scholarly journals Surgical correction of foot deformities as a method for prevention and treatment of diabetic foot syndrome

2018 ◽  
Vol 25 (3-4) ◽  
pp. 47-57
Author(s):  
M. V Parshikov ◽  
P. S Bardyugov ◽  
G. R Galstyan ◽  
N. V Yarygin ◽  
V. M Golovchak ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Mechanical Effect ◽  
Diabetic Foot Syndrome ◽  
Foot Deformities ◽  
Surgical Interventions ◽  
Ulcer Relapse ◽  
Study Results ◽  
Prevention And Treatment ◽  
Grade 3

Purpose: to study the potentialities of orthopaedic surgery in foot deformities as a method for prevention and treatment of diabetic foot syndrome (DFS). Patients and methods. During the period from 2014 to 2017 thirty seven patients (13 men and 24 women aged 47 - 75 years) with DFS were operated on for feet deformity. According to Texas University classification 4 patients had grade 0, 7 - grade 3 and 26 patients - grade 4a pathology. Primary deformities were observed in 13 cases, secondary deformities resulting from DFS - in 24 cases. Forty seven different surgical interventions were performed. All interventions were grouped according to D.G. Armstrong classification for DFS surgical treatment. The surgical task was the correction of biomechanics, unloading of foot segments that were subjected to high mechanical effect caused by the deformity. Results. The follow up period was from 2 moths to 3 years. Primary healing of the ulcers was observed after 32 surgical interventions. In 2 cases revision (more radical) surgical intervention was performed. No deformity relapse was noted. Postoperative wound suppuration was recorded in 1 case. Ulcer relapse was observed in 1 case. Conclusion. The study results allow suggesting a significant role and wide-ranging potentialities of surgical orthopaedics for the effective and functional treatment of patients with DFS.

scholarly journals COMPARATIVE CHARACTERISTICS OF TREATMENT RESULTS USING THE OFFLOADING MEANS IN PATIENTS WITH PURULENT-NECROTIC COMPLICATIONS OF DIABETIC FOOT SYNDROME

2021 ◽  
Vol 74 (8) ◽  
pp. 1891-1893
Author(s):  
Rostyslav S. Shevchenko ◽  
Stanislav I. Shevchenko ◽  
Dmytro S. Pryimenko ◽  
Oksana S. Tsyganenko ◽  
Vladimir M. Feskov
Keyword(s):  
Pain Intensity ◽  
Diabetic Foot ◽  
Inpatient Treatment ◽  
Healing Process ◽  
Laboratory Data ◽  
Diabetic Foot Syndrome ◽  
Clinical Indicators ◽  
Surgical Interventions ◽  
Accelerate Wound Healing ◽  
Minimal Contact

The aim: To conduct a comparative analysis of clinical data, laboratory results, and pain intensity in patients using developed by us device for offloading the foot and plaster splint during inpatient treatment of purulent-necrotic complications of diabetic foot syndrome. Materials and methods: We examined 76 patients with purulent-necrotic complications of diabetic foot syndrome, who used a plaster splint and a device for offloading the foot. We evaluated the clinical indicators of the healing process, laboratory data and pain intensity. Results: Comparing the results of using the device for offloading the foot and the plaster splint showed that the developed by us device had a positive effect on the dynamics of the healing process: the edema disappeared on average 1.5 days earlier; the redness vanished on average 2.5 days earlier. We observed granulation and epithelialization significantly earlier (p <0.05) than in the group where the plaster splint was used. The number of recorded surgical interventions was statistically significant and less (p <0.05) in the group where our device was used. Low pain rates were in patients using a device for offloading the foot due to minimal contact of the wound surface with the floor. Conclusions: According to the results of comparative using the device for offloading the foot and plaster splint, we found out that using the device for offloading the foot allows creating statistically significant better conditions to accelerate wound healing in patients and reduce the duration of inpatient treatment.

