keywords = vascular disease (Clic here for more details about this article) |
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