LA CONSULTA SEMANAL

 

SEPTIEMBRE 2000

 

 

CONSULTA

Pie diabético

 

BMJ 2000 Jun 10;320(7249):1589-91[Texto completo]

ABC of arterial and venous disease. Ulcerated lower limb.

London NJ, Donnelly R

University of Nottingham, UK.

Publication Types:

  Review

  Review, tutorial

 

Diabet Med 1999 Oct;16(10):799-800

Diabetic foot disease--where is the evidence?

Connor H

Publication Types:

  Comment

  Editorial

  Review

  Review, tutorial

Comments:

  Comment on: Diabet Med 1999 Oct;16(10):801-12

 

Diabetes Care 1999 Aug;22(8):1354-60

Consensus Development Conference on Diabetic Foot Wound Care: 7-8 April 1999,Boston, Massachusetts. American Diabetes Association.

American Diabetes Association, Alexandria, VA 22314, USA.

Publication Types:

  Consensus development conference

  Review

 

BMJ 1999 Jul 31;319(7205):318 [Texto completo]

Laterality of lower limb amputation in diabetic patients. Particular attention should be paid to dominant foot at regular review.

Evans PM, Williams C, Page MD, Alcolado JC

Publication Types:

  Comment

  Letter

Comments:

  Comment on: BMJ 1999 Feb 6;318(7180):367

 

Postgrad Med 1999 Jul;106(1):97-102 [Texto completo]

Local wound care in diabetic foot complications. Aggressive risk management and ulcer treatment to avoid amputation.

Muha J

Carolina Podiatry Associates, Florence, South Carolina 29505, USA.jmamem@aol.com

Techniques to prevent and treat lower extremity amputation in patients with diabetes vary from simple foot inspection to complicated vascular and reconstructive surgery. Early identification of risk factors, careful and regular evaluation, and aggressive treatment in a multidisciplinary team approach prevent amputation in most cases of diabetic foot ulcer. Suitable treatment of these ulcers consists of minimizing pressure, resolving infection, correcting ischemia, and maintaining a warm, moist, clean environment to enhance wound healing. Success in these efforts not only preserves quality of life for diabetic patients but also saves money for the healthcare system.

Publication Types:

  Review

  Review, tutorial

Comments:

  Comment in: Postgrad Med 1999 Nov;106(6):27

 

Postgrad Med 1999 Jul;106(1):85-6, 89-94 [Texto completo]

Antimicrobial therapy for diabetic foot infections. A practical approach.

Shea KW kshea@carolinashospital.com

Infection of the diabetic foot is a common problem in clinical practice and is associated with significant morbidity. Optimal management requires a multidisciplinary approach. Aggressive surgical debridement and wound management, carefully chosen antimicrobial therapy, and modification of host factors (i.e., hyperglycemia, concomitant arterial insufficiency) are all equally important for a successful outcome. Empirical antibiotic selection should be followed by culture-guided definitive therapy.

Publication Types:

  Review

  Review, tutorial

 

Postgrad Med 1999 Jul;106(1):74-8, 83 [Texto completo]

Preventing diabetic foot complications. Tight glucose control and patient education are the keys.

Culleton JL Division of Endocrinology, Carolina Health Care, Florence, SC 29501, USA. jculleton@flosc.net

Foot disease is a common complication of diabetes that can have tragic consequences. Tight glucose control can reduce microvascular diabetic complications, including peripheral sensory neuropathy and thus development of foot ulcers. Patient education is essential for risk-factor reduction and early recognition of foot complications. Awareness and training of healthcare providers in diagnosing and treating diabetic foot disease are paramount and may begin with such simple measures as adding a wall poster or chart reminder to conduct foot examinations in all diabetic patients at every office visit.

Publication Types:

  Review

  Review, tutorial

 

Diabetes Care 1999 May;22(5):692-5

Healing of diabetic neuropathic foot ulcers receiving standard treatment. A meta-analysis.

Margolis DJ, Kantor J, Berlin JA

Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia 19104, USA. dmargoli@cceb.med.upenn.edu

OBJECTIVE: The aim of the study was to determine the percentage of individuals with neuropathic diabetic foot ulcers receiving good wound care who heal within a defined period of time. RESEARCH DESIGN AND METHODS: We conducted a systematic review of the control groups of clinical trials that evaluated a treatment for diabetic neuropathic foot ulcers. The meta-analytic techniques used include an estimation of the weighted mean percentage healed by end point, an evaluation of the homogeneity of trials, and an estimate of the 95% CI of the grouped data. Grouped-data univariate and multivariate logistic regression was conducted to assess the impact of mean age, ulcer size, and duration on the percentage of ulcers healed at end point. RESULTS: We found a total of 10 control groups meeting our criteria. Six control groups used 20 weeks as the end point for healing or nonhealing. For the six control arms with a 20-week end point, we found a weighted mean healing rate of 30.9% (95% CI 26.6-35.1). A similar analysis for the four 12-week arms found a mean healing rate of 24.2% (19.5-28.8). We failed to detect any statistically significant heterogeneity for either the 20-week or the 12-week trials. CONCLUSIONS: After 20 weeks of good wound care, approximately 31% of diabetic neuropathic ulcers heal. Similarly, after 12 weeks of good care, approximately 24% of neuropathic ulcers attain complete healing. Further patient-level analyses are necessary to definitively determine the associations of age, wound size, and wound duration with likelihood of healing.