Alpelisib (ALP) + endocrine therapy (ET) in patients (pts) with PIK3CA-mutated hormone receptor-positive (HR+), human epidermal growth factor-2-negative (HER2-) advanced breast cancer (ABC): First interim BYLieve study results.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 1040-1040 ◽  
Author(s):  
Hope S. Rugo ◽  
Manuel Ruiz Borrego ◽  
Stephen K. L. Chia ◽  
Dejan Juric ◽  
Nicholas C. Turner ◽  
...  
Keyword(s):  
Pik3ca Mutation ◽  
Safety Data ◽  
Dose Intensity ◽  
Open Label ◽  
Safety And Efficacy ◽  
Hormone Receptor Positive ◽  
Study Results ◽  
Common Grade ◽  
Grade 3

1040 Background: In the phase 3 SOLAR-1 study, ALP + fulvestrant (FUL) improved PFS in pts with HR+, HER2– ABC with a PIK3CA mutation overall and in the small group of pts with prior cyclin-dependent kinase 4/6 inhibitor (CDKi) use. We report interim data from the BYLieve study in pts with PIK3CA-mutated ABC and prior CDKi exposure. Methods: BYLieve is an ongoing, phase 2, open-label, non-comparative study of ALP 300 mg QD + ET in men and women with PIK3CA-mutated HR+, HER2– ABC whose disease progressed on/after CDKi + ET. Pts are permitted ≤2 prior anticancer therapies and ≤1 prior chemotherapy regimen for ABC. Pts with prior CDKi and AI ( FUL cohort) receive ALP and FUL 500 mg Q28d + C1d15 IM. Pts with prior CDKi and FUL ( LET cohort) receive ALP and letrozole (LET) 2.5 mg PO QD. In this preplanned interim analysis, conducted after ≥20 pts in FUL had ≥6 mo of follow-up, descriptive data are reported for preliminary safety and efficacy in the FUL and LET cohorts. Results: At data cutoff, 64 and 36 pts were enrolled in the FUL and LET cohorts, respectively; 39 pts ( FUL, n = 21; LET, n = 18) have safety and efficacy data with ≥6 mo follow-up and are reported here. Data on 100 pts enrolled at the time of data cutoff will be presented. In the 39 pts with ≥6 mo follow-up, median ALP duration was 5.3 and 5.5 mo in FUL and LET, respectively; median duration of FUL and LET was 5.6 mo. Median relative ALP dose intensity was 93% ( FUL) and 87% ( LET). Most common grade ≥3 adverse events were hyperglycemia (38.1% ( FUL) and 27.8% ( LET)) and rash (4.8% ( FUL) and 27.8% ( LET)). Only 2 pts (5%; 1 pt per cohort) discontinued due to an AE. In pts with centrally confirmed PIK3CA mutation (n = 20 ( FUL); n = 17 ( LET)), ORR was 20% ( FUL) and 18% ( LET), CBR was 40% ( FUL) and 35% ( LET). Efficacy and safety data for the 100 enrolled pts will be presented at the meeting. Conclusions: Pending further readout of the ongoing BYLieve trial, safety and tolerability of ALP and hormonal therapy in pts with prior CDKi are consistent with those of SOLAR-1; discontinuation due to toxicity was rare. NCT03056755. Clinical trial information: NCT02437318.

scholarly journals Grade III meningioma: 10 year single centre case series

2019 ◽  
Vol 21 (Supplement_4) ◽  
pp. iv18-iv18
Author(s):  
Hari Mcgrath ◽  
Jose Lavrador ◽  
Ioannis Christodoulides ◽  
Prajwal Ghimire ◽  
Richard Gullan ◽  
...  
Keyword(s):  
Case Series ◽  
Extent Of Resection ◽  
Tumour Recurrence ◽  
Subtotal Resection ◽  
Who Grade ◽  
Surgical Interventions ◽  
Grade 3 ◽  
Oncology Centre ◽  
Rhabdoid Features

