1/8. A case of pyoderma gangrenosum on the stump of an amputated right leg.We present here a case of pyoderma gangrenosum (PG) on the stump of an amputated leg. The patient was a 69-year-old woman who had both of her legs amputated due to acute arterial occlusion. An ulcer first appeared nine years later, after which point it continued to fluctuate in size. Complications included regional blood flow disorder at the amputated stump, diabetes, and secondary infection. Despite various therapies, the ulcer exacerbated, and hypoproteinemia, increased CRP, and fever were confirmed. The patient was diagnosed as having PG based on her clinical symptoms and because the ulcer did not respond to various therapies. The ulcer improved significantly in response to administration of 40 mg/day of prednisolone, and complete epithelialization was later achieved. Given the presence of multiple complications, it was extremely difficult to confirm PG. Therefore, it is important for physicians to consider PG as one of the causes of intractable ulcers.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/8. Partial calcanectomy in the treatment of chronic heel ulceration.Chronic decubitus ulceration of the heels is a common condition encountered by podiatric physicians, especially in diabetic patients. Very often these ulcerations can progress to osteomyelitis of the calcaneus. Many times, this in turn leads to a below-the-knee amputation. A partial calcanectomy is a viable alternative to below-the-knee amputation. A more functional limb both mechanically and cosmetically is achieved, and the morbidity and mortality associated with the calcanectomy is less than with a below-the-knee amputation. A brief overview of the history and outcomes associated with this procedure is outlined and a case utilizing a partial calcanectomy is presented.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/8. depression and chronic diabetic foot disability. A case report of suicide.Evidence at the scene of death and the postmortem examination led the pathologist to conclude suicide by intentional insulin overdose. The examination was conducted one day after the patient's death. The amount of insulin injected is not known, but levels of insulin in the vitreous gel were extremely high. While glucose and insulin are more stable in vitreous than in postmortem blood, the longer the delay between death and sample collection, the greater the uncertainty of the exact concentrations of substances at the time of death [42]. patients with diabetes may have at their disposal the resources to end their lives; misuse of insulin and suicide by insulin overdose are presumably underreported events. Not only do diabetics have insulin available, but they may also have narcotics, tricyclic antidepressants or other drugs that are toxic at high doses. Even in the absence of depression, all patients with diabetes face multiple emotional issues related to the diagnosis and course of the disease. Diabetes often requires significant lifestyle changes, such as diet and physical activity, upon its diagnosis. patients face the possibility of long-term, possibly debilitating, complications: vision loss, sexual dysfunction, and amputation. Any podiatrist who treats a large number of diabetic patients will encounter the situation of a patient at risk of losing a limb. A patient may consciously or unconsciously view amputation as punishment; limb loss interferes physically with bodily function and has extensive emotional consequences as well. It is important for patients to be involved with a healthcare team (including primary care physician, nurse educator, ophthalmologist, and podiatrist) that provides support throughout their lives [3]. As learned early on in podiatry school, podiatric physicians don't treat feet; they treat patients who have foot problems. It is as important to know when to refer a patient to the primary care physician or a psychiatrist for mental health complaints as it is to know when to refer a patient to an orthopedic surgeon for hip pain or to an ophthalmologist for vision problems. We do not propose that this patient's diabetic foot disease was the direct cause of his depression and suicide; however, the prevalence of depression in the general population and its even higher rates in patients with chronic medical illness require awareness of these problems by all members of the medical profession.- - - - - - - - - - ranking = 3keywords = physician (Clic here for more details about this article) |
4/8. Approach to managing diabetic foot ulcers.INTRODUCTION: Of an estimated 1.7 to 2 million Canadians with diabetes, approximately 10% will present each year to their family doctors with plantar ulcers. Nearly 3500 will require major lower extremity amputations. SOURCES OF INFORMATION: Most of the recommendations outlined in this paper are based on level I evidence from excellent bench research and epidemiologic studies. MAIN MESSAGE: Both insulin-dependent and non-insulin-dependent diabetics develop foot infections. These patients are on average 60 years old and have had diabetes for more than 10 years. physicians who insist on excellent blood sugar control, provide ongoing patient education on diabetic foot care, prescribe appropriate shoes, and practise an aggressive multidisciplinary approach to wound care can reduce the rate of lower extremity amputations by more than 50%. CONCLUSION: Foot problems remain one of the main challenges associated with diabetes, but family physicians can manage them successfully.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/8. Imaging infection with 18F-FDG-labeled leukocyte PET/CT: initial experience in 21 patients.The aim of this study was to assess the feasibility and the potential role of PET/CT with (18)F-FDG-labeled autologous leukocytes in the diagnosis and localization of infectious lesions. methods: Twenty-one consecutive patients with suspected or documented infection were prospectively evaluated with whole-body PET/CT 3 h after injection of autologous (18)F-FDG-labeled leukocytes. Two experienced nuclear medicine physicians who were unaware of the clinical end-diagnosis reviewed all PET/CT studies. A visual score (0-3)-according to uptake intensity-was used to assess studies. The results of PET/CT with (18)F-FDG-labeled white blood cell ((18)F-FDG-WBC) assessment were compared with histologic or biologic diagnosis in 15 patients and with clinical end-diagnosis after complete clinical work-up in 6 patients. RESULTS: Nine patients had fever of unknown etiology, 6 patients had documented infection but with unknown extension of the infectious disease, 4 patients had a documented infection with unfavorable evolution, and 2 patients had a documented infection with known extension. The best trade-off between sensitivity and specificity was obtained when a visual score of >or=2 was chosen to identify increased tracer uptake as infection. With this threshold, sensitivity, specificity, and accuracy were each 86% on a patient-per-patient basis and 91%, 85%, and 90% on a lesion-per-lesion basis. In this small group of patients, the absence of areas with increased WBC uptake on WBC PET/CT had a 100% negative predictive value. CONCLUSION: Hybrid (18)F-FDG-WBC PET/CT was found to have a high sensitivity and specificity for the diagnosis of infection. It located infectious lesions with a high precision. In this small series, absence of areas with increased uptake virtually ruled out the presence of infection. (18)F-FDG-WBC PET/CT for infection detection deserves further investigation in a larger prospective series.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/8. Fatal pontine hemorrhage after podiatric surgery. A case report.The authors present a case of massive fatal pontine hemorrhage as a complication of hypertension in a patient treated for an infected diabetic ulcer. The podiatric physician must be aware of the risks associated with concomitant medical problems such as hypertension and ensure that proper therapeutic measures are taken to avoid the potential for catastrophic complications.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/8. Multiple epidural abscesses and spinal anesthesia in a diabetic patient. Case report.BACKGROUND AND OBJECTIVES. Spinal anesthesia as a cause of epidural abscess is extremely rare. infection at the site of needle placement is the usual cause of abscess formation. methods. Immunocompromised patients, and in this case a diabetic patient may be at higher risk for this complication. RESULTS. Anesthesiologist need to be aware of factors that may lead to epidural abscess formation. CONCLUSIONS. The signs and symptoms of this unfortunate complication should be uppermost in the physician's mind when assessing new neurologic deficits after regional anesthesia.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/8. Use of the Cam Walker in treating diabetic ulcers. A case report.This case study shows how a Cam Walker when equipped with an arch filler can be another tool the physician may use to help heal diabetic ulcerations. Even after other methods of conservative care have failed, the Cam Walker with an arch filler has been shown to gradually decrease and heal diabetic ulcerations on the plantar aspect of the foot. It accomplishes this by decreasing the pressure on the ulcerative areas and by decreasing the velocity with which the foot strikes the ground.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |