Ulcer Relapse Research Articles

Usefulness of Simple-Designed Bilobed Flap for Reconstruction of Ischial Decubitus Ulcer.

Summary:The pressure ulcer of the ischial region is often accompanied by complete paraplegia in patients with spinal cord injury and is attributable to the compression and breakdown of tissue arising from constant sitting. Characteristically, a pressure ulcer of this region is circular and deep. We recently reconstructed ischial decubitus ulcer of 8 patients using simple-designed bilobed flap. In all cases, the flap survived completely without any complication. Moreover, none of the patients in this group experienced any pressure ulcer relapse during the postoperative follow-up from 1 year 1 month to 9 years. In the vicinity of the ischial region, the buttock contains the most abundant amount of fatty tissue. Therefore, for our technique, we create the first flap in the buttock neighboring the defect and the second flap on the posterior thigh. Using this approach, it is possible to cover the skin or soft tissue defect of the ischial region with the flap from the buttock having a thickness large enough to bear the patient’s weight during sitting. The first flap is arranged parallel to the gluteal sulcus, and the second flap from the thigh is moved to the first-flap donation site. This technique allows closure of the wound without producing tension along the suture line. The bilobed flap, which does not require the artery to be included in the flap, is applicable for patients with relapsing pressure ulcer having a history of surgery. Our flap operative procedure is particularly useful in the reconstruction of ischial decubitus ulcer.

Comparison of Arthrodesis with Total Contact Casting for Midfoot Ulcerations Associated with Charcot Neuroarthropathy.

BackgroundGross deformity of the foot in Charcot neuroarthropathy can lead to foot collapse and subsequent ulceration, infection, amputation, or premature death. Total-contact casting (TCC) is a well-established treatment for neuropathic diabetic plantar foot ulcers. It was hypothesized that arthrodesis plus TCC may have advantages over TCC alone. This pilot study compared the effectiveness of arthrodesis plus TCC with TCC alone for the prevention, treatment, and recurrence of midfoot ulcerations associated with Charcot neuroarthropathy.Material/MethodsTwenty-one subjects with plantar ulcers associated with unilateral diabetic Charcot midfoot neuroarthropathy were randomly assigned to ADS or TCC groups. The ADS group underwent an extended medial column arthrodesis procedure and TCC; ulcers were sutured directly. The TCC group underwent TCC alone with dressing changes. All patients underwent nerve conduction studies and quantitative sensory testing at baseline and during follow-up (6 and 12 months). Healing time and ulcer relapse rate were evaluated.ResultCompared with the TCC group, there were fewer lesions in the ADS group after treatment (P<0.05). Temperature testing and vibration perception threshold improved significantly after ADS (P<0.05). Although the number of patients positive for pinprick and light touch sensations increased after surgery, not all patients recovered these sensations. Healing time was not significantly different between the 2 groups (24.25±3.89 vs. 25.89±2.84 days, P>0.05). There was no ulcer recurrence after 12 months in the ADS group compared with 33.3% in the TCC group.ConclusionsAn extended medial column arthrodesis may partly improve sensory impairments and restore protective sensation in patients with Charcot neuroarthropathy.