Abstract Rationale WHO Grade 3 meningiomas are a rare, malignant subtype of meningioma. Few controlled case series detailing its treatment and follow-up are to be found in the literature. Methods Retrospective cohort study of patients treated in a single neuro-oncology centre in the period between September 2008 and March 2019 with an initial diagnosis of WHO Grade 3 meningioma. Demographic and clinical data has been collected from the available medical records. Results 9 patients were included in this series: 2 had convexity, 2 sphenoid wing, 2 parafalcine, 1 parasagittal with a further 3 multiple locations and 1 patient with parietal convexity meningioma. 3 tumours displayed rhabdoid features, whilst 4 displayed papillary features and a further 2 displayed epithelial structures. All patients underwent surgical intervention: 5 patients had a subtotal resection with 3 having total resection. 3/4 of reported Simpson Grading was grade 2, whilst the remaining 1/4 was grade 1. The extent of resection for 1 patient was uncertain. Post surgically, 6 received adjuvant radiotherapy, 2 had no further treatment and 1 received gamma knife therapy. No patient received chemotherapy. 5 patients saw no tumour recurrence at follow up appointments (mean 50 months). Within 2 years of their respective surgical interventions, 4 patients died due to tumour recurrence and associated complications (3 patients). Conclusion To establish a uniform approach to treatment of patients with WHO Grade 3 meningiomas is challenging. Management involves a patient-centred approach based on multidisciplinary meeting decisions. Multicentre registries may allow further conclusions.

scholarly journals Endovascular management of patients with coronary artery disease and diabetic foot syndrome: A long-term follow-up

2011 ◽  
Vol 8 (2) ◽  
pp. 78-81 ◽  
Author(s):  
Rigatelli Gianluca ◽  
Cardaioli Paolo ◽  
dell’Avvocata Fabio ◽  
Giordan Massimo ◽  
Lisato Giovanna ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Diabetic Foot ◽  
Diabetic Foot Syndrome ◽  
Endovascular Management ◽  
Long Term Follow Up ◽  
Artery Disease

scholarly journals Analysis of Clinical Profiles, Deformities, and Plantar Pressure Patterns in Diabetic Foot Syndrome

2021 ◽  
Vol 11 (23) ◽  
pp. 11464
Author(s):  
Claudia Giacomozzi ◽  
Giada Lullini ◽  
Alberto Leardini ◽  
Paolo Caravaggi ◽  
Maurizio Ortolani ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Plantar Pressure ◽  
Weight Bearing ◽  
Descriptive Analysis ◽  
Biomechanical Analysis ◽  
Diabetic Foot Syndrome ◽  
Foot Bones ◽  
Patients With Diabetes ◽  
Ct Analysis

Diabetic foot syndrome refers to heterogeneous clinical and biomechanical profiles, which render predictive models unsatisfactory. A valuable contribution may derive from identification and descriptive analysis of well-defined subgroups of patients. Clinics, biology, function, gait analysis, and plantar pressure variables were assessed in 78 patients with diabetes. In 15 of them, the 3D architecture of the foot bones was characterized by using weight-bearing CT. Patients were grouped by diabetes type (T1, T2), presence (DN) or absence (DNN) of neuropathy, and obesity. Glycated hemoglobin (HbA1c) and plantar lesions were monitored during a 48-month follow-up. Statistical analysis showed significant differences between the groups for at least one clinical (combined neuropathy score, disease duration, HbA1c), biological (age, BMI), functional (joint mobility, foot alignment), or biomechanical (regional peak pressure, pressure-time integral, cadence, velocity) variable. Twelve patients ulcerated during follow-up (22 lesions in total), distributed in all groups but not in the DNN T2 non-obese group. These showed biomechanical alterations, not always occurring at the site of lesion, and HbA1c and neuropathy scores higher than the expected range. Three of them, who also had weight-bearing CT analysis, showed >40% of architecture parameters outside the 95%CI. Appropriate grouping and profiling of patients based on multi-instrumental clinical and biomechanical analysis may help improve prediction modelling and management of diabetic foot syndrome.

scholarly journals Vacuum therapy in complex treatment of neuropathic form of diabetic foot syndrome in Ghana

2020 ◽  
Vol 5 (3) ◽  
pp. 16-24
Author(s):  
W. M. Rdeini ◽  
V. A. Mitish ◽  
Yu. S. Paskhalova ◽  
S. L. Sokov
Keyword(s):  
West Africa ◽  
Diabetic Foot ◽  
Local Treatment ◽  
Main Group ◽  
Diabetic Foot Syndrome ◽  
Comprehensive Treatment ◽  
Vacuum Therapy ◽  
City Hospital ◽  
Study Results ◽  
Antiseptic Solutions