Publication Types:

  Meta-analysis

 

Am J Surg 1998 Aug;176(2A Suppl):11S-19S

The development and complications of diabetic foot ulcers.

Laing P

Wrexham Maelor Hospital, Clwyd, United Kingdom.

Neuropathy and ischemia, two common complications of diabetes mellitus, are the primary underlying risk factors for the development of foot ulcers and their complications. The presence of symmetric distal polyneuropathy, encompassing motor, sensory, and autonomic involvement, is one of the most important factors in the development of diabetic foot ulcers. Perhaps one third of diabetic foot ulcers have a mixed neuropathic and ischemic etiology. Although neuropathy and ischemia are the primary predisposing factors in the formation of diabetic foot ulcers, an initiating factor, such as physical or mechanical stress, is required for an ulcer to develop. Ischemic ulcers develop as a result of low perfusion pressure in a foot with inadequate blood supply, whereas neuropathic ulcers result from higher pressures in a foot with adequate blood supply but loss of protective sensation. In addition to increasing the risk of ulceration, diabetes mellitus also increases the risk of infection by impairing the body's ability to eliminate bacteria. The processes by which ulcers develop are reviewed here.

Publication Types:

  Review

  Review, tutorial

 

Am J Surg 1998 Aug;176(2A Suppl):5S-10S

The burden of diabetic foot ulcers.

Reiber GE, Lipsky BA, Gibbons GW

Department of Epidemiology and Health Services, University of Washington, VA Puget Sound Health Care System, Seattle 98108, USA.

Lower extremity ulcers represent a major concern for patients with diabetes and for those who treat them, from both a quality of life and an economic standpoint. Studies to evaluate quality of life have shown that patients with foot ulcers have decreased physical, emotional, and social function. Analyses of economic impact have shown (1) the majority of costs occur in the inpatient setting, (2) a lack of financial benefit when comparing primary amputation with an aggressive approach to limb salvaging including vascular reconstruction, and (3) private insurance provides greater reimbursement for inpatient care than does Medicare. Results of etiologic studies suggest that hyperglycemia induces diabetes-related complications through sorbitol accumulation and protein glycation, and the resultant nerve damage manifests as peripheral neuropathy, which predisposes to ulcer development. Patients with diabetes also have an increased incidence of peripheral vascular disease, impaired wound healing, and decreased ability to fight infection. In light of these factors, it is sometimes difficult to determine the optimal course for patient management. This review is aimed at helping healthcare providers make better decisions about treatment, resource use, and strategies for future foot ulcer prevention.

Publication Types:

  Review

  Review, tutorial

 

Nurs Clin North Am 1998 Dec;33(4):629-41

Preventing amputations in the diabetic population.

Spollett GR

Primary Care Division, Yale University School of Nursing, New Haven, Connecticut 06536-0740, USA.

More than 50% of all lower extremity amputations occur in patients with diabetes. This phenomenon is largely preventable through risk factor reduction and proper foot care education. In cases where lower extremity injury or infection are present prompt and aggressive care can preserve the limb. New techniques for revascularization to ulcerated areas of the foot are promoting wound healing and improving long term outcomes.

Publication Types:

  Review

  Review, tutorial

 

Med Clin North Am 1998 Jul;82(4):949-71

Foot problems in diabetes.

Slovenkai MP

Department of Orthopaedic Surgery, Lahey Clinic, Burlington, Massachusetts, USA.

Prevention and care of diabetic foot complications continue to represent a major challenge to the treating clinician. Neuropathy, infection, deformity, and vascular insufficiency threaten the diabetic foot and the overall functional well being of the diabetic patient. Although foot problems in diabetes cannot be eradicated completely, the opportunity exists to diagnose and manage diabetic foot conditions effectively, to educate and motivate patients to care for their feet, to minimize complications, and to decrease health care costs.

Publication Types:

  Review

  Review, tutorial

 

Am Fam Physician 1998 Jun;57(11):2705-10 [Texto completo]

The Charcot foot in diabetes: six key points.

Caputo GM, Ulbrecht J, Cavanagh PR, Juliano P

Division of General Internal Medicine, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pa., USA.

The Charcot foot commonly goes unrecognized, particularly in the acute phase, until severe complications occur. Early recognition and diagnosis, immediate immobilization and a lifelong program of preventive care can minimize the morbidity associated with this potentially devastating complication of diabetic neuropathy. If unrecognized or improperly managed, the Charcot foot can have disastrous consequences, including amputation. The acute Charcot foot is usually painless and may mimic cellulitis or deep venous thrombosis. Although the initial radiograph may be normal, making diagnosis difficult, immediate detection and immobilization of the foot are essential in the management of the Charcot foot. A lifelong program of patient education, protective footwear and routine foot care is required to prevent complications such as foot ulceration.