Difficulties at work and work motivation of ulcerative colitis suffers

Because ulcerative colitis (UC) repeats remission and relapse, it is necessary to keep the condition at the relapse time in mind when considering support to provide UC suffers with at the workplace. The aim of this survey was to clarify the difficulties at work and work motivation that UC suffers feel at present and experience at the worsening time, and the factors for maintaining work motivation. We carried out an anonymous questionnaire survey of patients with present or past work experience. The difficulties at work (17 items) and work motivation (4 items) in the past week and at the time when the symptoms were most intensive during work were investigated using a newly designed questionnaire. We regarded the time in the past week as the present, and the time when the symptoms were most intensive during work as the worsening time. There were 70 respondents (response rate 32.0%). Their mean age was 43.8 years, and their mean age at onset was 33.8 years. All subjects, except 2 subjects after surgery, took medicine. Fifty-three (75.7%) of the subjects were in remission at the present, and most of them (91.4%) managed their physical condition well. Difficulties at work that many subjects worried about at the present were relevant to work conditions, such as "Others at workplace do not understand having an intractable and relapsing disease" (41.4%) or "Feel delayed or lack of chance of promotion or career advancement due to the disease" (38.6%). At the worsening time, the management of physical condition went wrong, and the frequency of hospital visits was increased, but few subjects consulted with superiors or colleagues at workplace. Difficulties at work that many subjects underwent at the worsening time were relevant to symptoms, such as "Feel physically tired" (80.0%) or "Decline foods or alcoholic beverages offered at business parties" (72.9%). Those who maintained work motivation even at the worsening time received no work-related consideration and had an adviser in the workplace to talk to about the disease. These results suggest that to provide UC suffers with support at the workplace, it is important to create a working atmosphere in which UC suffers can easily notify superiors and colleagues of their disease or can consult a doctor regularly, and for the superiors and colleagues to become advisors in the workplace to talk to about disease and work.

The best way to reduce reulcerations: if you understand biomechanics of the diabetic foot, you can do it.

Foot ulcer recurrence is still an unresolved issue. Although several therapies have been described for preventing foot ulcers, the rates of reulcerations are very high. Footwear and insoles have been recommended as effective therapies that prevent the development of new ulcers; however, the majority of studies have analyzed their effects in terms of reducing peak plantar pressure rather than ulcer relapse. Knowledge of biomechanical considerations is low, in general, in the team approach to diabetic foot because heterogeneous professionals having competence in recurrence prevention are involved. Assessment of biomechanical alterations define a foot type position; examining foot structure and recording plantar pressure could help in appropriate insole and footwear prescription and design. Patient education and compliance should be taken into consideration for better therapy success. When patients suffer from rigid deformities or have undergone an amputation, surgical offloading should be considered as an alternative.

Conservative Surgical Treatment of Infected Ulceration of the First Metatarsophalangeal Joint With Osteomyelitis in Diabetic Patients

Ulceration of the plantar aspect of the first metatarsophalangeal joint is a common localization in the diabetic foot. Conservative treatment of this lesion is a challenging problem, performed through the soft tissues and osseous debridement. The present study included a cohort of 28 patients affected by diabetes mellitus and a first ray lesion penetrating the bone. After surgical debridement with removal of the infected bone, we positioned antibiotic-loaded bone cement and stabilized the treated area with an external fixator. All patients with critical limb ischemia had their vascular disease treated before the procedure. The mean follow-up was 12.2 ± 6.9 months. Four patients developed a relapse of the ulceration after the procedure. In the postoperative period, 1 patient (3.57%) developed dehiscence of the surgical site and underwent a second procedure. In the follow-up period, 2 patients (7.14%) experienced bone cement dislocation. In 1 of these patients, a new ulceration was observed dorsally to the surgical site. The approach was surgical revision with bone cement replacement and stabilization with a new external fixator. In the other patient, given the absence of ulcerations, the cement was removed, and arthrodesis with internal stabilization using 2 cannulated screws was performed. One patient (3.57%), who had developed a relapse of ulceration after recurrent critical ischemia, underwent a percutaneous revascularization procedure and transmetatarsal amputation. During the follow-up period, no ulceration recurrences, transfer ulcerations, shoe fit problems, or gait abnormalities were detected in the other 24 patients. Our study presents the results of a technique requiring a 1-stage surgical approach to a relatively common problem, which is often difficult to solve.

Can We Repackage Omeprazole Capsules Into Multicompartment Compliance Aids?

Can We Repackage Omeprazole Capsules Into Multicompartment Compliance Aids?