Diabetic foot syndrome (DFS) is a serious public health problem in developing countries, where medical resources are limited, and the vast majority of patients turn to medical facilities too late with severe forms of the disease and often in advanced stages.Objective: to evaluate the effectiveness of negative pressure wound therapy (NPWT) in treating patients with a neuropathic form of DFS compared with traditional methods to reduce the number of high amputations and overall mortality in Ghana.Materials and research methods. A prospective, non-randomized, comparative clinical study of the results of examination and treatment of 59 patients with type 2 diabetes mellitus (DM) was performed at the Seventh-day Adventist City Hospital (Ghana, West Africa), Kumasi University Hospital and the Effiduase District Hospital (Ghana, West Africa) in the period from January 1, 2011 to December 31, 2013, there were 37 female patients (63.3 %), 22 male patients (36.7 %). The volume of foot tissue damage varied from II to IV degree according to Wagner classification (II degree was diagnosed in 55.6 % of cases). The average age of patients was 31.5 ± 7.3 (20–72) years. The average duration of DM was 7.3 ± 4.2 years. Bacteriological examination of wounds showed that Staphylococcus aureus was most often an isolated pathogen. All microorganisms identified from patients’ wounds had high resistance to commonly used antibiotics. Patients were randomly assigned to groups. NPWT is the only topical treatment in the main group; traditional dressings with antiseptic solutions (iodophors) were used in the comparison group.Study results. Comprehensive treatment of patients in both groups included surgical debridement of purulent foci, local treatment (NPWT or dressings with antiseptic solutions) and skin grafting or healing by secondary intention after the transition of the wound process to the reparative stage. None of the patients in both groups had a high amputation. Not a single fatal outcome has been recorded. In patients of the main group, the transition of the wound process to the reparative stage was carried out in a shorter time compared with those treated without NPWT.Conclusion. Treatment of the neuropathic form of DFS with the NPWT (for example, patients in Ghana) reduces the hospital stay and the number of high amputations of the lower extremities, and improves the quality of life of patients.

Experience of endovascular treatment of patients with chronic ischemia threatening the loss of a limb

2021 ◽  
Vol 88 (2) ◽  
pp. 38-43
Author(s):  
V.Ya. Rudman ◽  
◽  
K.A. Kalashnikov ◽  
G.A. Burov ◽  
◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Lower Extremities ◽  
Limb Loss ◽  
Diabetic Foot Syndrome ◽  
Correct Selection ◽  
Chronic Ischemia ◽  
Critical Ischemia ◽  
Endovascular Revascularization ◽  
Global Trend

The aim of the study was to assess the technical feasibility of endovascular revascularization of the arteries of the lower extremities in the development of critical ischemia of the lower extremities (chronic ischemia with threatening limb loss), including diabetic foot syndrome. Two clinical cases of endovascular revascularization of lower limb arteries with the development of chronic ischemia with threatening limb loss and diabetic foot syndrome were analyzed. Median age was 61 (60–62) years; there was 1 male (50 %). Upon hospitalization, the risk of limb loss according to the WIfI classification was assessed in one case as high, in the other as medium. The efficiency of revascularization was 100 %. In 1 case (50 %), a second intervention was required. High amputation after surgery during the next year of follow-up was 100 % not necessary. The duration of the operation was 120–150 minutes. The survival rate during the year of follow-up after surgery was 100 %. Clinical observation demonstrates that even with the correct selection of patients, stratification of risk factors for both possible loss of a limb and the risk of surgery, as well as the correctness of the chosen tactics for revascularization of the CPR, only with an increase in the number of procedures performed, routing training and the creation of specialized centers is it possible to achieve satisfactory results in treatment of this problem, which, as the global trend shows, will worsen as the incidence of diabetes increases and the population ages

scholarly journals The use of dressing materials based on the lipid-colloid technology for the local treatment of diabetic foot syndrome

2010 ◽  
Vol 13 (3) ◽  
pp. 129-132
Author(s):  
Vladimir Nikolaevich Khramilin
Keyword(s):  
Diabetic Foot ◽  
Chronic Wounds ◽  
Local Treatment ◽  
Ankle Brachial Index ◽  
Local Therapy ◽  
Diabetic Foot Syndrome ◽  
Materials Used ◽  
Dressing Materials ◽  
High Absorption