Publication Types:

  Review

  Review, tutorial

 

Am Fam Physician 1998 Mar 15;57(6):1325-32, 1337-8 [Texto completo]

Diabetic foot ulcers: prevention, diagnosis and classification.

Armstrong DG, Lavery LA

Department of Orthopaedics, University of Texas Health Science Center at San Antonio, USA.

Diabetic ulcers are the most common foot injuries leading to lower extremity amputation. Family physicians have a pivotal role in the prevention or early diagnosis of diabetic foot complications. Management of the diabetic foot requires a thorough knowledge of the major risk factors for amputation, frequent routine evaluation and meticulous preventive maintenance. The most common risk factors for ulcer formation include diabetic neuropathy, structural foot deformity and peripheral arterial occlusive disease. A careful physical examination, buttressed by monofilament testing for neuropathy and noninvasive testing for arterial insufficiency, can identify patients at risk for foot ulcers and appropriately classify patients who already have ulcers or other diabetic foot complications. Patient education regarding foot hygiene, nail care and proper footwear is crucial to reducing the risk of an injury that can lead to ulcer formation. Adherence to a systematic regimen of diagnosis and classification can improve communication between family physicians and diabetes subspecialists and facilitate appropriate treatment of complications. This team approach may ultimately lead to a reduction in lower extremity amputations
related to diabetes.

Publication Types:

  Review

  Review, tutorial

 

Clin Infect Dis 1997 Dec;25(6):1318-26

Osteomyelitis of the foot in diabetic patients.

Lipsky BA

General Internal Medicine Clinic, Veterans Affairs Puget Sound Health Care System, Seattle, Washington 98108-1532, USA.

Osteomyelitis of the foot, a common and serious problem in diabetic patients, results from diabetes complications, especially peripheral neuropathy. Infection generally develops by spread of contiguous soft-tissue infection to underlying bone. The major diagnostic difficulty in diabetic patients is distinguishing bone infection from noninfectious neuropathic bony lesions. Certain clinical signs suggest osteomyelitis, but imaging tests are usually needed. The 111In-labeled leukocyte scan and magnetic resonance imaging are the most diagnostically useful. Staphylococcus aureus is the most common etiologic agent, followed by other aerobic gram-positive cocci. Aerobic gram-negative bacilli and anaerobes are occasionally isolated, often in mixed infections. Antimicrobial therapy is best directed by cultures of the infected bone, obtained percutaneously or at surgery. Antibiotic therapy should usually be given parenterally, at least initially, and continued for at least 6 weeks. Surgical debridement or resection of the infected bone, when feasible, improves the outcome. With appropriate therapy most cases of osteomyelitis can be successfully managed.

Publication Types:

  Review

  Review, tutorial

 

Am Fam Physician 1997 Nov 15;56(8):2021-8, 2033-4 [Texto completo]

Guidelines on the care of diabetic nephropathy, retinopathy and foot disease.

Zoorob RJ, Hagen MD

Louisiana State University Medical Center, New Orleans, USA.

Diabetes mellitus is a common disease frequently managed by family physicians. Because of its high prevalence and associated comorbidity, diabetes mellitus has received a great deal of attention from several specialty organizations. The American Diabetes Association, the American Board of Family Practice and the Centers for Disease Control and Prevention have published specific practice guidelines and recommendations for the care of diabetic patients. These recommendations include annual comprehensive foot examinations, yearly ophthalmologic screening for retinopathy, and urinalysis for microalbuminuria. The use of angiotensin converting enzyme inhibitors is advocated for the majority of diabetic patients with proteinuria or hypertension. Based on recent evidence, improved glycemic control is also increasingly advocated. Compliance with practice guidelines by primary care physicians has historically been poor. Mechanisms such as the use of patient problem lists and diabetic flow sheets can serve as reminders to physicians and can facilitate closer adherence to practice guidelines.

Publication Types:

  Review

  Review, tutorial

 

Am Fam Physician 1997 Jul;56(1):195-202 

Foot infections in patients with diabetes.

Caputo GM, Joshi N, Weitekamp MR

Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.

The combination of sensory neuropathy, ischemia and direct adverse effect on host defense mechanisms makes patients with diabetes vulnerable to foot infections. A high degree of clinical suspicion and vigilance is necessary for early diagnosis of soft tissue infections and their differentiation from noninfected ulcers. Diagnosis and assessment depend primarily on clinical history and physical examination, although radiographs, scans and laboratory tests may also provide useful clinical data. The ability to detect bone in the base of an ulcer with a blunt sterile probe may be particularly useful in assisting the recognition of osteomyelitis. Most non-limb-threatening infections are caused by Gram-positive cocci, but more serious infections are often polymicrobial. Effective treatment is based on a comprehensive strategy of wound care, avoidance of weight bearing, optimal metabolic control, appropriate antibiotic use and, possibly, surgical intervention.

Publication Types:

  Review

  Review, tutorial

 

 

Envia tu Sugerencia