FORWARD-MORPHOLOGICAL CRITERIA OF ULCERATIVE COLITIS RELAPSE AND CONTINUOUS FLOW IN CHILDREN

Inflammatory bowel disease is one of the most difficult groups of pathologies in pediatric gastroenterology, due to the steady growth of their prevalence, offset debut at an earlier age, the increase in the incidence of severe complicated forms. Established clinical, genetic, serologic criteria for progression of ulcerative colitis are contradictory, and some--the reach of most medical institutions. to evaluate the prognostic significance of morphological features of ulcerative colitis relapse and continuous flow. a retrospective study conducted histological kolonobioptatov 26 children with recurrent, 20--with a continuous flow of ulcerative colitis during their primary treatment in a hospital, the comparison group consisted of 50 children without inflammatory bowel disease. morphological characteristics identified predictors of recurrent ulcerative colitis in the form of severe eosinophilic infiltration of the epithelium, lamina propria of the mucosa. For a continuous flow was characterized: high density cell infiltration of the lamina propria mucosa epithelium predominantly under represented plasma cells, fibroblasts, sclerosis of the basal membrane, the presence of epithelial arcades deformed crypt abscesses. the extended study of biopsy material, including assessment of the composition and location of infiltration, fibroblast pool of epithelial-connective relationships in the colonic mucosa of children with ulcerative colitis will not only assess the inflammatory process, but also to predict the course of disease, thereby defining a long-term tactics treatment.

Genotypic and phenotypic patterns of antimicrobial susceptibility of Helicobacter pylori strains among Egyptian patients

Helicobacter pylori (H. pylori) is currently recognized as one of the most common chronic bacterial infections worldwide. Eradication of bacteria is effective in healing peptic ulcers, preventing ulcer relapses, and potentially decreasing the risk of progression to gastric carcinoma. For successful eradication of bacteria, it is imperative that the clinician be aware of the current antimicrobial susceptibility profiles of isolates within the region. Therefore, the aim of this study is to compare the phenotypic and genotypic patterns of antibiotics’ susceptibility to H. pylori strains among Egyptian patients.60 symptomatic cases were enrolled. H. pylori infection was diagnosed by upper endoscopy as well as biopsy. Antimicrobial susceptibility to H. pylori strains was assessed in all subjects by disc diffusion and Ellipsometer testing (E-testing) methods. Further molecular characterization of genes encoding antimicrobial resistance of isolated strains was done by the polymerase chain reaction (PCR).For metronidazole and ciprofloxacin, we compared the phenotypic and genotypic patterns of resistance as detected by PCR amplification of the resistance genes. Resistance rates by E-test were 100% and 25% for metronidazole and ciprofloxacin respectively from 16 isolated H. pylori strains.Improving the knowledge of resistance mechanisms, the elaboration of rational and efficacious associations for the treatment H. pylori infection are of high importance especially in determining the therapeutic outcome. Further progress should ultimately focus on the establishment of a cheap, feasible and reliable laboratory test to predict the outcome of a therapeutic scheme.

SPECTROPHOTOMETRIC METHOD FOR ESTIMATION OF RABEPRAZOLE SODIUM IN TABLETS

A simple, rapid, accurate, economical and reproducible spectrophoto metric method for estimation of rabeprazole sodium ( RAB ) has been developed. The method employs estimation by straight line equation obtained from calibration curve of rabeprazole sodium. Analysis was performed at 284.0nm which is absorbance maximum of the said drug in 20% v/v aqueous methanol as solvent . The method obeys Beer's law between 4.08 - 24.5 µ g/. Results of analysis were validated statistically by ICH guidelines 1996. INTRODU CTION Rabeprazole sodium I.P. or 2 - (((4 - (3 - methoxypropoxy) - 3 - methyl - 2 - pyridinyl) methyl)sulfinyl) - 1H - benzimidazole , is a selective and irreversible proton pump inhibitor and it has proven efficacy in healing, symptoms relief and prevention of relapse of ga stric ulcer, duodenal ulcer and gasteroesophageal reflux disease 1 . Various chromatographic 2 - 6 and spectrometric 7 - 8 methods have been developed for quantification of rabeprazole sodium. No doubt, available chromatographic methods are accurate and precis e with good reproducibility, but the cost of analysis is quite high owing to expensive instrumentation, reagent required, expertise and more time per sample analysis, this makes these chromatographic methods unsuitable for routine analysis. Variations in c olumns and instruments accuracy due to manufacturer to manufacturer variation complicate transfer of these HPLC methods. Extensive literature survey revealed that only a single UV method is however reported till date for the estimation of rabeprazole sodiu m in tablet dosage form. That's why it was thought to develop new simple, economical, accurate, reproducible and rapid analytical methods for estimation of rabeprazole sodium in tablets by UV spectroscopy.