Aim. Clinical assessment of the use of dressing materials based on the lipid-colloid technology for the local treatment of diabetic foot syndrome (DFS). Materials and methods. The study included 24 patients with DM1 and DM2 and neuropathic or neuroischemic forms of DFS in the absence of pronounced leg ischemia (ankle-brachial index >0.7). Duration of the observation period was 8 weeks, the patients were examined once in 2 weeks. The dressing materials used in the study were based on the Cellosorb NA, Cellosorb Ag, Urgotul S Ag. technology (Laboratories Urgo). Efficacy and safety of the dressing materials were estimated from the wound size, degree of exudation, characteristics of the wound bed and the surrounding tissues. The data obtained were treated using Statistica v. 7.0 software (StatSoft Inc.). Results. Efficacy of local therapy was assessed based on the Pressure Ulcer Scale of Healing (PUSH). Neither local nor systemic adverse events related to the use of the above dressing materials were registered during the follow-up. Cellosorb NA and Cellosrb Ag hydrocellular dressings showed high absorption activity and atraumatic properties. Most patients especially those using Cellosorb Ag were free from local infection. Conclusion. Dressing materials based on the lipid-colloid technology are safe and meet all requirements for the means of local treatment of chronic wounds.

A retrospective comparison between regorafenib and TAS-102 for refractory metastatic colorectal cancer.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 723-723 ◽  
Author(s):  
Toshiki Masuishi ◽  
Hiroya Taniguchi ◽  
Satoshi Hamauchi ◽  
Azusa Komori ◽  
Yosuke Kito ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Median Duration ◽  
Previous Treatment ◽  
Wild Type ◽  
Optimal Sequence ◽  
Study Results ◽  
Grade 3 ◽  
Ecog Ps

723 Background: Regorafenib (R) and TAS-102 (T) prolonged survival for patients (pts) with refractory metastatic colorectal cancer (mCRC) in phase 3 trials. However, little is known regarding optimal sequence of administration of R and T, because of lack of head-to-head trials. Methods: We retrospectively evaluated pts who had been treated with R or T in two institutions from May 2013 to March 2015. Inclusion criteria were ECOG PS 0–2, refractory or intolerant to fluoropyrimidines, oxaliplatin, irinotecan, angiogenesis inhibitors, and anti-EGFR antibodies (if KRAS wild type), and no previous treatment with R or T. Results: A total of 182 pts (R/T: 138/44) were eligible for the study. The baseline characteristics were similar for the two groups as follows (R/T): median age, 64/63.5; male, 61%/52%; and KRAS wild type, 52%/59%. However, the proportion of pts with ECOG PS 2 (8%/18%) and who had not received irinotecan (1%/14%) was lower in R than in T. Efficacies were as follows (R/T): response rate, 0.8%/0%; disease control rate, 34%/33%; median time to treatment failure, 1.8/1.9 months (m) (median duration of follow-up, 5.6/5.0 m); median progression-free survival (PFS), 2.1/2.0 m (HR 1.09, p= 0.62, adjusted HR 0.97, p= 0.89 [11 covariates such as age, PS, and KRAS status]); median survival time (MST), 5.9/5.8 m (HR 0.92, p= 0.70); and MST for 74 eligible pts (R/T: 30/44) after the approval of T in Japan, 6.4/5.8 m (HR 0.94, p= 0.84, median duration of follow-up 4.7/5.0 m). Subgroup analysis suggested that pts with higher age and poor PS had shorter PFS in R than in T. The frequency (R/T) of grade 3 or 4 hand–foot syndrome and increased ALT were higher in R than in T (21%/0% and 10%/0%). Conversely, the frequencies of grade 3 or 4 neutropenia, anemia, and febrile neutropenia were lower in R than in T (2%/34%, 8%/27%, and 0%/7%, respectively). The main reason for discontinuation was disease progression (R/T: 85%/82%). Subsequent chemotherapies were received in 53%/46% (R/T). Conclusions: Our retrospective analysis suggested that regorafenib and TAS-102 had similar efficacy in patients with refractory mCRC. Our study results indicate that different toxicity profiles should be considered when selecting a drug treatment.

Sign in / Sign up

Export Citation Format

Share Document