Gangrene In Patients Research Articles

Transmetatarsal amputation for infection or gangrene in patients with diabetes mellitus. 1949.

Transmetatarsal amputation for infection or gangrene in patients with diabetes mellitus. 1949.

Vascular Calcification, Autonomic Neuropathy, and Peripheral Blood Flow in Patients with Diabetic Nephropathy

The possibility that digital gangrene in patients with diabetic nephropathy might be due to abnormalities of peripheral blood flow secondary to vascular calcification has been investigated. Twenty patients with renal failure due to diabetic nephropathy were studied. Peripheral blood flow was measured using venous occlusion plethysmography, together with an assessment of medial arterial calcification on plain radiographs of the hands and feet, and transcutaneous oxygen tension (TcPO2). Hallux blood flow was markedly raised (median 22.5, range 11.5-56.5, ml min-1 100-ml-1) compared with non-diabetic control subjects (4.7, 1.1-10.5, ml min-1 100-ml-1; p less than 0.01) and similar to that in diabetic patients with autonomic neuropathy (29.5, 16.7-49.6, ml min-1 100-ml-1). Although vascular calcification was common and extensive in the patients with diabetic nephropathy, TcPO2 measurements in the supine foot were normal and did not indicate tissue ischaemia. We conclude that despite extensive vascular calcification high peripheral blood flow occurs in the feet of these patients at rest together with normal transcutaneous oxygen tension.

Three Cases of Gas Gangrene in Patients with Diabetes Mellitus and a Review of the Japanese Literature

Three Cases of Gas Gangrene in Patients with Diabetes Mellitus and a Review of the Japanese Literature

Computer-aided prediction of gangrenous and perforating appendicitis.

The clinical details of 100 patients with proved acute appendicitis were compared with those of 100 patients with perforating or gangrenous appendicitis. Twenty features were found to be significantly different between the two groups. This information was incorporated into a computer data base and used in the differential diagnosis of abdominal pain. A program written to predict the probability that gangrene or perforation was present in patients with appendicitis gave a diagnostic accuracy over 91%. A clinical scoring index, which accurately predicted the state of the appendix in 88% of patients, was constructed from the significant differences between the two groups. When clinical scoring or computer analysis predicts a high probability of perforation or gangrene in patients with appendicitis, surgery should be performed without delay.

Results of midleg amputations for gangrene in diabetics.

The results of midleg amputations in a series of 127 cases of gangrene in patients with diabetes were reported by one of us (S. S.) in 1948. 1 It was stressed in that report that amputations at the midleg level were preferred to thigh amputations because of lower mortality, better function and lessened tendency to persistent stump pain. Since then a change in technic has been adopted. While almost all the patients with operation up to 1945 were treated by guillotine amputations without skin closure, allowing healing by granulation of the stump, almost all amputations since that date have been closed, and in the majority of patients healing has taken place by primary union. This has resulted in a striking reduction in mortality and a considerable saving of time. We report herein the results of this improved procedure and summarize the data on the entire group of cases up to