Penbactam for Helicobacter pylori eradication: A randomised comparison of quadruple and triple treatment schedules in an Iranian population

Background & study aimsSelection of the best drug regimens for eradication of Helicobacter pylori infection especially in patients at risk of peptic ulcer relapses and the development of complications is challenging. This study assessed and compared the efficacy of the two common PPI based triple therapies to a quadruple therapy including PPI, metronidazole, amoxicillin and a bismuth compound in Iranian population. Patients & MethodsThree hundred and thirty patients with peptic ulcer and H. pylori infection were included in the study. Patients were randomly assigned to one of the three treatment protocols all given twice daily: (a) A 14-day quadruple therapy (OMAB group) comprising omeprazole 20mg, metronicazole 500mg, amoxicillin 1g, and bismuth subcitrate 240mg; (b) A 14-day triple regimen (OCP group) comprising omeprazole 20mg plus clarithromycine 500mg and penbactam 750mg and (c) A 14-day triple regimen (OCA group) comprising omeprazole 20mg plus clarithromycine 500mg and amoxicillin 1g. Cure was defined as a negative urea breath test at least six weeks after treatment. ResultsThe per-protocol eradication rates achieved with both OCP regimen (87.0%) and OCA treatment (90.8%) were significantly higher than the OMAB treatment protocol (56.0%); however, no significant difference emerged in eradication rates between the two triple treatment schedules. No significant differences between the groups were found in most side-effects. ConclusionTwo-week quadruple therapy showed a lower eradication rate compared to common triple treatment schedules when used as first-line eradication treatment for H. pylori infection in Iranian population.

Feasibility and Effectiveness of Internal Pedal Amputation of Phalanx or Metatarsal Head in Diabetic Patients with Forefoot Osteomyelitis

From January 2007 to December 2009, 207 diabetic patients were consecutively admitted to our foot center because of osteomyelitis of a phalanx or metatarsal head. The removal of infected bone was performed by internal bone resection in 110 patients (group A) and amputation in 97 patients (46.9%; group B). Dehiscence occurred in 15 patients (13.6%) patients in group A and 10 patients (10.3%) in group B (p = 0.464). A total of 206 patients (99.5%) were followed up from January 1, 2007 to December 31, 2011. Ulcer relapse occurred in 12 patients (12.4%) in group A and 18 patients (16.4%) in group B (p = .437). A contralateral ulcer occurred in 10 group A patients (10.3%) and 14 group B patients (12.7%; p = .667). The results of the present study have demonstrated that bone resection with preservation of the soft tissue envelope is feasible in approximately one half of diabetic patients with forefoot osteomyelitis and does not result in any risk of major dehiscence or ulcer recurrence compared with ray or toe amputation.

Structure and Proposed Mechanism for the pH-Sensing Helicobacter pylori Chemoreceptor TlpB

pH sensing is crucial for survival of most organisms, yet the molecular basis of such sensing is poorly understood. Here, we present an atomic resolution structure of the periplasmic portion of the acid-sensing chemoreceptor, TlpB, from the gastric pathogen Helicobacter pylori. The structure reveals a universal signaling fold, a PAS domain, with a molecule of urea bound with high affinity. Through biophysical, biochemical, and invivo mutagenesis studies, we show that urea and the urea-binding site residues play critical roles in the ability of H.pylori to sense acid. Our signaling model predicts that protonation events at Asp114, affected by changes in pH, dictate the stability of TlpB through urea binding.

STUDY ON EFFICACY OF QUADRUPLE THERAPY RACM IN PATIENTS WITH HP- POSITIVE GASTRIC ULCER

Objectives: Gastric ulcer is a chronis disease with a lot of dangerous complications and H. pylori is a major cause of gastric ulcer. Eradicating H. pylori helps reducing ulcer relapse and preventing cancer. The aim of study: to evaluate the rate of H. pylori infection in gastric ulcer and efficacy of quadruple therapy RACM for 5 days in patients with gastric ulcer with H. pylori positive. Materials and methods: Total 98 patients with gastric ulcer have been performed the endoscopy and CLO-Test, treated with quadruple therapy RACM for 5 days and evaluate efficacy 4 weeks after ending treatment. Results: The rate of H. pylori in gastric ulcer is 82.65%. The rate of H. pylori eradication is 88.71%. The effect of reducing pain of therapy is 90.32%; and the rate of reducing pain: 96.37% in successfully H. pylori-eradicated group and in the other group 42.85% (p &lt; 0.05). The effect of healing ulcer of therapy is 77.41%; and the rate of healing gastric ulcer: 83.63% in successfully H. pylori-eradicated group and in the other group 28.57% (p &lt; 0.05). The adverse effects of therapy included tiredness: 11.29%, lose appetite: 8.06% and diarrhea: 6.45%. Conclutions: Quadruple therapy RACM for 5 days showed an effective, safe and simple regime for eradicating H. pylori and should be considered to apply as the first lines treatment for H. pylori.

Comparison of the efficacy of irsogladine maleate and famotidine for the healing of gastric ulcers after Helicobacter pylori eradication therapy: a randomized, controlled, prospective study

Objective. Helicobacter pylori eradication therapy alone cannot heal gastric ulcers in Japanese patients. Irsogladine has previously been shown to accelerate the healing of gastric ulcers after H. pylori eradication therapy. And we previously reported that histamine H2 receptor antagonists inhibit gastric ulcer relapse after H. pylori eradication therapy. We therefore compared the efficacy of irsogladine with famotidine as appropriate treatments for ulcers after eradication therapy. Methods. Gastric ulcer patients with H. pylori infection (n = 119) were randomized to treatment with irsogladine 4 mg/day (n = 60) or famotidine 40 mg/day (n = 59) following 1-week H. pylori eradication therapy. After treatment, assessments of gastric ulcer healing were performed. Results. The ulcer healing rates in patients receiving irsogladine and famotidine were 85.2% (46/54) and 79.6% (43/54), respectively, and were not significantly different (p = 0.4484). In the famotidine group, the healing rate was significantly lower in patients who drink alcohol than in those who do not (60.0% vs. 91.2%; p = 0.0119). However, in the irsogladine group the healing rate did not differ between patients who drink alcohol and those who do not. Furthermore, the healing rate in smokers was significantly higher in the irsogladine group (88.0%) than in the famotidine group (59.1%) (p = 0.0233). Conclusions. Irsogladine and famotidine are both acceptable in treatment after H. pylori eradication therapy in gastric ulcer patients. Findings also suggest that irsogladine is more beneficial than famotidine in patients who drink alcohol and smoke.

Quadruple versus common triple-treatment regimens for Helicobacter pylori eradication in the Iranian population: A randomised study

Background and study aims Selection of the best drug regimens for effective eradication of Helicobacter pylori ( H. pylori) infection, especially in patients at risk of peptic ulcer relapses and development of complications of peptic ulcer disease, is challenging. This study assessed and compared the efficacy of the two common proton pump inhibitor (PPI)-based triple therapies to a quadruple therapy including PPI, metronidazole, amoxicillin and a bismuth compound in Iranian population. Patients and methods A total of 330 patients with peptic ulcer and H. pylori infection were included in the study. Patients were randomly assigned to one of the three treatment protocols: (1) a 14-day quadruple therapy (OMAB group) comprising omeprazole 20 mg, metronidazole 500 mg, amoxicillin 1 g and bismuth subcitrate 240 mg; (2) a 14-day triple regimen (OCP group) comprising omeprazole 20 mg plus clarithromycin 500 mg and penbactam 750 mg; and (3) a 14-day triple regimen (OCA group) comprising omeprazole 20 mg plus clarithromycin 500 mg and amoxicillin 1 g, all given twice daily. Cure was defined as a negative urea breath test at least 6 weeks after treatment. Results The intention-to-treat H. pylori eradication rates achieved with both OCP regimen (87.0%) and OCA treatment (88.8%) were significantly higher than the OMAB treatment protocol (56.0%); however, no significant difference emerged in eradication rates between the two triple-treatment schedules. No significant differences were found in most side effects between the groups. Conclusion Two-week quadruple therapy showed a lower eradication rate compared with common triple-treatment schedules when used as a first-line eradication treatment for H. pylori infection in the Iranian population.

Improved conjunctival transplantation for corneal ulcer.

To evaluate the therapeutic effect of pedical conjunctival flap transposition on refractory corneal ulcer. The data of 56 eyes of 56 patients with refractory corneal ulcer who underwent pedical conjuctival transposition in a tertiary eye unit in China from June 2005 to June 2009 were retrospectively analyzed. There were 36 infective corneal ulcers, 9 keratoplasty graft ulcers, 4 traumatic ulcers, and 7 chemical burn ulcers. All patients were treated with focal debridement and pedical conjuctival flap transposition. Forty-seven out of 56 (83.9%) were cured after one surgery, and 5 (8.9%) had conjunctival flap retraction, among which 3 underwent the second surgery and 2 had the third surgery to completely heal. Four patients (7.2%) turned to lamellar keratoplasty because of fungal corneal ulcer relapse. Ulcer in 52 patients healed and the globe preserved. They had different levels of vision improvement. Pedical conjunctival flap transposition is effective for refractory corneal ulcer.

Interaction of Helicobacter pylori Infection and Nonsteroidal Anti‐Inflammatory Drugs in Gastric and Duodenal Ulcers

Gastric (GU) and duodenal ulcers (DU) are in most instances either induced by Helicobacter pylori infection or by nonsteroidal anti-inflammatory drugs (NSAIDs). Whether eradication of H. pylori is beneficial in NSAID users for preventing NSAID induced GU and DU has been the focus of different studies. Mechanisms shared by both H. pylori and NSAIDs for the induction of GU and DU were reviewed and randomized controlled trials on H. pylori eradication for prevention and healing of GU and DU in patients requiring NSAID therapy were identified by a PubMed search. Key factors in the induction of GU and DU for both H. pylori and NSAIDs are a decrease in pH, imbalance between apoptosis and proliferation, reduction in mucosal blood flow, and recruitment of polymorphonucleates in distinct compartments. For primary ulcer prevention, H. pylori eradication before starting an NSAID therapy reduces the risk of NSAID induced GU and virtually abolishes the risk of DU. H. pylori eradication alone is not sufficient for secondary prevention of NSAID induced GU and DU. H. pylori infection appears to further increase the protective effects of proton-pump inhibitors (PPI) to reduce the risk of ulcer relapse. H. pylori eradication does not influence the healing of both GU and DU if NSAID intake is discontinued. Duodenal ulcer is more closely related to H. pylori infection than GU in NSAID users. H. pylori eradication is recommended for primary prevention of GU and DU in patients requiring NSAID therapy. PPI therapy is mandatory for secondary prevention of gastroduodenal ulcers, and appears to further reduce the risk of ulcer relapse in the presence of H. pylori.

De novo erosive esophagitis in duodenal ulcer patients related to pre-existing reflux symptoms, smoking, and patient age, but not to Helicobacter pylori eradication: a one-year follow-up study

It remains unclear whether the Helicobacter pylori eradication may cause or provoke gastroesophageal reflux disease. Therefore, we aimed to elucidate the role of H. pylori eradication and other factors in the development of erosive esophagitis in patients with duodenal ulcer. We enrolled 183 H. pylori-positive duodenal ulcer patients without erosive esophagitis. Final endoscopy was performed 12 months later or in case if ulcer relapse was suspected. H. pylori was diagnosed by the urease test and histology if the results of at least one of the tests were positive. A total of 142 patients were assigned to the eradication treatment. The control group included 41 volunteers--20-mg omeprazole b.i.d. for 4 weeks was administered. A total of 150 patients completed the study. Of the 119 patients, 70 (58.8%) were cured from H. pylori, and in 49 (41.2%) of patients, treatment of H. pylori was unsuccessful. All 31 controls remained H. pylori-positive. At the final endoscopy, erosive esophagitis was found in 19 (12.7%) patients. Erosive esophagitis developed in 8 (11.4%) successfully eradicated patients, in 9 (18.4%) unsuccessfully treated patients, and in 2 (6.5%) controls (P>0.05 comparing the groups). Multivariate logistic regression analysis revealed 3 factors at baseline, which were significant (P<0.05) in predicting the occurrence of erosive esophagitis: age more than 43 years (OR, 4.96; 95% CI, 1.47-16.71), nonerosive gastroesophageal reflux disease (OR, 3.96; 95% CI, 1.34-11.68), and smoking (OR, 3.17; 95% CI, 1.01-9.17). H. pylori eradication did not influence the incidence of erosive esophagitis in patients with duodenal ulcer during a one-year follow-up period. Pre-existing nonerosive gastroesophageal reflux disease, smoking, and older age are important predictors of de novo development of erosive esophagitis.

S1054 Preliminary Results From the Ulcerative Colitis Relapse Prevention Study (UCRPT)

S1054 Preliminary Results From the Ulcerative Colitis Relapse Prevention Study (UCRPT)

Conservative management of diabetic forefoot ulceration complicated by underlying osteomyelitis: the benefits of magnetic resonance imaging

To assess efficacy of conservative management of neuropathic forefoot ulcers with underlying osteomyelitis in subjects with diabetes when magnetic resonance imaging (MRI) is used to confirm or establish diagnosis and to guide antibiotic duration. A retrospective cohort study over 6 years assessing rates of ulcer healing, relapse and amputation. Antibiotics were continued for 3-month cycles with interval MRI: if the lesion had healed and bone signal change resolved or improved, antibiotics were discontinued; if the lesion had not healed or there was no difference in bone signal change, antibiotics were continued for a further 3-month cycle; clinical or radiological deterioration resulted in endoluminal or open vascular surgical intervention where appropriate, or digital or more proximal amputation. There were 53 episodes in 47 subjects (mean +/- sd age 62 +/- 13 years, duration of diabetes 19 +/- 13 years, glycated haemoglobin 8.4 +/- 1.6%; six with Type 1 diabetes and seven with end-stage renal failure). Successful healing without relapse was achieved in 40 episodes (75%) [median (range) duration of antibiotics 6 (3-12) months and follow-up post-cessation of antibiotics 15 (3-58) months]. Relapse occurred in six episodes (13%) at 31 (2-38) months post-cessation of antibiotics. There were one major (2%) and eight minor (15%) amputations. Five subjects have died (11%), all without foot ulcers. High rates of healing and low rates of amputation were achieved. The use of MRI was associated with long courses of antibiotics, but particularly low relapse rate.